ATI RN
Multidimensional Basis of Health Protective Behaviors Questions
Question 1 of 5
A nurse prepares to teach important medication information to a patient of Mexican heritage. How should the nurse manage the teaching environment?
Correct Answer: A
Rationale: The correct answer is A: Stand very close to the patient while teaching. This approach is important when teaching patients of Mexican heritage as they tend to value close interpersonal relationships. Standing close conveys a sense of warmth and connection, facilitating trust and understanding. Maintaining direct eye contact (B) can be perceived as confrontational in some cultures. Maintaining a neutral emotional tone (C) may come across as disinterested or cold. Sitting 4 feet or more away (D) can create a sense of distance and may be seen as disrespectful or uninviting.
Question 2 of 5
Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with BPD?
Correct Answer: A
Rationale: The correct answer is A because individuals with Borderline Personality Disorder (BPD) benefit from a nursing approach that is firm, consistent, and empathetic. Being firm sets clear boundaries, consistency builds trust, and empathy shows understanding. This approach helps address specific behaviors, validates the client's feelings, and promotes a sense of safety in the therapeutic relationship. Choice B, promoting self-expression with laissez-faire leadership, may lead to boundary issues and lack of structure, exacerbating BPD symptoms. Choice C, authoritative leadership, can be perceived as controlling and may trigger negative reactions in clients with BPD. Choice D, overlooking inappropriate behaviors, can reinforce maladaptive patterns and hinder progress in therapy.
Question 3 of 5
Which is the priority nursing diagnosis when providing care to a client diagnosed with paranoid personality disorder?
Correct Answer: A
Rationale: The correct answer is A: Risk for violence directed toward others R/T suspicious thoughts. This is the priority nursing diagnosis for a client with paranoid personality disorder because individuals with this disorder often have intense distrust and suspicion of others, which can lead to potential violent behaviors. Addressing this risk is crucial for ensuring the safety of both the client and others. Choice B, Risk for suicide, is not the priority as paranoid personality disorder is not typically associated with a high risk of suicide. Choice C, Altered sensory perception, is not directly related to paranoid personality disorder. Choice D, Social isolation, while a common issue for individuals with this disorder, does not pose an immediate risk to others like the potential violence associated with suspicious thoughts.
Question 4 of 5
Which factor should the nurse recognize distinguishes personality disorders from psychosis?
Correct Answer: B
Rationale: The correct answer is B because major disturbances of thought are absent in personality disorders, whereas they are a hallmark of psychosis. Individuals with personality disorders typically have stable thought processes despite maladaptive behaviors or traits. Choices A, C, and D are incorrect because they do not accurately distinguish personality disorders from psychosis. A, C, and D do not address the fundamental difference in thought disturbances between the two conditions.
Question 5 of 5
Which developmental characteristic should the nurse identify as typical of a client diagnosed with severe intellectual disability (ID)?
Correct Answer: D
Rationale: The correct answer is D because individuals with severe intellectual disability often have limitations in communication skills, leading them to express their needs and wants through behaviors rather than verbal communication. This is a common characteristic of severe ID. Choices A, B, and C are incorrect as severe ID typically involves challenges in self-care activities, speech development, and psychomotor skills. These individuals often require significant support in these areas.