The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient

Correct Answer: D

Rationale: The correct answer is D because the patient is experiencing command auditory hallucinations that pose an imminent threat to themselves or others. This is indicative of acute psychosis requiring immediate psychiatric intervention. Choice A is experiencing common emotional distress and can be managed on an outpatient basis. Choice B has self-inflicted minor harm but does not present an immediate danger. Choice C is likely experiencing side effects of medication and can be managed without urgent inpatient care. In summary, only choice D presents a clear and immediate risk that necessitates admission to the psychiatric unit.

Correct Answer: C

Rationale: The correct answer is C: Administer the antacid 1 hour after the antipsychotic medication. Aluminum salts can reduce the absorption of certain medications, including antipsychotics. Giving the antacid 1 hour after the antipsychotic medication allows for adequate absorption of the antipsychotic while still providing relief from gastric symptoms. Option A would not be ideal as it may interfere with the absorption of the antipsychotic. Option B could potentially decrease the effectiveness of the antipsychotic by reducing its absorption. Option D is not recommended as aluminum salts can cause reflux when lying down, potentially worsening the patient's symptoms.

Correct Answer: A

Rationale: The correct answer is A because the sudden onset of confusion is a key characteristic of delirium, whereas dementia typically has a gradual progression. Choice B suggests a symptom of dementia - progressive memory loss. Choice C indicates a hallucination, which can occur in both delirium and dementia. Choice D describes memory and cognitive impairment, which can be seen in both conditions but is more indicative of dementia due to the chronic nature of forgetfulness.

Correct Answer: A

Rationale: Correct Answer: A Rationale: Assessing normal sleep patterns is the initial step to understand the client's current sleep habits and identify specific disturbances in their sleep pattern. This assessment is crucial for developing an individualized care plan tailored to the client's needs. By gathering information on the client's sleep patterns, the nurse can effectively determine the underlying causes of the disturbance and implement appropriate interventions. This proactive approach ensures that interventions are evidence-based and address the client's unique situation. Summary of other choices: B: Discouraging napping during the day may be relevant but should come after assessing the client's sleep patterns to determine if daytime napping is contributing to the disturbance. C: Discouraging the use of caffeine and nicotine is important, but this intervention should be based on the assessment findings and individual client factors. D: Teaching relaxation exercises can be beneficial, but without understanding the client's specific sleep patterns and needs, it may not address the root cause of the sleep pattern disturbance.

Correct Answer: C

Rationale: The correct answer is C. REM sleep and body temperature cycles are inversely related. During REM sleep, our body temperature decreases, which is essential for the body to conserve energy and maintain a state of relaxation. This decrease in body temperature during REM sleep helps promote the restoration and rejuvenation of the body. It is crucial for the nurse to convey this information accurately to the community group to emphasize the importance of quality sleep for overall health. Choice A is incorrect because there is indeed an observable relationship between REM sleep and body temperature. Choice B is incorrect as higher levels of REM sleep are associated with lower body temperatures, not higher. Choice D is incorrect as the experience of REM sleep is not directly proportional to a rise in body temperature; instead, it is inversely related.