ATI PN Mental health DEC 2024
Total Questions : 55
Showing 25 questions, Sign in for moreA nurse in a mental health facility is collecting a blood specimen from a client.
The client is hallucinating and states, "That looks like a snake, and I won't let it take all of my blood.”. Which of the following responses should the nurse make?.
No explanation
.A nurse is caring for a client who has depressive disorder following the recent death of their partner.
Which of the following responses should the nurse make?.
Explanation
Choice A rationale:
This statement is generalizing the client’s feelings, which can lead to a lack of individualized care.
Choice B rationale:
This statement is not acknowledging the client’s feelings of grief, which can lead to a lack of trust in the nurse-client relationship.
Choice C rationale:
This statement is self-disclosing personal information, which can lead to boundary violations in the nurse-client relationship.
Choice D rationale:
This statement is encouraging the client to express their feelings, which can help in the grieving process.
.A nurse is participating in a community program about eating disorders.
Which of the following information about bulimia nervosa should the nurse include in the presentation?.
Explanation
Choice A rationale:
This statement is incorrect. People with bulimia nervosa often consume large amounts of food in a short period of time, known as binge eating.
Choice B rationale:
This statement is correct. Despite the binge-purge cycle, individuals with bulimia nervosa can maintain an average or ideal body weight, making the disorder less noticeable.
Choice C rationale:
This statement is incorrect. While self-induced vomiting is a common method of purging in bulimia nervosa, other methods such as excessive exercise, fasting, or misuse of laxatives, diuretics, or enemas can also be used.
Choice D rationale:
This statement is incorrect. While bulimia nervosa can lead to various health complications, it is not directly associated with the development of diabetes mellitus.
.A nurse is collecting data from a client who is experiencing opioid withdrawal.
Which of the following manifestations should the nurse expect?.
Explanation
Choice A rationale:
This statement is incorrect. Opioid withdrawal typically results in tachycardia, not bradycardia.
Choice B rationale:
This statement is correct. Diarrhea is a common symptom of opioid withdrawal.
Choice C rationale:
This statement is incorrect. Opioid withdrawal often results in restlessness and agitation, not hypokinesis.
Choice D rationale:
This statement is incorrect. Opioid withdrawal typically results in dilated pupils, not meiosis.
.A nurse is providing information to a client about smoking cessation.
Which of the following medications should the nurse include?.
Explanation
Choice A rationale:
This statement is incorrect. Aripiprazole is an antipsychotic medication and is not used for smoking cessation.
Choice B rationale:
This statement is correct. Bupropion is an antidepressant that has been shown to be effective in helping people quit smoking.
Choice C rationale:
This statement is incorrect. Quetiapine is an antipsychotic medication and is not used for smoking cessation.
Choice D rationale:
This statement is incorrect. Risperidone is an antipsychotic medication and is not used for smoking cessation.
.A nurse is collecting data from a client who experienced physical abuse as a child.
Which of the following findings should the nurse identify as a risk factor for the client to become a perpetrator of child abuse?.
Explanation
Choice A rationale:
Absence of impulsive behaviors is not a risk factor for becoming a perpetrator of child abuse. Impulsive behaviors can lead to unpredictable and potentially harmful actions, but their absence does not increase the risk of abusive behavior.
Choice B rationale:
Being involved in community activities is generally a positive factor and does not increase the risk of becoming a perpetrator of child abuse. It can provide a support network and positive role models, which can help prevent abusive behaviors.
Choice C rationale:
Low tolerance for frustration is a risk factor for becoming a perpetrator of child abuse. Frustration can lead to anger and potentially harmful actions, especially if the person does not have effective coping mechanisms.
Choice D rationale:
A submissive personality is not a risk factor for becoming a perpetrator of child abuse. While it may affect interpersonal relationships, it does not directly increase the risk of abusive behavior.
.A nurse is contributing to the plan of care for a client who is to start therapy with fluoxetine.
Which of the following is an expected outcome for this client?.
Explanation
Choice A rationale:
Absence of seizures is not an expected outcome of fluoxetine therapy. Fluoxetine is an antidepressant, not an anticonvulsant.
