ATI RN
ATI Mental Health Capstone Assessment Questions
Question 1 of 5
A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety?
Correct Answer: B
Rationale: The correct answer is B: Moderate. The patient's tremulous voice, increased respirations, and elevated pulse indicate a moderate level of anxiety. These physiological signs suggest heightened stress and arousal, which are characteristic of moderate anxiety. Mild anxiety would not typically present with such pronounced physical symptoms. Severe anxiety would exhibit even more severe physical manifestations, while panic anxiety would involve extreme distress and potential loss of control.
Question 2 of 5
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 3 of 5
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 4 of 5
The nurse is caring for a 30-year-old white man whose wife has recently died. The patient has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important?
Correct Answer: D
Rationale: The correct answer is D because asking the patient if he is thinking about killing himself is crucial in assessing suicide risk, which is a primary concern in cases of clinical depression. This step allows the nurse to evaluate the patient's safety and take appropriate measures to prevent self-harm. Referring the patient for long-term psychotherapy (A) is important but not the most immediate concern in ensuring the patient's safety. Determining the patient's risk of psychosis (B) is not as relevant in this scenario as addressing the immediate risk of suicide. While understanding the patient's family history of depression (C) may provide context, it does not directly address the patient's current safety and well-being.
Question 5 of 5
Demanding proof from the client is to"challenging" as persistent questioning of the client and pushing for answers the client does not wish to discuss is to:
Correct Answer: D
Rationale: The correct answer is D: "Probing." Probing involves persistently questioning and pushing for answers from the client, similar to how demanding proof challenges the client. Probing seeks to uncover deeper insights or information, even if the client may not initially wish to discuss it. A: "Advising" is incorrect because advising involves offering guidance or recommendations to the client, which is different from persistent questioning. B: "Defending" is incorrect as it involves supporting or justifying the client's actions or positions, not pushing for more information. C: "Rejecting" is incorrect as it involves dismissing or refusing the client's input or requests, not actively seeking more information like probing does.