Extract:

Client has dementia and exhibits aphasia; Client has bipolar disorder and displays constant pacing; Client has schizophrenia and uses neologisms; Client has depressive disorder and has poor personal hygiene.

Question 1 of 5

A nurse on an acute mental health unit is assessing four clients. Which of the following clients is the highest priority?

A. A client who has dementia and exhibits aphasiaB. A client who has bipolar disorder and displays constant pacingC. A client who has schizophrenia and uses neologismsD. A client who has depressive disorder and has poor personal hygiene

Correct Answer: B

Rationale: Constant pacing in bipolar disorder indicates potential agitation, which could escalate to harm, making this client the highest priority.

Extract:

Client expresses concern about purse theft during surgery.

Question 2 of 5

A nurse is preparing a client for surgery. The client expresses concern that someone might steal her purse during the procedure. Which of the following actions should the nurse take?

A. Offer to store the purse at the nurses' station.B. Tell the client to leave her purse in a drawer of the bedside table.C. Place the purse in the clothing bag with the client's other belongings.D. Offer to place the purse in the facility safe.

Correct Answer: D

Rationale: Storing the purse in the facility safe provides the highest security, addressing the client's concern effectively.

Extract:

Client's condition discussed at nurses' station with visitor present; AP informing friend about client's condition.

Question 3 of 5

A charge nurse is observing the staff on the unit. Which of the following situations should the charge nurse identify as a breach of confidentiality? (Select all that apply.)

A. A nurse and a provider are discussing a client's condition at the nurses' station while a visitor is present.B. An assistive personnel logs out of the computer prior to responding to a call light.C. A nurse is reviewing an electronic list of all clients admitted to the unit.D. A nurse is faxing data about a client to a referred provider.E. An assistive personnel is informing a friend of the client about their condition.

Correct Answer: A,E

Rationale: Discussing a client's condition in a public area and sharing information with unauthorized individuals violate confidentiality.

Extract:

Question 4 of 5

A nurse is serving on a committee whose task is to plan cost-effective care at the facility. Which of the following client care tasks should the nurse recommend?

A. Change peripheral IV primary tubing every 96 hr.B. Replace peripheral IV solution bags every 96 hr.C. Replace total parenteral nutrition solution bags every 48 hr.D. Change total parenteral nutrition IV tubing every 48 hr.

Correct Answer: A

Rationale: Changing IV tubing every 96 hours balances infection prevention with cost-effectiveness, aligning with standard practice.

Extract:

Client admitted earlier that day, refuses two medications stating, 'I've never taken these before.'

Question 5 of 5

A nurse in a rehabilitation facility is administering medications to a client who was admitted earlier that day. The client refuses two of the medications, stating, 'I've never taken these before.' Which of the following actions should the nurse take first?

A. Consult the pharmacist about the client's prescribed medications.B. Call the provider to clarify the client's prescribed medications.C. Compare the client's medication administration record with the prescriptions on the transfer orders.D. Review the intended purpose of the prescribed medications with the client.

Correct Answer: C

Rationale: Comparing the medication record with transfer orders identifies discrepancies, ensuring safety before proceeding.

Nurselytic

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ATI RN Leadership 2023 Exam 2 Questions

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