GMCH Chandigarh - 2022
Mental Health Nursing
Medium
In a psychiatry ward, which of the following patients should the nurse assess first?
Appeared in: GMCH Chandigarh - 2022
Explanation
- The patient with an acute attack of severe anxiety is the highest priority.
- This is an acute, unstable condition that can escalate to panic, leading to physiological distress (e.g., hyperventilation, tachycardia) and psychological crisis.
- There is an immediate risk of impaired judgment, loss of control, and potential for self-harm or impulsive acts, which requires immediate nursing intervention to ensure safety.
- Prioritization frameworks in nursing, such as Maslow's hierarchy and the principle of 'acute vs. chronic', dictate that immediate threats to safety and physiological stability must be addressed first.
Why Other Options Were Wrong
- Option A: A patient with chronic schizophrenia who is withdrawn is exhibiting a baseline, chronic symptom. While this requires ongoing care, it is a stable condition and does not represent an immediate crisis.
- Option C: A patient with agoraphobia staying in their room is displaying a characteristic and chronic symptom of their condition. This avoidance behavior is part of the illness and is not an acute, life-threatening emergency.
- Option D: While constipation is uncomfortable and needs to be addressed, it is a common physical complaint and is not immediately life-threatening. It is a lower-priority problem compared to an acute psychological crisis.
Related Visual
- Visual 1: Flowchart: Nursing Prioritization Framework (Acute vs. Chronic, Unstable vs. Stable, Maslow's Hierarchy). This visual would help illustrate the decision-making process for prioritizing patient care.
- Visual 2: Infographic: Signs and Symptoms of a Severe Anxiety/Panic Attack. This would detail the physiological, cognitive, and behavioral signs a nurse should look for.
Clinical Relevance
- Nursing practice connection: Knowing Prioritization of care in a psychiatric nursing setting helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- Prioritization is a fundamental nursing skill essential for safe and effective care, especially in a setting with multiple patients with complex needs.
- Recognizing the difference between acute and chronic presentations of mental illness is critical for preventing harm. An acute anxiety attack can be as dangerous as an acute medical event due to the risk of accidents or self-harm.
- What if? If the patient with chronic schizophrenia suddenly became agitated and started responding to internal stimuli, they would become the highest priority due to the immediate risk of harm to self or others.
How to Approach the Question
- Identify the core question: This is a prioritization question asking who to see 'first'.
- Analyze each option through the lens of nursing prioritization principles: Acute vs. Chronic, Unstable vs. Stable, and Safety/Risk.
- Evaluate Option A (Chronic Schizophrenia): 'Chronic' and 'withdrawn' suggest a stable, baseline state. Lower priority.
- Evaluate Option B (Acute Anxiety): 'Acute' and 'severe' signal an unstable, high-risk situation. High priority.
- Evaluate Option C (Agoraphobia): Staying in the room is a chronic, coping behavior. Lower priority.
- Evaluate Option D (Depression/Constipation): A physical complaint, but not life-threatening. Lower priority.
Concept Tested & Keywords
- Concept Tested: Prioritization of care in a psychiatric nursing setting.
- Stem keywords: psychiatry ward, assess first, prioritization
- Lead-in keywords: first
- Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.
Question ID
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