ATI RN
ATI Mental Health 2023 II Questions
Extract:
Question 1 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 2 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 3 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.
Question 4 of 5
A nurse is assessing a client who has been receiving electroconvulsive therapy. Which of the following findings indicates the treatment is effective?
Correct Answer: A
Rationale: The correct answer is A: Improvement in manifestations of depression. Electroconvulsive therapy (ECT) is primarily used to treat severe depression. Improvement in manifestations of depression, such as improved mood, energy levels, and interest in activities, indicates the treatment is effective. Reduced frequency of panic attacks (
B) and seizures (
C) are not typically treated with ECT. Decreased fear of heights (
D) is not a common indicator of ECT effectiveness.
Question 5 of 5
A nurse is caring for a client who has just received a terminal cancer diagnosis from his provider. Which of the following actions should the nurse take?
Correct Answer: B
Rationale: The correct answer is B: Allow the client unlimited time for the grieving process. This is because receiving a terminal cancer diagnosis is a traumatic event that requires emotional support and time to process. By allowing the client unlimited time for the grieving process, the nurse is providing emotional support and acknowledging the client's need to come to terms with the diagnosis. Changing the subject (
A) may invalidate the client's emotions. Discouraging the client from forming new relationships (
C) is not appropriate as social support is important during such difficult times. Offering advice about treatment choices (
D) may not be suitable at this stage as the focus should be on emotional support rather than treatment decisions.