ATI RN
ATI RN Mental Health 2023 with NGN Questions
Extract:
Nurses' Notes
2200:
According to the police officer's report, the client was found sleeping near railroad tracks. Refused to give name, and no identification found. Client states they were, "Just doing what they were told to do. Didn't know it would take so long for the train to come." Client appears disheveled with poor hygiene. Client does not follow simple commands, refuses to answer questions, and will not make eye contact.
2230:
Client refusing to follow prescribed treatment plan. States they believe someone is trying to poison them. Noted to occasionally be mumbling as if talking to unseen others.
Provider Prescriptions
2200:
Clozapine 200 mg PO twice per day
Risperidone 4 mg PO twice per day
Question 1 of 4
A nurse in a mental health facility is admitting a client who was brought in by the police department. Exhibits:Complete the diagram by selecting from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
Correct Answer: A, A,C, B,D
Rationale: Action to Take: A, A; Potential Condition: C; Parameter to Monitor: B, D.
Rationale: The client is likely experiencing schizophrenia based on brought in by the police, so actions to take include providing a safe environment (placing client in a room near the nurses' station) and administering antipsychotic medications to address the condition. Potential condition of seizures (
C) should be monitored closely. Parameters to monitor include behavior changes (
B) and medication efficacy (
D) to assess progress and ensure safety. Other choices are incorrect as they do not align with the client's likely condition or best practices in mental health care.
Extract:
Medical History
The client was diagnosed with obsessive-compulsive disorder 4 years ago.
Nurses’ Notes
Day 1 of admission at 1300:
The client is withdrawn, exhibits a flat affect, and makes limited eye contact with others. The client’s clothing is dirty and body odor is noted. The client reports sleeping 2 to 3 hours per night and losing 5.4 kg (12 lb) in the last month. The client also reports handwashing for several minutes multiple times per day. The client’s hands are noted to be red, but the skin is intact. The client is constantly folding and unfolding a small piece of paper during conversation. The client refuses to leave the room or eat lunch and declines the offer to watch a movie in the day room with peers. The client also declines the offer to take a shower at this time.
Day 3 of admission at 1835:
The client showered this morning without prompting. The client ate 75% of lunch and dinner in the day room with peers. The client’s hands remain reddened with a 1 cm x 1 cm area of peeling skin noted on the center of the right palm. The client’s affect rapidly changed throughout the afternoon and early evening; the client is now talkative and appears content. The client was overheard speaking to their sibling on the phone a few minutes ago, telling their sibling they could have the client’s car.
Provider Prescriptions
Day 1 of admission: Fluvoxamine 100 mg PO at bedtime Buspirone 10 mg PO twice daily Paroxetine 20 mg PO daily
Question 2 of 4
A nurse on an inpatient mental health unit is caring for a client.Exhibits:The nurse is discussing the assessment findings on day 3 of admission during the 1900 change of-shift report. For each finding, specify whether the finding indicates potential improvement in or worsening of the client’s condition.
| Options | Indicates potential improvement | Indicates potential worsening |
|---|---|---|
| Giving away car | ||
| Hygiene | ||
| Food intake | ||
| Condition of skin on right hand | ||
| Rapid change in mood |
Correct Answer:
Rationale:
Correct
Answer:
Rationale:
- Giving away car (1): Potential worsening, as it may indicate a lack of attachment or impulsivity.
- Hygiene (0): No indication provided regarding improvement or worsening based on hygiene.
- Food intake (1): Potential improvement if the client is eating well and maintaining nutrition.
- Condition of skin on right hand (1): Potential worsening if there are signs of self-harm or neglect.
- Rapid change in mood (0): Not listed in the provided options for assessment findings.
Summary:
- A, C, D are the correct answers as they provide indications of potential improvement or worsening in the client's condition.
- B and E are not relevant to the assessment findings provided in the question.
Extract:
Nurses’ Notes
The client was brought in by a family member who states that the client has been drinking nonstop since the death of the client’s parents 3 months ago. The client has a history of alcohol use disorder for over 20 years. The client attended an inpatient rehabilitation program 5 years ago and remained sober until several months ago when both parents died. According to the client’s family member, the client has been unable to cope with the sudden death of their parents. The client is currently unemployed after being laid off. The client’s family member states, “Everything combined caused the drinking to start again.”
