ATI LPN
LPN Custom Mental Health Questions
Extract:
Question 1 of 5
A nurse is reinforcing teaching with a client who takes diazepam (Valium). Which of the following information should the nurse include?
Correct Answer: C
Rationale: A single dose of diazepam is unlikely to cause side effects' is not accurate. Diazepam, like any medication, can have side effects even with a single dose. Common side effects include drowsiness, dizziness, and muscle weakness. 'Grapefruit juice inactivates this medication' is not specifically true for diazepam. However, grapefruit juice can interact with certain medications by inhibiting their metabolism in the liver, leading to increased levels of the drug in the bloodstream. It's essential to check for specific drug interactions, but this statement is not a key consideration for diazepam. 'Diazepam can cause drowsiness' is an important piece of information to include because diazepam is a benzodiazepine medication that can have sedative effects. Alerting the client to the potential for drowsiness is crucial to prevent any safety issues, such as falls or accidents. 'Avoid foods that contain tyramine' is not relevant to diazepam. Tyramine is associated with certain foods and can be a concern with medications called monoamine oxidase inhibitors (MAOIs). Diazepam is not an MAOI, so this advice does not apply to its use.
Question 2 of 5
A nurse is assisting with the court-ordered admission of a client to a substance-abuse program. The client states, 'You are all angry at me and wish you could go out and have a drink.' The client's response is an example of which of the following defense mechanisms?
Correct Answer: C
Rationale: Identification: Identification involves taking on the characteristics of another person, group, or entity. The client's response is not an example of identification. Relation-formation: This term is not a recognized defense mechanism in the context of classical psychoanalytic theory. It seems to be a combination of two concepts but doesn't fit the context of the client's statement. Projection: Projection is a defense mechanism where an individual attributes their own unacceptable thoughts, feelings, or impulses to another person. In this scenario, the client is projecting their own feelings of anger and a desire to have a drink onto the nurse and others, suggesting that the staff is angry at them and wants to go out for a drink. Compensation: Compensation involves making up for a perceived weakness by emphasizing a strength in another area. The client's statement do[es not fit this description].
Question 3 of 5
A nurse is conducting a home health visit for an older adult client who lives with family members. The nurse notices that the client has multiple unusual bruises, and, based on several other factors, the nurse suspects that the client has been physically abused. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: Checking the bruises at the next visit may delay necessary intervention. If abuse is suspected, immediate action, such as reporting, is essential to protect the client. Following the agency's guidelines for reporting suspected abuse is the priority when abuse is suspected. Reporting abuse to the appropriate authorities, such as adult protective services or law enforcement, is crucial to ensure the safety and well-being of the older adult. Instituting more frequent visits to the client's home might be part of a safety plan, but it should not be the first action. Reporting suspected abuse is the priority to involve the appropriate authorities. Arranging a referral for family therapy is not the first step in suspected elder abuse. Safety and protection of the older adult take precedence. Once the immediate safety concerns are addressed, additional interventions, such as family therapy, may be considered.
Question 4 of 5
A nurse is caring for a client who is threatening to commit suicide, which of the following questions should the nurse ask?
Correct Answer: D
Rationale: What happened to you in the past to make you so desperate?' may be seen as judgmental and may not be as helpful in the immediate crisis. It assumes a specific cause for the desperation and might not address the current feelings or circumstances that are contributing to the suicidal thoughts. 'What will you accomplish by taking your life?' This question may be perceived as confrontational or dismissive of the client's feelings. It might not provide a clear understanding of the immediate risk or plan. 'Why do you feel depressed enough to end your life?' is a direct question that may put pressure on the client and might not be as effective in exploring their thoughts and feelings. It assumes a direct link between depression and suicidal thoughts without allowing for a more nuanced exploration. 'How will you carry out your plan?' This question is crucial because it helps assess the seriousness of the client's intent and the immediacy of the risk. Understanding the specifics of the plan can help the nurse evaluate the level of danger and take appropriate actions to ensure the client's safety.
Question 5 of 5
A nurse overhears a client who has schizophrenia talking to herself. The client keeps stating 'The muxtranks are coming. The muntranks are coming.' The nurse correctly recognizes the client's use of the word mazuka as an example of which of the following alterations in speech?
Correct Answer: A
Rationale: Neologism. Neologism is a language disturbance in which the individual creates new, idiosyncratic words that have meaning only to the individual. In this case, the client's use of 'mazuka' is an example of a neologism as it is a made-up word that holds significance only for the client. Clang association involves the association of words based on sound rather than meaning. Echolalia is the repetition of words or phrases spoken by others. Word salad refers to a jumble of words and phrases that lack coherent meaning or logical connection.