ATI LPN
ATI LPN Mental Health Exam IV Questions
Extract:
Question 1 of 5
A nurse is assisting with teaching a class about documenting blood pressure. The nurse should include documenting which of the following information?
Correct Answer: A
Rationale: [Note: Document error lists A but explains hepatomegaly for right-sided failure, unrelated to BP. Assuming intent was Q32 as BP doc.] Frequency (
A) tracks trends, vital for BP management. Interventions (
B), response (
C), person (
D), and site (E) are key but secondary. A aligns with teaching focus on monitoring.
Question 2 of 5
A nurse recognizes unexplained fussiness and irritability in an infant, as well as unexplained injuries. The nurse should suspect which of the following?
Correct Answer: D
Rationale: Sexual abuse: While sexual abuse can cause physical and emotional symptoms, the combination of unexplained injuries and fussiness/irritability is more suggestive of physical trauma. Neglect: Neglect involves failure to provide for the child's basic needs, which can lead to developmental issues, but is less likely to cause unexplained injuries. Munchausen syndrome by proxy: Munchausen syndrome by proxy involves a caregiver fabricating or inducing illness in a child for attention. It can cause unexplained injuries, but the focus is more on medical symptoms. Shaken baby syndrome: Shaken baby syndrome results from violently shaking an infant, leading to physical injuries, irritability, and fussiness. It fits the description of unexplained injuries and behavioral changes.
Question 3 of 5
A nurse is making a home visit for a 16-year-old adolescent who attempted suicide. Which of the following behaviors should alert the nurse that the adolescent still has suicidal intent?
Correct Answer: A
Rationale: Planning to give his CD collection to his girlfriend: Giving away prized possessions is a common warning sign of suicidal intent, indicating that the person is preparing for their absence. Preferring to eat his meals while watching TV: This behavior is relatively normal and does not necessarily indicate suicidal intent. Stating that he wants to be with his peers more than with his parents: Wanting to spend time with peers is typical for adolescents and does not specifically indicate suicidal intent. Telling his parents that he doesn't want to talk about the attempt: Not wanting to discuss the attempt could be due to embarrassment, guilt, or other reasons, but it is not as direct an indicator of ongoing suicidal intent as giving away possessions.
Question 4 of 5
A nurse is collecting data on a client who has bradycardia. Which of the following findings should the nurse expect?
Correct Answer: C
Rationale: Bradycardia (<60 BPM) reduces cardiac output, impairing cerebral perfusion and causing lightheadedness. Volume deficit may cause tachycardia, not bradycardia. Anxiety typically increases heart rate. Fever raises heart rate to meet metabolic demand, not lowers it. Lightheadedness reflects inadequate brain oxygenation.
Question 5 of 5
A nurse is collecting data from a client who has atrial fibrillation. When documenting the quality of the client’s pulse, which of the following terms should the nurse use?
Correct Answer: A
Rationale: Atrial fibrillation causes an irregular pulse due to chaotic atrial impulses, disrupting ventricular rhythm. Not palpable (
B) implies no pulse, bounding (
C) suggests strength, and regular (
D) contradicts AF’s irregularity. “Irregular” accurately describes AF’s pulse quality.