ATI RN
ATI RN Mental Health 2023 Exam 3 Questions
Extract:
Question 1 of 5
A nurse is caring for a client who was involuntarily committed and is scheduled to receive electroconvulsive therapy (ECT). The client refuses the treatment and will not discuss why with the healthcare team. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Documenting the client's refusal of the treatment in the medical record is the correct action. It is essential to record the client's decision and the discussion surrounding it to respect their rights and provide a legal record. Even with involuntary commitment, clients retain the right to refuse treatment unless legally deemed incompetent or a danger, requiring specific legal processes. Asking family to encourage ECT doesn’t address autonomy, telling them they can’t refuse is incorrect, and stating ECT doesn’t need consent is unethical.
Extract:
Nurses’ Notes
2000:
Client presents to the triage desk accompanied by a friend. The client states, “I need help. I was raped about an hour ago.” The client’s friend states, “I think they may have been drugged.” Allergies: penicillin, doxycycline Physical exam: General: exhibits anxiety Respiratory: breath sounds clear Cardiovascular: S1, S2, no murmur Abdomen: soft, mildly tender Skin: bruising to upper arms bilaterally, broken fingernails
Vital Signs
2015:
Blood pressure: 128/88 mm Hg
Heart rate: 80/min
Respiratory rate: 16/min
Temperature: 37°C (98.6°F)
Weight: 67.1 kg (147.9 lbs.)
Diagnostic Results
2030:
Urine drug screen: GHB (gamma-hydroxybutyric acid): positive
Question 2 of 5
A nurse is caring for a client in the emergency department.Drag words from the choices below to fill in each blank in the following sentence. The nurse should identify that the client’s ------------------------ and -------------------- are consistent with sexual assault.
Correct Answer: A,B
Rationale: GHB in diagnostic results and abdominal tenderness with bruising support sexual assault. Other vitals (BP, temp) are normal and less specific.
Extract:
Question 3 of 5
For which of the following adverse effects should a nurse monitor a client taking citalopram?
Correct Answer: B
Rationale: Decreased libido is a known adverse effect of citalopram, an SSRI. SSRIs can affect sexual function due to increased serotonin levels, leading to decreased libido, difficulty achieving orgasm, or erectile dysfunction. Urinary retention is not commonly linked to citalopram; bruising may occur rarely with bleeding risks but isn’t typical; and jaundice, indicating liver issues, is rare and not routine to monitor unless other risk factors are present.
Question 4 of 5
A nurse is teaching a client who is about to start taking fluoxetine. The nurse should instruct the client that which of the following supplements interacts adversely with fluoxetine?
Correct Answer: A
Rationale: St. John's wort is known to interact adversely with fluoxetine. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat depression. St. John's wort also affects serotonin levels, and when combined with fluoxetine, it increases the risk of serotonin syndrome, a potentially life-threatening condition characterized by symptoms like confusion, rapid heart rate, and muscle rigidity. Soy protein, echinacea, and ginkgo biloba do not have significant interactions with fluoxetine that pose such risks.
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 5 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: Group therapy (
B), improved appetite (
C), cognition (
D), and stable vitals (E) show progress in alcohol use disorder treatment. Self-reported alcohol reduction (
A) is unreliable, and grief stages (F) are subjective.