ATI RN
ATI RN Custom NURS 120 Psychiatric Nursing FA23 Exam 2 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has been diagnosed with schizophrenia and appears confused and has distortions in their thinking and speech patterns. Which of the following is the priority nursing intervention for this client?
Correct Answer: C
Rationale: Providing reassurance and safety addresses immediate needs in confusion and distorted thinking. Group activities (
A), distraction (
B), and PRN medications (
D) are secondary.
Question 2 of 5
A nurse is planning care for a client who is in the manic phase of bipolar disorder. Which of the following interventions should the nurse include in the client's plan of care?
Correct Answer: A
Rationale: Having consistent unit routines provides stability and predictability, beneficial for mania. Stimulating environments (
B) can worsen symptoms, seclusion (
C) may cause isolation, and discouraging napping (
D) risks fatigue.
Question 3 of 5
A nurse is preparing to teach a client about his prescription of lithium for the treatment of bipolar disorder. Which of the following statements should the nurse include in the teaching?
Correct Answer: D
Rationale: Weekly blood tests during the first month monitor lithium levels to prevent toxicity. Stopping for diarrhea (
A), empty stomach (
B), and low-salt diet (
C) are incorrect.
Extract:
Medical History: Borderline personality disorder.
Alcohol use disorder.
History of suicidal ideation.
Medication Administration Record: Fluoxetine 20 mg PO daily.
Nurses' Notes: . 1500: Client admitted for evaluation and treatment following arrest for driving while under the influence of alcohol.
Client reports recent breakup of romantic relationship and subsequent job loss.
States, "I was too upset to go to work, and then they fired me. Like I needed that stress, too.”. 1700: Noted client has multiple cuts on arms and legs and there is a broken mirror with blood on it on the floor.
Client states, "I feel so alone.
Question 4 of 5
There is no one that cares about me.”. For each potential nursing action, click to specify if the potential action is anticipated, nonessential, or contraindicated for the client.
| anticipated | nonessential | contraindicated |
|---|---|---|
| Instruct the client to avoid foods with tyramine. | ||
| Apply wrist restraints. | ||
| Offer sympathy and attention to maladaptive behavior. | ||
| Encourage the client to talk about feelings prior to maladaptive behavior. | ||
| Maintain same staff members caring for the client. |
Correct Answer:
Rationale: Encouraging feelings (
D) and consistent staff (E) are anticipated. Tyramine avoidance (
A) is for MAOIs, restraints (
B) are a last resort, and sympathy to maladaptive behavior (
C) reinforces negativity.
Extract:
Question 5 of 5
A nurse is assessing a client who is receiving treatment with multiple antipsychotic medications and who suddenly became ill. Findings include blood pressure changes, hyperpyrexia, and diaphoresis. The nurse should recognize that which of the following adverse effects may be occurring?
Correct Answer: B
Rationale: Neuroleptic malignant syndrome causes hyperpyrexia, unstable blood pressure, and diaphoresis. Pseudoparkinsonism (
A), acute dystonia (
C), and tardive dyskinesia (
D) do not typically include these symptoms.