ATI RN
ATI RN Mental health 2019 NGN II Questions
Question 1 of 5
A nurse is assisting with obtaining informed consent for a client who has been declared legally incompetent. Which of the following actions should the nurse take?
Correct Answer: C
Rationale:
Correct Answer: C. Request that the client's guardian sign the consent.
Rationale: In the case of a legally incompetent client, consent must be obtained from their legal guardian. This ensures that decisions made on behalf of the client are in their best interest and legally sound. The guardian is authorized to make decisions on behalf of the incompetent client and can provide informed consent for medical procedures. This process upholds ethical standards and protects the client's rights.
Summary of other choices:
A: Explaining implied consent to the client's family does not involve the legal guardian of the incompetent client and may not be legally sufficient.
B: Contacting the facility social worker is not the appropriate step as the legal guardian should be directly involved in providing consent.
D: Asking the charge nurse to obtain informed consent is not appropriate as the legal guardian is the designated decision-maker for an incompetent client.
Question 2 of 5
A nurse is preparing for an interprofessional team meeting regarding a newly admitted client who has major depressive disorder. Which of the following findings obtained during the initial assessment is the priority to report to other disciplines?
Correct Answer: D
Rationale: The correct answer is D: Psychomotor retardation. This finding is the priority to report as it can indicate severe depression and potential risk for self-harm or suicide. Psychomotor retardation can lead to decreased functioning and increased lethargy. Significant weight loss (
A) can be concerning but may not pose an immediate risk. Markedly neglected hygiene (
B) can be addressed later. Poor problem-solving skills (
C) may be a symptom of depression but do not indicate immediate danger.
Question 3 of 5
A nurse is caring for a client in the emergency department who states that she was beaten and sexually assaulted by her partner. After a rapid assessment,which of the following actions should the nurse plan to take next?
Correct Answer: B
Rationale: The correct answer is B: Provide a trained advocate to stay with the client. This is the next crucial step to ensure the client's safety and emotional support. The advocate can offer guidance, resources, and help the client make informed decisions about further actions. Offering prophylactic medication (
A) is important but not the immediate priority. Conducting a pregnancy test (
C) can wait until the client feels ready. Requesting a mental health consultation (
D) is important but addressing the immediate need for support is the priority.
Question 4 of 5
A nurse is caring for a client whose partner died 6 months ago. Which of the following findings is the nurse's priority?
Correct Answer: D
Rationale:
Correct Answer: D - The client states that he is unable to eat more than once a day.
Rationale: This is the priority finding because it indicates a potential physical health issue. Poor nutrition can lead to various health complications, especially when coupled with grief. The nurse should address this concern promptly to ensure the client's well-being.
Summary of Other
Choices:
A: Anger about the provider not saving the partner's life is a common emotion in grief but does not pose an immediate threat to the client's health.
B: Feeling guilty about not spending more time with the partner is a common emotional response to loss but does not pose an immediate threat to the client's health.
C: Recalling negative experiences from the marriage may be distressing but does not indicate an immediate physical health concern.
Question 5 of 5
A nurse is reviewing the medication administration record of a client who has major depressive disorder and a new prescription for selegiline. The nurse should recognize that which of the following client medications is contraindicated when taken with selegiline?
Correct Answer: C
Rationale: The correct answer is C: Fluoxetine. Selegiline, an MAOI, interacts with SSRIs like fluoxetine, leading to serotonin syndrome. This is due to the combined increase in serotonin levels. Acetaminophen (
A), warfarin (
B), and calcium carbonate (
D) do not have significant interactions with selegiline.