Choice B rationale:
Reduction in hand tremors is not an expected outcome of fluoxetine therapy. Fluoxetine is used to treat depression, obsessive-compulsive disorder, some eating disorders, and panic attacks.
Choice C rationale:
Decreased hallucinations is not an expected outcome of fluoxetine therapy. Fluoxetine is not typically used to treat conditions that cause hallucinations.
Choice D rationale:
Improved mood is an expected outcome of fluoxetine therapy. As an antidepressant, fluoxetine works by balancing chemicals in the brain that affect mood and emotions.
.A client is becoming increasingly agitated, anxious, and tense.
The nurse notes a clenched jaw and a change in the pitch of the client's voice.
Which of the following interventions should the nurse implement first?.
Explanation
Choice A rationale:
Obtaining a prescription for haloperidol is not the first intervention the nurse should implement. Medication should be considered only after non-pharmacological interventions have been attempted.
Choice B rationale:
Taking the client to the seclusion room is not the first intervention the nurse should implement. Seclusion should be used only as a last resort when all other interventions have failed and the client is a danger to themselves or others.
Choice C rationale:
Verbally de-escalating the client is the first intervention the nurse should implement. This involves using calm, clear communication to help the client regain control of their emotions.
Choice D rationale:
Placing the client in restraints is not the first intervention the nurse should implement. Restraints should be used only as a last resort when all other interventions have failed and the client is a danger to themselves or others.
.A nurse is assisting with the care of a client who has dementia.
Which of the following actions should the nurse take?.
Explanation
Choice A rationale:
Making a personal introduction to the client at each interaction is a recommended approach for clients with dementia. It helps to orient the client and establish a connection, which can reduce confusion and anxiety.
Choice B rationale:
Giving a client with dementia a list of foods to choose from for dinner may be overwhelming due to impaired decision-making abilities.
Choice C rationale:
Choice D rationale:
Providing a dark environment for sleeping can be disorienting for a client with dementia. A low level of light can help the client maintain orientation to their surroundings.
.A nurse in a substance use disorder clinic is explaining the alcohol recovery process to a client's family.
Which of the following should the nurse identify as the first step toward successful recovery from alcohol use disorder?.
Explanation
Choice A rationale:
Acknowledging an inability to control drinking is the first step in many recovery models, including the 12-step program of Alcoholics Anonymous. This step involves admitting that alcohol has taken over one’s life.
Choice B rationale:
Agreeing to a prescription for an alcohol use deterrent can be a part of the recovery process, but it is not typically the first step.
Choice C rationale:
Incorporating a form of spirituality into daily life can be a part of the recovery process for some individuals, but it is not typically the first step.
Choice D rationale:
Forming a close support network is crucial in the recovery process, but it comes after acknowledging the problem.
.A nurse in a substance use disorder clinic is explaining the alcohol recovery process to a client's family.
Which of the following should the nurse identify as the first step toward successful recovery from alcohol use disorder?.
Explanation
Choice A rationale:
Acknowledging an inability to control drinking is the first step in many recovery models, including the 12-step program of Alcoholics Anonymous. This step involves admitting that alcohol has taken over one’s life.
Choice B rationale:
Agreeing to a prescription for an alcohol use deterrent can be a part of the recovery process, but it is not typically the first step.
Choice C rationale:
Incorporating a form of spirituality into daily life can be a part of the recovery process for some individuals, but it is not typically the first step.
Choice D rationale:
Forming a close support network is crucial in the recovery process, but it comes after acknowledging the problem.
.A nurse is reinforcing teaching about a new prescription for haloperidol with a client who has schizophrenia.
Which of the following statements by the client indicates an understanding of the teaching?.
Explanation
Choice A rationale:
Ringing in the ears is not a common side effect of haloperidol.
Choice B rationale:
A metallic taste is not typically associated with haloperidol use.
Choice C rationale:
Urinary incontinence is not a known side effect of haloperidol.
Choice D rationale:
Haloperidol can cause photosensitivity, making the skin more sensitive to the sun.
.A nurse is contributing to the plan of care for a client who has bipolar disorder and whose admission was voluntary.
