ATI RN
ATI Real Life Mental Health Schizophrenia Questions
Question 1 of 9
After completing the mental status assessment of a 9-year-old boy, the nurse documents the findings. Which of the following would the nurse document as reflecting the child's motor activity? Select all that apply.
Correct Answer: C
Rationale: The correct answer is C: Hyperalertness. Motor activity refers to physical movements and energy levels. Hyperalertness indicates increased arousal and responsiveness, which can manifest as fidgeting, restlessness, or excessive movement. This is a direct indicator of the child's motor activity. A: Favorite story, Huckleberry Finn - This choice is related to cognitive function and interests, not motor activity. B: Short attention span - This choice is related to cognitive function and focus, not motor activity. D: Went to the park last weekend - This choice is related to past events and activities, not current motor activity.
Question 2 of 9
While assessing an older adult patient for mental health issues, the nurse pays special attention to the patient's sensory function based on the understanding of which of the following?
Correct Answer: B
Rationale: The correct answer is B because sensory decline in older adults can impact their ability to process information, potentially affecting the results of a mental status examination. This is crucial as sensory deficits can lead to misinterpretation of cues, affecting the assessment of mental health issues. Choices A, C, and D are incorrect as they do not directly address the impact of sensory function on mental health assessment. Choice A is incorrect as decline in functioning is not necessarily a uniform pattern in all older adults. Choice C is incorrect as it focuses on the impact of sensory function on medication reactions rather than mental health assessment. Choice D is incorrect as it discusses changes in cognitive abilities rather than the direct impact of sensory decline on mental status examination.
Question 3 of 9
A nurse asks a patient, "If you had fever and vomiting for 3 days, what would you do?" Which aspect of the mental status examination is the nurse assessing?
Correct Answer: B
Rationale: The correct answer is B: Cognition. The nurse is assessing the patient's thought process and decision-making abilities in response to a hypothetical scenario. By asking what the patient would do if experiencing fever and vomiting, the nurse is evaluating the patient's cognitive function. This question assesses the patient's ability to problem-solve, plan, and make decisions, which are key components of cognition. Summary: A: Behavior is incorrect as the question does not pertain to the patient's actions or reactions. C: Affect and mood are incorrect as the question does not focus on the patient's emotions. D: Perceptual disturbances are incorrect as the question does not relate to the patient's sensory perceptions.
Question 4 of 9
A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which psychosocial crisis is evident?
Correct Answer: D
Rationale: The correct answer is D: Autonomy versus shame and doubt. At 26 months, children are in the toddler stage where they are developing autonomy and independence. The child's negative behavior, refusal of toilet training, and constant use of "No!" suggest a struggle with asserting independence (autonomy) while also feeling the shame and doubt associated with not meeting expectations. This aligns with Erikson's psychosocial stage of Autonomy versus shame and doubt. A: Trust versus mistrust is resolved in infancy, where the child develops trust in caregivers. B: Initiative versus guilt occurs in early childhood when children explore their abilities and may feel guilty for overstepping boundaries. C: Industry versus inferiority is experienced in middle childhood, focusing on feelings of competence and accomplishment versus inadequacy. In summary, the child's behavior and resistance to toilet training indicate a conflict between asserting independence and feeling shame and doubt, which aligns with Autonomy versus shame and doubt.
Question 5 of 9
After completing the mental status assessment of a 9-year-old boy, the nurse documents the findings. Which of the following would the nurse document as reflecting the child's motor activity? Select all that apply.
Correct Answer: C
Rationale: The correct answer is C: Hyperalertness. Motor activity refers to physical movements and energy levels. Hyperalertness indicates increased arousal and responsiveness, which can manifest as fidgeting, restlessness, or excessive movement. This is a direct indicator of the child's motor activity. A: Favorite story, Huckleberry Finn - This choice is related to cognitive function and interests, not motor activity. B: Short attention span - This choice is related to cognitive function and focus, not motor activity. D: Went to the park last weekend - This choice is related to past events and activities, not current motor activity.
Question 6 of 9
The nurse is caring for a female adolescent client diagnosed with depression and substance abuse. Which of the following would be most appropriate for the nurse to do?
Correct Answer: B
Rationale: The correct answer is B because asking about thoughts of harming herself is essential to assess suicide risk in clients with depression and substance abuse. It is crucial for the nurse to ensure the client's safety. Choice A is incorrect because hyperactivity is not typically associated with depression and substance abuse in adolescents. Choice C is incorrect because Wernicke's syndrome is not directly related to the client's current diagnoses. Choice D is incorrect because excessive anxiety, while important, is not as immediately critical as assessing suicide risk in this situation.
Question 7 of 9
A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic?
Correct Answer: B
Rationale: Rationale: 1. Lorazepam is a fast-acting benzodiazepine used for acute anxiety relief. 2. It acts quickly to reduce anxiety symptoms. 3. Buspirone is not suitable for acute relief as it takes weeks to show effectiveness. 4. Amitriptyline and desipramine are tricyclic antidepressants, not fast-acting anxiolytics.
Question 8 of 9
In managing the milieu for clients experiencing disorientation and fear, what would the nurse consider a priority?
Correct Answer: D
Rationale: The correct answer is D: client safety. In managing disoriented and fearful clients, ensuring client safety is a priority. This includes preventing harm, falls, and injury. Safety measures help to create a secure environment for the client. Educating the client and family (A) is important but ensuring immediate safety takes precedence. Recreational activities (B) and social skills (C) are secondary to addressing the immediate safety needs of the client.
Question 9 of 9
A client on an inpatient psychiatric unit has pressured speech and flight of ideas and is extremely irritable. During an intake assessment, which is the most appropriate nursing response?
Correct Answer: C
Rationale: The correct answer is C because it focuses on exploring the reason for the client's hospitalization, which is essential in understanding their current mental state. This response acknowledges the client's feelings and concerns, leading to a therapeutic relationship. Choice A does not address the immediate needs of the client. Choice B is too broad and does not guide the client towards discussing the relevant issues. Choice D does not facilitate a deeper exploration of the client's condition and may encourage the client's pressured speech without addressing the underlying issues.