A nurse interviews a 17-year-old male victim... Which comment should the nurse offer?

Correct Answer: B

Rationale: The correct answer is B) Male victims often experience physical injuries and are assaulted by more than one person. This response shows empathy, acknowledges the common experiences of male victims, and addresses potential physical injuries and multiple assailants, which are crucial aspects of assessing a psychiatric emergency involving a male victim of assault. Option A is incorrect as it perpetuates harmful gender stereotypes suggesting that men are better equipped to handle emotional pain than women, which is not supported by evidence and can further stigmatize male victims seeking help. Option C is not the best response as it redirects the focus to other male friends who may have been victims, potentially minimizing the individual's experience and needs in that moment. Option D is inappropriate as it places blame on the victim by asking why they think they became a victim of sexual assault, which can be retraumatizing and shift the responsibility away from the perpetrator. In an educational context, it is important for healthcare providers to approach psychiatric emergencies involving victims of assault with sensitivity, empathy, and a trauma-informed lens. Understanding the unique challenges and experiences faced by male victims of assault is crucial in providing appropriate care and support. Acknowledging physical injuries, the possibility of multiple assailants, and offering non-judgmental support are key components of effectively managing such situations.

Correct Answer: A

Rationale: The most appropriate response in this scenario is option A) "Are you thinking of harming yourself?" This response demonstrates a crucial aspect of addressing psychiatric emergencies, which is assessing the risk of self-harm or suicide. The victim's statement indicates a profound level of distress and feelings of being unable to recover from the trauma, suggesting potential suicidal ideation. By directly inquiring about thoughts of self-harm, the responder can assess the immediate risk and take appropriate actions to ensure the individual's safety. Option B) "It will take time, but you will feel the same as before the attack" is incorrect because it minimizes the severity of the victim's experience and emotions. Trauma, especially from violent incidents like rape, can have long-lasting effects and may not necessarily result in the victim feeling the same as before the attack. Providing false reassurance can invalidate the victim's feelings and hinder the therapeutic process. Option C) "Your friends will understand when you explain it was not your fault" is also incorrect as it focuses on external validation from others rather than addressing the victim's internal struggles. While social support is important, it is essential to first address the victim's immediate emotional needs and safety concerns. Option D) "You will be able to find meaning from this experience as time goes on" is not the most appropriate response in a psychiatric emergency where the priority is to assess the individual's immediate safety and well-being. While finding meaning in traumatic experiences can be a part of the healing process in the long term, it is not the primary concern when someone is expressing distress and hopelessness. In an educational context, it is vital to emphasize the importance of active listening, empathy, and appropriate risk assessment in psychiatric emergencies. Teaching responders to prioritize safety, validate emotions, and provide support while understanding the gravity of the situation is crucial in effectively managing such critical incidents.

Correct Answer: A

Rationale: In a psychiatric emergency such as assessing a rape victim, the priority during the interview is to focus on the coping mechanisms the patient is using. This is the correct answer because understanding how the patient is currently managing the traumatic event can provide crucial insights into their immediate needs and emotional state. By identifying coping mechanisms, the nurse can offer appropriate support and interventions tailored to the individual's coping strategies. Option B, the patient's previous sexual experiences, is not a priority during the initial assessment of a rape victim. While understanding the patient's history may be relevant in a broader context, the immediate focus should be on addressing the current crisis and ensuring the patient's safety and well-being. Option C, the patient's history of sexually transmitted diseases, is also not a priority during the initial assessment of a rape victim in a psychiatric emergency. While assessing for any physical health concerns is important, it should not take precedence over addressing the emotional and psychological trauma experienced by the patient. Option D, signs and symptoms of emotional and physical trauma, is important in the overall assessment of a rape victim; however, understanding the coping mechanisms the patient is using takes precedence as it provides valuable information for immediate intervention and support. In an educational context, emphasizing the prioritization of assessing coping mechanisms in a rape victim interview highlights the importance of a patient-centered approach in psychiatric emergencies. It underscores the significance of understanding the individual's unique ways of managing trauma to provide effective and tailored care.

Correct Answer: A

Rationale: The most appropriate investigation for the 74-year-old man with painless jaundice, pale stools, weight loss, and yellow sclera and skin is a CT scan of the abdomen (Option A). This imaging modality is essential as it can provide detailed information on the structures within the abdomen, including the liver, gallbladder, pancreas, and bile ducts. In this case, the symptoms suggest a possible biliary obstruction or pancreatic pathology, which can be visualized effectively through a CT scan. Endoscopic retrograde cholangio-pancreatography (ERCP) (Option B) and MR cholangio-pancreatography (MRCP) (Option C) are also valuable diagnostic tools for evaluating biliary and pancreatic disorders. However, in this scenario, a CT scan is preferred initially due to its broader scope in assessing various abdominal structures simultaneously, providing a comprehensive view of the potential underlying pathology. A PET scan of the abdomen (Option D) is not the most appropriate investigation in this case. PET scans are more commonly used to detect metabolic activity in tissues and are not the primary imaging modality for evaluating structural abnormalities in the abdomen, making it less suitable for the current clinical presentation. Educationally, understanding the rationale behind selecting the most appropriate investigation is crucial for healthcare professionals to make informed decisions in clinical practice. By comprehending the advantages of each imaging modality and matching them to specific clinical scenarios, practitioners can optimize patient care by choosing the most effective diagnostic approach.

Correct Answer: C

Rationale: The most important initial investigation in this case is option C) Capillary glucose. This choice is correct because the patient presents with symptoms suggestive of diabetic ketoacidosis (DKA), a life-threatening complication of diabetes. The symptoms of blurred vision, polydipsia, weight loss, and vital signs such as tachycardia, hypotension, and tachypnea are all indicative of DKA. Measuring capillary glucose levels will help confirm the diagnosis of hyperglycemia, which is essential for prompt initiation of treatment to stabilize the patient's condition. Option A) Arterial blood gases could be considered to assess the acid-base status and electrolyte abnormalities associated with DKA, but capillary glucose is more specific and crucial for the initial diagnosis. Option B) Blood cultures are not indicated as the primary concern in this scenario is the management of DKA, and blood cultures are not typically the first-line investigation for this condition. Option D) Full blood count is not the most pertinent investigation in this case as it does not directly address the urgent need to confirm hyperglycemia and initiate appropriate treatment for DKA. In an educational context, understanding the importance of prompt and accurate diagnosis in psychiatric emergencies like DKA is crucial for healthcare providers. This case highlights the significance of recognizing and managing medical conditions that can present with psychiatric symptoms, emphasizing the need for a comprehensive approach to patient care in emergency settings. This rationale underscores the critical role of clinical reasoning and prioritization of investigations to ensure timely and effective interventions for patients in psychiatric emergencies.