For which of the following interventions should the nurse confirm that the client has given informed consent?.
Explanation
Choice A rationale:
Attending a cognitive behavioral therapy class does not require informed consent as it is a non-invasive form of treatment.
Choice B rationale:
Informed consent is necessary when taking an experimental medication to ensure the client understands the potential risks and benefits.
Choice C rationale:
Light therapy is a non-invasive treatment and does not typically require informed consent.
Choice D rationale:
Participating in a group exercise program is a non-invasive form of treatment and does not require informed consent.
.A nurse is caring for a client who has an anxiety disorder.
The client transforms their anxiety into physical manifestations.
The nurse should recognize that the client is ing which of the following manifestations?.
Explanation
Choice A rationale:
Reaction formation is a defense mechanism where a person behaves in a way opposite to their true feelings.
Choice B rationale:
Somatization is the process of experiencing mental or emotional distress as physical symptoms.
Choice C rationale:
Intellectualization is a defense mechanism where a person uses reasoning to block out emotional stress.
Choice D rationale:
Sublimation is a defense mechanism where a person transforms unacceptable impulses into socially acceptable behaviors.
A nurse is reinforcing teaching with a newly licensed nurse about the Patient Self-Determination Act (PSDA). Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?.
No explanation
.A nurse is contributing to the plan of care for a client who has acute delirium.
Which of the following interventions should the nurse include in the plan of care? .
Explanation
Choice A rationale:
Discouraging visitation from the client’s family could increase feelings of isolation and confusion, which could exacerbate delirium.
Choice B rationale:
A high-stimulation environment could overstimulate the client and worsen delirium.
Choice C rationale:
Limiting the client’s need to make decisions can reduce stress and confusion, which can help manage delirium.
Choice D rationale:
Keeping the client’s room dark at night could disrupt the client’s sleep-wake cycle and potentially worsen delirium.
.A nurse is reinforcing behavior management techniques with the parent of a school-age child who has conduct disorder.
Which of the following statements by the parent indicates an understanding of the redirection technique? .
Explanation
Choice A rationale:
Re-engaging the child in an appropriate activity is a good example of the redirection technique.
Choice B rationale:
Moving closer to the child when they are agitated could escalate the situation rather than calm it.
Choice C rationale:
Using role-playing to enhance new behavioral skills is a good strategy, but it is not an example of the redirection technique.
Choice D rationale:
Ignoring attention-seeking behaviors could lead to an escalation of those behaviors as the child seeks attention.
.A nurse is collecting data from a client who has schizophrenia.
Which of the following client statements indicates that the client is experiencing a command hallucination? .
Explanation
Choice A rationale:
This statement indicates a delusion, not a command hallucination. Delusions are fixed false beliefs that are not based in reality.
Choice B rationale:
This statement indicates a command hallucination. Command hallucinations involve hearing voices that direct the person to take action.
Choice C rationale:
This statement indicates paranoia, not a command hallucination. Paranoia involves intense anxious or fearful feelings and thoughts often related to persecution or threat.
Choice D rationale:
This statement indicates a visual hallucination, not a command hallucination. Visual hallucinations involve seeing things that aren’t there.
.A nurse is reinforcing teaching with a client who has bipolar disorder and has a new prescription for lithium.
To address possible adverse effects, the nurse should include that which of the following laboratory values will be monitored while the client is taking this medication? .
Explanation
Choice A rationale:
While liver enzymes are important to monitor for many medications, they are not typically affected by lithium.
Choice B rationale:
Uric acid levels are not typically affected by lithium.
Choice C rationale:
Lithium can affect the sodium levels in the body, making it important to monitor these levels while taking this medication.
Choice D rationale:
Erythrocyte sedimentation rate is not typically affected by lithium.
.A nurse is caring for a client who has depression and reports only sleeping a few hours each night.
Which of the following instructions should the nurse give the client to promote sleep? .
Explanation
Choice A rationale:
Alcohol can interfere with sleep patterns and should not be used as a sleep aid.
Choice B rationale:
Napping can make it harder to fall asleep at night.
Choice C rationale:
Eating just before bedtime can cause discomfort and disrupt sleep.
