ATI RN
RN ATI Mental Health Proctored Exam 2023 With NGN Questions
Extract:
Question 1 of 5
A nurse is planning care for a client who has borderline personality disorder and engages in self-mutilation. Which intervention should the nurse include?
Correct Answer: B
Rationale: The correct answer is B: Encourage the client to express feelings of anger. This intervention focuses on addressing the underlying emotions that may lead to self-mutilation in clients with borderline personality disorder. By encouraging the client to express their feelings of anger, the nurse can help them develop healthier coping mechanisms and reduce the urge to self-harm. Restricting access to personal belongings (
A) may lead to feelings of frustration and exacerbate the behavior. Placing the client in seclusion (
C) can be traumatic and may not address the root cause of the behavior. Telling the client to stop self-mutilation (
D) is dismissive and oversimplifies the complexity of the disorder.
Question 2 of 5
A nurse in an acute mental health care facility is prioritizing care for multiple clients. Which of the following clients should the nurse see first?
Correct Answer: D
Rationale: The correct answer is D. The nurse should see the client taking clozapine and reporting a sore throat first because clozapine can cause agranulocytosis, a serious side effect characterized by a low white blood cell count, which can lead to life-threatening infections. Monitoring for signs of infection, such as a sore throat, is crucial to prevent complications. This client's situation requires immediate attention to assess the severity of the sore throat and take necessary actions to prevent further complications.
Choice A is incorrect because although mocking behavior can be disruptive, it does not pose an immediate threat to the client's health or safety.
Choice B is incorrect as the client's distress over a change in routine, while important, does not present an immediate risk to their well-being.
Choice C, assisting a client with ADLs, is important but can be prioritized after addressing the urgent health concern of the client taking clozapine.
Question 3 of 5
A nurse is planning care for a client who has borderline personality disorder and engages in self-mutilation. Which intervention should the nurse include?
Correct Answer: B
Rationale: The correct answer is B: Encourage the client to express feelings of anger. In clients with borderline personality disorder, self-mutilation often stems from difficulty expressing and managing intense emotions. Encouraging the client to express feelings of anger helps them explore and process emotions in a healthier way, reducing the need for self-harm. Restricting access to personal belongings (
A) may lead to increased feelings of distress and lack of control. Placing the client in seclusion (
C) can escalate feelings of abandonment and worsen the behavior. Simply telling the client to stop self-mutilation (
D) overlooks the underlying emotional issues.
Question 4 of 5
A nurse is admitting a client who has schizophrenia. The client states, "I'm hearing voices." Which of the following responses is the priority for the nurse to state?
Correct Answer: A
Rationale: The correct answer is A: "What are the voices telling you?" This response demonstrates active listening and shows empathy towards the client's experience, which helps in building trust. By asking about the content of the voices, the nurse can assess the severity of the hallucinations and potential risks.
Choice B does not address the client's concerns effectively.
Choice C is important but not the priority at this moment as assessing the hallucinations is crucial.
Choice D is relevant but doesn't address the immediate need to assess the content of the voices.
Question 5 of 5
A client with schizophrenia is prescribed risperidone. Which of the following should the nurse monitor for as an adverse effect of this medication?
Correct Answer: B
Rationale: The correct answer is B: Weight gain. Risperidone is known to cause metabolic side effects, including weight gain. This is due to its effect on increasing appetite and altering metabolism. Monitoring weight regularly is important to detect and manage this adverse effect. Increased blood pressure (
A) is not a common side effect of risperidone. Excessive salivation (
C) is associated with other medications like clozapine. Bradycardia (
D) is not typically caused by risperidone.