Vital Signs
Admission, 1600:
Temperature: 36.1 °C (97° F)
Blood pressure: 98/66 mm Hg
Heart rate: 76/min
Respiratory rate: 10/min
Pulse oximetry: 95% on room air
Day 2, 0800:
Temperature: 37.3 °C (99.1° F)
Blood pressure: 198/86 mm Hg
Heart rate: 116/min
Respiratory rate: 22/min
Hospital day 5, 0800:
Temperature: 36.1 °C (97° F)
Blood pressure: 128/66 mm Hg
Heart rate: 74/min
Respiratory rate: 12/min
Pulse oximetry: 96% on room air
Diagnostic Results
Blood alcohol level (BAC): 310 mg/dL (normal range: 0 to 50 mg/dL)
History & Physical
Neurological: The client is intoxicated, has slurred speech, and is unable to coherently respond to questions.
Cardiovascular: Normal sinus rhythm and pulses are palpable. No history of heart disease.
Respiratory: Chest clear to auscultation and no shortness of breath noted. No history of respiratory disorders, and the client states they quit smoking over 20 years ago.
Gastrointestinal: The client reports weight loss over the past 3 months and minimal appetite.
Genitourinary: The client reports no known problems.
Impression: Relapse of alcohol use disorder.
Plan: Admit for alcohol use disorder and observe for alcohol withdrawal.
Provider Prescriptions
Perform Alcohol Use Disorders Identification Test (AUDIT).
Complete blood count.
Basic metabolic profile.
Nutrition consultation.
Consult counselor for grief therapy.
Substance use group therapy.
Diazepam 10 mg PO three times a day.
Propranolol 40 mg PO twice a day.
Metoclopramide 10 mg IM every 6 hr PRN nausea and/or vomiting.
Question 3 of 4
A nurse is reviewing the day 5 vital signs.Exhibits:A nurse is evaluating the client’s response to treatment. Select the 4 findings that indicate the client is progressing with their plan of care.
Correct Answer: A, B, D, E
Rationale:
Correct
Answer: A, B, D, E
Rationale:
A: Vital signs - Monitoring vital signs helps assess the client's physiological response to treatment. Stable vital signs indicate progress.
B: Movement through stages of grief - Progression through grief stages signifies emotional healing and adaptation to treatment.
D: Participation in group therapy - Active participation in therapy shows engagement and willingness to work on recovery.
E: Appetite - Improved appetite suggests physical improvement and response to treatment.
Incorrect
Choices:
C: Cognition - Although important, cognition alone may not always directly indicate progress in response to treatment.
F: The client resolves to limit alcohol consumption - While important for health, this choice does not directly reflect progress in response to treatment.
Extract:
2045
• X-ray of left wrist
• Hydrocodone 2.5 mg/acetaminophen 325 mg, 2 tablets PO now
2345:
• Discharge to home.
• Follow-up with orthopedist, their office will call tomorrow.
• Keep left arm elevated with splint on.
• Ice left wrist per written instructions provided.
• Ibuprofen 800 mg PO every 8 hr PRN pain
Medical History
• Premenstrual dysphoric disorder
• No known allergies
Physical Examination 2030
• Left wrist injury and edema
• Finger-shaped bruises on the left forearm
• Reports pain with movement of left wrist and hand as 8 on a 0 to 10 pain scale, and pain as 6 at rest. Grimacing and tearfulness noted with movement. Fingers warm with capillary refill less than 2 seconds.
2145:
• Reports left wrist pain as 6 with movement and as 4 at rest on a 0 to 10 pain scale.
Nurses’ Notes 2030
• Client presents for evaluation of left wrist injury reportedly following an incident of partner violence. The client states their partner had been drinking heavily prior to the physical altercation. The client reports the partner roughly grabbed their left arm while yelling loudly in their face. The client was able to free their arm and was walking to their car to leave when the partner aggressively pushed the client from behind. The client fell forward, using both arms to brace their fall. The client states the partner saw their wrist injury and began crying and apologizing, promising to never drink again. The client states, “I’ve heard that promise so many times, but they’ve never cried before, so I think it is sincere this time.”