Choice D rationale:
Limiting caffeine intake can help improve sleep, as caffeine is a stimulant that can interfere with the ability to fall asleep.
.A nurse in a mental health facility is caring for a client who has antisocial personality disorder and alcohol dependency.
The nurse should encourage the client to participate in which of the following groups? .
Explanation
Choice A rationale:
Psychodrama is a therapeutic approach that uses dramatic role play to help clients gain insight into their feelings and behaviors. However, it may not be the most effective for a client with antisocial personality disorder and alcohol dependency.
Choice B rationale:
Crisis intervention is a short-term therapy to stabilize a client during an acute crisis. It may not address the long-term needs of a client with antisocial personality disorder and alcohol dependency.
Choice C rationale:
Dual diagnosis treatment is designed for clients who have a mental health disorder and a substance use disorder. This would be the most appropriate for a client with antisocial personality disorder and alcohol dependency.
Choice D rationale:
Codependency support groups are typically for family members and friends of individuals with substance use disorders. They may not be the most beneficial for the client themselves.
.A nurse is collecting data from a client who has antisocial personality disorder.
Which of the following findings should the nurse expect? (Select all that apply.) .
Explanation
Choice A rationale:
Preoccupation with details is more commonly associated with obsessive-compulsive personality disorder, not antisocial personality disorder.
Choice B rationale:
Manipulative behaviors are a common characteristic of antisocial personality disorder. Individuals with this disorder often manipulate others for personal gain.
Choice C rationale:
Splitting, or viewing others as all good or all bad, is a defense mechanism often used by individuals with antisocial personality disorder.
Choice D rationale:
Impulsiveness is a common characteristic of antisocial personality disorder. Individuals with this disorder often act without considering the consequences.
Choice E rationale:
Lack of empathy is a common characteristic of antisocial personality disorder. Individuals with this disorder often have difficulty understanding or sharing the feelings of others.
.A nurse in a mental health clinic is collecting data from a client to determine the client's risk for suicide.
Which of the following findings should the nurse identify as a risk factor for suicide? (Select all that apply.) .
Explanation
Choice A rationale:
Alcohol use disorder is a risk factor for suicide. Alcohol can increase impulsivity and decrease inhibitions, which can lead to suicidal behaviors.
Choice B rationale:
Being currently married is generally considered a protective factor against suicide, not a risk factor.
Choice C rationale:
Access to lethal means, such as guns in the home, is a significant risk factor for suicide.
Choice D rationale:
A family history of suicide, including a sibling history of suicide, is a risk factor for suicide.
Choice E rationale:
Terminal illnesses, such as liver cancer, can increase feelings of hopelessness and despair, which are risk factors for suicide.
.A nurse is collecting data from a client who has anorexia nervosa.
Which of the following findings should the nurse expect? (Select all that apply.) .
Explanation
Choice A rationale:
Diarrhea is not typically associated with anorexia nervosa. Constipation is more common due to reduced food intake.
Choice B rationale:
Hypotension can occur in anorexia nervosa due to decreased circulating blood volume from inadequate fluid and food intake.
Choice C rationale:
Cold extremities can be a sign of anorexia nervosa due to the body’s attempt to conserve heat in response to inadequate caloric intake.
Choice D rationale:
Tooth erosion can occur in anorexia nervosa due to frequent vomiting, which exposes the teeth to stomach acid.
Choice E rationale:
Lanugo, or fine body hair, can develop in anorexia nervosa as the body’s attempt to insulate itself due to loss of body fat.
.A nurse is collecting data from an older adult client who was admitted with heart failure.
The nurse should report which of the following findings to the provider as an indication of delirium? .
Explanation
Choice A rationale:
A consistent state of depression is not indicative of delirium, but rather a mood disorder.
Choice B rationale:
Fluctuating levels of orientation are a hallmark sign of delirium and should be reported to the provider.
Choice C rationale:
Obsessive behaviors are not typically associated with delirium, but may be indicative of an anxiety disorder.
Choice D rationale:
Gradual memory loss is more indicative of dementia, not delirium, which is typically a sudden onset.
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