**The Psychiatric Emergency Grid: Suicide, Safety
& Psychopharmacology**
Question 1
A client with major depressive disorder tells the nurse, “I have a plan to kill myself by overdosing on my
pills tonight.” What is the priority action?
A. Ask the client to sign a no-suicide contract
B. Place the client on one-to-one observation
C. Remove all sharp objects from the room
D. Notify the provider for an involuntary hold
---
💫RATIONALE✔️✔️: A client with a specific plan and intent requires immediate one-to-one observation to
prevent suicide, followed by environmental safety.
💫ANSWER✔️✔️: B. Place the client on one-to-one observation
Question 2
A client with bipolar disorder in a manic phase has not slept for 72 hours, is pacing, and has lost 5 kg.
Which intervention is most appropriate?
A. Seclude the client until calm
B. Offer high-calorie finger foods and fluids
C. Restrict visitors and telephone use
D. Administer haloperidol IM immediately
---
💫RATIONALE✔️✔️: Finger foods allow the manic client to eat while moving, meeting nutritional needs
without forced rest.
💫ANSWER✔️✔️: B. Offer high-calorie finger foods and fluids
Question 3
,A client with schizophrenia tells the nurse, “The FBI planted a chip in my tooth to track me.” What is the
therapeutic response?
A. “That’s not possible. The FBI doesn’t do that.”
B. “I understand you believe that. It must be frightening.”
C. “Why do you think the FBI is tracking you?”
D. “Have you been taking your medication regularly?”
---
💫RATIONALE✔️✔️: Acknowledging the client’s feeling without reinforcing the delusion validates
emotional experience and maintains rapport.
💫ANSWER✔️✔️: B. “I understand you believe that. It must be frightening.”
Question 4
A client with alcohol withdrawal has a heart rate of 130 bpm, BP 160/95 mm Hg, and is hallucinating.
Which medication should the nurse administer first?
A. Haloperidol 5 mg IM
B. Lorazepam 2 mg IM
C. Thiamine 100 mg IM
D. Naltrexone 50 mg PO
---
💫RATIONALE✔️✔️: Severe alcohol withdrawal requires benzodiazepines (lorazepam) to prevent seizures
and delirium tremens.
💫ANSWER✔️✔️: B. Lorazepam 2 mg IM
Question 5
A client with borderline personality disorder has a history of self-harm. The nurse finds the client cutting
her arm with a piece of glass. What is the priority action?
A. Calmly take the glass and assess the wound
B. Place the client in seclusion immediately
C. Call a code for behavioral emergency
D. Administer a PRN antipsychotic medication
,---
💫RATIONALE✔️✔️: Safety first: remove the sharp object, then assess injury, then implement behavioral
strategies.
💫ANSWER✔️✔️: A. Calmly take the glass and assess the wound
Question 6
A client with dementia is pacing the hallways and trying to leave the unit. Which intervention is most
appropriate?
A. Apply a soft wrist restraint
B. Administer haloperidol PRN
C. Redirect to a supervised walking group
D. Close the unit doors and lock them
---
💫RATIONALE✔️✔️: Redirection to activity addresses the behavior without restraint, preserves dignity,
and reduces fall risk.
💫ANSWER✔️✔️: C. Redirect to a supervised walking group
Question 7
A client with post-traumatic stress disorder (PTSD) reports recurrent nightmares and flashbacks. Which
medication is FDA-approved for this condition?
A. Paroxetine
B. Lorazepam
C. Propranolol
D. Quetiapine
---
💫RATIONALE✔️✔️: Paroxetine and sertraline are SSRIs approved for PTSD; they reduce core symptoms
of re-experiencing and hyperarousal.
💫ANSWER✔️✔️: A. Paroxetine
Question 8
, A client with schizophrenia on clozapine has a white blood cell count of 2,500/mcL. What is the priority
action?
A. Repeat the WBC in 24 hours
B. Notify the provider and hold clozapine
C. Administer filgrastim as ordered
D. Continue clozapine and monitor for infection
---
💫RATIONALE✔️✔️: WBC <3,000 or ANC <1,500 requires clozapine discontinuation and provider
notification to prevent agranulocytosis.
💫ANSWER✔️✔️: B. Notify the provider and hold clozapine
Question 9
A client with bipolar disorder on lithium has a level of 1.2 mEq/L and reports fine hand tremors. What is
the appropriate nursing action?
A. Hold the next lithium dose
B. Document as an expected side effect
C. Administer a PRN benzodiazepine
D. Notify the provider for possible toxicity
---
💫RATIONALE✔️✔️: Fine tremors at therapeutic levels (0.8-1.2) are common and often benign;
reassurance and hydration may help.
💫ANSWER✔️✔️: B. Document as an expected side effect
Question 10
A client with generalized anxiety disorder is started on buspirone. Which statement indicates
understanding?
A. “I will feel less anxious within 30 minutes of taking it.”
B. “I should take this medication consistently every day, not just when anxious.”
C. “I can stop this medication abruptly if I feel better.”
D. “This medication works like alprazolam for panic attacks.”
& Psychopharmacology**
Question 1
A client with major depressive disorder tells the nurse, “I have a plan to kill myself by overdosing on my
pills tonight.” What is the priority action?
