ATI RN
ATI Mental Health Exam 1 Questions
Extract:
Question 1 of 5
A novice nurse is beginning work on a behavioral health unit and states to the preceptor "What if I encounter a client that is sexually aggressive? Which is the appropriate response by the preceptor?
Correct Answer:
Rationale:
Correct Answer: A: Set firm limits and boundaries for the client.
Rationale:
1. Setting firm limits and boundaries is essential in managing sexually aggressive behavior to ensure safety.
2. Establishing clear boundaries communicates expectations and consequences to the client.
3. It empowers the nurse to maintain control and handle the situation professionally.
4. Reporting to the director (choice
B) should be done after setting immediate boundaries.
5. Walking away (choice
C) or ignoring the behavior (choice
D) can escalate the situation and compromise safety.
Question 2 of 5
A nurse is performing a mental status examination (MSE) on a client who has a new diagnosis of dementia. Which of the following components should the nurse include?
Correct Answer:
Rationale:
Correct Answer: F: A, B, E
Rationale:
1. Grooming: Assessing grooming habits helps evaluate the client's ability to perform activities of daily living, which can be affected in dementia.
2. Long-term memory: Testing long-term memory provides insight into the client's cognitive function, a key aspect of dementia evaluation.
3. Affect: Evaluating affect helps determine the client's emotional state and can indicate changes related to dementia progression.
Therefore, including grooming, long-term memory, and affect in the MSE is crucial for assessing self-care abilities, cognitive function, and emotional well-being in a client with dementia.
Summary of other choices:
- Support systems: While important for overall care, assessing support systems is not a direct component of the MSE for dementia evaluation.
- Presence of pain: While assessing pain is important, it is not typically included in a standard MSE for dementia diagnosis.
Question 3 of 5
The nurse observes the client experiencing a panic attack in the day room in the behavioral health unit. Which is the priority action by the nurse?
Correct Answer:
Rationale:
Correct Answer: C: Stay with the client and maintain a safe environment
Rationale:
1. Staying with the client: Provides immediate support, reassurance, and comfort during a panic attack.
2. Maintaining a safe environment: Ensures the client's physical safety and prevents any harm.
3. Priority: Addressing the client's immediate distress is crucial before any long-term interventions.
4. Safety: Panic attacks can be overwhelming, and having a supportive presence can help calm the client.
Summary:
A: Educating the client can wait until after the acute panic attack is managed.
B: Taking the client for a walk might not be safe during a panic attack.
D: Redirecting the client may not address the immediate distress and could escalate the situation.
Question 4 of 5
A nurse is assessing a client's circulatory system. Which of the following pulse sites should the nurse avoid assessing bilaterally at the same time?
Correct Answer:
Rationale:
Correct Answer: D: Carotid
Rationale: Assessing the carotid pulse bilaterally simultaneously can compress the carotid arteries, potentially reducing blood flow to the brain and causing harm. It is crucial to assess the carotid pulse one side at a time to prevent any adverse effects on cerebral circulation.
Summary:
A: Femoral - Can be assessed bilaterally.
B: Popliteal - Can be assessed bilaterally.
C: Brachial - Can be assessed bilaterally.
D: Carotid - Should not be assessed bilaterally due to the risk of reducing cerebral blood flow.
E: - Not applicable.
F: D - Incorrect.
G: - Not applicable.
Question 5 of 5
During the assessment the nurse asks the client to describe the client's problems. The purpose of this question is to obtain information about what?
Correct Answer:
Rationale:
Correct Answer: D: Perception of the problem
Rationale:
1. Asking clients to describe their problems helps the nurse understand their perception of the situation.
2. Perception influences how clients interpret and react to their issues.
3. Understanding their perception assists in tailoring care to meet their specific needs.
4. Personal needs (
Choice
A) may be part of the client's description but not the primary purpose.
5. Communication skills (
Choice
B) are important but not the main focus of this question.
6. Admitting diagnosis (
Choice
C) is a medical term and not related to the client's personal understanding.
7.
Choice F is a repetition of the correct answer.
Summary: The correct answer, Perception of the problem (
D), is crucial for individualized care, unlike the other choices that do not directly address the client's subjective understanding.