ATI RN
ATI RN Mental Health 2023 Questions
Extract:
Question 1 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, D, E
Rationale:
Correct Answer: B, C, D, E
Rationale:
B: Putting locks at the top of doors can prevent the client from wandering at night, reducing the risk of falls.
C: Encouraging physical activity prior to bedtime can help the client feel more tired and improve sleep quality, potentially reducing wandering behavior.
D: Positioning the mattress on the floor can decrease the risk of injury from falls if the client does wander during the night.
E: Installing sensor devices on outside doors can alert the caregiver if the client tries to leave the house, allowing for immediate intervention.
Incorrect
Choices:
A: Placing the client in a reclining chair may not address the underlying issue of wandering and falls, and it may not be a safe or comfortable option for the client.
F:
G:
Question 2 of 5
A nurse in an acute care facility is planning care for a client who has a history of alcohol use disorder and is admitted while intoxicated. Which of the following interventions should the nurse plan for the client?
Correct Answer: D
Rationale: Methadone hydrochloride is not indicated for the management of alcohol intoxication or withdrawal. It is primarily used for opioid addiction treatment. While monitoring for orthostatic hypotension is important in clients with alcohol use disorder, implementing seizure precautions is a higher priority because alcohol withdrawal can lead to seizures. Acidifying the client's urine is not indicated in the care of an intoxicated client with alcohol use disorder. Implementing seizure precautions is essential in clients with alcohol use disorder who are at risk for alcohol withdrawal syndrome, which can include seizures as a potential complication.
Question 3 of 5
A nurse is beginning a therapeutic relationship with a client. The nurse should plan to accomplish which of the following tasks during the working phase?
Correct Answer: D
Rationale: Informing the client about confidentiality rights typically occurs during the orientation phase of the therapeutic relationship, not the working phase. Establishing boundaries between the nurse and the client is an ongoing process that occurs throughout the therapeutic relationship, not just during the working phase. Setting short- and long-term objectives for the future typically occurs during the orientation phase and continues throughout the therapeutic relationship, not just during the working phase. During the working phase of the therapeutic relationship, the nurse and client collaborate to achieve the goals identified during the orientation phase. The nurse evaluates the client's progress toward these goals and adjusts interventions as necessary to promote therapeutic outcomes.
Question 4 of 5
A nurse is caring for a client who has a new diagnosis of metastatic lung cancer. The client states, 'I can't think about that until after my first grandchild is born next week.' The nurse should identify the client's statement as indicating the maladaptive use of which of the following defense mechanisms?
Correct Answer: D
Rationale: The correct answer is D: Suppression. The client is consciously avoiding thinking about their cancer diagnosis by focusing on the upcoming birth of their grandchild. Suppression involves pushing unwanted thoughts or feelings out of one's consciousness. Compensation (
A) is making up for a perceived weakness by emphasizing a strength. Sublimation (
B) is channeling unacceptable impulses into socially acceptable activities. Regression (
C) is reverting to an earlier stage of development. In this scenario, the client is not displaying any of these defense mechanisms, but rather using suppression to temporarily avoid dealing with their diagnosis.
Question 5 of 5
A nurse is talking to a client following a group therapy session. The client tells the nurse that one of the other clients in the group made an inappropriate comment. Which of the following responses should the nurse make?
Correct Answer: B
Rationale:
Correct Answer: B
Rationale: Option B, "You sound upset about today's session," is the most appropriate response because it acknowledges the client's feelings without dismissing or minimizing them. By reflecting the client's emotions, the nurse demonstrates empathy and validates the client's experience. This response opens up a space for the client to express their feelings further and facilitates a therapeutic dialogue.
Incorrect
Choices:
A: Asking "Why do you think that he said that to you?" places the focus on the client's interpretation rather than validating their emotions.
C: "I think you should ignore the comment" dismisses the client's feelings and does not address the impact of the inappropriate comment.
D: "I agree that the comment was inappropriate" does not address the client's emotional state and may come off as insincere.