ATI RN
ATI RN Mental Health Asn Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has dementia. When performing a Mental Status Examination (MSE), the nurse should include which of the following data? (Select all that apply.)
Correct Answer: A, C, D, E
Rationale: The correct answers are A, C, D, and E. In a Mental Status Examination for a client with dementia, assessing the ability to perform calculations (
A) is important to evaluate cognitive function. Recall ability (
C) is crucial as memory impairment is a common feature of dementia. Long-term memory (
D) is essential to assess for signs of cognitive decline. The level of orientation (E) is vital to determine the client's awareness of time, place, and person, which can be impaired in dementia. Coping skills (
B) are important but not typically assessed in an MSE for dementia. The other choices (F, G) do not directly relate to the cognitive impairment typically seen in dementia.
Question 2 of 5
A male nurse is assigned to care for a female client who was admitted to the hospital for treatment of injuries following a domestic abuse incident. The client tells the nurse manager she does not want a male nurse as her caregiver. Which of the following nursing responses should the nurse manager make?
Correct Answer: D
Rationale: The correct answer is D. The nurse manager should respect the client's wishes and arrange for a female nurse to care for her. This is important for the client's comfort and sense of safety. Option A only addresses personal hygiene care, not overall nursing care. Option B focuses on the nurse's capabilities, not the client's preferences. Option C is dismissive of the client's concerns and does not address the issue directly. It is essential to prioritize the client's feelings and choices in this sensitive situation.
Question 3 of 5
A nurse is providing teaching for a client who has major depressive disorder and is seeking voluntary admission to an acute mental health facility. Which of the following statements should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: "You will still need to give informed consent for treatments after admission." This statement is important to include in teaching because even after being admitted to a mental health facility, the client retains the right to give informed consent for any treatments or interventions. It emphasizes the client's autonomy and involvement in decision-making regarding their care.
The other options are incorrect:
A: "You will give up your right to refuse antidepressant medications upon admission." This statement is incorrect as the client still has the right to refuse specific treatments even after admission.
B: "Your provider is required to notify your employer of your admission." This statement is incorrect as confidentiality laws protect the client's privacy and do not require notification to the employer.
D: "You cannot leave the facility until your provider completes a discharge summary." This statement is incorrect as the client has the right to leave the facility against medical advice, although there may be consequences or processes to follow.
Question 4 of 5
A nurse in an emergency department is assessing a client who has been taking haloperidol for 3 months. The client has a temperature of 39.5° C (103.4° F), blood pressure of 150/110 mm Hg, and muscle rigidity. Which of the following complications should the nurse suspect?
Correct Answer: D
Rationale: The correct answer is D: Neuroleptic malignant syndrome (NMS). The client's symptoms of high fever, hypertension, and muscle rigidity are classic signs of NMS, a rare but life-threatening adverse effect of antipsychotic medications like haloperidol. NMS is a medical emergency that can lead to severe complications such as rhabdomyolysis, renal failure, and even death if not promptly recognized and treated. Agranulocytosis (
A) is a potential side effect of some antipsychotic medications but typically presents with symptoms like fever and sore throat due to low white blood cell count. Akathisia (
B) is a movement disorder characterized by restlessness and a compelling need to move, which is not consistent with the client's symptoms. Tardive dyskinesia (
C) is a late-onset movement disorder associated with long-term antipsychotic use and typically presents with involuntary movements of the face and extremities, not fever
Question 5 of 5
A nurse is discussing the manifestations of alcohol withdrawal with a client who has a history of alcohol use disorder. Which of the following client statements indicates understanding?
Correct Answer: A
Rationale: The correct answer is A because alcohol withdrawal symptoms, including tremors, typically begin within 6-24 hours after the last drink. This statement shows an accurate understanding of the timing of alcohol withdrawal manifestations.
Choice B is incorrect because Disulfiram is a medication used to deter alcohol consumption, not block cravings.
Choice C is incorrect because alcohol withdrawal symptoms can last beyond 5-7 days.
Choice D is incorrect because vitamin C does not prevent cirrhosis or liver damage from alcohol abuse.