ATI RN
ATI Mental Health Exam 3 Questions
Extract:
Question 1 of 5
A client who has bipolar disorder approaches the nurse and reveals fresh,self-inflicted,superficial cuts going up and down his right arm. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: The correct answer is B: Inspect the cuts for debris. The nurse should first assess the client's physical well-being to ensure there is no immediate danger or risk of infection. Inspecting the cuts for debris is crucial to prevent infection and assess the severity of the self-inflicted wounds. Documenting the size and location of the cuts (choice
A) can be done after ensuring the wounds are clean. Administering a tetanus antitoxin (choice
C) is not necessary unless there is evidence of contamination with soil or rust. Implementing the client's behavioral modification plan (choice
D) is important but not the priority when the client's physical health is at risk.
Question 2 of 5
A nurse at a walk-in mental health clinic is assessing a client experiencing severe anxiety. The nurse should recognize the client might exhibit which of the following manifestations?
Correct Answer: C
Rationale: The correct answer is C: Threatening behaviors. Severe anxiety can lead to aggressive or threatening behaviors as a result of feeling overwhelmed or unable to cope. This can be a manifestation of the fight-or-flight response triggered by intense anxiety. The other choices are incorrect because attention-seeking conduct (
A) is more commonly associated with personality disorders, mild fidgeting (
B) may indicate mild anxiety but not severe anxiety, and mild difficulty problem solving (
D) is a cognitive manifestation that is less likely to be prominent in cases of severe anxiety.
Question 3 of 5
A nurse in a mental health facility is planning care for a client who has obsessive-compulsive disorder (OCD) and is newly admitted to the unit. Which of the following actions should the nurse plan to take regarding the client's compulsive behaviors?
Correct Answer: D
Rationale: The correct answer is D: Plan the client's schedule to allow time for rituals. For clients with OCD, rituals provide a sense of control and comfort. Allowing time for these rituals in the schedule can help prevent distress and agitation. Isolating the client (
A) can worsen symptoms. Setting strict limits (
B) may increase anxiety. Confronting the client (
C) can be counterproductive as it may lead to defensiveness and resistance.
Therefore, planning the schedule to accommodate rituals (
D) is the most appropriate approach.
Question 4 of 5
A nurse in an acute care mental health facility is preparing to administer morning medication for a client who has been taking lithium for 2 weeks and has a current lithium level of 1.0 mEq/L. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct answer is A: Administer the morning dose of lithium. The nurse should administer the medication as prescribed because the client's current lithium level of 1.0 mEq/L is within the therapeutic range (0.6-1.2 mEq/L). Holding the medication (option
D) unnecessarily disrupts the treatment plan and can potentially lead to a relapse of the client's condition. Checking the medication record for refusals (option
B) is not necessary at this point since the current lithium level is within the therapeutic range. Gastric lavage (option
C) is not indicated as the lithium level is not extremely elevated. In summary, administering the morning dose of lithium is appropriate as the current level is therapeutic, ensuring continuity of care and adherence to the treatment plan.
Question 5 of 5
A nurse is preparing to administer levothyroxine 100 mcg PO daily. Available is levothyroxine 50 mcg tablets. How many tablets should the nurse administer daily? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 2
Rationale:
To administer 100 mcg of levothyroxine daily using 50 mcg tablets, the nurse should give 2 tablets. Each tablet is 50 mcg, so 2 tablets equal 100 mcg, meeting the prescribed dose. The nurse should round the answer to the nearest whole number, which is 2 in this case. Other choices like 1 tablet (50 mcg) would be insufficient to reach the required 100 mcg dose.
Choices above 2 tablets would exceed the prescribed dose, potentially leading to adverse effects. It's important to ensure the correct dosage is given to maintain the patient's thyroid hormone levels within the therapeutic range.