ATI LPN
ATI LPN Mental Health Exam IV Questions
Extract:
Question 1 of 5
A nurse recognizes unexplained fussiness and irritability in an infant, as well as unexplained injuries. The nurse should suspect which of the following?
Correct Answer: D
Rationale: Sexual abuse: While sexual abuse can cause physical and emotional symptoms, the combination of unexplained injuries and fussiness/irritability is more suggestive of physical trauma. Neglect: Neglect involves failure to provide for the child's basic needs, which can lead to developmental issues, but is less likely to cause unexplained injuries. Munchausen syndrome by proxy: Munchausen syndrome by proxy involves a caregiver fabricating or inducing illness in a child for attention. It can cause unexplained injuries, but the focus is more on medical symptoms. Shaken baby syndrome: Shaken baby syndrome results from violently shaking an infant, leading to physical injuries, irritability, and fussiness. It fits the description of unexplained injuries and behavioral changes.
Question 2 of 5
A 46-year-old African American man is in an outpatient clinic for a physical examination. His blood pressure (BP) is 126 mm Hg, his body mass index (BMI) is 24, and he reports no previous medical problems. Which of the following actions should the nurse take?
Correct Answer: D
Rationale: African American men have a higher prostate cancer risk, with screening (PSA test) recommended from age 45. BP of 126 mm Hg is normal (<120/80 mm Hg), and BMI 24 is healthy (18.5–24.9), so annual visits, weight loss, or hypertension advice aren’t urgent. PSA screening aligns with age and risk profile.
Question 3 of 5
A nurse is sitting in the day room at an acute care mental health facility with a group of clients who are watching television. Suddenly one of the client's jumps up screaming and runs out of the room. Which of the following actions should the nurse take?
Correct Answer: C
Rationale: Ignore the incident since it is an attention-seeking behavior: Ignoring the incident is not appropriate because the client may be in distress or at risk of harm. Stay with the group and ask another client to go and check on the situation: Asking another client to check on the situation is not appropriate, as it is the nurse's responsibility to ensure the safety of all clients. Follow the client to determine the cause of the behavior: Following the client allows the nurse to assess and intervene appropriately to ensure the client's safety and address the cause of the behavior. Ask the group what they think about the client's behavior: Discussing the behavior with the group is not appropriate in an emergency situation and does not address the immediate needs of the distressed client.
Question 4 of 5
A nurse is reinforcing teaching with a young adult female client who has been prescribed lisinopril. Which of the following instructions should the nurse plan to include? (Select all that apply)
Correct Answer: B, D, E
Rationale: Lisinopril, an ACE inhibitor, requires specific instructions:
B) Pregnancy is a contraindication due to fetal harm risk, necessitating immediate notification.
D) A persistent dry cough is a common side effect due to bradykinin buildup, requiring reporting. E) Blood pressure monitoring is essential to assess efficacy.
A) Cholesterol monitoring isn’t directly tied to lisinopril, which targets blood pressure, not lipids.
C) Potassium-rich foods should be moderated, not increased, due to hyperkalemia risk with ACE inhibitors.
Question 5 of 5
A nurse is assisting with teaching a class about documenting blood pressure. The nurse should include documenting which of the following information?
Correct Answer: B, C, E
Rationale: Documenting interventions (
B), patient response (
C), and site (E) ensures care continuity and accuracy (e.g., arm vs. leg affects readings). Frequency (
A) and person (
D) are useful but less critical for immediate clinical decisions. B, C, E are essential per nursing standards.