A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, and diaphoretic and reports nightmares. The pulse rate is 130 beats/minute. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient

is attempting to obtain attention by manipulating staff.

has symptoms of alcohol withdrawal delirium.

may have sustained a head injury before admission.

is having an acute psychosis.

Answer and Explanation

The Correct Answer is B

A. The patient’s symptoms are physiological and neurological, not intentional behaviors for attention.

B. Alcohol withdrawal delirium (delirium tremens) typically occurs 48–72 hours after the last drink and includes tremors, agitation, anxiety, diaphoresis, tachycardia, hallucinations, and nightmares—all present in this patient.

C. Although head injury can cause confusion and agitation, the timing of symptoms following alcohol withdrawal aligns more closely with delirium tremens.

D. Acute psychosis can present with hallucinations, but in this case, the onset following alcohol cessation and accompanying autonomic hyperactivity point toward alcohol withdrawal delirium.

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Correct Answer is A

Explanation

A. Aripiprazole is an atypical antipsychotic with a lower risk of weight gain, metabolic syndrome, and hypertension compared with olanzapine or clozapine, making it suitable for a patient who is overweight and hypertensive. It effectively treats positive symptoms such as auditory hallucinations and may improve social functioning.

B. Olanzapine is effective for schizophrenia but is associated with significant weight gain, hyperlipidemia, and worsening hypertension, making it less appropriate for this patient.

C. Clozapine is reserved for treatment-resistant schizophrenia due to risks of agranulocytosis, myocarditis, and metabolic side effects; it is not first-line for this patient.

D. Ziprasidone has a lower risk of metabolic side effects than olanzapine or clozapine, but it carries a risk of QT prolongation, which may be concerning in hypertensive patients with potential cardiac risks.

A. Lorazepam (Ativan) B. Amitriptyline (Elavil) C. Buspirone (Buspar) D. Desipramine (Norpramin)

Correct Answer is A

Explanation

A. Lorazepam is a benzodiazepine that acts quickly to relieve acute anxiety, making it the medication of choice for sudden episodes of severe anxiety.

B. Amitriptyline is a tricyclic antidepressant used for long-term management of depression and anxiety, not for rapid relief of acute anxiety.

C. Buspirone is an anxiolytic effective for chronic anxiety but has a delayed onset of action and is not effective for sudden episodes.

D. Desipramine is a tricyclic antidepressant primarily used for depression and certain chronic anxiety disorders, not for immediate relief of severe anxiety.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate?

Correct Answer is A

Explanation

A patient experiences a sudden episode of severe anxiety. Which medication would be the expected drug to be given to help with the sudden episode of severe anxiety?

Correct Answer is A

Explanation

A nurse is providing teaching for a client who has major depressive disorder and is seeking voluntary admission to an acute mental health facility. Which of the following statements should the nurse include?

A nurse assesses a patient who reports a 3-week history of depression and periods of uncontrolled crying. The patient says. "My business is bankrupt and was served with divorce papers." Which subsequent statement by the patient alerts the nurse to a covert suicidal message?

An adult outpatient diagnosed with major depressive disorder has a history of several suicide attempts by overdose. Given this patient's history and diagnosis, which antidepressant medication would the nurse expect to be prescribed to this patient?

Which assessment findings are likely for an individual who recently injected heroin?

Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient

A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident?

A nurse is caring for a client who has severe manifestations of schizophrenia and is medicated as needed for agitation with haloperidol. The nurse should assess the client for which of the following adverse effects?

The nurse expects which medication to be prescribed to maintain abstinence to a patient with an addiction to either alcohol or opioids?