ATI LPN
ATI LPN Mental Health Level 4 test II Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has an anxiety disorder. Which of the following findings should the nurse recognize as a manifestation of mild anxiety?
Correct Answer: C
Rationale: Incoherent speech: This is a symptom of severe or panic-level anxiety, not mild anxiety. Chest pain: This is associated with more severe anxiety, particularly panic attacks. Irritability: Mild anxiety can cause irritability and heightened awareness of surroundings, which may manifest as restlessness or slight tension. Insomnia: While it can occur with anxiety, it is more commonly linked to moderate or severe levels.
Extract:
Nurse Notes
Client: Doug Smith
Patient presents with symptoms of anxiety escalated to a panic attack. Patient reports chest pain, tingling in fingers, and difficulty breathing, with a sense of impending doom. Patient appears anxious and distressed, with rapid shallow breathing. SPO2 levels initially low due to hyperventilation. Provided reassurance to the patient and explained that symptoms are related to a panic attack, not a heart attack.
Vital signs
• Temperature: 36.7°C (98.1°F)
• Heart rate: 110 bpm
• Respiratory rate: 28 breaths/min
• Blood pressure: 140/90 mmHg
• Oxygen saturation: 94% on room air (increased to 98% with 2L O2 via nasal cannula)
EKG
Normal sinus rhythm. Mild tachycardia noted.
Provider orders
02 @ 2L keep SPO2 > 92%
ABGS
CBC, BMP
UA with reflex
Psych evaluation and treat
0.5 mg IVP Ativan- One-time order give now
No Caffeine, limit processed foods and sugar/carbs in diet
Question 2 of 5
Doug has been seen in the ER for his anxiety that has escalated to a panic attack. He thought he was dying because his symptoms were very similar to a heart attack with tingling in his fingers, pain in his chest, and difficulty breathing. He was even starting to feel out of sorts due to his lack of oxygen related to his low SPO2 levels related to his hyperventilation. In class we discussed it being caused by respiratory alkalosis. In the left column there are items that will require follow up by either the nurse or Doug to maintain a successful plan of care upon discharge. If they are for the nurse she must educate Doug, if they are for Doug, he must comply with the plan...either way if they require follow up, place a check in the FOLLOW UP Column, if they don't place a check in the N/A Column. Each item will have one check in one of the columns.
| Options | Follow Up | N/A |
|---|---|---|
| Controlling son's success | ||
| Focus on the Positives | ||
| Better Relationship with Son | ||
| Techniques to Manage Stress | ||
| Energy Drinks | ||
| Conflict Resolution |
Correct Answer: B,C,D,E,F
Rationale: A (N/
A) Controlling son's success: This does not directly relate to Doug's health or anxiety management plan, so it falls under N/A. Focus on the positives: Encouraging positive thinking can improve Doug's coping skills, making it a follow-up item. Better relationship with son: Addressing family dynamics can improve Doug's overall mental health, requiring follow-up. Techniques to manage stress: Essential for managing anxiety and preventing future panic attacks, requiring follow-up. Energy drinks: Caffeine can exacerbate anxiety symptoms, making this a follow-up item. Conflict resolution: Managing interpersonal conflict is key to reducing stress, requiring follow-up.
Extract:
Question 3 of 5
Which questions below are appropriate to ask Patient Jane? Select all that apply.
Correct Answer: B,C,D
Rationale: Why don't you leave? This question can come across as judgmental and may make Jane feel defensive or unsupported. B. Is there a safe place to go if you need to? Asking about a safe place respects her autonomy and helps assess her safety plan. C. Do you have children, and are they safe? Ensures the welfare of potential dependents who may also be at risk. D. Are you concerned about your safety? Allows Jane to express concerns about her current situation without feeling pressured. E. You can get help; we can hide you! Offering to 'hide' someone could create unrealistic expectations and might compromise her safety. F. Who is hurting you? This is enough now! This confrontational approach may escalate Jane's fear and deter her from sharing information. G. Please stop the madness. This is dismissive and lacks empathy, making it highly inappropriate in a trauma-informed care approach.
Question 4 of 5
A nurse is caring for a client following reported physical abuse. The client is quiet and withdrawn. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: Invite a family member to be present for the nursing history: This may discourage the client from sharing truthful information if the family member is the perpetrator. Display disapproval toward the perpetrator: Displaying judgment can increase the client's distress and reduce their openness. Probe the client to offer a factual account of the abuse: Pressuring the client to share details can retraumatize them. Be direct and honest when communicating with the client. Direct, honest communication helps build trust, which is essential for abused clients who may feel vulnerable.
Question 5 of 5
A nurse is caring for a 9-year-old child in a pediatric clinic. The client's parent shares that they left an abusive partner a year ago and is in a safe place. Which of the following should the nurse identify as a sign the impact violence may have had on the child?
Correct Answer: C
Rationale: The child participates in school activities: Participation in activities may suggest resilience and a return to normalcy, rather than a sign of trauma. The child talks about best friends at school: Positive social interactions suggest healthy coping and adjustment. The child reports abdominal pain at night when going to bed. Psychosomatic symptoms such as abdominal pain are common in children who have experienced trauma or stress. These physical complaints often reflect unresolved emotional distress. The child is doing well in school: Academic success is not typically associated with trauma symptoms and may reflect stability.