ATI RN
Psychiatric Emergencies Questions
Question 1 of 5
When an emergency department nurse teaches a victim... Which symptoms should be included...?
Correct Answer: A
Rationale: The correct answer is A) Development of fears and phobias. In the context of psychiatric emergencies, it is crucial for emergency department nurses to recognize and address symptoms related to the development of fears and phobias in victims. Traumatic events can lead to the manifestation of these symptoms as part of the individual's psychological response. By understanding and identifying these symptoms, nurses can provide appropriate support and interventions to help the victim cope with their experiences. Option B) Decreased motor activity is not the most appropriate choice in this scenario because while it can be a symptom of certain psychiatric conditions, it may not be as directly related to the immediate needs of a victim in a psychiatric emergency situation. Option C) Feelings of numbness, although a valid symptom in some cases of psychiatric distress, may not be as specific or urgent as the development of fears and phobias in the context of a psychiatric emergency. Option D) Flashbacks and dreams are also common symptoms in individuals who have experienced trauma, but in the context of a psychiatric emergency, addressing the victim's immediate emotional and psychological needs, such as fears and phobias, takes precedence. Educationally, understanding the nuances of psychiatric symptoms in emergency situations is crucial for healthcare professionals to provide effective and empathetic care to individuals in crisis. By focusing on the most pertinent symptoms, nurses can tailor their interventions to better support the mental health and well-being of their patients.
Question 2 of 5
A 26 year old woman has taken an overdose of paracetamol and is seen in the Emergency Department. She says the overdose was impulsive and now regrets taking the tablets. Investigations: Paracetamol level below treatment line for N-acetylcysteine. Which is the most appropriate course of action?
Correct Answer: B
Rationale: The most appropriate course of action in this scenario is option B) Assessment by liaison psychiatry in the Emergency Department. This option is correct because the patient has presented with an impulsive overdose, indicating a psychiatric emergency that requires immediate evaluation by mental health professionals. A liaison psychiatry assessment will help determine the patient's mental health status, risk of self-harm or suicide, and appropriate treatment plan. Option A) Admit to psychiatric ward may not be necessary at this stage without a comprehensive assessment to determine the level of risk and appropriate care needed for the patient. Option C) Discharge home with GP follow-up is not appropriate given the impulsive overdose and the need for immediate mental health evaluation. Option D) Prescribe antidepressant medication is not the correct course of action without a thorough assessment to determine the underlying psychiatric issues and appropriate treatment plan. In an educational context, it is crucial for healthcare providers to recognize and respond to psychiatric emergencies effectively. Understanding the importance of timely psychiatric evaluation and intervention in cases of overdose can help prevent further harm and provide appropriate care for individuals experiencing mental health crises. Liaison psychiatry services play a vital role in managing psychiatric emergencies in the emergency department setting, ensuring that patients receive the necessary mental health support and interventions.
Question 3 of 5
A 78 year old man has low back pain for 6 weeks and is seen in his GP surgery. There is no radiation of pain. He has no history of trauma. Investigations: Haemoglobin 78 g/L, ESR 98 mm/hr. Which is the most likely diagnosis?
Correct Answer: C
Rationale: The correct answer is C) Multiple myeloma. In this case, the patient presents with low back pain, anemia (Hb 78 g/L), and an elevated ESR (98 mm/hr), which are concerning for a systemic condition like multiple myeloma. Multiple myeloma is a malignancy of plasma cells that can present with bone pain, anemia, and elevated inflammatory markers like ESR. Option A) Discitis typically presents with localized back pain, fever, and tenderness over the affected vertebrae, often following a recent infection or procedure. The absence of these symptoms makes discitis less likely. Option B) Mechanical back pain is a common cause of back pain, usually related to musculoskeletal strain or injury. However, the presence of anemia and elevated ESR in this case suggests a more systemic issue than mechanical back pain. Option D) Osteoporotic wedge fracture is common in older adults and can cause back pain, but it typically does not present with anemia and elevated ESR. In this case, the laboratory findings are more suggestive of a systemic process like multiple myeloma. In an educational context, this question highlights the importance of considering systemic conditions in older adults presenting with nonspecific symptoms like back pain and anemia. Understanding the clinical features and laboratory findings associated with different conditions helps healthcare providers make accurate diagnoses and provide appropriate care for patients with psychiatric emergencies.
Question 4 of 5
A 30 year old man took an overdose of 45 paracetamol 500 mg tablets 10 hours ago and is seen in the Emergency Department. Which is the most appropriate initial management?
Correct Answer: D
Rationale: In the case of a 30-year-old man who overdosed on paracetamol, the most appropriate initial management is option D) No treatment required. This is the correct choice because the ingestion occurred 10 hours ago, and in cases of paracetamol overdose beyond 4 hours, the efficacy of interventions like gastric lavage or activated charcoal is limited. Awaiting paracetamol levels before further action, as in option A, could delay necessary treatment. Gastric lavage, as in option B, is not recommended due to the risk of complications and lack of proven benefit after the initial few hours post-ingestion. Giving 50 g charcoal orally, as in option C, is also not indicated at this stage. Educationally, understanding the time-sensitive nature of interventions in paracetamol overdose is crucial for healthcare providers managing psychiatric emergencies. This scenario highlights the importance of prompt assessment and appropriate decision-making based on the timeline of ingestion to optimize patient outcomes.
Question 5 of 5
A 40 year old woman is found at home in a drowsy state and taken to the Emergency Department. She has dilated pupils, dry mucous membranes and a palpable bladder. Which medication is most likely responsible?
Correct Answer: A
Rationale: In this scenario, the most likely medication responsible for the woman's presentation is Amitriptyline (Option A). Amitriptyline is a tricyclic antidepressant that can cause anticholinergic toxicity, leading to symptoms such as dilated pupils, dry mucous membranes, and urinary retention (palpable bladder) due to its potent anticholinergic effects. Fluoxetine (Option B) is a selective serotonin reuptake inhibitor (SSRI) and typically does not cause the anticholinergic symptoms described in the case. Lithium (Option C) is a mood stabilizer and is not known to produce these specific anticholinergic effects. Phenelzine (Option D) is a monoamine oxidase inhibitor (MAOI) and does not typically result in anticholinergic toxicity. In an educational context, understanding the side effect profiles of different psychiatric medications is crucial for healthcare professionals, especially those working in emergency settings. Recognizing the signs of anticholinergic toxicity can aid in prompt and appropriate management of psychiatric emergencies, ensuring patient safety and optimal outcomes.