ATI RN
ATI RN Mental Health 2023 Exam 3 Questions
Extract:
Medical History
A 21-year-old client was brought to the emergency department by their college friend. The friend reports that the client has been in their room for a week and has not bathed or attended class for one week. Current medications include venlafaxine 150 mg daily. The client denies the use of over-the-counter and herbal medications but has thought about starting St. John’s Wort to help with symptoms.
Nurses’ Notes
0800: The client is dressed in wrinkled sweatpants, a stained t-shirt, and is sitting alone at breakfast. The client ate one bite of toast. The client makes no eye contact, stands up slowly, and asks to go back to the room to sleep.
0945: The client is out in the day room after sleeping for 1 hour. The client is walking with their head down. The client reports having no interest in classes or contacting friends and states, “I just feel so sad and hopeless right now.” The client lost their parents in a car accident at age 18 and fell into a deep depression. The client tried therapy and an antidepressant and found the interventions effective.
Question 1 of 5
A behavioral health unit nurse is caring for a newly admitted client.Exhibits:Complete the following sentence by using the lists of options: The client demonstrates risk for ___ due to ___.
Correct Answer: A,B
Rationale: The client’s sadness and hopelessness, linked to parental loss and isolation, indicate a risk exacerbated by feeling powerless over life events.
Extract:
Question 2 of 5
A nurse is planning care for a client who has borderline personality disorder. Which of the following interventions should the nurse plan to include to assist the client with impaired social interactions with others?
Correct Answer: D
Rationale: Assigning the same staff daily provides stability and trust, aiding social interaction for a client with borderline personality disorder. Avoiding maladaptive behaviors hinders therapy, exploring abandonment is relevant but indirect, and encouraging dependency is counterproductive.
Question 3 of 5
A nurse is assessing a client who has bipolar disorder. Which of the following findings should the nurse identify as an indication that the client is experiencing acute mania?
Correct Answer: D
Rationale: A lack of sleep is a hallmark of acute mania, where clients feel little need for rest, exacerbating other symptoms. Detailed scheduling, refusal to converse, and isolation align more with depression or other states, not mania’s high energy.
Question 4 of 5
A nurse is providing teaching about self-care behaviors to a client who has major depressive disorder. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: B
Rationale: Using past coping mechanisms indicates understanding of self-care by applying effective strategies to manage depression. Staying in bed, avoiding discussion, or relying on others contradict active self-care principles aimed at improving mood and independence.
Question 5 of 5
A nurse is caring for a client who is in physical restraints. Which of the following actions by the client indicates the restraints can be discontinued?
Correct Answer: B
Rationale: If the client demonstrates control over their actions, it suggests they are no longer at immediate risk of harm, allowing consideration for discontinuing restraints. This aligns with guidelines to use restraints only when necessary and remove them as soon as safe. An apology, a request for release, or a contract are positive but insufficient without evidence of sustained behavioral control.