A client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess?

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ATI Mental Health Capstone Assessment Questions

Question 1 of 9

A client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess?

Correct Answer: C

Rationale: The correct answer is C: Dilated pupils. Opioid withdrawal commonly presents with dilated pupils due to the noradrenergic rebound effect. This occurs as the body tries to compensate for the suppression of noradrenaline caused by chronic opioid use. Rhinorrhea and lacrimation are associated with opioid withdrawal but are typically seen in early withdrawal stages. Dysphoria is a common symptom in opioid withdrawal but is not specific to moderate withdrawal.

Question 2 of 9

A nurse is working in a community mental health center that provides care to a large population of Asian descent. When developing programs for this community, which of the following would be most important for the nurse to address?

Correct Answer: C

Rationale: The correct answer is C: Label avoidance. In Asian cultures, there is a strong emphasis on saving face and avoiding labels related to mental health issues. This can lead individuals to avoid seeking help or disclosing their struggles to others. Addressing label avoidance is crucial in order to reduce barriers to accessing mental health services within the Asian community. Incorrect choices: A: Public stigma - While public stigma is important to address, the focus should be on understanding and addressing the specific cultural factors that contribute to stigma within the Asian community. B: Self-stigma - While self-stigma is significant, addressing label avoidance can help individuals overcome internalized stigma by creating a more accepting environment. D: Negative life events - While negative life events can impact mental health, addressing label avoidance is more essential in this context to ensure individuals feel comfortable seeking help despite these challenges.

Question 3 of 9

The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is:

Correct Answer: B

Rationale: The correct answer is B: Deep brain stimulation. This approach involves surgically implanting electrodes in specific brain areas to stimulate underactive regions in depression. It is effective in modulating neural circuits associated with mood regulation. Transcranial magnetic stimulation (A) involves non-invasive magnetic pulses to stimulate brain regions. Vagus nerve stimulation (C) targets the vagus nerve to regulate mood. Electroconvulsive therapy (D) uses controlled electric currents to induce seizures, primarily for severe depression cases. However, deep brain stimulation is specifically aimed at targeting and stimulating underactive brain regions associated with depression, making it the most appropriate choice in this context.

Question 4 of 9

Which patient statement indicates the helpfulness of the nurse-patient relationship?

Correct Answer: A

Rationale: The correct answer is A because the patient expresses gratitude for the nurse's support, acknowledges increased understanding, and demonstrates empowerment in managing their issue. This indicates a positive and effective nurse-patient relationship. Choice B focuses on seeking advice rather than mutual understanding. Choice C highlights the nurse's role in controlling anxiety, overshadowing the patient's agency. Choice D emphasizes sympathy from the nurse rather than the patient's growth and understanding.

Question 5 of 9

A female psychiatric patient is talking to the nurse about her reasons for being hospitalized. She begins to discuss her relationship with her female significant other. The patient is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, 'Should I break up with my partner?' Which response by the nurse would be most effective in building rapport between the patient and nurse?

Correct Answer: C

Rationale: The correct response is C: "It sounds like you're beginning to be uncomfortable in this relationship." This response is effective because it acknowledges the patient's feelings and shows empathy without judgment. It validates the patient's concerns and opens up further discussion. Option A is incorrect as it is judgmental and dismissive of the patient's sexual orientation. Option B is also incorrect as it ignores the patient's current feelings and suggests pursuing a relationship based on societal norms. Option D is incorrect as it shifts the focus away from the patient's concerns and does not address the underlying issues in the relationship.

Question 6 of 9

Before assessing a new patient, a nurse is told by another health care worker, "I know that patient. No matter how hard we work, there isn't much improvement by the time of discharge." The nurse's responsibility is to

Correct Answer: B

Rationale: The correct answer is B because the nurse should assess the patient based on data collected from all sources to form an independent evaluation. This ensures a comprehensive understanding of the patient's condition and needs. Documenting the other worker's assessment (choice A) may limit the nurse's own assessment. Validating the worker's impression by contacting the patient's significant other (choice C) may introduce bias. Discussing the worker's impression with the patient during the assessment interview (choice D) may influence the patient's responses. The best approach is for the nurse to gather all relevant information and make an objective assessment.

Question 7 of 9

While assessing an older adult, the nurse allows ample time for the patient to respond based on the understanding of which of the following?

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. Allowing ample time for the older adult to respond acknowledges the possible cognitive changes that may come with aging. 2. It promotes effective communication and respects the individual's autonomy. 3. It helps reduce the risk of miscommunication and misunderstanding. 4. It enhances the nurse's ability to gather accurate information and provide appropriate care. Summary: B: This choice assumes irreversible memory impairment without evidence, leading to premature judgment. C: Decreased cerebral oxygen flow is not necessarily related to the need for ample time in communication with older adults. D: Weighing pros and cons of perceived risk is not directly related to the need for ample time in communication with older adults.

Question 8 of 9

A nurse is part of a multidisciplinary team working with groups of depressed patients. One group of patients receives supportive interventions and antidepressant medication. The other group receives only medication. The team measures outcomes for each group. Which type of study is evident?

Correct Answer: D

Rationale: The correct answer is D: Clinical epidemiology. Clinical epidemiology involves studying the outcomes of interventions in patient groups, which is evident in this scenario. The nurse is part of a team measuring outcomes in depressed patients receiving different treatment approaches. A: Incidence refers to the rate of occurrence of new cases in a population over a specified period. This study is not focused on new cases but rather on the outcomes of interventions. B: Prevalence refers to the proportion of a population found to have a condition at a specific point in time. This study is not assessing the prevalence of depression but rather the outcomes of different treatment approaches. C: Comorbidity refers to the presence of two or more conditions in a patient. While comorbidity may be relevant in this study, the main focus is on the outcomes of interventions rather than the presence of multiple conditions. In summary, the study described involves evaluating outcomes of interventions in depressed patients, aligning with the principles of clinical epidemiology.

Question 9 of 9

Which interaction is an example of dialogue that would be used in the context of reality therapy?

Correct Answer: D

Rationale: The correct answer is D because it reflects the key principles of reality therapy, which focuses on personal responsibility and choices. In this dialogue, the nurse is helping the client explore their behavior and choices that led to the consequence of losing their pass. By asking the client about their actions and readiness for the pass, the nurse is encouraging self-reflection and accountability. This approach aligns with reality therapy's emphasis on helping clients understand how their choices impact their lives. Choices A, B, and C are incorrect because they do not directly address personal responsibility and choice. Choice A focuses on offering a relaxation exercise without addressing the client's role in managing their anxiety. Choice B focuses on exploring the client's past experiences with punishment but does not guide the client towards self-reflection on their current behavior. Choice C suggests discussing anxiety without directly addressing the client's choices or accountability.

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