ATI RN
PICO Question Psychiatric Emergency Nursing Questions
Question 1 of 5
Patient with schizophrenia enters the psychiatric unit with symptoms. Which action should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Check the medication list. This is crucial as patients with schizophrenia often take antipsychotic medications that help manage their symptoms. Checking the medication list ensures the patient is receiving the appropriate treatment and dosage. Assessing for signs of infection (B) and monitoring vital signs (C) are important but not the priority in this case. Providing a quiet environment (D) is beneficial for patients with schizophrenia, but checking the medication list takes precedence to ensure proper treatment.
Question 2 of 5
A male client with schizophrenia is demonstrating echolalia, which is becoming annoying to other clients on the unit. What intervention is best for the RN to implement?
Correct Answer: D
Rationale: The correct answer is D: Escort the client to his room. This intervention is best because it addresses the behavior causing disturbance without isolating the client or administering unnecessary sedatives. By escorting the client to his room, the nurse provides a supportive and non-punitive approach to managing the behavior. It allows the client to have a quiet space to calm down, reducing the annoyance to other clients. Isolating the client may worsen the behavior or create feelings of abandonment. Administering a sedative should be avoided unless absolutely necessary to ensure client safety. Avoiding recognizing the behavior does not address the issue or provide any support to the client.
Question 3 of 5
A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve?
Correct Answer: B
Rationale: Rationale: Option B is the correct choice because it adheres to a tyramine-restricted diet. Mashed potatoes, ground beef patty, corn, green beans, and apple pie are all low in tyramine. Tyramine is found in aged, fermented, and pickled foods, as well as in certain fruits and vegetables. The other options contain foods high in tyramine: hot dogs, banana bread, caffeinated coffee (Option A); avocado, ham, chocolate cake (Option C); and smoked sausage, cheddar cheese, and yeast rolls (Option D). Therefore, Option B is the best choice for a tyramine-restricted diet.
Question 4 of 5
A patient diagnosed with major depressive disorder does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective?
Correct Answer: A
Rationale: The correct answer is A: Make observations. This technique is effective because it allows the nurse to show nonjudgmental acceptance and support without pressuring the patient to engage in lengthy conversations. By making observations, the nurse can acknowledge the patient's behavior without requiring a response, thus respecting the patient's need for space and limited interaction. Option B: Asking the patient direct questions may feel intrusive and overwhelming for someone with major depressive disorder who is withdrawn. Option C: Phrasing questions to require yes or no answers limits the patient's ability to express themselves fully and may not promote a sense of support and acceptance. Option D: Frequently reassuring the patient to reduce guilt feelings may come across as insincere or patronizing, and may not address the patient's need for nonjudgmental acceptance in communication.
Question 5 of 5
A patient diagnosed with major depressive disorder repeatedly tells staff, 'I have cancer. It's my punishment for being a bad person.' Diagnostic tests reveal no cancer. Select the priority nursing diagnosis.
Correct Answer: B
Rationale: The correct answer is B: Risk for suicide. The patient's belief of having cancer as punishment indicates distorted thinking and a high level of hopelessness, which increases the risk for suicide. This is a priority because it addresses the immediate safety of the patient. Powerlessness (A) may be relevant but doesn't address the imminent risk of harm. Stress overload (C) is not as critical as suicide risk in this scenario. Spiritual distress (D) may be present but doesn't address the immediate safety concern of potential suicide.