A patient is thin, tense, jittery, and has dilated pupils. The patient says, 'My heart is pounding in my chest. I need help.' The patient allows vital signs to be taken but then becomes suspicious and says, 'You could be trying to kill me.' The patient refuses further examination. Abuse of which substance is most likely?

Correct Answer: D

Rationale: The correct answer is D: Amphetamines. The patient's symptoms of agitation, dilated pupils, paranoia, and refusal of further examination are consistent with amphetamine intoxication. Amphetamines can cause increased heart rate, jitteriness, and paranoia. PCP (A) can also cause paranoia and hallucinations but typically presents with more dissociative symptoms. Heroin (B) typically causes sedation and respiratory depression, not agitation. Barbiturates (C) would likely cause sedation and impaired consciousness, not the symptoms described.

Correct Answer: B

Rationale: The correct answer is B because holding a meeting for staff to provide support, express feelings, and identify overlooked clues or faulty judgments is crucial in addressing the emotional impact of the patient's suicide and identifying any potential errors in care. This measure promotes teamwork, communication, and a culture of learning from adverse events to prevent future occurrences. Option A is incorrect because verifying the security of the patient's medical record does not directly address the emotional impact on staff or the need for reflection on care provided. Option C is incorrect as consulting the legal department focuses on potential legal consequences rather than immediate emotional and clinical considerations. Option D is incorrect because documenting a report of a sentinel event is necessary but does not address the immediate need for staff support and reflection on care provided.

Correct Answer: C

Rationale: Rationale: Choice C (Paranoid delusions of being followed by alien monsters) predicts the highest risk for directing violent behavior as paranoid delusions can lead to extreme fear and aggression towards perceived threats. Delusions of being followed by alien monsters can trigger a sense of imminent danger, leading to potentially violent actions. In contrast, choices A, B, and D are less likely to directly result in violent behavior towards others. Major depressive disorder with delusions of worthlessness (A) may lead to self-harm but not necessarily violence towards others. Obsessive-compulsive disorder (B) is characterized by repetitive behaviors and thoughts, not typically violent tendencies. Completed alcohol withdrawal and beginning a rehabilitation program (D) indicate a positive step towards recovery, reducing the risk of violent behavior.

Correct Answer: A

Rationale: The correct answer is A: make sure there is adequate physical space between the nurse and patient. This is the best course of action to ensure the safety of both the nurse and the patient. By maintaining physical distance, the nurse can prevent any potential harm or escalation of the situation. It allows the patient to have personal space and reduces the risk of physical confrontation. Moving closer (B) or maintaining an arm's length distance (C) may provoke the patient further. Initiating a conversation about appropriate behavior (D) can be ineffective or even escalate the situation without first ensuring physical safety.

Correct Answer: D

Rationale: The correct answer is D because it acknowledges the widow's emotions, validates her feelings, and expresses empathy. It shows understanding and support without making assumptions or judgments about her condition. A: This response jumps to conclusions about hallucinations, which may not be relevant to the widow's situation. B: This response invalidates the widow's grief and may increase her feelings of guilt or shame. C: This response stigmatizes the widow's mental illness and suggests a drastic intervention without assessing her current needs.