ATI RN
ATI Capstone Mental Health Questions
Question 1 of 5
The nurse is preparing to assess a 78-year-old patient who has been diagnosed with major depression. Which of the following would the nurse expect to assess as a normal finding?
Correct Answer: C
Rationale: The correct answer is C: Dulled taste sensation. Major depression can affect taste perception causing dulled taste sensation. This is a normal finding in older adults with depression due to changes in neurotransmitters. A: Decrease in body fat and B: Increased muscle mass are not typical findings in major depression, as it can lead to changes in appetite and weight loss. D: Enhanced visual acuity is not a normal finding in major depression; it is more likely a symptom of another condition or unrelated to the depressive disorder.
Question 2 of 5
A client comes to the emergency department complaining of a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and his pulse is racing. The client states that he is being treated for depression with selegiline. Which question by the nurse would be most important to ask at this time?
Correct Answer: B
Rationale: The correct answer is B: "What have you had to eat or drink today?" This question is important because the client is taking selegiline, a monoamine oxidase inhibitor (MAOI), which has dietary restrictions. Foods high in tyramine can lead to a hypertensive crisis when combined with MAOIs. The client's symptoms of severe headache, flushing, and diaphoresis are indicative of a potential hypertensive crisis. By asking about the client's recent dietary intake, the nurse can assess for potential tyramine-containing foods that may have triggered the symptoms. Choice A: "When did you last have blood drawn to check your drug level?" is not as important at this time because the client's symptoms suggest an acute issue that requires immediate intervention, rather than monitoring drug levels. Choice C: "Are you having any chest pain?" is important for assessing cardiac involvement but is not the most crucial question in this scenario. Choice D: "Do you use any herbal remedies
Question 3 of 5
A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step two when he states which of the following?
Correct Answer: B
Rationale: Step-by-step rationale: 1. Step 2 in AA involves believing in a higher power's ability to help overcome alcoholism. 2. The client stating "I realize that there is a higher power that can help me" aligns with step 2. 3. This step acknowledges the need for external support beyond oneself in the recovery process. 4. Choice A refers to step 9, making amends. Choice C refers to step 1, admitting powerlessness. Choice D refers to step 8, making amends.
Question 4 of 5
To establish rapport with a 10-year-old child who is hospitalized in a psychiatric setting, which statement by the nurse would be most appropriate?
Correct Answer: D
Rationale: The correct answer is D: "Would you like to play a game of checkers with me?" This choice is most appropriate as it focuses on building a therapeutic relationship through a non-threatening and engaging activity. Playing a game of checkers can help establish rapport, foster trust, and create a sense of normalcy for the child in a psychiatric setting. It allows for social interaction, provides a distraction, and can help the child feel more comfortable and open up to the nurse. Explanation of why the other choices are incorrect: A: Comparing the child's situation to Cinderella's in a fairy tale may not be relatable or relevant to the child's experiences, potentially minimizing their feelings and concerns. B: Using a tool to measure self-control and initiative may come off as clinical and impersonal, possibly making the child feel like they are being evaluated rather than supported. C: Asking the child to draw a picture of themselves may be intimidating or invasive, as it delves into personal expression without
Question 5 of 5
A nurse has formulated several nursing diagnoses for a homeless client after a thorough nursing assessment. Of these, which of the following would the nurse determine as the priority?
Correct Answer: C
Rationale: The correct answer is C: Imbalanced nutrition. This is the priority because it addresses the client's physiological needs, which are essential for survival and overall well-being. The nurse should prioritize addressing basic needs such as nutrition before addressing psychological or social needs. Anxiety (A), powerlessness (B), and impaired social interaction (D) are important but secondary to addressing the client's immediate physiological needs. It is important to address the most critical issue first to ensure the client's health and safety.