RML MAINS 2025
Mental Health Nursing
Hard
A patient arrives in the emergency department behaving aggressively, talking excessively, and showing signs of being a danger to others. What drug should the nurse administer first?
Appeared in: RML MAINS 2025
Explanation
- Haloperidol is a potent, first-generation antipsychotic medication used for rapid tranquilization in psychiatric emergencies.
- It has a rapid onset of action, especially when administered intramuscularly, making it ideal for controlling acute agitation, aggression, and psychotic symptoms quickly to ensure safety.
- It is a well-established first-line or second-line agent for managing severe agitation in emergency settings, often used alone or in combination with a benzodiazepine.
- Its primary action of blocking dopamine receptors effectively targets the underlying psychotic processes that can drive aggressive behavior.
Why Other Options Were Wrong
- Option A: Lithium is a mood stabilizer with a very slow onset of action (days to weeks) and is not effective for managing acute agitation.
- Option C: Phenobarbitone is a barbiturate primarily used as an anticonvulsant. It is not a first-line treatment for psychiatric agitation due to its high risk of respiratory depression and sedation.
- Option D: Librium (chlordiazepoxide) is a long-acting benzodiazepine. While benzodiazepines can treat agitation, they are not the preferred first-line agent for severe aggression with psychotic features.
Related Visual
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pharmacological management of acute agitation and aggression in a psychiatric emergency in acute care settings.
- Nurses in emergency and psychiatric settings must be proficient in rapidly assessing and managing agitated patients to ensure the safety of everyone in the unit.
- The nurse's role includes attempting verbal de-escalation, preparing and administering emergency medications as ordered, and closely monitoring the patient for both therapeutic effects and adverse reactions (e.g., extrapyramidal symptoms, over-sedation).
- What if the patient's history revealed a known allergy to haloperidol or a diagnosis of a seizure disorder? In that case, haloperidol would be contraindicated. An alternative, such as a second-generation antipsychotic (e.g., olanzapine, ziprasidone) or a benzodiazepine, would be considered, depending on the clinical picture.
How to Approach the Question
- First, identify the core problem: a patient with acute, severe agitation who is a danger to others in an emergency setting.
- Recognize the keyword 'first,' which signals the need for a rapid and effective intervention.
- Evaluate each drug option based on its class, primary indication, and onset of action.
- Eliminate Lithium due to its slow onset and use as a long-term mood stabilizer.
- Eliminate Phenobarbitone as it is primarily an anticonvulsant and not a first-line agent for this type of agitation.
- Compare Haloperidol and Librium. Recognize that Haloperidol, an antipsychotic, is better suited for undifferentiated agitation with potential psychosis than Librium, a benzodiazepine primarily for alcohol withdrawal.
Concept Tested & Keywords
- Concept Tested: Pharmacological management of acute agitation and aggression in a psychiatric emergency.
- Stem keywords: emergency department, aggressively, talking excessively, danger to others
- Lead-in keywords: first
- Clinical cues: The combination of aggression, excessive talking (logorrhea), and being a danger to others points to an acute manic or psychotic episode requiring immediate intervention.
- Negative lead-in flag: false
Question ID
QxBeei73Bu8fB08HQIqAy1
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 5561-5563, 8837-8839
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 2558-2560
Practise the full RML MAINS 2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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