ATI LPN
ATI LPN Mental Health Level 4 Exam Questions
Extract:
Question 1 of 5
A nurse is caring for a client who has delusional behavior. The client states, 'I can’t go to group today. I am expecting a high level official to visit me!' Which of the following responses should the nurse make?
Correct Answer: A
Rationale: The correct answer, indicated as A.
Rationale: Acknowledge the client’s delusion while gently redirecting them to the necessary activity (group therapy). This approach maintains engagement without directly confronting the delusion. Ignoring the delusion and focusing only on group therapy may cause the client to feel unheard or dismissed. Dismissing the delusion is not therapeutic and could undermine trust. Asking 'why' could challenge the delusion, leading to defensiveness rather than productive conversation.
Question 2 of 5
A nurse is caring for a client who has major depressive disorder and has experienced a recent loss. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: The correct answer, indicated as B.
Rationale: While crying may be a normal expression of grief, determining the client’s stage of grief is more important for assessing the client’s emotional needs. Determining the client’s stage of grief is the first step to understanding the client’s emotional state and providing appropriate support. Encouraging expression is important, but first, understanding the client’s grief stage will guide the intervention. Spiritual support is valuable, but first, understanding the client’s emotional response is necessary before offering this type of assistance.
Question 3 of 5
A nurse assisting in the care of a client who has a mood disorder. Which of the following client statements by the client indicates readiness for discharge?
Correct Answer: C
Rationale: The correct answer, indicated as C.
Rationale: This statement suggests dependency and a lack of readiness to take responsibility for self-care. While family support is important, the client should be able to demonstrate some level of independence for discharge readiness. Taking medications as prescribed and knowing who to contact in case of suicidal thoughts shows insight and preparedness for discharge. This statement reflects avoidance and a lack of motivation, indicating that the client is not yet ready for discharge.
Question 4 of 5
A nurse is reinforcing teaching with the spouse of a client about how to take a blood pressure. Which of the following actions by the spouse indicates a need for further instruction?
Correct Answer: C
Rationale: The correct answer, indicated as C.
Rationale: Wrapping the blood pressure cuff snugly around the arm is correct, as the cuff needs to be secure to ensure an accurate reading. Centering the cuff bladder over the brachial artery is correct, as this is necessary for accurate blood pressure measurement. Placing the client's arm above the level of the heart is incorrect. The arm should be at heart level to ensure the accuracy of the reading. If the arm is elevated, it could result in a falsely low reading. Checking the instrument gauge to ensure the reading starts at zero is correct. This step is important to ensure the accuracy of the measurement.
Question 5 of 5
A nurse in a community clinic is speaking to a parent who expresses concern for her adolescent son. Which of the following statements by the mother should indicate to the nurse that the adolescent is at risk for suicide?
Correct Answer: D
Rationale: The correct answer, indicated as D.
Rationale: Spending time with friends is generally a healthy social behavior. Being religious and attending services does not indicate suicidal risk. Sleeping 9 hours per night is within a normal range for an adolescent. The statement about the basketball coach committing suicide may indicate the adolescent is at risk for suicide, as exposure to suicide can increase the likelihood of suicidal behavior.