The nurse is interviewing a client admitted to an inpatient psychiatric unit with a diagnosis of depressive disorder. Which is the primary goal in the assessment phase of the nursing process for this client?

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Mental Health ATI Proctored 2023 Questions

Question 1 of 5

The nurse is interviewing a client admitted to an inpatient psychiatric unit with a diagnosis of depressive disorder. Which is the primary goal in the assessment phase of the nursing process for this client?

Correct Answer: C

Rationale: Step 1: Assessment is the first phase of the nursing process. Step 2: Collecting and organizing information is crucial to understand the client's current situation. Step 3: By collecting data, the nurse can identify the client's needs and create an individualized care plan. Step 4: Building trust and rapport (Choice A) is important but is more focused on the therapeutic relationship, which is part of the implementation phase. Step 5: Identifying goals and outcomes (Choice B) is part of the planning phase. Step 6: Identifying and validating the medical diagnosis (Choice D) is the responsibility of the healthcare provider and is not the primary goal of the nursing assessment.

Question 2 of 5

After working with a patient who has a history of violent behavior to identify possible clues that suggest that his behavior is escalating, the nurse and patient develop a plan for prevention. Which strategy would they be least likely to include?

Correct Answer: C

Rationale: The correct answer is C: Turning up the music loud. This strategy would be least likely to be included because it does not directly address the escalation of violent behavior. Counting to 10 and taking slow deep breaths are both commonly used techniques to help manage anger and prevent escalation. Taking a voluntary time out is also effective in creating a safe space to de-escalate. Turning up the music loud may serve as a distraction, but it does not actively address the underlying issues or help the patient stay in control of their emotions.

Question 3 of 5

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?

Correct Answer: A

Rationale: Step-by-step rationale for why A (Dopamine) is the correct answer: 1. Dopamine hypothesis: Excess dopamine activity is linked to schizophrenia symptoms such as hallucinations and delusions. 2. Studies show antipsychotic drugs targeting dopamine receptors effectively alleviate these symptoms. 3. Dopamine dysregulation theory: Suggests abnormalities in dopamine transmission contribute to schizophrenia. 4. Serotonin, norepinephrine, and GABA are not directly implicated in hallucinations and delusions in schizophrenia.

Question 4 of 5

Which activity is most appropriate for a child with ADHD?

Correct Answer: D

Rationale: The correct answer is D: Tennis. Physical activities like tennis are beneficial for children with ADHD as they help release excess energy and improve focus. Tennis involves physical movement, coordination, and strategy, which can enhance concentration and self-regulation skills. Reading an adventure novel (A) may be too sedentary for a child with ADHD, limiting their ability to focus. Monopoly (B) and Checkers (C) are good for cognitive development but may not provide enough physical activity to help manage ADHD symptoms effectively. Tennis, on the other hand, offers a combination of physical exercise and mental engagement, making it the most appropriate choice for a child with ADHD.

Question 5 of 5

The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate?

Correct Answer: C

Rationale: The correct answer is C because delirium is characterized by a rapid onset of altered consciousness. Delirium is an acute condition that manifests quickly, unlike dementia which is more gradual. The sudden change in consciousness is a key factor in diagnosing delirium. Choice A is incorrect as talking normally is not a primary diagnostic criterion for delirium. Choice B is incorrect as gradual confusion over time is more indicative of dementia rather than delirium. Choice D is incorrect as exposure to an infectious agent is not a primary cause for delirium, although it could contribute in some cases.

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