A fourth-grade boy teases and makes jokes about a cute girl in his class. A nurse would recognize this behavior as indicative of which defense mechanism?

Correct Answer: C

Rationale: The correct answer is C: Reaction formation. This defense mechanism involves expressing the opposite of one's true feelings or impulses. In this scenario, the boy may actually have feelings of attraction towards the girl but is teasing her as a way to mask those feelings. Displacement (A) involves redirecting emotions from the original source to a substitute target. Projection (B) is attributing one's own unacceptable feelings onto others. Sublimation (D) is channeling unacceptable impulses into constructive activities. In this case, the boy's behavior aligns most closely with reaction formation as he is displaying the opposite of his true emotions.

Correct Answer: A

Rationale: The correct answer is A) Quetiapine. Quetiapine, an atypical antipsychotic, is commonly used in the treatment of bipolar depression. The symptoms described in the scenario - hypersomnia, hyperphagia, low energy, feelings of discouragement, disinterest, and suicidal ideation - are indicative of a depressive episode in bipolar disorder. Quetiapine helps stabilize mood, reduce depressive symptoms, and prevent manic episodes. Option B) Divalproex is a mood stabilizer commonly used in bipolar disorder, but it is more effective in treating manic episodes rather than depressive symptoms. Option C) Bupropion is an antidepressant that can exacerbate manic symptoms in bipolar disorder and is not the first-line treatment for bipolar depression. Option D) Pramipexole is a dopamine agonist primarily used in Parkinson's disease and restless leg syndrome, not as a first-line treatment for bipolar depression. Educationally, understanding the rationale behind each option helps students grasp the importance of proper medication selection based on the patient's symptoms and diagnosis. It reinforces the need for accurate assessment and appropriate treatment in psychiatric emergencies to ensure optimal patient outcomes.

Correct Answer: D

Rationale: Rationale: The correct answer is D) Mania. Mania is a state characterized by elevated mood, increased energy levels, and sometimes impulsivity. In catatonic excitement, individuals exhibit heightened motor activity, agitation, and may even be violent or destructive, which closely aligns with the symptoms of mania. Option A) Catalepsy is a state of decreased responsiveness and often involves maintaining a rigid posture for an extended period, which is not characteristic of catatonic excitement. Option B) Stereotypies refer to repetitive movements that serve no purpose and are not directly related to the increased motor activity seen in catatonic excitement. Option C) Automatisms are involuntary, unconscious movements that are not typically associated with the purposeless, excessive motor activity seen in catatonic excitement. Educational Context: Understanding the differences between psychiatric states is crucial for healthcare professionals, especially when dealing with psychiatric emergencies. Recognizing the symptoms of catatonic excitement, such as heightened motor activity and agitation, can help in providing appropriate and timely interventions to ensure the safety and well-being of the individual experiencing such a state. Knowledge of different psychiatric states also aids in accurate diagnosis and treatment planning in mental health settings.

Correct Answer: B

Rationale: In the context of psychiatric emergencies, understanding the neurobiological basis of suicidal behavior is crucial for effective assessment and intervention. The correct answer is B) Serotonin deficiency. Serotonin, a neurotransmitter, plays a key role in regulating mood, emotions, and impulse control. Research has consistently linked low levels of serotonin to an increased risk of suicidal ideation and behavior. Option A) Dopamine excess is more commonly associated with conditions like schizophrenia and mania, which can result in agitation and psychosis but are not the primary neurotransmitter imbalance seen in suicidal behavior. Option C) Acetylcholine excess is not directly linked to suicidal behavior and is more related to conditions like Alzheimer's disease. Option D) Gamma-aminobutyric acid deficiency is associated with anxiety disorders and epilepsy, but not specifically with suicidal behavior. Educationally, this question highlights the importance of understanding the underlying neurochemical factors contributing to psychiatric emergencies. By recognizing the role of serotonin deficiency in suicidal behavior, healthcare providers can tailor treatment approaches such as selective serotonin reuptake inhibitors (SSRIs) to address this imbalance and reduce the risk of self-harm. This knowledge underscores the need for a comprehensive assessment and targeted interventions in managing psychiatric emergencies effectively.

Correct Answer: D

Rationale: In this scenario, the correct answer is option D) Exercise suicide self-restraint by refraining from attempts to harm self for 24 hours. This option reflects an immediate and crucial aspect of managing a patient who attempted suicide. It demonstrates the patient's ability to resist harming themselves, which is a primary concern in psychiatric emergencies. Option A is incorrect because verbalizing a will to live by the end of the second hospital day may not necessarily indicate immediate safety or stability. Option B is incorrect as it focuses on acquiring coping mechanisms rather than ensuring safety. Option C is incorrect as delineating personal strengths does not directly address the risk of self-harm. In an educational context, understanding the importance of immediate safety measures in psychiatric emergencies is critical for healthcare professionals. This question highlights the significance of assessing and managing suicide risk in patients who have attempted self-harm, emphasizing the need for vigilant monitoring and interventions to ensure patient safety. By selecting the correct option, healthcare providers can prioritize interventions that directly address the prevention of further self-harm.