ATI RN
ATI RN Mental Health 2023 with NGN Questions
Extract:
Question 1 of 5
A nurse is planning to delegate client care for several clients in a mental health facility. Which of the following tasks should the nurse delegate to an assistive personnel?
Correct Answer: D
Rationale: The correct answer is D because participating in solitary activities with a client who has mania is a task that can be safely delegated to an assistive personnel. Solitary activities do not require specialized nursing skills and can help the client manage their symptoms in a therapeutic manner. This task can also promote a sense of independence and self-regulation for the client.
A, B, and C are incorrect choices because they involve providing education, obtaining informed consent, or discussing medication-related information, which require a higher level of knowledge, critical thinking, and communication skills that are typically within the scope of practice of a licensed nurse. Delegating these tasks to an assistive personnel could potentially lead to misunderstandings, errors, or legal implications.
Question 2 of 5
A nurse is providing teaching to the partner of a client who has Alzheimer's disease and a new prescription for donepezil. Which of the following pieces of information should the nurse include?
Correct Answer: A
Rationale: The correct answer is A: "You should administer the medication immediately before bedtime." Donepezil is typically recommended to be taken at bedtime to reduce the risk of side effects such as nausea and insomnia. Administering it at this time also helps with adherence to the medication schedule.
Choice B is incorrect because donepezil does not cure Alzheimer's disease, so the dose is not decreased as the disease improves.
Choice C is incorrect because while donepezil may help with symptoms, it does not stop the progression of the disease.
Choice D is incorrect because donepezil does not decrease the risk of falls; in fact, it may cause side effects that increase the risk of falls.
Question 3 of 5
A nurse is caring for a client who is receiving end-of-life care. The client states, 'The nurses here don’t do a good job caring for me.' Which of the following responses should the nurse make?
Correct Answer: D
Rationale: The correct response is D: "Can you tell me more about what is upsetting you?" This response demonstrates active listening and empathy, allowing the client to express their concerns and feelings. By encouraging open communication, the nurse can address the client's specific needs and provide appropriate support. This approach fosters trust and enhances the therapeutic relationship, leading to better end-of-life care.
Choices A, B, and C do not directly address the client's expressed dissatisfaction and may come across as dismissive or deflective.
Choice A shifts the focus to family dynamics, choice B generalizes the client's feelings, and choice C assumes the nurses' intentions without acknowledging the client's perspective.
Question 4 of 5
A nurse is caring for a client who has schizophrenia and is experiencing auditory hallucinations. Which of the following actions should the nurse take first?
Correct Answer: A
Rationale: The correct answer is A: Ask the client what they are hearing. This is the first action the nurse should take to assess the nature and content of the auditory hallucinations. Understanding the hallucinations will help the nurse determine the level of distress the client is experiencing and develop an appropriate care plan.
Choice B: Focusing on reality-based topics may be helpful but should come after assessing the hallucinations to establish rapport and trust with the client.
Choice C: Taking the client for a walk outside may not address the immediate concern of the auditory hallucinations and may not be appropriate without first understanding the hallucinations.
Choice D: Encouraging the client to listen to music may not be helpful if the auditory hallucinations are distressing and could potentially exacerbate the symptoms.
Question 5 of 5
A nurse is assessing a client who has a recent diagnosis of dissociative identity disorder. The client tells the nurse, 'I think my blackouts are actually caused by low blood sugar.' The nurse should recognize the client is using which of the following defense mechanisms?
Correct Answer: D
Rationale: The correct answer is D: Rationalization. The client is attributing their blackouts to a seemingly logical and acceptable cause (low blood sugar) rather than acknowledging the true underlying issue of dissociative identity disorder. Rationalization involves creating logical explanations or justifications for behaviors, thoughts, or feelings that are otherwise unacceptable. In this case, the client is using rationalization to avoid facing the uncomfortable reality of their dissociative symptoms.
Incorrect choices:
A: Suppression involves consciously avoiding or pushing away thoughts or feelings. This does not apply to the client's situation.
B: Sublimation involves channeling unacceptable impulses into more socially acceptable behaviors. This is not demonstrated in the client's statement.
C: Projection involves attributing one's own thoughts or feelings to others. This is not evident in the client's statement.
Therefore, rationalization is the most appropriate defense mechanism being used by the client in this scenario.