ATI LPN
ATI LPN Mental Health 2023 II Questions
Extract:
Question 1 of 5
A nurse is caring for a client who was placed in four-point restraints by the nursing staff following an episode of violent behavior. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: Providing range-of-motion exercises every 2 hours helps to prevent complications associated with immobility, such as muscle atrophy and pressure ulcers. This is a critical safety measure for clients in restraints.
Question 2 of 5
A nurse is caring for a client who becomes extremely agitated and asks if they can go to a separate room to be alone for an hour. The nurse should document which of the following de-escalation techniques in the client's medical record?
Correct Answer: D
Rationale: Timeout allows the client to have a moment away from stimuli to regain control and calm down, which is a recognized de-escalation technique. This matches the client’s request and supports de-escalation efforts.
Question 3 of 5
A nurse is reinforcing teaching with a client who started taking haloperidol decanoate 125 mg IM 1 month ago. Which of the following statements by the client should the nurse address?
Correct Answer: D
Rationale: Spending several hours outside in the sun could increase the risk of photosensitivity, a side effect of haloperidol. The nurse should address this to educate the client on protective measures like sunscreen use.
Question 4 of 5
A nurse is caring for a client who has dementia and is experiencing an increased number of falls. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Placing the client near the nurses' station allows for closer monitoring and quicker intervention, which can help prevent falls. This is a practical, non-restrictive measure to enhance safety.
Question 5 of 5
A nurse is preparing to administer sertraline 50 mg PO once daily to a client who has depressive disorder. Available is sertraline oral solution 20 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)
Correct Answer: 2.5
Rationale:
Step 1: (50 mg ÷ 20 mg/mL) × 1 mL = 2.5 mL. The nurse should administer 2.5 mL to deliver the prescribed 50 mg dose, calculated based on the concentration of the available solution.