ATI RN
ATI Mental Health 2023 II Questions
Extract:
Question 1 of 5
A nurse is caring for an adult client who has been placed in physical restraints due to aggressive behavior. Which of the following actions should the nurse take?
Correct Answer: A
Rationale: Frequent toileting checks ensure comfort/safety. Renewal intervals vary, 30-min checks insufficient, hydration less urgent.
Extract:
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 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 member estimates the client's last drink was 2 hr ago.
Vital Signs
Admission, 1600:
Temperature 36.1° C (97° F)
Blood pressure 98/66 mm Hg
Heart rate 76/min
Respiratory rate 10/min
Pulse oximetry 95% on room air
Diagnostic Results
Blood alcohol level (BAC) 310 mg/dL (0 to 50 mg/dL)
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.
Question 2 of 5
A nurse in a mental health facility is admitting a client.Exhibits:A nurse is caring for a client who was admitted for alcohol use disorder. Which of the following findings require follow-up by the nurse? Select all that apply.
Correct Answer: B,C,D,E,F
Rationale: Recent drinking (
B), BAL (
C), loss (
D), low RR (E), and slurred speech (F) need follow-up. Smoking, cardiac, GI, GU less urgent.
Extract:
Question 3 of 5
A nurse is caring for a client who states, 'Things will never work out.' Which of the following responses should the nurse make?
Correct Answer: C
Rationale: Hopelessness may signal suicidal ideation; assessing safety is priority. Focusing on self dismisses, 'why' risks defensiveness, and suggesting medication is premature.
Question 4 of 5
A nurse is caring for a client who has antisocial personality disorder and reports planning to hurt their partner upon discharge. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: The nurse has a legal and ethical duty to report threats of harm to others, prioritizing safety over confidentiality. Extending stay is secondary, risk management is not immediate, and confidentiality does not apply here.
Extract:
Vital Signs
Admission, 1600:
• Temperature 36.1° C (97° F)
• Blood pressure 98/66 mm Hg
• Heart rate 76/min
• Respiratory rate 10/min
• Pulse oximetry 95% on room air
Day 2, 0800:
• Temperature 37.3° C (99.1° F)
• Blood pressure 198/86 mm Hg
• Heart rate 116/min
• Respiratory rate 22/min
Hospital day 5,0800:
• Temperature 36.1° C (97° F)
• Blood pressure 128/66 mm Hg
• Heart rate 74/min
• Respiratory rate 12/min
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 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 member estimates the client's last drink was 2 hr ago.
Day 2, 0800:
Client is in the bathroom vomiting. Assisted the client with oral feeding and he has a good appetite.
He resolves to limit his alcohol intake moving forward. He has currently accepted the news about his parents demise and is attending group therapy.
Question 5 of 5
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: A,B,D,E
Rationale: Appetite (
A), grief acceptance (
B), therapy (
D), and resolve (E) show progress. Cognition lacks evidence.