ATI RN
ATI Custom NUR 316 Fall 2023 1MHE Module 4 - 1st 5 units Questions
Extract:
Question 1 of 5
A nurse is providing education to a group of staff members about schizophrenia. Which of the following age groups should the nurse include as the age when schizophrenia is typically diagnosed?
Correct Answer: C
Rationale: The correct answer is C: Young adulthood. Schizophrenia is typically diagnosed in late teens to early 30s. This is when symptoms commonly appear and are more identifiable due to the onset of stressors like academic or occupational demands. School-age and preschooler choices are too early for schizophrenia onset. Older adulthood is less likely for new diagnoses.
Question 2 of 5
A nurse is caring for a client who has been diagnosed with schizophrenia. The client has been wearing the same clothes for the past week and appears unkept and unbathed. Which of the following statements should the nurse make to the client?
Correct Answer: C
Rationale:
Correct Answer: C - It is now time for you to bathe
Rationale: The nurse should use a direct, clear, and non-confrontational approach to encourage the client to bathe. This statement acknowledges the importance of personal hygiene without shaming the client. It sets a clear expectation and provides a gentle reminder for the client to engage in self-care activities. By using a neutral and supportive tone, the nurse respects the client's autonomy while promoting health and well-being.
Summary of Other
Choices:
A: Incorrect - Ignoring the lack of self-care enables further neglect and does not address the client's needs.
B: Incorrect - Forcing the client to bathe in a confrontational manner may cause distress and resistance.
D: Incorrect - This statement comes off as judgmental and may make the client defensive, hindering effective communication and rapport-building.
Question 3 of 5
A nurse is assessing a newly admitted client who states that they do not want to live anymore and plan to end their life. Which of the following actions should the nurse take?
Correct Answer: A
Rationale:
Correct Answer: A
Rationale: Asking the client about the lethality of their plan is crucial in assessing the level of risk for self-harm. It helps determine the immediacy and seriousness of the situation. This information guides the nurse in developing a safety plan and appropriate interventions. Encouraging the client to focus on the positive aspects of life (
B) may overlook the severity of the situation. Reassuring the client that everything will work out (
C) may minimize their feelings and not address the underlying issue. Allowing the client time alone to self-reflect (
D) can be dangerous if the plan is lethal, as it increases the risk of harm.
Extract:
A nurse is caring for a client who has schizophrenia.
Nurses' Notes.
Day 1 1230: A 38-year-old client who has schizophrenia is admitted.
Diagnosed 15 years ago.
Client reports, "I have been hearing voices again telling me to hurt myself.
I hear voices at nighttime so I am not sleeping well.”. Day 1 1730: Vital Signs.
Client consumed 35% of evening meal.
Client appears nervous but reports not hearing voices at this time.
Day 1 1930: Nurse enters client's room.
Client is standing on bed and states, "Do you see that man? He is telling me he is going to hurt me.”. Client pointing to corner of the room.
Client is talking to themselves and states, "I don't want to hurt myself.
Tell the voices to go away!" Nurse asks the client who they are talking to and states, "Tell me more about who is trying to hurt you.”.
Question 4 of 5
The nurse is reviewing the client's medical record.Select the "3" findings that require immediate follow-up by the nurse.
Correct Answer: B,C,D
Rationale: The correct answer is B, C, and D. Hallucinations, delusions, and insomnia are symptoms that indicate a potential mental health issue requiring immediate follow-up. Hallucinations and delusions suggest psychosis, while insomnia may indicate an underlying mental health condition or stress.
Choice A is a common developmental concern, not requiring immediate follow-up.
Choice E, appetite, is less urgent compared to symptoms indicating mental health issues.
Extract:
Question 5 of 5
A nurse on an acute care mental health unit is examining the belongings of a client who is being admitted following a suicide attempt. Which of the following belongings should the nurse ask the client's partner to take back home?
Correct Answer: A
Rationale: The correct answer is A: Necklace. The nurse should ask the client's partner to take back the necklace because it could potentially be used as a means for self-harm or suicide. Necklaces can be easily manipulated to create ligatures for strangulation. Lace-up tennis shoes, nylon socks, and cotton underwear do not pose the same risk as they cannot be easily used for self-harm in a mental health setting. It is essential to remove any items that could pose a danger to the client's safety.