ATI RN
Psychiatric Emergencies Questions
Question 1 of 5
Which goal for treatment of alcohol use disorder should the nurse address first?
Correct Answer: D
Rationale: The correct answer is D: Achieve physiological stability. This is the most crucial goal to address first because individuals with alcohol use disorder often experience physical health complications due to alcohol consumption. Achieving physiological stability involves addressing withdrawal symptoms, managing any medical issues related to alcohol use, and ensuring the individual's physical health is stable before moving on to other treatment goals. Learning about addiction and recovery (A), developing coping strategies (B), and establishing a peer support system (C) are important aspects of treatment but should come after ensuring the individual's physiological stability to prevent any medical emergencies or complications.
Question 2 of 5
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.
Question 3 of 5
A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, 'Bugs are crawling on my legs.' Which problem is the patient experiencing?
Correct Answer: C
Rationale: The correct answer is C: Tactile hallucinations. The patient's complaint of bugs crawling on their legs indicates a sensory perception disturbance, which is characteristic of tactile hallucinations. This symptom is commonly associated with conditions like schizophrenia or substance use. Aphasia (A) is a language disorder, not related to sensory perceptions. Dystonia (B) is a movement disorder, not associated with hallucinations. Mnemonic disturbance (D) refers to memory issues, not sensory hallucinations. In this case, the patient's symptom points to a sensory perception distortion, making tactile hallucinations the most appropriate choice.
Question 4 of 5
A patient previously hospitalized for 2 weeks committed suicide the day after discharge. Which initial nursing measure will be most important regarding this event?
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.
Question 5 of 5
Which clinical scenario predicts the highest risk for directing violent behavior toward others?
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.