ATI RN
ATI RN Mental Health 2023 Exam 3 Questions
Extract:
Question 1 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: Initiating social interactions is an appropriate, measurable outcome for autism spectrum disorder, targeting core deficits in communication and social skills. Delusions are unrelated to autism, peer pressure isn’t a specific goal, and meeting needs without manipulation is too broad and not autism-specific.
Question 2 of 5
A nurse is providing teaching to the caregiver of an older adult client who has Alzheimer's disease and is being cared for at home. The client wanders at night and has a history of previous falls. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
Correct Answer: B,C,E
Rationale: Sensors (
B) alert caregivers to wandering, a mattress on the floor (
C) reduces fall injury, and high locks (E) prevent exits. A chair (
A) doesn’t address wandering and may harm, while bedtime activity (
D) may increase alertness, not sleep.
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
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.
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 member estimates the client’s last drink was 2 hours ago.
Question 3 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: A,C,D,F,G
Rationale: GI issues (
A), high BAC (
C), recent loss (
D), recent drinking (F), and neurological symptoms (G) need follow-up due to physical and psychological risks in alcohol use disorder. Others are stable or less urgent.
Extract:
Question 4 of 5
A nurse is assessing a client who has bipolar disorder. Which of the following findings should the nurse identify as an indication that the client is experiencing acute mania?
Correct Answer: D
Rationale: A lack of sleep is a hallmark of acute mania, where clients feel little need for rest, exacerbating other symptoms. Detailed scheduling, refusal to converse, and isolation align more with depression or other states, not mania’s high energy.
Question 5 of 5
A nurse in an acute care facility is planning care for a client with a history of alcohol use disorder who is admitted while intoxicated. Which of the following interventions should the nurse implement?
Correct Answer: A
Rationale: Implementing seizure precautions is critical for a client with alcohol use disorder admitted while intoxicated. Alcohol withdrawal can lead to seizures, a life-threatening risk, requiring a safe environment and emergency readiness. Orthostatic hypotension monitoring is useful but secondary; methadone is for opioid withdrawal, not alcohol; and acidifying urine is irrelevant to alcohol management.