A 60 year old man is anuric on the renal unit. Ultrasound: stone impacted at the pelvi-ureteric junction. Which is the most appropriate therapeutic intervention?

Correct Answer: C

Rationale: The most appropriate therapeutic intervention in this case is option C) Percutaneous right nephrostomy. This intervention involves placing a tube directly into the kidney to drain urine when the normal passage is blocked, such as in the case of an impacted stone at the pelvi-ureteric junction. Bladder catheterization (option A) would not address the actual blockage in the ureter and would not help in relieving the obstruction caused by the stone. Lithotripsy (option B) is a procedure to break up stones in the kidney or ureter, but it may not be effective for a stone impacted at the pelvi-ureteric junction. Retrograde drainage of the right renal tract (option D) may not provide adequate drainage for the obstruction at the junction. Educationally, understanding the appropriate therapeutic interventions for urinary tract obstructions due to stones is crucial for nurses in a psychiatric emergency setting. Prompt and correct intervention can prevent further complications such as renal failure or sepsis. Nurses need to be able to recognize the signs and symptoms of urinary tract obstructions and understand the appropriate interventions to provide optimal patient care.

Correct Answer: D

Rationale: The most appropriate next investigation for the 65-year-old man with a dry cough, progressive shortness of breath, finger clubbing, and bibasal fine end-inspiratory crackles is a High resolution CT scan of the chest (Option D). High resolution CT scan of the chest is the most appropriate investigation in this case because it can provide detailed imaging of the lung parenchyma. This will help in identifying any structural abnormalities such as interstitial lung disease, which can present with the symptoms described. It can also reveal the extent and distribution of lung involvement, aiding in diagnosis and treatment planning. The other options are not as suitable in this scenario: A) Broncho-alveolar lavage: This procedure is invasive and is usually reserved for specific indications such as suspected infections or malignancies. B) Cardiopulmonary exercise test: This test is more relevant in assessing cardiovascular and pulmonary function during exercise and is not indicated as the next step in this case. C) Echocardiography: While important in assessing cardiac function, it is less likely to provide information regarding the lung parenchyma and is not the most appropriate investigation at this stage. In an educational context, understanding the rationale behind choosing the appropriate investigative approach is crucial for nurses working in psychiatric emergency settings. It demonstrates critical thinking skills and clinical reasoning, which are essential for providing quality patient care. By grasping the significance of selecting the most relevant investigation based on the clinical presentation, nurses can contribute effectively to the diagnostic process and subsequent management of patients in psychiatric emergencies.

Correct Answer: D

Rationale: In this scenario, the most appropriate investigation to confirm the diagnosis in an 81-year-old man presenting with increasing confusion, agitation, and worsening urinary incontinence in a nursing home is option D) Urine culture & sensitivity. The correct answer is D because the symptoms of increasing confusion and urinary incontinence suggest a potential urinary tract infection (UTI), especially in an elderly individual. A urine culture and sensitivity test can help identify the specific bacteria causing the infection and determine the most effective antibiotic for treatment. Option A) Blood culture is less likely to confirm the diagnosis of a UTI, as the primary focus should be on investigating the urinary system rather than the bloodstream. Option B) Chest X-ray is not indicated in this case unless there are specific respiratory symptoms or concerns, as it would not directly help in confirming a UTI diagnosis. Option C) CT of the head is also not the most appropriate investigation for the symptoms presented, as it would primarily be used to assess for intracranial pathology and is not specific to diagnosing a UTI. Educationally, this question highlights the importance of considering common conditions in the elderly population, such as UTIs, which can present atypically with symptoms like confusion and agitation. It emphasizes the need for targeted investigations based on presenting symptoms to ensure accurate diagnosis and appropriate treatment in a psychiatric emergency nursing setting.

Correct Answer: C

Rationale: The most likely underlying diagnosis in this scenario is option C) Haemolytic uraemic syndrome (HUS). HUS is a condition characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. In this case, the presentation of bloody diarrhea, low hemoglobin, and low platelet count are indicative of HUS, especially given the history of a farm trip which raises suspicion of exposure to E. coli bacteria commonly associated with this condition. Option A) Bacillus cereus enteritis is unlikely as this bacterium typically causes food poisoning with symptoms such as nausea, vomiting, and abdominal cramps, but not the characteristic triad seen in HUS. Option B) Diabetic ketoacidosis is associated with hyperglycemia, ketosis, and metabolic acidosis, which are not present in the clinical picture described. Option D) Thrombotic thrombocytopenic purpura (TTP) shares some similarities with HUS, but in TTP, there is typically more profound thrombocytopenia and neurological symptoms, which are not mentioned in the case. Educationally, this question highlights the importance of recognizing the clinical manifestations of pediatric emergencies, particularly in differentiating between conditions that may present with similar symptoms but require distinct management approaches. Understanding the pathophysiology and typical presentations of conditions like HUS is crucial for nurses working in emergency settings to facilitate prompt and appropriate interventions for pediatric patients.

Correct Answer: C

Rationale: In this scenario, the correct answer is C) Dopamine. In schizophrenia, an excess of dopamine activity in certain brain regions is believed to contribute to the development of symptoms such as hallucinations. Dopamine is a neurotransmitter that plays a key role in regulating mood, behavior, and cognition. Excess dopamine activity in the mesolimbic pathway is associated with positive symptoms of schizophrenia, including hallucinations. Option A) Acetylcholine is not primarily implicated in schizophrenia. While it does play a role in cognitive function, its dysfunction is not the primary cause of auditory hallucinations in schizophrenia. Option B) Adenosine triphosphate is not a neurotransmitter but rather a molecule involved in cellular energy transfer. It is not directly implicated in the pathophysiology of schizophrenia. Option D) Substance P is a neuropeptide involved in pain transmission and inflammation, but it is not primarily implicated in the neurotransmitter dysfunction seen in schizophrenia. Educationally, understanding the role of neurotransmitters in psychiatric disorders like schizophrenia is crucial for nurses working in psychiatric emergency settings. It helps nurses tailor interventions, such as medication administration, to target specific neurotransmitter systems and alleviate symptoms effectively. Knowledge of neurotransmitter pathways also aids in recognizing signs of medication side effects or interactions, contributing to safe and holistic patient care.