ATI RN
ATI RN Mental health 2019 NGN II Questions
Extract:
Question 1 of 5
A nurse is 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: B
Rationale: Informing the client of their right to refuse respects autonomy and legal principles.
Question 2 of 5
A nurse is teaching a newly licensed nurse about contributing factors that can lead to the development of conduct disorder. Which of the following factors related to family dynamics should the nurse include in the teaching?
Correct Answer: B
Rationale: Parental presence particularly a father's involvement influences emotional and behavioral development reducing conduct disorder risk.
Question 3 of 5
A nurse is receiving change-of-shift report for four clients. Which of the following clients should the nurse see first?
Correct Answer: C
Rationale: A client taking clozapine who reports a sore throat should be seen first. Clozapine is associated with a risk of agranulocytosis a severe condition that can lead to a dangerously low white blood cell count. A sore throat can be an early sign of infection and in the context of clozapine use it is crucial to assess and monitor for agranulocytosis promptly. This condition is life-threatening and requires immediate attention to prevent complications.
Question 4 of 5
A nurse is caring for a client who has schizophrenia and is taking clozapine. Which of the following findings is the priority for the nurse to report to the provider?
Correct Answer: D
Rationale: Sore throat is a priority finding for the nurse to report to the provider. Sore throat is a sign of infection,inflammation or irritation of the throat which can be caused by various factors such as viruses bacteria allergens or irritants. However,in a client who is taking clozapine sore throat can also indicate a serious and potentially fatal adverse effect of the medication: severe neutropenia. Neutropenia is a condition in which the number of neutrophils a type of white blood cell that fights infection is abnormally low. This increases the risk of developing serious and life-threatening infections especially in the mouth throat and respiratory tract. Clozapine can cause neutropenia in some patients especially during the first 18 weeks of treatment and it is the most common reason for discontinuing the medication.
Therefore any client who is taking clozapine and develops a sore throat should be evaluated by the provider as soon as possible to rule out neutropenia and initiate appropriate treatment if needed. The nurse should also educate the client on the importance of regular blood tests to monitor the absolute neutrophil count (AN
C) and the signs and symptoms of infection such as fever chills weakness or sore throat. The nurse should also instruct the client to avoid contact with people who are sick practice good hygiene and report any signs of infection immediately.
Question 5 of 5
A nurse is caring for a client who has Alzheimer's disease. Which of the following findings should the nurse expect?
Correct Answer: B
Rationale: Failure to recognize familiar objects is common in Alzheimer's due to cognitive decline.