ATI RN
ATI Mental Health 2023 II Questions
Extract:
Medical History
The client is 18 years old and is being admitted into the inpatient eating disorder clinic. The client has had a history of anorexia nervosa since age 16. BMI has fluctuated from 15 to 19 over the past 3 years.
Client reports restricting caloric intake to 400 cal/day, fasting, and dieting. The client also reports frequent episodes of binge eating, self-induced vomiting, frequent laxative use, and exercising three times per day, every day.
Client states, "I am so fat. No matter what I do, I can't get skinny or lose enough weight." The client's guardian reports that the client is a perfectionist and has obsessive thoughts related to food and diet.
The client has dry, pale skin that appears thin and fragile, with decreased turgor, especially in areas like the forearms or abdomen. The mucous membranes, including the mouth and lips, are dry and cracked. The urine output is reduced, with minimal amount of dark yellow urine.
Vital Signs
Heart rate 44/min
Respiratory rate 20/min
BP 86/50 mm Hg
Temperature 36.2° C (97.2° F)
Question 1 of 5
A nurse is initiating the plan of care for a client who has anorexia nervosa.Exhibits:Complete the following sentence by using the lists of options.The nurse should first address the client’s ___ followed by the client’s ___
Correct Answer: A,B
Rationale: Action to Take: A, B; Potential Condition: Anorexia nervosa; Parameter to Monitor: A, B.
Rationale: In anorexia nervosa, the client may be malnourished, leading to potential cardiovascular complications. Monitoring blood pressure and heart rate is crucial to assess cardiac function and overall health status. Addressing these parameters first allows the nurse to identify any immediate risks related to the client's condition. Monitoring temperature, vomiting, urine output, or skin turgor may be important in the overall assessment but addressing the cardiovascular status takes precedence in this scenario.
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:
Correct
Answer: B, C, D, E, F
Rationale:
B: Client's recent consumption of alcohol should be followed up as it indicates potential relapse or withdrawal symptoms.
C: Blood alcohol level should be monitored to assess intoxication level or withdrawal risk.
D: Client's recent loss may trigger emotional distress or exacerbate alcohol use disorder symptoms.
E: Respiratory assessment is crucial due to potential respiratory depression associated with alcohol use.
F: Neurological assessment is needed to evaluate cognitive function and potential alcohol-related neurological impairment.
Summary:
A: Smoking history is not directly related to immediate alcohol use disorder management.
G: Cardiac assessment is not a priority unless there are specific cardiac symptoms present.
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 3 of 5
The client is at risk for developing ___ as evidenced by the client’s ___
Correct Answer: A,B
Rationale: Action to Take: A, B; Potential Condition: C; Parameter to Monitor: D, E.
Rationale:
1. Action A (Dysphoria): Addressing client's emotional distress is crucial in preventing further complications.
2. Action B (History of alcohol consumption): Identifying substance abuse history helps in personalized interventions.
3. Potential Condition C (Dementia): Client's cognitive impairment may exacerbate risks and require tailored care.
4. Parameter to Monitor D (Age): Age is a significant factor in assessing the client's overall health and potential risks.
5. Parameter to Monitor E (History of rehabilitation): Past rehabilitation experiences can influence current treatment effectiveness.
These choices are selected based on their direct relevance to the client's risk factors and individual characteristics.
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
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
Question 4 of 5
A nurse is caring for a client who is experiencing alcohol withdrawal.Exhibits:A nurse is planning care for a client who has alcohol use disorder. For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.
| Options | Anticipated | Contraindicated |
|---|---|---|
| Group therapy | ||
| Nutritional consult | ||
| Propranolol 40 mg PO twice a day | ||
| Perform Alcohol Use Disorders Identification Test (AUDIT) | ||
| Schedule electroconvulsive therapy (ECT) | ||
| Diazepam 10 mg PO three times a day | ||
| Methadone 40 mg PO daily |
Correct Answer:
Rationale:
To determine the correct answer, we must consider the client's alcohol withdrawal symptoms and appropriate interventions. Group therapy is anticipated as it provides support. Nutritional consult (
B) is anticipated to address potential malnutrition. Propranolol (
C) is contraindicated in alcohol withdrawal due to risk of hypotension and masking of symptoms. AUDIT (
D) is anticipated for screening. ECT (E) is not indicated for alcohol withdrawal. Diazepam (F) may be considered for severe withdrawal symptoms. Methadone (G) is not indicated for alcohol withdrawal.
Therefore, the correct answer is (0, 1, 0, 1).
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
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.
Question 5 of 5
The nurse should first administer ___ followed by administering ___
Correct Answer: A,B
Rationale: Action to Take: A, B; Potential Condition: Nausea/Vomiting; Parameter to Monitor: Blood pressure, Heart rate.
Rationale: Metoclopramide is commonly used to treat nausea/vomiting, making it a suitable initial choice. Propranolol can be administered to manage symptoms of anxiety or tremors that may occur. Monitoring blood pressure and heart rate is crucial due to potential side effects of these medications on cardiovascular function. Methadone, a pain medication, is not appropriate for this scenario. Propanolol is misspelled and not relevant.