ATI LPN
ATI LPN Mental Health Exam IV Questions
Question 1 of 5
A nurse is preparing to administer digoxin to a client who has left-sided heart failure. Which of the following clinical manifestations should the nurse expect to see in this client? (Select all that apply.)
Correct Answer: A, C, D
Rationale: Left-sided heart failure causes pulmonary congestion:
A) Dyspnea from fluid in lungs;
C) Orthopnea from lying flat, worsening lung fluid;
D) Crackles from alveolar fluid.
B) Jugular vein distention is right-sided failure’s systemic congestion sign. A, C, D reflect left-sided pathology.
Question 2 of 5
A nurse is reinforcing discharge teaching for a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication?
Correct Answer: B
Rationale: Warfarin, an anticoagulant, increases bleeding risk. Avoiding aspirin (also a blood thinner) prevents excessive anticoagulation, showing understanding. High vitamin K intake counteracts warfarin by aiding clotting factor synthesis. Alcohol increases bleeding risk, and while electric razors reduce cuts, this isn’t specific to warfarin’s effects but a safety measure.
Question 3 of 5
A nurse is sitting in the day room at an acute care mental health facility with a group of clients who are watching television. Suddenly one of the client's jumps up screaming and runs out of the room. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Ignore the incident since it is an attention-seeking behavior: Ignoring the incident is not appropriate because the client may be in distress or at risk of harm. Stay with the group and ask another client to go and check on the situation: Asking another client to check on the situation is not appropriate, as it is the nurse's responsibility to ensure the safety of all clients. Follow the client to determine the cause of the behavior: Following the client allows the nurse to assess and intervene appropriately to ensure the client's safety and address the cause of the behavior. Ask the group what they think about the client's behavior: Discussing the behavior with the group is not appropriate in an emergency situation and does not address the immediate needs of the distressed client.
Question 4 of 5
A nurse is reinforcing teaching with a client who has peripheral vascular disease (PVD). The nurse should recognize that which of the following statements by the client indicates a need for further teaching?
Correct Answer: C
Rationale: Elastic-top stockings (
C) constrict blood flow in PVD, worsening circulation—indicating misunderstanding. Not going barefoot (
A), checking water temp (
B), and avoiding leg crossing (
D) are correct, protecting feet and circulation. C requires correction.
Question 5 of 5
A nurse is preparing to perform a 12-lead electrocardiogram (ECG). Which of the following instructions should the nurse provide to the client?
Correct Answer: A
Rationale: A 12-lead ECG requires electrode placement on the chest and limbs to record heart activity, making this the key instruction. Remaining still (
B) and short duration (
D) are true but secondary. Slight pressure (
C) may occur, but it’s not the primary focus. Electrode placement is procedural core.