ATI RN
ATI RN Mental Health 2023 with NGN Questions
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 1 of 5
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 2 of 5
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.
Extract:
Question 3 of 5
A nurse is creating a plan of care for a client who has schizophrenia and is experiencing command hallucinations. Which of the following interventions should the nurse include in the plan?
Correct Answer: D
Rationale: The correct answer is D: Maintain a low level of environmental stimuli. Command hallucinations are auditory hallucinations that instruct the individual to perform certain actions. By reducing environmental stimuli, the nurse can help minimize triggers that may exacerbate the hallucinations. This intervention aims to create a calming and safe environment for the client, reducing the likelihood of responding to the hallucinations. Providing reassurance through touch (choice
A) may not address the underlying issue of hallucinations and could potentially be triggering. Encouraging increased socialization (choice
B) may overwhelm the client and increase stress. Avoiding eye contact (choice
C) may create a barrier in communication and trust-building. Overall, maintaining a low level of environmental stimuli is the most appropriate intervention to support the client in managing command hallucinations.
Question 4 of 5
A nurse is caring for a client who has obsessive-compulsive personality disorder (OCPD). Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Preoccupation with details. Individuals with obsessive-compulsive personality disorder (OCP
D) often display an intense focus on perfectionism and rigid adherence to rules and details. This preoccupation can manifest in various aspects of their lives, such as work, relationships, and daily routines. This behavior is a key characteristic of OCPD and distinguishes it from other personality disorders.
Incorrect answers:
A: Lack of empathy - While individuals with OCPD may struggle with expressing emotions, the primary feature is not a lack of empathy.
C: Exploitative behavior - Exploitative behavior is not a typical feature of OCPD; it is more commonly associated with antisocial personality disorder.
D: Excessive clinging - Excessive clinging is not a characteristic of OCPD; it may be more indicative of dependent personality disorder.
Question 5 of 5
A nurse is caring for a client who has obsessive-compulsive personality disorder (OCPD). Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: The correct answer is B: Preoccupation with details. Individuals with obsessive-compulsive personality disorder (OCP
D) are characterized by a rigid adherence to rules, orderliness, and perfectionism, leading to a preoccupation with details. This is a key feature of OCPD as these individuals tend to focus excessively on minute details, leading to difficulty in completing tasks efficiently. Lack of empathy (
A), exploitative behavior (
C), and excessive clinging (
D) are not typical findings in OCPD. Lack of empathy is more characteristic of antisocial personality disorder, exploitative behavior is more characteristic of narcissistic personality disorder, and excessive clinging is not a common feature of OCPD.