An Agitated Individual Is Brought to the Emergency Department by Friends

question 12

Multiple Choice

An agitated individual is brought to the emergency department by friends who state that the patient took a hallucinogenic drug at a party and then tried to jump from a second-story window. The priority nursing diagnosis for the patient is

• A) disturbed thought process related to drug effects.
• B) risk for injury related to altered perception.
• C) ineffective health maintenance related to drug use.
• D) powerlessness related to loss of behavioral control.

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Definitions:

Object Permanence

The understanding that objects continue to exist even when they cannot be seen, heard, or otherwise sensed, a concept developed in early infancy.

Ambivalent Attachment

A type of insecure attachment characterized by mixed feelings of dependence and exploration; the child may both seek and resist closeness.

Secure

The state of being free from danger or threat, or the assurance that information, resources, or possessions are protected against loss, damage, or unauthorized access.

Avoidant

Relating to behavior characterized by the desire to avoid particular situations or stimuli, often due to fear or anxiety.