ATI RN
Behavioral Health Nursing Care Plans Questions
Question 1 of 5
A patient states, 'I'm not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up.' Which nursing intervention should have the highest priority?
Correct Answer: D
Rationale: The nurse would place a priority on monitoring and reinforcing suicide self-restraint because it relates directly and immediately to patient safety. Patient safety is always a priority concern. The nurse should monitor and reinforce all patient attempts to control anxiety, improve sleep patterns, and develop self-esteem, while giving priority attention to suicide self-restraint.
Question 2 of 5
A nurse is working with a patient diagnosed with generalized anxiety disorder. The patient states, 'I can't stop worrying about everything, even things that don't matter.' Which of the following interventions is most appropriate?
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 3 of 5
A patient says, 'Please don't share information about me with the other people.' How should the nurse respond?
Correct Answer: A
Rationale: A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff needs to know pertinent data. The other incorrect responses promote incomplete disclosure on the part of the patient, require daily renegotiation of an issue that should be resolved as the nurse-patient contract is established, and suggest mutual problem solving. The relationship must be patient centered. See relationship to audience response question.
Question 4 of 5
A nurse is working with a patient diagnosed with bipolar disorder. The patient is in the manic phase and is engaging in risky behaviors. Which of the following is the most appropriate nursing intervention?
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 5 of 5
A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
Correct Answer: C
Rationale: Asking, 'Am I correct in understanding that "¦' permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.