A patient with acute agitation has a temperature of 38.9°C, a heart rate of 132 per minute, and a blood pressure of 88/54 mmHg. Which nursing action is most appropriate?
Correct answer: B. Recognize possible medical instability and obtain urgent review
- A. Place the patient in a stimulating group activity
- B. Recognize possible medical instability and obtain urgent review
- C. Ask the patient to walk until the agitation improves
- D. Delay physical assessment until psychiatric symptoms settle
Explanation
Fever, tachycardia, and hypotension indicate possible medical deterioration, intoxication, infection, or a serious medication reaction. Circulation and urgent medical assessment take priority over routine psychiatric interventions.
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About Psychiatric Emergencies
Psychiatric emergencies include suicidal behavior, homicide risk, severe agitation, panic, acute psychosis, delirium, overdose, and withdrawal states. Students examine rapid risk assessment, crisis intervention, de-escalation, environmental safety, emergency medication, observation levels, and the immediate priorities that differ from routine psychiatric nursing care.
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