Extract:

Question 1 of 5

A nurse is caring for a school-age child who has conduct disorder and is in physical restraints after becoming physically aggressive toward other clients on the unit. Which of the following actions should the nurse take?

A. Keep the restraints on for a minimum of 1 hour.B. Monitor the child's vital signs every 15 minutes.C. Ask the provider to renew the prescription for the restraints every 24 hours.D. Arrange an in-person evaluation by the child's provider within 2 hours of initiating restraints.

Correct Answer: B

Rationale: Monitoring vital signs every 15 minutes ensures safety during restraints. Fixed duration isn’t standard, renewal is periodic, evaluation is secondary.

Question 2 of 5

A nurse is caring for a client who has a substance use disorder. The client states, 'The state took my child away after my overdose. I don’t want to go on living without them.' Which of the following therapeutic responses should the nurse make?

A. If you attend counseling, you will get your child back.'B. We can ask the physician to prescribe a sedative.'C. Have you thought about harming yourself?'D. Can a family member try to obtain temporary custody of your child?'

Correct Answer: C

Rationale: Asking about self-harm assesses suicide risk, the priority. Counseling promises are false, sedatives avoid the issue, custody is premature.

Question 3 of 5

A nurse is interviewing a client who reports ongoing feelings of depression after the death of his sibling 9 months ago. Which of the following actions should the nurse take?

A. Recommend that the client participate in more solitary activities.B. Explain to the client that the duration of grief is highly variable and can last for years.C. Encourage the client to avoid discussing the events surrounding the sibling’s death.D. Caution the client against feeling angry at the sibling.

Correct Answer: B

Rationale: Explaining variable grief duration normalizes the experience. Solitude worsens, avoiding discussion hinders, cautioning anger invalidates.

Question 4 of 5

A nurse is caring for a client who is under observation for suicidal ideations and has verbalized a suicide plan. The client demands privacy and to be left alone. Which of the following statements should the nurse make?

A. Until your medication has reached therapeutic levels, you will need constant observation.'B. Since you are trying to follow the treatment plan, we can submit your request to the provider.'C. If you complete a contract that states you will not harm yourself, you can be alone.'D. We are concerned about you and need to keep you safe.'

Correct Answer: D

Rationale: Expressing concern prioritizes safety empathetically. Medication levels don’t address emotion, requests give false hope, contracts are unreliable.

Question 5 of 5

A nurse is planning overall strategies to address problems for a client who has borderline personality disorder. Which of the following strategies is the priority for the nurse to incorporate in the plan of care?

A. Encourage the client to attend weekly support group meetings.B. Discuss the appropriate use of assertive behavior with the client.C. Implement measures to prevent intentional self-inflicted injury.D. Assist the client to maintain awareness of her thoughts and feelings.

Correct Answer: C

Rationale: Preventing self-harm is the priority due to BPD’s high risk. Support groups, assertiveness, and awareness are secondary.

Nurselytic

ATI RN

ATI RN

ATI RN Mental Health 2023 Exam 2 Questions

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Question 4 of 5

Question 5 of 5

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