ATI RN
Mental Health Exam 1 Practice Questions Questions
Question 1 of 5
Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. He is cachexic, has multiple scabs on his arms and legs, and has lower extremity edema. An appropriate nursing diagnosis for Donald along with an expected outcome is:
Correct Answer: C
Rationale: The correct answer is C: Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs.
Rationale:
1. Donald is cachexic, indicating severe malnutrition.
2. Multiple scabs suggest poor wound healing due to malnutrition.
3. Lower extremity edema can be a sign of protein deficiency.
4. The nursing diagnosis of Nutrition: Less than body requirements fits Donald's clinical presentation.
5. The expected outcome of Maintains nutrient intake for metabolic needs addresses the goal of improving Donald's nutritional status.
Summary:
A: Risk for injury/Remains free from injury - Not the best choice as Donald's primary issue is malnutrition, not injury risk.
B: Ineffective denial/Accepts responsibility for behavior - Not relevant to the physical health issues presented by Donald.
D: Risk for suicide/Expresses feelings, plans for the future - Donald's symptoms do not suggest a risk for suicide.
Question 2 of 5
A patient is being discharged from the psychiatric unit this afternoon, and the nurse needs to teach the patient about discharge medications. The patient is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau's views regarding anxiety, the nurse would expect to implement the teaching plan at which time?
Correct Answer: B
Rationale: The correct answer is B: When his anxiety decreases to a mild level. According to Peplau, anxiety can be a driving force for learning and growth. When anxiety is at a moderate level, it indicates a level of readiness for learning. Implementing the teaching plan when the patient's anxiety decreases to a mild level ensures that the patient is still motivated to learn and engage in the teaching process. Waiting until the anxiety stabilizes (option
A) may lead to missed opportunities for effective teaching. Expecting the patient to be completely free of anxiety (option
C) is unrealistic and may delay the teaching process. Waiting until the patient's anxiety escalates to the panic level (option
D) would not be conducive to effective learning as it may impair the patient's ability to process and retain information.
Question 3 of 5
A nurse is developing a teaching plan for a client with an impulse-control disorder. The nurse is planning to explain the emotional aspects associated with the behavior as part of the plan. Which of the following would the nurse describe as occurring first before the individual commits the act?
Correct Answer: B
Rationale: The correct answer is B: Tension. In impulse-control disorders, the individual typically experiences increasing tension or anxiety before engaging in impulsive behavior. This tension builds up and leads to a sense of urgency to act, overriding rational decision-making. This initial tension is a key emotional aspect that precedes the impulsive act. Remorse (choice
A) and regret (choice
C) occur after the act, as the individual reflects on their actions. Pleasure (choice
D) is experienced during or after the impulsive behavior, but it is not the first emotional aspect that occurs.
Therefore, understanding and addressing the tension is crucial in managing impulse control disorders.
Question 4 of 5
A nurse is assessing a patient with a psychiatric illness. The nurse interprets which patient statement as reflecting the concept of cognitive triad?
Correct Answer: A
Rationale: The correct answer is A because it reflects the cognitive triad, a concept in cognitive therapy. The patient is displaying negative beliefs about themselves (I always mess things up), the world (my whole world is a mess), and the future (my future will be a big mess). This pattern of negative thinking about oneself, the world, and the future is characteristic of the cognitive triad.
Choice B is incorrect because it describes someone else (the sister) and does not reflect the patient's negative self-view.
Choice C is incorrect as it describes the bosses and not the patient's own thoughts.
Choice D is incorrect as it refers to a superstitious belief about bad things happening in threes, which is unrelated to the cognitive triad.
Question 5 of 5
A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient's self-esteem but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario?
Correct Answer: D
Rationale: The correct answer is D because cultural considerations are crucial in nursing care.
Step 1: Assessing the patient's culture is essential to understanding behaviors like eye contact.
Step 2: Filipino culture may view direct eye contact as disrespectful or submissive.
Step 3: Lack of cultural awareness can hinder effective interventions.
Step 4: Interventions should be culturally sensitive to be impactful. Summary: A: Focused on technique, not cultural relevance. B: Neglects the nurse's role in holistic care. C: Assumes negative emotions without evidence.