ATI RN
ATI RN Mental Health 2023 Exam 3 Questions
Extract:
Medical History and Physical Examination
Neurological: The client is intoxicated, has slurred speech, and is unable to respond coherently to questions.
Cardiovascular: Normal sinus rhythm and pulses palpable. No history of heart disease.
Respiratory: Chest clear to auscultation and no shortness of breath noted. No history of respiratory disorders and the client states they quit smoking over 20 years ago.
Gastrointestinal: The client reports weight loss over the past 3 months and minimal appetite.
Genitourinary: The client reports no known problems.
Impression:
Relapse of alcohol use disorder.
Plan:
Admit for alcohol use disorder and observe for alcohol withdrawal.
Vital Signs
Admission, 1600:
Temperature: 36.1°C (97°F)
Blood pressure: 98/66 mm Hg
Heart rate: 76/min
Respiratory rate: 10/min
Pulse oximetry: 95% on room air
Day 2, 0800:
Temperature: 37.3°C (99.1°F)
Blood pressure: 198/86 mm Hg
Heart rate: 116/min
Respiratory rate: 22/min
Nurse’s Notes
The client was brought in by a family member who states that the client has been drinking ‘nonstop’ since the death of the client’s parents 3 months ago. The client has a history of alcohol use disorder for over 20 years. The client attended an inpatient rehabilitation program 5 years ago and remained sober until several months ago when both parents died. According to the client’s family member, the client has been unable to cope with the sudden death of their parents. The client is currently unemployed after being laid off. The client’s family member states, “Everything combined caused the drinking to start again.” The family member estimates the client’s last drink was 2 hours ago. On Day 2 at 0800, the client is in the bathroom vomiting. The nurse assisted the client with oral and facial hygiene. The client states, “I feel awful.” The client is oriented, lethargic, and weak with visible hand shaking. The client reports they were up most of the night.
Diagnostic Results
Blood alcohol level (BAC): 310 mg/dL (0 to 50 mg/dL)
Question 1 of 5
A nurse is caring for a client who is experiencing alcohol withdrawal.Exhibits A nurse is planning care for a client who has alcohol use disorder. For each potential provider's prescription, specify if the potential prescription is anticipated or contraindicated for the client.
Correct Answer:
Rationale:
Correct Answer:
Rationale:
- Methadone is contraindicated as it may worsen the client's condition due to its potential for respiratory depression.
- Nutritional consult is anticipated to address potential malnutrition and vitamin deficiencies common in alcohol use disorder.
- Performing AUDIT is contraindicated as it may not be appropriate during acute alcohol withdrawal.
- Complete blood count and basic metabolic profile are anticipated to assess for any alcohol-related complications.
- Group therapy is anticipated to provide social support and coping skills.
- Schedule ECT is contraindicated as it is not indicated for alcohol withdrawal.
- Diazepam is anticipated to manage alcohol withdrawal symptoms.
Extract:
History & Physical
Neurological: Client is intoxicated, has slurred speech, and is unable to coherently respond to questions.
Cardiovascular: Normal sinus rhythm and pulses palpable. No history of heart disease.
Respiratory: Chest clear to auscultation and no shortness of breath noted. No history of respiratory disorders and client states they quit smoking over 20 years ago.
Gastrointestinal: Client reports weight loss over the past 3 months and minimal appetite.
Genitourinary: Client reports no known problems.
Impression:
Relapse of alcohol use disorder.
Plan:
Admit for alcohol use disorder and observe for alcohol withdrawal.
Diagnostic Results
Blood alcohol level (BAC) 310 mg/dL (0 to 50 mg/dL)
Provider Prescriptions
Perform Alcohol Use Disorders Identification Test (AUDIT)
Complete blood count
Basic metabolic profile
Nutrition consultation
Consult counselor for grief therapy
Substance use group therapy
Diazepam 10 mg PO three times a day
Propranolol 40 mg PO twice a day
Metoclopramide 10 mg IM every 6 hr PRN nausea and/or vomiting
Nurses’ Notes
Client brought in by a family member who states that the client has been drinking ‘nonstop since the death of the client’s parents 3 months ago.’
Client has a history of alcohol use disorder for over 20 years.
Client attended an inpatient rehabilitation program 5 years ago and remained sober until several months ago when both parents died.
According to the client’s family member, the client has been unable to cope with the sudden death of their parents.
Client is currently unemployed after being laid off.
Client’s family member states, 'Everything combined caused the drinking to start again.’
Family members estimate the client’s last drink was 2 hours ago.
Vital Signs
Admission, 1600:
•
o Temperature: 36.1°C (97°F)
o Blood pressure: 98/66 mm Hg
o Heart rate: 76/min
o Respiratory rate: 10/min
o Pulse oximetry: 95% on room air
Day 2, 0800:
•
o Temperature: 37.3°C (99.1°F)
o Blood pressure: 198/86 mm Hg
o Heart rate: 116/min
o Respiratory rate: 22/min
Hospital day 5, 0800:
•
o Temperature: 36.1°C (97°F)
o Blood pressure: 128/66 mm Hg
o Heart rate: 74/min
o Respiratory rate: 12/min
o Pulse oximetry: 96% on room air
Question 2 of 5
A nurse is reviewing the day 5 vital signs and nurse’s notes.A nurse is evaluating the client’s response to treatment. Select the 4 findings that indicate the client is progressing with their plan of care.
Correct Answer: B,C,D,E
Rationale: The correct answer is B, C, D, E. Participation in group therapy (
B) indicates engagement in treatment. Stable appetite (
C) shows physical improvement. Maintained cognition (
D) signifies mental progress. Consistent vital signs (E) reflect physiological stability.
Choice A lacks specificity and doesn't measure treatment progress.
Choice F is not directly related to the client's plan of care.
Extract:
Question 3 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: C
Rationale: The correct answer is C: Improvement in manifestations of depression. Electroconvulsive therapy is primarily used to treat severe depression.
Therefore, improvement in depressive symptoms indicates the treatment's effectiveness. Reduced frequency of seizures (
A) is not relevant to ECT. Reduced panic attacks (
B) and decreased fear of heights (
D) are not direct indications of ECT effectiveness. Make sure to monitor for potential side effects of ECT such as memory problems.
Question 4 of 5
A nurse is conducting an admission interview with a client who is experiencing mania. Which of the following findings should the nurse report to the provider?
Correct Answer: C
Rationale: The correct answer is C. Reporting eating twice in the past week is a critical finding to report because it indicates a significant decrease in nutritional intake, which can lead to serious health complications. This is particularly concerning in the context of mania, as individuals experiencing manic episodes may neglect self-care, including eating regularly. In contrast, choices A, B, and D are all common behaviors associated with mania but do not pose an immediate threat to the client's physical health.
Choice A may indicate a hygiene issue, choice B is a symptom of pressured speech often seen in mania, and choice D reflects disinhibition commonly observed in manic states. However, these behaviors do not directly jeopardize the client's well-being in the same way as severe nutritional deprivation.
Question 5 of 5
A nurse is planning care for a client who has borderline personality disorder. Which of the following interventions should the nurse plan to include to assist the client with impaired social interactions with others?
Correct Answer: D
Rationale: The correct answer is D. Assigning the same staff members daily helps establish consistency and trust, which is crucial for clients with borderline personality disorder who struggle with unstable relationships and fear of abandonment. This intervention promotes continuity of care and helps the client feel more secure. A is incorrect because discussing maladaptive behaviors is essential for therapy. B is incorrect as exploring feelings of abandonment requires professional guidance. C is incorrect as encouraging dependent behaviors can hinder progress.