ATI RN
ATI RN Mental Health 2023 with NGN Questions
Extract:
Medical History
The client was diagnosed with obsessive-compulsive disorder 4 years ago.
Nurses’ Notes
Day 1 of admission at 1300:
The client is withdrawn, exhibits a flat affect, and makes limited eye contact with others. The client’s clothing is dirty and body odor is noted. The client reports sleeping 2 to 3 hours per night and losing 5.4 kg (12 lb) in the last month. The client also reports handwashing for several minutes multiple times per day. The client’s hands are noted to be red, but the skin is intact. The client is constantly folding and unfolding a small piece of paper during conversation. The client refuses to leave the room or eat lunch and declines the offer to watch a movie in the day room with peers. The client also declines the offer to take a shower at this time.
Day 3 of admission at 1835:
The client showered this morning without prompting. The client ate 75% of lunch and dinner in the day room with peers. The client’s hands remain reddened with a 1 cm x 1 cm area of peeling skin noted on the center of the right palm. The client’s affect rapidly changed throughout the afternoon and early evening; the client is now talkative and appears content. The client was overheard speaking to their sibling on the phone a few minutes ago, telling their sibling they could have the client’s car.
Provider Prescriptions
Day 1 of admission: Fluvoxamine 100 mg PO at bedtime Buspirone 10 mg PO twice daily Paroxetine 20 mg PO daily
Question 1 of 5
A nurse on an inpatient mental health unit is caring for a client.Exhibits:The nurse is discussing the assessment findings on day 3 of admission during the 1900 change of-shift report. For each finding, specify whether the finding indicates potential improvement in or worsening of the client’s condition.
| Options | Indicates potential improvement | Indicates potential worsening |
|---|---|---|
| Giving away car | ||
| Hygiene | ||
| Food intake | ||
| Condition of skin on right hand | ||
| Rapid change in mood |
Correct Answer:
Rationale: Giving away car (
A) suggests worsening (suicidal risk), hygiene (
B) and food intake (
C) improve (showering, eating 75%), skin (
D) worsens (excessive washing), mood change (E) improves (content, talkative).
Extract:
Question 2 of 5
A nurse is providing teaching about relapse prevention to a client who has schizophrenia. Which of the following statements by the client indicates an understanding of the teaching?
Correct Answer: B
Rationale: Reporting sleep issues to a counselor shows understanding, as it’s an early relapse sign. Avoiding TV isn’t key, listening to voices reinforces them, and isolation worsens symptoms.
Extract:
2045
• X-ray of left wrist
• Hydrocodone 2.5 mg/acetaminophen 325 mg, 2 tablets PO now
2345:
• Discharge to home.
• Follow-up with orthopedist, their office will call tomorrow.
• Keep left arm elevated with splint on.
• Ice left wrist per written instructions provided.
• Ibuprofen 800 mg PO every 8 hr PRN pain
Medical History
• Premenstrual dysphoric disorder
• No known allergies
Physical Examination 2030
• Left wrist injury and edema
• Finger-shaped bruises on the left forearm
• Reports pain with movement of left wrist and hand as 8 on a 0 to 10 pain scale, and pain as 6 at rest. Grimacing and tearfulness noted with movement. Fingers warm with capillary refill less than 2 seconds.
2145:
• Reports left wrist pain as 6 with movement and as 4 at rest on a 0 to 10 pain scale.
Nurses’ Notes 2030
• Client presents for evaluation of left wrist injury reportedly following an incident of partner violence. The client states their partner had been drinking heavily prior to the physical altercation. The client reports the partner roughly grabbed their left arm while yelling loudly in their face. The client was able to free their arm and was walking to their car to leave when the partner aggressively pushed the client from behind. The client fell forward, using both arms to brace their fall. The client states the partner saw their wrist injury and began crying and apologizing, promising to never drink again. The client states, “I’ve heard that promise so many times, but they’ve never cried before, so I think it is sincere this time.”
• Left arm elevated on 2 pillows. Ice pack applied to left wrist.
2045:
• Provider in to see client. Prescriptions received.
2145:
• Client returned to room from radiology department via wheelchair. Left arm elevated and ice pack reapplied. A law enforcement officer in to talk with client after receiving a 911 call from the client’s neighbor who witnessed the physical altercation.
2330:
• Client declines to press charges against partner, per report of law enforcement officer. The client agreed to a social services referral, appointment scheduled for tomorrow. Discussed safety plan with client and the client reports having an envelope of important papers already hidden at home. Also provided the client with the phone numbers for the local crisis hotline and safe house. The client is receptive to information but states, “I need to work on my relationship a while longer. I really think things will get better this time.”
Question 3 of 5
A nurse in an emergency department is caring for a client who recently experienced partner violence.Exhibits:The nurse is reviewing the client’s medical record at discharge. For each finding, specify whether the finding indicates a potential improvement in or a worsening of the client’s physical or psychological status.
| Options | Indicates potential improvement | Indicates potential worsening |
|---|---|---|
| Client states that the partner will not be violent in the future. | ||
| Client agrees to an appointment with a social worker. | ||
| Client's reported pain level of the left wrist. | ||
| Client requests help developing a safety plan. | ||
| Client claims responsibility for the physical altercation. |
Correct Answer:
Rationale: Denial of future violence (
A) worsens psychologically, social worker (
B) and safety plan (
D) improve, less pain (
C) improves physically, blaming self (E) worsens.
Extract:
Question 4 of 5
A nurse in a mental health facility is caring for a client who is being aggressive toward other clients. Which of the following actions is the priority for the nurse to take?
Correct Answer: C
Rationale: Asking about intent to harm assesses immediate safety risks, the priority in aggression. Stress reduction, role modeling, and lists are secondary.
Question 5 of 5
A nurse is caring for a client who is receiving end-of-life care. The client states, 'The nurses here don’t do a good job caring for me.' Which of the following responses should the nurse make?
Correct Answer: D
Rationale: Asking for more detail shows empathy and gathers info to improve care. Family talk avoids the issue, grieving labels dismissively, and reassurance doesn’t address concerns.