ATI LPN
ATI LPN Mental Health Exam IV Questions
Extract:
Question 1 of 5
A nurse is contributing to the plan of care for a client who is admitted with deep vein thrombosis (DVT) of the left leg. Which of the following interventions should the nurse include in the plan?
Correct Answer: D
Rationale: Monitoring platelet levels ensures safety during anticoagulant therapy for DVT (e.g., heparin-induced thrombocytopenia risk). Ice (
A) isn’t standard (warmth is used), vasodilators (
B) don’t treat clots, and fluids (
C) prevent thickening, not restricted. Platelets are key for bleeding risk.
Question 2 of 5
A nurse is assisting in the plan of care for a client who has a suspected myocardial infarction. Which of the following medications should the nurse plan to administer first?
Correct Answer: D
Rationale: Oxygen addresses hypoxia in suspected MI, increasing myocardial oxygen supply to limit damage (normal SpO2 95–100%). Morphine relieves pain, nitroglycerin dilates vessels, and aspirin prevents clotting, but oxygen is the priority per MONA protocol (Morphine, Oxygen, Nitroglycerin, Aspirin) when hypoxia is possible.
Question 3 of 5
A nurse is reinforcing teaching about warfarin with a client who has a new onset of atrial fibrillation. Which of the following statements should the nurse include in the teaching?
Correct Answer: C
Rationale: Warfarin prevents strokes in atrial fibrillation by reducing clot formation (via vitamin K inhibition), not dissolving clots (
A), slowing ventricles (B, antiarrhythmic role), or restoring rhythm (
D). Stroke prevention is its primary role due to atrial clot risk.
Question 4 of 5
A nurse is assisting with planning of care for a client following a suicide attempt. Which of the following interventions is an appropriate suicide precaution?
Correct Answer: A
Rationale: Inspect the client's personal belongings. Inspecting the client's personal belongings helps to ensure that the client does not have access to items that could be used for self-harm, such as sharp objects or medications. Assign the client to a private room. Assigning a client who has attempted suicide to a private room can increase isolation and the risk of self-harm, as they are not easily observed. Tuck bedcovers over client's hands and arms. This intervention is not effective and could potentially restrict the client's movement, increasing feelings of distress. Remove utensils from the client's meal trays. Removing utensils, especially sharp ones, from meal trays helps to prevent the client from using them to harm themselves.
Question 5 of 5
A nurse recognizes unexplained fussiness and irritability in an infant, as well as unexplained injuries. The nurse should suspect which of the following?
Correct Answer: D
Rationale: Sexual abuse: While sexual abuse can cause physical and emotional symptoms, the combination of unexplained injuries and fussiness/irritability is more suggestive of physical trauma. Neglect: Neglect involves failure to provide for the child's basic needs, which can lead to developmental issues, but is less likely to cause unexplained injuries. Munchausen syndrome by proxy: Munchausen syndrome by proxy involves a caregiver fabricating or inducing illness in a child for attention. It can cause unexplained injuries, but the focus is more on medical symptoms. Shaken baby syndrome: Shaken baby syndrome results from violently shaking an infant, leading to physical injuries, irritability, and fussiness. It fits the description of unexplained injuries and behavioral changes.