• Left arm elevated on 2 pillows. Ice pack applied to left wrist.
2045:
• Provider in to see client. Prescriptions received.
2145:
• Client returned to room from radiology department via wheelchair. Left arm elevated and ice pack reapplied. A law enforcement officer in to talk with client after receiving a 911 call from the client’s neighbor who witnessed the physical altercation.
2330:
• Client declines to press charges against partner, per report of law enforcement officer. The client agreed to a social services referral, appointment scheduled for tomorrow. Discussed safety plan with client and the client reports having an envelope of important papers already hidden at home. Also provided the client with the phone numbers for the local crisis hotline and safe house. The client is receptive to information but states, “I need to work on my relationship a while longer. I really think things will get better this time.”
Question 4 of 4
A nurse in an emergency department is caring for a client who recently experienced partner violence.Exhibits:The nurse is reviewing the client’s medical record at discharge. For each finding, specify whether the finding indicates a potential improvement in or a worsening of the client’s physical or psychological status.
| Options | Indicates potential improvement | Indicates potential worsening |
|---|---|---|
| Client states that the partner will not be violent in the future. | ||
| Client agrees to an appointment with a social worker. | ||
| Client's reported pain level of the left wrist. | ||
| Client requests help developing a safety plan. | ||
| Client claims responsibility for the physical altercation. |
Correct Answer:
Rationale: [1, 0, 0]
Correct
Answer: A: Client states that the partner will not be violent in the future.
Rationale: This indicates a potential improvement in the client's physical and psychological status as it suggests a commitment to a non-violent future.
Summary: B: Client agrees to an appointment with a social worker - While beneficial, it does not directly address future violence. C: Client's reported pain level of the left wrist - Focuses only on physical aspect. D: Client requests help developing a safety plan - Indicates awareness of potential danger but not future behavior. E: Client claims responsibility for the physical altercation - May not indicate a change in future violence.
Extract:
Medical History
The client is 19 years old, has severe anxiety, and was admitted to an inpatient mental health facility for observation and behavioral therapy two weeks ago. The client’s weight at the time of admission was 54.4 kg (120 lb). The client reported sleeping 3 to 4 hours per night due to recurrent nightmares, as well as a decrease in appetite. The client’s family member stated that the client had separated themselves from friends, refused to leave their house, and picked their skin until it bled. The client’s family member also mentioned that there is a family history of anxiety. The client reported previous participation in cognitive-behavioral therapy.
Nurses’ Notes
Nurses’ Notes The client appears to be well-groomed. The client’s current weight is 54 kg (119 lb). The client states they are sleeping 5 to 6 hours per night but are having occasional nightmares. The client verbalizes a decreased appetite and gastrointestinal discomfort. The client states, “I feel anxious about leaving my house. I feel like everyone is staring at me and judging me.” The client verbalizes that bullying experienced during high school has led to anxiety. The client engages in thought-stopping behavioral therapy and cognitive restructuring. The client reports taking escitalopram 20 mg daily, 2 hours after breakfast.
Medication Administration Record
• Escitalopram 20 mg once daily
Question 5 of 4
A nurse working in an outpatient mental health facility is caring for a client who has anxiety and was discharged from an inpatient mental health facility one week ago.Exhibits: A nurse in an outpatient mental health facility is assessing a client who has anxiety. Click to highlight the findings in the Nurses’ Notes that indicate an improvement in the client’s condition. To deselect, click on the finding again
Correct Answer: A, B, E, F
Rationale: The correct answers are A, B, E, F. A well-groomed appearance indicates self-care and improved mental state. Sleeping 5-6 hours with occasional nightmares suggests improved sleep patterns. Engaging in thought-stopping behavioral therapy and cognitive restructuring shows active participation in treatment. Reporting medication compliance with escitalopram indicates following the prescribed treatment plan.
Choices C and D indicate ongoing symptoms and concerns, while choice G focuses on past triggers rather than current improvement.