A. Ask the client to sign a no-suicide contract
B. Place the client on one-to-one observation
C. Remove all sharp objects from the room
D. Notify the provider for an involuntary hold
---
💫RATIONALE✔️✔️: A client with a specific plan and intent requires immediate one-to-one observation to
prevent suicide, followed by environmental safety.
💫ANSWER✔️✔️: B. Place the client on one-to-one observation
Question 2
A client with bipolar disorder in a manic phase has not slept for 72 hours, is pacing, and has lost 5 kg.
Which intervention is most appropriate?
A. Seclude the client until calm
B. Offer high-calorie finger foods and fluids
C. Restrict visitors and telephone use
D. Administer haloperidol IM immediately
---
💫RATIONALE✔️✔️: Finger foods allow the manic client to eat while moving, meeting nutritional needs
without forced rest.
💫ANSWER✔️✔️: B. Offer high-calorie finger foods and fluids
Question 3
,A client with schizophrenia tells the nurse, “The FBI planted a chip in my tooth to track me.” What is the
therapeutic response?
A. “That’s not possible. The FBI doesn’t do that.”
B. “I understand you believe that. It must be frightening.”
C. “Why do you think the FBI is tracking you?”
D. “Have you been taking your medication regularly?”
---
💫RATIONALE✔️✔️: Acknowledging the client’s feeling without reinforcing the delusion validates
emotional experience and maintains rapport.
💫ANSWER✔️✔️: B. “I understand you believe that. It must be frightening.”
Question 4
A client with alcohol withdrawal has a heart rate of 130 bpm, BP 160/95 mm Hg, and is hallucinating.
Which medication should the nurse administer first?
A. Haloperidol 5 mg IM
B. Lorazepam 2 mg IM
C. Thiamine 100 mg IM
D. Naltrexone 50 mg PO
---
💫RATIONALE✔️✔️: Severe alcohol withdrawal requires benzodiazepines (lorazepam) to prevent seizures
and delirium tremens.
💫ANSWER✔️✔️: B. Lorazepam 2 mg IM
Question 5
A client with borderline personality disorder has a history of self-harm. The nurse finds the client cutting
her arm with a piece of glass. What is the priority action?
A. Calmly take the glass and assess the wound
B. Place the client in seclusion immediately
C. Call a code for behavioral emergency
D. Administer a PRN antipsychotic medication
,---
💫RATIONALE✔️✔️: Safety first: remove the sharp object, then assess injury, then implement behavioral
strategies.
💫ANSWER✔️✔️: A. Calmly take the glass and assess the wound
Question 6
A client with dementia is pacing the hallways and trying to leave the unit. Which intervention is most
appropriate?
A. Apply a soft wrist restraint
B. Administer haloperidol PRN
C. Redirect to a supervised walking group
D. Close the unit doors and lock them
---
💫RATIONALE✔️✔️: Redirection to activity addresses the behavior without restraint, preserves dignity,
and reduces fall risk.
💫ANSWER✔️✔️: C. Redirect to a supervised walking group
Question 7
A client with post-traumatic stress disorder (PTSD) reports recurrent nightmares and flashbacks. Which
medication is FDA-approved for this condition?
A. Paroxetine
B. Lorazepam
C. Propranolol
D. Quetiapine
---
💫RATIONALE✔️✔️: Paroxetine and sertraline are SSRIs approved for PTSD; they reduce core symptoms
of re-experiencing and hyperarousal.
💫ANSWER✔️✔️: A. Paroxetine
Question 8
, A client with schizophrenia on clozapine has a white blood cell count of 2,500/mcL. What is the priority
action?
A. Repeat the WBC in 24 hours
B. Notify the provider and hold clozapine
C. Administer filgrastim as ordered
D. Continue clozapine and monitor for infection
---
💫RATIONALE✔️✔️: WBC <3,000 or ANC <1,500 requires clozapine discontinuation and provider
notification to prevent agranulocytosis.
💫ANSWER✔️✔️: B. Notify the provider and hold clozapine
Question 9
A client with bipolar disorder on lithium has a level of 1.2 mEq/L and reports fine hand tremors. What is
the appropriate nursing action?
A. Hold the next lithium dose
B. Document as an expected side effect
C. Administer a PRN benzodiazepine
D. Notify the provider for possible toxicity
---
💫RATIONALE✔️✔️: Fine tremors at therapeutic levels (0.8-1.2) are common and often benign;
reassurance and hydration may help.
💫ANSWER✔️✔️: B. Document as an expected side effect
Question 10
A client with generalized anxiety disorder is started on buspirone. Which statement indicates
understanding?
A. “I will feel less anxious within 30 minutes of taking it.”
B. “I should take this medication consistently every day, not just when anxious.”
C. “I can stop this medication abruptly if I feel better.”
D. “This medication works like alprazolam for panic attacks.”
