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Post-Rapid Tranquillisation Monitoring — MRCPsych Paper B MCQ

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ModerateMood DisordersPost-Rapid Tranquillisation MonitoringMRCPsych Paper B

A 28-year-old woman with bipolar I disorder and severe mania receives intramuscular lorazepam for rapid tranquillisation. She remains awake, has not taken alcohol or illicit drugs, has no pre-existing physical health problem, and was not harmed during any restrictive intervention. The administered dose has not exceeded the applicable maximum. According to NICE NG10, which monitoring plan is required as a minimum after rapid tranquillisation?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Monitor side effects, pulse, blood pressure, respiratory rate, temperature, hydration and consciousness at least hourly until there are no further physical health concerns

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · A = shown as D · B = shown as E

Option B is correct. NICE NG10 recommendation 1.4.45 requires monitoring of side effects, pulse, blood pressure, respiratory rate, temperature, hydration and level of consciousness at least every hour until there are no further concerns about physical health. Monitoring must increase to every 15 minutes if the person appears asleep or sedated, has taken alcohol or illicit drugs, has a pre-existing physical health problem, has been harmed during a restrictive intervention, or has received more than the applicable maximum dose. None of these enhanced-monitoring indications is present here. Behavioural observation alone (A) and 4-hourly observations (C) are inadequate. Routine continuous ECG monitoring (D) is not the specified post-intervention monitoring package. Fifteen-minute monitoring is risk-dependent rather than mandatory for every patient, making E incorrect.

Reference: National Institute for Health and Care Excellence. Violence and aggression: short-term management in mental health, health and community settings (NG10), recommendation 1.4.45. 2015. https://www.nice.org.uk/guidance/ng10/chapter/Recommendations