ATI RN
Psychiatric Emergency Questions
Question 1 of 5
Symptoms of withdrawal from opioids for which the nurse should assess include
Correct Answer: B
Rationale: The correct answer is B because symptoms of opioid withdrawal typically include nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. Nausea and vomiting are common gastrointestinal symptoms, diaphoresis is excessive sweating, anxiety is a psychological symptom, and hyperreflexia is an increase in reflexes. These symptoms are classic manifestations of opioid withdrawal. Choices A, C, and D do not align with the typical symptoms of opioid withdrawal. A includes symptoms more consistent with opioid intoxication, C includes nonspecific symptoms, and D includes unrelated symptoms.
Question 2 of 5
An older adult patient takes multiple medications daily. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of
Correct Answer: A
Rationale: The correct answer is A: delirium. Delirium is an acute and reversible condition characterized by sudden onset confusion, altered consciousness, inattention, and disorganized thinking. In this case, the patient's symptoms developed rapidly over a short period, suggesting an acute process. Delirium is commonly triggered by medication interactions or underlying medical conditions in older adults. The fluctuating levels of orientation, slurred speech, and unsteady gait are all indicative of delirium. Summary: B: Dementia is a chronic progressive condition with gradual cognitive decline, not sudden onset confusion. C: Amnestic syndrome is characterized by memory impairment, not the range of symptoms seen in delirium. D: Alzheimer's disease is a type of dementia and does not typically present with sudden onset confusion and fluctuating levels of orientation.
Question 3 of 5
Which statement by a depressed patient will alert the nurse to the patient's need for immediate, active intervention?
Correct Answer: B
Rationale: The correct answer is B because the statement indicates a lack of social support, which is a significant risk factor for worsening depression and potential self-harm. This indicates an immediate need for intervention to address the patient's feelings of isolation and hopelessness. A: This statement shows recognition of needing help, which is a positive sign and may not require immediate intervention. C: This statement refers to a potential additional stressor but does not indicate an immediate need for intervention. D: This statement suggests a history of self-harm but does not indicate a current immediate risk.
Question 4 of 5
Which behavior best demonstrates aggression?
Correct Answer: A
Rationale: The correct answer is A because the behavior of stomping away, going to grab a tray aggressively demonstrates physical aggression. This behavior involves a direct and forceful action that could potentially harm someone or indicate a threat. The other choices do not demonstrate the same level of physical aggression. Choice B shows emotional distress but not physical aggression. Choice C involves verbal expression of anger but does not involve physical actions. Choice D shows refusal to take medication but does not involve physical aggression. Therefore, choice A is the best demonstration of aggression in this scenario.
Question 5 of 5
A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say:
Correct Answer: C
Rationale: The correct answer is C because it demonstrates empathy and a desire to understand the patient's feelings. By addressing the patient by name and expressing a willingness to talk about their emotions, the nurse shows respect and attempts to de-escalate the situation. Choice A is too generic and may come off as confrontational. Choice B is authoritarian and dismissive of the patient's emotions. Choice D is coercive and does not address the underlying issues causing the behavior. Overall, choice C promotes therapeutic communication and patient-centered care.