ATI RN
Target Healthcare Questions
Question 1 of 5
A nurse observes a patient who is sitting alone in a room put hands over both ears and vigorously shake her head as though saying, 'No.' Later the patient cries and mutters, 'You don't know what you're talking about! Leave me alone.' What assessment should the nurse attempt to validate?
Correct Answer: C
Rationale: The correct answer is C: The patient is experiencing auditory hallucinations. The patient's behavior of covering both ears and shaking her head as if responding to voices, along with muttering and crying, suggests a sensory perception that is not based on external stimuli. This aligns with the characteristic symptoms of auditory hallucinations, which are common in conditions like schizophrenia. Choice A is incorrect because the patient's behavior is not necessarily seeking attention but rather responding to internal stimuli. Choice B is incorrect as the patient's emotional expression seems to be a result of the auditory hallucinations rather than being inappropriate. Choice D is incorrect as negative symptoms of schizophrenia typically involve a decrease or absence of normal functions, which is not clearly demonstrated in this scenario.
Question 2 of 5
To cope with the devastating effects of schizophrenia and other serious mental illnesses, family members or significant others and clients will benefit most from:
Correct Answer: C
Rationale: The correct answer is C: Ongoing treatment and support. This option is the most beneficial for coping with serious mental illnesses like schizophrenia because it involves long-term management and assistance. Ongoing treatment can include therapy, medication management, and support groups, which are crucial for helping individuals and their families manage symptoms and improve overall quality of life. Explanation: A: Regular psychoanalysis is not the most effective approach for managing the devastating effects of serious mental illnesses like schizophrenia. It may not provide the immediate support and intervention needed for crisis situations. B: Intensive short-term therapy may offer temporary relief, but ongoing treatment and support are essential for long-term management and stability. D: Continued medication adjustments are important, but they are just one aspect of a comprehensive treatment plan. Ongoing treatment and support encompass a broader range of interventions that are necessary for addressing the complex needs of individuals with serious mental illnesses.
Question 3 of 5
A nursing colleague says, 'This patient was admitted claiming to have been raped by her boyfriend, but just look at the sexy clothes she's wearing.' Which response reflects an understanding of the most likely source of the colleague's comment?
Correct Answer: D
Rationale: The correct answer is D because it addresses the underlying misconception that a person's clothing choices can justify or provoke sexual assault. By asking if the colleague believes the victim's clothing caused the assault, it challenges victim-blaming and highlights the importance of understanding consent and boundaries. Option A does not directly address the colleague's potentially victim-blaming statement. Option B brings up the colleague's personal experience, which is irrelevant and may not effectively challenge the problematic comment. Option C makes assumptions about the colleague's personal life, which is not relevant to the situation at hand.
Question 4 of 5
A child, aged 11 years, stays home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The home is cluttered and dirty. When asked about his parents, the child reluctantly reveals that he thinks his father does not like him very much because he calls him 'stupid' and says he can never do anything right. This should be assessed as:
Correct Answer: C
Rationale: Explanation: C: Emotional abuse is the correct assessment as the father's behavior of calling the child 'stupid' and criticizing him can cause psychological harm. This behavior undermines the child's self-esteem and mental well-being. The child's reluctance to speak about his parents also indicates emotional distress. Incorrect choices: A: Physical abuse involves causing physical harm, which is not evident in the scenario. B: Sexual abuse involves inappropriate sexual behavior, which is not indicated in the scenario. D: Economic abuse involves financial control or exploitation, which is not the primary issue in this scenario.
Question 5 of 5
A client displays disorganized thinking, difficult-to-follow speech, and silly, inappropriate affect. The client isolates himself from other clients and staff, ignores unit activities, and often seems to be listening and responding to unseen stimuli. This client's behavior most closely conforms to the characteristic behavior of:
Correct Answer: D
Rationale: The correct answer is D: Disorganized schizophrenia. This client's presentation aligns with the symptoms of disorganized schizophrenia, characterized by disorganized thinking, speech, and behavior, inappropriate affect, social withdrawal, and hallucinations. Residual schizophrenia (A) refers to a milder form of schizophrenia with lingering symptoms. Schizoaffective disorder (B) involves symptoms of both schizophrenia and mood disorders. Paranoid schizophrenia (C) is characterized by delusions and auditory hallucinations, which are not the primary symptoms displayed by the client in the question.