ATI RN Mental Health 2023 with NGN | Nurselytic

Correct Answer: D

Rationale: The correct answer is D. Offering to contact the client's spiritual advisor shows support for the client's spiritual needs, providing them with an opportunity to seek comfort and guidance from someone who shares their beliefs. This action respects the client's autonomy and individual preferences. It acknowledges the importance of spirituality in the grieving process, which can provide solace and coping mechanisms.

Options A, B, and C are incorrect:
A: Encouraging the client to internalize their feelings may hinder the grieving process and inhibit emotional expression, potentially leading to unresolved issues.
B: Changing the subject when the client expresses anger dismisses their emotions and prevents them from processing their feelings effectively.
C: Allowing the client to be alone during times of spiritual inadequacy may exacerbate feelings of isolation and hinder their ability to seek support and comfort.

Correct Answer: A

Rationale:
Correct Answer: A

Rationale: The nurse should prioritize the client's comfort and autonomy. By acknowledging the client's discomfort with massage therapy, the nurse shows respect for the client's preferences and can explore alternative treatment options with the provider. This response promotes client-centered care.
Summary of Other

Choices:
B: This response does not address the client's underlying discomfort with touch and may not adequately address the client's needs.
C: While exploring the client's reasons for not liking touch is important, it does not directly address the immediate issue of the client's preference for a different treatment.
D: Dismissing the client's concerns and suggesting that the anxiety will lessen once the massage begins is not respectful of the client's feelings and may increase their distress.

Correct Answer: B

Rationale: The correct answer is B: Offer the client the medication at the next scheduled dose time. This option respects the client's right to refuse treatment while also ensuring that the medication is still available for when the client may choose to take it. Administering the medication via IM injection without the client's consent (
Choice
A) violates the client's autonomy and right to refuse treatment. Informing the client that they do not have the right to refuse the medication (
Choice
C) is unethical and goes against the client's rights. Implementing consequences until the client takes the medication (
Choice
D) is coercive and does not promote a therapeutic relationship. Overall, choice B respects the client's autonomy while still ensuring the medication is available for when the client is ready to take it.

Correct Answer: C

Rationale: The correct answer is C: A translator of the same gender as the client. This choice is the most appropriate because it ensures effective communication while also considering the client's comfort and cultural sensitivity. By selecting a translator of the same gender as the client, the nurse can help foster trust and rapport, which are essential in a support group setting. This choice also helps in maintaining confidentiality and respecting the client's preferences.


Choice A: A unit secretary who speaks the same language as the client may not have the necessary skills or training for effective translation in a sensitive setting like a support group.


Choice B: Another client who speaks the same language as the client may not have the professional boundaries or neutrality required for accurate translation.


Choice D: Involving a family member of the client may compromise confidentiality and create potential conflicts of interest within the support group dynamic.

Correct Answer: C

Rationale: The correct answer is C: Focus the client on reality-based activities. This is important because redirecting the client's focus to reality-based activities can help ground them and reduce the intensity of hallucinations. By engaging in activities that connect them to the present moment, the client can gain a sense of control and stability.
Choice A is incorrect as denying the client's experience can lead to mistrust and distress.
Choice B is incorrect as avoiding direct questions may not address the client's needs effectively.
Choice D is incorrect as conveying sympathy alone may not provide the client with coping strategies.