ATI RN
Age Specific Patient Care Questions
Question 1 of 5
A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about:
Correct Answer: C
Rationale: Rationale: 1. Severe depression is typically treated with antidepressants like Sertraline (Zoloft). 2. Sertraline is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression. 3. The nurse should provide teaching on how to take the medication, potential side effects, and monitoring for effectiveness. 4. Other choices (A, B, D) are not typically used as first-line treatment for severe depression and may not be appropriate for this patient.
Question 2 of 5
A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation?
Correct Answer: C
Rationale: The correct answer is C because anosognosia, a symptom of schizophrenia, can prevent patients from recognizing they are ill due to the illness itself affecting their insight and awareness. Anosognosia is a neurocognitive deficit common in schizophrenia, where the brain's ability to recognize one's own illness is impaired. This leads the patient to genuinely believe they are not ill, even when presented with evidence to the contrary. Choice A: Denial is a psychological defense mechanism, not a symptom of schizophrenia. Choice B: Stigma might influence perceptions of mental illness, but it does not directly cause anosognosia in schizophrenia. Choice D: Command hallucinations can influence behavior, but they typically involve auditory commands unrelated to recognizing one's illness.
Question 3 of 5
The patient on the mental health unit who should be assessed as being at highest risk for directing violent behavior toward others is the patient who has:
Correct Answer: B
Rationale: The correct answer is B because paranoid delusions of being followed by the Mafia indicate a high level of suspiciousness and potential for harm to others. This patient may act out violently in self-defense or as a reaction to perceived threats. Choice A is incorrect as OCD rituals are typically not associated with violent behavior. Choice C is incorrect as severe depression is more likely to result in self-harm rather than harm towards others. Choice D is incorrect as completed alcohol withdrawal and entering a rehabilitation program do not inherently indicate an increased risk of violent behavior towards others.
Question 4 of 5
A community mental health nurse receives a new client for his caseload. The diagnosis of the client is residual schizophrenia. Documentation states that the client has a number of negative symptoms. Which symptom would the nurse expect to assess in the client?
Correct Answer: D
Rationale: The correct answer is D: Emotional blunting. In residual schizophrenia, negative symptoms involve deficits in normal emotional responses and behaviors. Emotional blunting refers to a reduction in the intensity of emotional expression, which is commonly seen in clients with residual schizophrenia. This symptom can include a lack of facial expressions, reduced vocal inflections, and overall flat affect. Choice A (Bizarre, somatic delusions) is incorrect as it refers to a positive symptom of schizophrenia involving distorted beliefs about the body. Choice B (Disorganized speech pattern) is incorrect as it is characteristic of disorganized schizophrenia, not residual schizophrenia. Choice C (Catatonic posturing) is incorrect as it is a symptom of catatonic schizophrenia, not residual schizophrenia.
Question 5 of 5
A client who has been diagnosed as having paranoid schizophrenia is highly suspicious and delusional. He hears voices telling him terrorists are plotting to assassinate him. He refuses to eat, saying the food is poisoned. The nursing action that best addresses his needs is to:
Correct Answer: B
Rationale: The correct answer is B: Allow client to select food from vending machines. This option respects the client's autonomy and addresses his specific delusion of food being poisoned. By allowing the client to select food from vending machines, he can choose items he believes are safe, which can help alleviate his paranoia and increase his trust in the care being provided. This approach promotes a therapeutic relationship and empowers the client in making choices about his care. Explanation of why other choices are incorrect: A: Explaining that others eat the food and are not harmed may not be effective as the client's delusion is strong, and rational arguments may not be helpful in this case. C: Assisting with personal hygiene and grooming is important but does not directly address the client's delusion about food being poisoned. D: Not allowing the client to verbalize delusional thoughts can escalate the client's distress and hinder the therapeutic relationship. It is essential to acknowledge the client's experiences and work towards building trust and rapport