ATI LPN
ATI LPN Mental Health Exam IV Questions
Extract:
Question 1 of 5
A nurse is making a home visit for a 16-year-old adolescent who attempted suicide. Which of the following behaviors should alert the nurse that the adolescent still has suicidal intent?
Correct Answer: A
Rationale: Planning to give his CD collection to his girlfriend: Giving away prized possessions is a common warning sign of suicidal intent, indicating that the person is preparing for their absence. Preferring to eat his meals while watching TV: This behavior is relatively normal and does not necessarily indicate suicidal intent. Stating that he wants to be with his peers more than with his parents: Wanting to spend time with peers is typical for adolescents and does not specifically indicate suicidal intent. Telling his parents that he doesn't want to talk about the attempt: Not wanting to discuss the attempt could be due to embarrassment, guilt, or other reasons, but it is not as direct an indicator of ongoing suicidal intent as giving away possessions.
Question 2 of 5
A nurse is collecting data from a client who has venous insufficiency. Which of the following findings should the nurse expect?
Correct Answer: D
Rationale: Pitting edema is a hallmark of venous insufficiency due to fluid leakage from high venous pressure. Thickened toenails (
A) are fungal-related, shiny skin (
B) and dusky color (
C) indicate arterial insufficiency. Edema reflects venous stasis.
Question 3 of 5
A nurse is assisting in the plan of care for a client who has dehydration and hypotension. Which of the following actions should the nurse plan to take?
Correct Answer: C
Rationale: Increasing fluid intake corrects dehydration and hypotension by restoring blood volume (normal BP 90/60–120/80 mmHg). Imagery (
A) reduces stress, not volume; elevating the head (
B) may worsen hypotension; Valsalva (D, E) treats arrhythmias, not this condition. Fluids are primary.
Question 4 of 5
A husband is yelling and swearing at his wife during an argument. He also is pacing and pounding his fist. This pattern of behavior is consistent with which stage in the assault cycle?
Correct Answer: C
Rationale: Recovery stage: The recovery stage occurs after the crisis has passed and the individual begins to calm down and return to baseline behavior. Crisis stage: The crisis stage involves the peak of aggression, often resulting in physical violence. Escalation stage: The escalation stage involves increasing agitation and aggressive behaviors, such as yelling, swearing, pacing, and fist-pounding, before reaching a crisis. Trigger stage: The trigger stage involves the initial event or situation that provokes the individual's anger or aggression.
Question 5 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.