ATI RN
ATI Mental Health assessment Questions
Extract:
Question 1 of 5
A nurse is reviewing the medical records of a group of clients. For which of the following clients should the nurse implement seizure precautions?
Correct Answer: B
Rationale: The correct answer is B: A client who is experiencing withdrawal from diazepam. Benzodiazepine withdrawal can lead to seizures due to the sudden decrease in GABA neurotransmission. Seizure precautions are necessary to ensure the safety of the client.
Incorrect
Choices:
A: Withdrawal from oxycodone does not typically lead to seizures.
C: A low lithium level does not necessarily indicate an imminent risk of seizures.
D: A low imipramine level is not associated with a high risk of seizures.
Question 2 of 5
A nurse is creating a plan of care for a newly admitted client who has obsessive-compulsive disorder. Which of the following interventions should the nurse include?
Correct Answer: C
Rationale: The correct answer is C: Provide the client with a structured schedule of daily activities. This is important for clients with obsessive-compulsive disorder as it helps establish predictability and routine, which can reduce anxiety and provide a sense of control. Structured activities can help the client focus their energy and attention away from obsessive thoughts and compulsive behaviors.
Other choices are incorrect:
A: Using detailed explanations may overwhelm the client with OCD and contribute to increased anxiety.
B: Maintaining a stimulating environment may exacerbate symptoms by increasing distractions and potential triggers.
D: Limiting time for rituals can be too restrictive and may lead to increased anxiety and distress for the client.
Question 3 of 5
A nurse is caring for a 4-year-old child who has autism spectrum disorder. Which of the following behaviors should the nurse expect? (Select all that apply.)
Correct Answer: A,C,D
Rationale: The correct behaviors to expect in a child with autism spectrum disorder are lack of eye contact, constant spinning of a toy, and withdrawal from physical contact. Lack of eye contact is a common characteristic in individuals with autism, as they may have difficulty with social interactions. Constant spinning of a toy is a repetitive behavior often seen in children with autism as a way to self-soothe or seek sensory stimulation. Withdrawal from physical contact can occur due to sensory sensitivities or difficulty with communication. Inability to play quietly (choice
B) is not a specific behavior associated with autism. The child may have difficulty with social interactions, but this does not necessarily result in inability to play quietly.
Question 4 of 5
A nurse is caring for a client who has become violent and is threatening self-harm following a crisis. After ensuring enough staff are available,which of the following actions should the nurse take first?
Correct Answer: C
Rationale: The correct answer is C: Acknowledge the client's emotions. This is the first action the nurse should take because it helps establish rapport and build trust with the client in a crisis situation. Acknowledging the client's emotions shows empathy and validates their feelings, which can help de-escalate the situation. Administering a sedative (choice
A) should not be the first action as it may escalate the client's aggression. Performing a debriefing (choice
B) can wait until the immediate crisis is under control. Placing the client in restraints (choice
D) should be a last resort and only used when the client or others are in immediate danger.
Question 5 of 5
A nurse is admitting a client who has borderline personality disorder and is at risk for self-mutilation. Which of the following interventions should the nurse incorporate in the plan of care?
Correct Answer: C
Rationale: The correct answer is C: Obtain a verbal contract from the client. This intervention involves having the client verbally agree not to engage in self-mutilation. This approach promotes client autonomy and responsibility for their actions, fostering a sense of control and empowerment. It also encourages open communication between the client and healthcare team, enhancing trust and collaboration. Providing additional attention (choice
A) may reinforce maladaptive behaviors in clients with borderline personality disorder. Applying mechanical restraints (choice
B) should be a last resort due to its restrictive and potentially traumatic nature. Limiting staff members (choice
D) may impede the client's access to necessary care and support.