ATI RN
ATI Mental Health 2023 II Questions
Extract:
Question 1 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: The correct answer is D: Reports a lack of sleep. In acute mania, individuals typically experience decreased need for sleep or insomnia. This symptom is crucial in diagnosing acute mania as it is a hallmark feature of the manic phase in bipolar disorder. It is important for the nurse to recognize this sign as it can lead to further exacerbation of manic symptoms and potential harm to the client.
A: Isolating oneself from others is a symptom of depression, not acute mania.
B: Writing a detailed daily activity schedule is a positive coping mechanism and does not necessarily indicate acute mania.
C: Refusing to engage in conversation could be a sign of social withdrawal, but it is not specific to acute mania.
In summary, reporting a lack of sleep is the key indicator of acute mania, while the other choices are more indicative of different mental health states or coping strategies.
Question 2 of 5
A nurseorius caring for a client who has an anxiety disorder and is scheduled for a procedure. The client informs the nurse that they do not want to have the procedure. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The correct answer is D: Inform the client that they have the legal right to refuse treatment at any time. This is the correct action because clients have the autonomy to make decisions about their own healthcare, including the right to refuse treatment. By informing the client of this right, the nurse respects the client's autonomy and ensures they are fully informed. Obtaining consent from a family member (
A) is not appropriate as the client is capable of making their own decisions. Requesting another nurse to review the procedure with the client (
B) may not address the client's concerns about the procedure. Encouraging the client to have the procedure (
C) goes against the client's autonomy and choice.
Question 3 of 5
A nurse is caring for a client who has a new diagnosis of metastatic lung cancer. The client states, 'I can’t think about that until after my first grandchild is born next week.' The nurse should identify the client’s statement as indicating the maladaptive use of which of the following defense mechanisms?
Correct Answer: C
Rationale: The correct answer is C: Suppression. The client is using suppression, a maladaptive defense mechanism, to temporarily avoid dealing with the distressing news of their cancer diagnosis by focusing on their upcoming grandchild's birth. Suppression involves consciously pushing unwanted thoughts or feelings out of awareness. It differs from sublimation (
A), which involves channeling unacceptable impulses into socially acceptable activities, compensation (
B), which involves making up for perceived weaknesses by emphasizing strengths, and regression (
D), which involves reverting to an earlier stage of development under stress. In this scenario, the client's statement does not align with these defense mechanisms, making suppression the most appropriate choice.
Question 4 of 5
A nurse is caring for an adult client who has been placed in physical restraints due to aggressive behavior. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: The correct action for the nurse is to assess the client's need for toileting every 15 minutes. This is important because physical restraints can lead to decreased mobility and can increase the risk of urinary retention or constipation. Regular assessment for toileting needs can prevent discomfort, skin breakdown, and potential complications. Asking the provider to renew the prescription every 8 hours (
Choice
B) is not the immediate responsibility of the nurse. Having a staff member check on the client every 30 minutes (
Choice
C) is not as crucial as assessing toileting needs. Offering hydration and nutrition every 2 hours (
Choice
D) is important but not as immediate as ensuring toileting needs are met.
Question 5 of 5
A nurse in a mental health facility is caring for a group of clients. After assessing the clients, which of the following clients requires an update to their plan of care to ensure client safety?
Correct Answer: D
Rationale: The correct answer is D because a client with bipolar disorder exhibiting poor impulse control poses a significant safety risk to themselves and others. Updating the plan of care to address this behavior is crucial to prevent harm. Clients with anorexia nervosa (
A) expressing fear of gaining weight may require support but do not necessarily pose a direct safety risk. Schizophrenic clients exhibiting clang associations (
B) may need intervention for communication but not necessarily for immediate safety. Clients with Alzheimer's (
C) experiencing memory difficulties may need additional support, but it does not directly impact safety like poor impulse control.