ATI LPN
ATI LPN Mental Health Level 4 test II Questions
Extract:
Question 1 of 5
A nurse is caring for a client who witnessed her brother's homicide and has posttraumatic stress disorder (PTSD). Which of the following findings should the nurse expect?
Correct Answer: A
Rationale: The client is easily startled by loud voices. Hypervigilance and being easily startled are hallmark symptoms of PTSD. The client talks constantly about the traumatic experience: Clients with PTSD often avoid discussing their trauma. The client reports satisfying personal relationships with family and close friends: PTSD can strain relationships due to emotional withdrawal and hypervigilance. The client is constantly drowsy and sleeps 11-12 hours daily: Clients with PTSD often experience insomnia or sleep disturbances, not prolonged sleep.
Question 2 of 5
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions is the nurse's priority?
Correct Answer: D
Rationale: Offer the client high-calorie fluids: This is not a priority during a panic attack. Addressing physical needs comes later. Administer an antianxiety medication to the client: Medication may be part of treatment but is not the immediate priority. Teach the client relaxation exercises: Relaxation exercises are valuable but should be introduced after the acute phase of the panic attack has passed. Remain with the client in a quiet area. Remaining with the client provides reassurance, safety, and emotional support, which are critical during a panic attack.
Question 3 of 5
A nurse is caring for a client who has panic disorder. The client tells the nurse she is suddenly feeling very apprehensive, has a sense that something catastrophic is going to happen, and that she sees bugs flying around her room. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: Reinforce reality with the client. While reinforcing reality can help in addressing the client's hallucinations (seeing bugs), it may not be the immediate priority when the client is experiencing severe panic. Instruct the client to take deep breaths: Helping the client to take deep breaths can provide immediate relief from acute anxiety by promoting relaxation and helping to reduce the physiological symptoms of panic. Once the client is calmer, other interventions can be considered. Assist the client to identify the cause of the anxiety: Insight into triggers is more appropriate after the acute episode resolves. Administer an antianxiety medication to the client: While this may be necessary, it is not the immediate first action in this scenario.
Question 4 of 5
A nurse is talking to a client who is explaining about her home situation and the intimate partner violence she recently experienced. Which of the following responses should the nurse make?
Correct Answer: A
Rationale: 'I'd like to hear more about how you are feeling.' This response demonstrates empathy and encourages the client to express her feelings, which is critical for emotional support. 'Let's talk about what is going on at work.': This dismisses the client's concerns and shifts focus away from the abuse. 'Now that you have come for help, you will feel much better.': This is dismissive and minimizes the client's experience. 'Why do you think your partner is angry with you?': This implies blame and can further traumatize the client.
Question 5 of 5
A nurse is caring for an older adult client whom the nurse suspects has experienced abuse by a nonpartner. Which of the following principles does the nurse demonstrate by reporting their concern to a supervisor?
Correct Answer: D
Rationale: Human dignity: While reporting supports the client's dignity, this principle focuses more on respecting inherent worth rather than safety. Ethical decision-making: This refers to the process of resolving ethical dilemmas but is not specific to reporting abuse. Trusting relationships: While trust is important, this principle does not directly relate to reporting suspected abuse. Nonmaleficence: Nonmaleficence is the ethical principle of doing no harm. Reporting suspected abuse aligns with the nurse's responsibility to protect the client from harm.