ATI RN
ATI RN Mental Health 2023 III Questions
Extract:
Question 1 of 5
A nurse is screening a group of clients for potential mental health conditions. Which of the following questions should the nurse ask to determine a client's risk for self-harm?
Correct Answer: A
Rationale: The correct answer is A: "Have you ever felt you should decrease your consumption of alcohol?" This question assesses the client's potential risk for self-harm by addressing the issue of alcohol consumption, which is a common risk factor for self-harm behaviors. Clients who feel the need to decrease their alcohol intake may be at higher risk for self-harm.
Choice B is incorrect as it focuses on liver damage and not on self-harm risk.
Choice C is irrelevant to self-harm risk assessment.
Choice D addresses family alcohol use but does not directly assess the individual's risk for self-harm. It is important to ask specific questions related to self-harm behaviors to accurately assess the client's risk.
Question 2 of 5
A nurse in a mental health clinic is assessing a client who has borderline personality disorder. Which of the following findings should the nurse expect?
Correct Answer: D
Rationale: The correct answer is D: Intense efforts to avoid abandonment. Individuals with borderline personality disorder often exhibit a fear of abandonment, leading to frantic efforts to avoid real or imagined separation. This can manifest as clingy behavior, extreme emotional reactions to perceived rejection, and difficulty tolerating being alone. This finding is a hallmark of borderline personality disorder and is crucial for the nurse to assess and address in their care plan. The other options are incorrect because individuals with borderline personality disorder may actually have a strong desire for interpersonal relationships, may struggle with impulsivity and unstable sense of self rather than reluctance to discard objects, and may have difficulties with employment due to emotional dysregulation rather than inability to maintain employment.
Question 3 of 5
A nurse is performing screening assessments for active older adult clients at a community clinic. Which of the following tests should the nurse include in the screening?
Correct Answer: B
Rationale: The correct answer is B: Geriatric Depression Scale. This test is essential for screening older adults as depression is common but often overlooked in this population. The Geriatric Depression Scale helps detect symptoms of depression, which can significantly impact the overall health and well-being of older adults. The other choices are not appropriate for screening active older adults. A: CAGE Questionnaire is used for alcohol abuse screening, not depression. C: Denver Developmental Screening Test is for children, not older adults. D: Pain Assessment in Advanced Dementia Scale is specific to assessing pain in dementia patients, not active older adults.
Therefore, the Geriatric Depression Scale is the most relevant choice for screening active older adult clients in a community clinic.
Question 4 of 5
A nurse is reviewing laboratory results of a client who has schizophrenia and is taking risperidone. For which of the following findings should the nurse notify the provider?
Correct Answer: B
Rationale: The correct answer is B: Blood glucose 256 mg/dL (74 to 106 mg/dL). The nurse should notify the provider because this finding indicates hyperglycemia, a potential side effect of risperidone. Risperidone can lead to metabolic changes, including increased blood glucose levels. Hyperglycemia is a serious concern as it can lead to complications such as diabetic ketoacidosis.
Therefore, prompt notification to the provider is crucial for further evaluation and management.
Other choices are within the normal ranges or close to the normal values for WBC count, sodium, and platelets, which do not require immediate provider notification.
Question 5 of 5
A nurse is caring for a client who has major depressive disorder and states that he has given away his personal belongings. Which of the following responses should the nurse make?
Correct Answer: B
Rationale: The correct response is B: Can you tell me how you have been feeling lately? This open-ended question allows the nurse to gather more information about the client's emotional state and assess the severity of the situation. It shows empathy and encourages the client to express their feelings.
Choice A minimizes the client's emotions.
Choice C may come off as judgmental.
Choice D jumps to a solution without addressing the client's current emotional needs.