A nurse cares for a rape victim given flunitrazepam... Which intervention has priority?

Correct Answer: D

Rationale: In the context of caring for a rape victim who has been given flunitrazepam, a benzodiazepine known to cause sedation and respiratory depression, the priority intervention is D) Respiratory depression. This is because respiratory depression can quickly lead to life-threatening complications such as hypoxia and respiratory arrest. A) Coma is not the priority as the immediate concern is addressing physiological issues that could lead to further harm. B) Seizures are not typically associated with flunitrazepam and are not the most immediate concern in this scenario. C) Hypotonia, while a potential side effect of benzodiazepines like flunitrazepam, is not as immediately life-threatening as respiratory depression. Educationally, understanding the priority interventions in psychiatric emergencies is crucial for healthcare providers to deliver timely and effective care, especially in high-stress situations like caring for victims of assault. Prioritizing interventions based on the most urgent needs of the patient can significantly impact outcomes and ensure patient safety.

Correct Answer: A

Rationale: In the context of psychiatric emergencies, the correct answer is option A) Allow the patient to talk at a comfortable pace. This response is appropriate because it prioritizes providing a safe and supportive environment for the patient to express their feelings and experiences. Allowing the patient to talk at their own pace can help them feel in control and respected, which is crucial in cases of trauma such as abduction and rape. Option B) Placing the patient in a private room with a caregiver may not be the most suitable response initially as it might increase the feeling of isolation for the patient, which can be distressing in a traumatic situation. Option C) Posing questions in nonjudgmental, empathetic ways is important in communication with patients, but in this specific scenario, actively listening and allowing the patient to lead the conversation is more crucial initially. Option D) Inviting the patient's family members to the examination room could potentially retraumatize the patient or make them feel overwhelmed. In cases of sexual assault, it is essential to prioritize the patient's comfort and autonomy in deciding who they want to involve in their care. Educationally, understanding the importance of trauma-informed care and patient-centered approaches in psychiatric emergencies is vital for healthcare professionals. Providing a rationale for each option helps reinforce the principles of patient advocacy, empathy, and communication skills necessary for effectively managing such sensitive situations.

Correct Answer: D

Rationale: The correct answer is D) Ulceration. Explanation: In the given clinical scenario of chronic diarrhea, weight loss, anemia, and skin rash, with findings of anemia and anisocytosis on blood tests, the most likely histological appearance on small bowel biopsy would be ulceration. Ulceration is a common finding in conditions like Crohn's disease, celiac disease, or infectious enteritis, which can present with similar symptoms. Why the other options are wrong: A) Hyperplasia of Brunner's glands: This finding is associated with conditions like duodenal ulcers, not typically seen in the context described in the question. B) Increased intraepithelial macrophages: This finding is more suggestive of conditions like celiac disease or inflammatory bowel disease, which typically present with different clinical features. C) Increased lymphocytes in submucosa: This finding is more commonly associated with inflammatory conditions like celiac disease, rather than the chronic diarrhea and skin rash described in the question. Educational context: Understanding the histological appearance on small bowel biopsy is crucial in diagnosing various gastrointestinal conditions, especially in cases of chronic diarrhea and weight loss. This question highlights the importance of integrating clinical findings with histopathological features to arrive at an accurate diagnosis in patients with gastrointestinal symptoms.

Correct Answer: C

Rationale: The most appropriate diagnostic investigation in this scenario is a CT pulmonary angiogram (Option C) to rule out pulmonary embolism. Given the patient's sudden onset of chest pain and breathlessness post-operatively, along with haemoptysis and normal chest examination findings, there is a high suspicion for pulmonary embolism. A CT pulmonary angiogram is the gold standard for diagnosing pulmonary embolism due to its high sensitivity and specificity. Arterial blood gases (Option A) may be useful in assessing oxygenation and ventilation status, but in this case, the clinical presentation points more towards a possible pulmonary embolism. A chest X-ray (Option B) may not show definitive findings for pulmonary embolism and is not the recommended initial diagnostic test. D-dimer (Option D) is a screening test for thrombotic disorders but lacks specificity; a positive result would necessitate further testing like a CT pulmonary angiogram to confirm the diagnosis. In an educational context, understanding the rationale behind choosing the most appropriate diagnostic test based on the clinical presentation is crucial for medical professionals to provide timely and accurate patient care, especially in emergent situations like suspected pulmonary embolism. The ability to differentiate between various diagnostic options based on clinical clues is a key skill for healthcare providers in managing psychiatric emergencies effectively.

Correct Answer: B

Rationale: The correct answer is B) Metabolic alkalosis. In this scenario, the infant's symptoms of vomiting, constant hunger, and weight loss suggest a condition known as pyloric stenosis, where there is obstruction at the outlet of the stomach, leading to persistent vomiting. This vomiting results in the loss of hydrochloric acid from the stomach, leading to metabolic alkalosis. Option A) Metabolic acidosis is incorrect because the symptoms do not suggest an excess of acid in the body. Option C) Normal acid/base state is incorrect because the symptoms clearly point towards an imbalance. Option D) Respiratory acidosis is incorrect as there are no signs of respiratory compromise in the scenario provided. Understanding acid-base imbalances is crucial in diagnosing and managing various medical conditions. In this case, recognizing the metabolic alkalosis associated with pyloric stenosis can guide appropriate interventions and treatment strategies, highlighting the importance of clinical correlation in pediatric emergencies. This knowledge is essential for healthcare providers, especially those working in emergency or pediatric settings, to ensure timely and accurate assessment and intervention in such critical situations.