ATI RN
ATI RN Mental health 2019 NGN II Questions
Extract:
Question 1 of 5
A nurse is assessing a client who has delirium. Which of the following findings requires immediate intervention by the nurse?
Correct Answer: A
Rationale: Command hallucinations which may instruct harmful actions require immediate intervention to ensure client safety.
Question 2 of 5
A nurse is educating a patient with an eating disorder about the treatment options. Which statement made by the patient indicates a need for further teaching?
Correct Answer: C
Rationale: Relapse prevention is critical for sustained recovery indicating a misunderstanding needing correction.
Question 3 of 5
A nurse is leading a critical incident stress debriefing with a group of staff members following a mass trauma incident. Which of the following interventions should the nurse take first?
Correct Answer: B
Rationale: Ensuring confidentiality creates a safe environment encouraging open participation in the debriefing.
Question 4 of 5
A nurse is assessing a client who has a history of substance use disorder and states,"People are out to get me. The client has tachycardia and hypertension. The nurse should suspect acute toxicity of which of the following substances?
Correct Answer: D
Rationale: Cocaine toxicity is the most likely cause of the client's symptoms. Cocaine can lead to paranoia tachycardia and hypertension. The combination of these symptoms suggests acute cocaine toxicity making it the priority concern for the nurse. Prompt intervention is necessary to address the potential life-threatening effects of cocaine toxicity.
Question 5 of 5
A nurse is caring for a client who was involuntarily committed and is scheduled to receive electroconvulsive therapy (ECT). The client refuses the treatment and will not discuss why with the health care team. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: Documenting refusal respects autonomy and informs the care team maintaining ethical standards.