ATI RN
ATI RN Mental Health Asn Questions
Extract:
Question 1 of 5
A nurse on an inpatient eating disorders unit is caring for a client who has anorexia nervosa and has a body mass index of 17.2. Which of the following actions should the nurse take? (Select all that apply.)
Correct Answer: A, B, D, E
Rationale: The correct actions are A, B, D, and E.
A: Providing small meals frequently helps prevent overwhelming the client and supports gradual weight restoration.
B: Daily weight monitoring is crucial in tracking progress and ensuring the client's safety.
D: Staying with the client during meals and afterward helps prevent purging behaviors and offers support.
E: Offering privileges for sustained weight gain reinforces positive behavior and motivation for recovery.
Incorrect options:
C: Allowing the client to choose meals may lead to restrictive eating habits and hinder weight restoration.
F: No information given.
G: No information given.
Question 2 of 5
A nurse is caring for a client who has delusional behavior and states, "I can't go to group therapy today. I am expecting a high-level official to visit me." The nurse responds, "I understand, but it is time for group therapy, and we expect everyone to attend. Let's walk over together.” For which of the following reasons is the nurse's response considered therapeutic?
Correct Answer: A
Rationale: The correct answer is A because the nurse's response clearly articulates what is expected of the client, which helps maintain structure and promote accountability. By stating the expectation for the client to attend group therapy, the nurse is establishing boundaries and reinforcing the therapeutic environment. This approach helps the client understand the importance of participating in treatment activities.
Choice B is incorrect because empathy towards the delusion may validate the client's false beliefs, which is not therapeutic in this context.
Choice C is incorrect as the response is not primarily aimed at setting limits on manipulative behavior but rather at promoting participation in therapy.
Choice D is incorrect as the response does not involve reflection but rather straightforward communication of expectations.
Question 3 of 5
A nurse is caring for a client who is terminally ill and exhibiting signs of impending death. The client's medical record states that the client is a practicing Roman Catholic. Which of the following nursing actions is appropriate?
Correct Answer: A
Rationale: The correct answer is A: Offer to make arrangements for the Sacrament of the Sick. This is appropriate because the client is a practicing Roman Catholic, and the Sacrament of the Sick is a sacrament in the Catholic faith administered to the sick or dying. Offering to arrange for this sacrament shows respect for the client's religious beliefs and provides spiritual comfort.
Choice B is incorrect because staying with the client's body after death is not necessarily a religious practice and may not align with the client's beliefs.
Choice C is incorrect as it assumes the client's faith requires a specific individual to bathe the body, which may not be the case for all Roman Catholics.
Choice D is incorrect as it is not relevant to the client's religious needs and may hinder communication during this sensitive time.
Question 4 of 5
A nurse is caring for a client who requires a crisis intervention for acute anxiety. Which of the following actions is the highest priority?
Correct Answer: A
Rationale: The correct answer is A: Protecting the client from injury. This is the highest priority because ensuring the client's physical safety takes precedence in a crisis situation. If the client is at risk of harming themselves or others, immediate action must be taken to prevent injury. Determining the cause of anxiety, ensuring the client feels safe, and identifying coping skills are important but secondary priorities once the client's safety is assured. In a crisis situation, physical safety is paramount before addressing underlying causes or providing emotional support.
Question 5 of 5
A nurse is caring for a client who is having difficulty sleeping and is pacing the floor. The client’s head is down, and he is wringing his hands. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: The correct answer is C: Remain with the client. By remaining with the client, the nurse can provide support and reassurance, assess the client's emotional state, and ensure the client's safety. This action shows empathy and promotes therapeutic communication. Encouraging the client to go back to bed (
A) may not address the underlying issue causing the restlessness. Giving a PRN sleeping medication (
B) without further assessment may not be appropriate and could mask the client's feelings. Exploring alternatives to pacing (
D) is a good intervention but should come after providing immediate support and understanding the client's needs.