ATI RN
ATI RN Mental Health 2023 Exam 3 Questions
Extract:
Question 1 of 5
A nurse is developing a plan of care for a client who has paranoid personality disorder. Which of the following actions should the nurse include in the plan?
Correct Answer: C
Rationale: The correct answer is C: Provide written information about the client's treatment plan. For a client with paranoid personality disorder, providing written information is important as it helps establish trust and transparency in the nurse-client relationship. Written information can reduce the client's anxiety about the treatment plan and provide a sense of control over their care. Monitoring for splitting behaviors (
A) is not directly related to paranoid personality disorder. Isolating the client (
B) goes against the therapeutic goal of promoting social interactions. Encouraging countertransference (
D) is inappropriate as it involves the nurse projecting their feelings onto the client, which can hinder the therapeutic process.
Question 2 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: D
Rationale: The correct answer is D: Offer hydration and nutrition to the client every 2 hours. This is essential to ensure the client's basic physiological needs are met while in restraints. Hydration and nutrition are vital for the client's well-being and overall health. Offering these every 2 hours helps prevent dehydration and malnutrition. Checking on the client every 30 minutes (Option
A) is important, but providing hydration and nutrition takes precedence. Assessing the client's need for toileting every 15 minutes (Option
B) may not be necessary unless there are specific concerns. Asking the provider to renew the prescription every 8 hours (Option
C) is not directly related to the client's immediate care needs.
Question 3 of 5
A nurse is developing a plan of care for a client who has paranoid personality disorder. Which of the following actions should the nurse include in the plan?
Correct Answer: C
Rationale: The correct answer is C: Provide written information about the client's treatment plan. For a client with paranoid personality disorder, providing written information is important as it helps establish trust and transparency in the nurse-client relationship. Written information can reduce the client's anxiety about the treatment plan and provide a sense of control over their care. Monitoring for splitting behaviors (
A) is not directly related to paranoid personality disorder. Isolating the client (
B) goes against the therapeutic goal of promoting social interactions. Encouraging countertransference (
D) is inappropriate as it involves the nurse projecting their feelings onto the client, which can hinder the therapeutic process.
Extract:
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.
Diagnostic Results
Blood alcohol level (BAC) 310 mg/dL (0 to 50 mg/dL)
Provider Prescriptions
Perform Alcohol Use Disorders Identification Test (AUDIT)
Complete blood count
Basic metabolic profile
Nutrition consultation
Consult counselor for grief therapy
Substance use group therapy
Diazepam 10 mg PO three times a day
Propranolol 40 mg PO twice a day
Metoclopramide 10 mg IM every 6 hr PRN nausea and/or vomiting
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 an 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 members estimate the client’s last drink was 2 hours ago.
Vital Signs
Admission, 1600:
•
o Temperature: 36.1°C (97°F)
o Blood pressure: 98/66 mm Hg
o Heart rate: 76/min
o Respiratory rate: 10/min
o Pulse oximetry: 95% on room air
Day 2, 0800:
•
o Temperature: 37.3°C (99.1°F)
o Blood pressure: 198/86 mm Hg
o Heart rate: 116/min
o Respiratory rate: 22/min
Hospital day 5, 0800:
•
o Temperature: 36.1°C (97°F)
o Blood pressure: 128/66 mm Hg
o Heart rate: 74/min
o Respiratory rate: 12/min
o Pulse oximetry: 96% on room air
Question 4 of 5
A nurse is reviewing the day 5 vital signs and nurse’s notes.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: B,C,D,E
Rationale: The correct answer is B, C, D, E. Participation in group therapy (
B) indicates engagement in treatment. Stable appetite (
C) shows physical improvement. Maintained cognition (
D) signifies mental progress. Consistent vital signs (E) reflect physiological stability.
Choice A lacks specificity and doesn't measure treatment progress.
Choice F is not directly related to the client's plan of care.
Extract:
Question 5 of 5
A nurse is planning care for an adolescent who has autism spectrum disorder. Which of the following outcomes should the nurse include in the plan of care?
Correct Answer: A
Rationale: The correct answer is A: Initiates social interactions with caregivers. For individuals with autism spectrum disorder, social skills development is a key goal. By initiating social interactions with caregivers, the adolescent can practice communication, build relationships, and enhance social functioning. This outcome focuses on improving social interaction abilities, which is crucial for the adolescent's overall well-being and integration into society.
Other choices are incorrect because:
B: Acknowledging delusions is not typically a characteristic of autism spectrum disorder.
C: Changing behavior due to peer pressure may not be appropriate or beneficial for someone with autism spectrum disorder.
D: Meeting own needs without manipulating others is a positive trait, but it is not specific to the goals of social interaction and communication targeted in this case.