ATI RN
ATI RN Custom NURS 120 Psychiatric Nursing FA23 Exam 2 Questions
Extract:
A nurse in a mental health facility is caring for a client.
Medical History: Antisocial personality disorder.
Substance use disorder.
Nurses' Notes:. 1400: Client admitted to facility by court order for evaluation following arrest for disorderly conduct and resisting arrest.
Client states, "That judge is so stupid.
I don't belong here!" Client has rigid posture, is pacing around the room attempting to intimidate staff and other clients on the unit.
Extra staff members gather.
1500: Client escorted to room.
Client becomes flirtatious with assistant personnel (AP). Client introduced to roommate, whom they ignore.
Continues to flirt with AP. 1800: Client refuses to go to dining room for dinner.
States, "I'm not sitting down with a bunch of nuts.
Question 1 of 5
Bring my food to me!". For each potential nursing action, click to specify if the potential action is anticipated or contraindicated for the client.
| anticipated | contraindicated |
|---|---|
| Use bargaining to improve behavior. | |
| Provide rewards for positive behavior. | |
| Ignore negative behavior. | |
| Maintain a low-stimuli environment. |
Correct Answer:
Rationale: Rewards for positive behavior (
B) and low-stimuli environment (
D) are anticipated for antisocial personality disorder. Bargaining (
A) reinforces manipulation, and ignoring negative behavior (
C) avoids accountability.
Extract:
Question 2 of 5
A nurse is assessing a client who has schizophrenia which has been treated with fluphenazine for several years. Which of the following findings should the nurse document as manifestations of tardive dyskinesia (TD)?
Correct Answer: A
Rationale: Twisting tongue movements are characteristic of tardive dyskinesia. Shuffling gait (
B) is parkinsonism, fever (
C) is NMS, and tapping (
D) is akathisia.
Extract:
A nursing student is looking at a telemetry screen with multiple rhythms. The unit is a step-down cardiac unit with delicate patients. Patients on Census. The unit has:
1. 84-year-old male with AFib, diaphoretic, and complaining of fatigue.
2. 45-year-old female with SVT not responding to adenosine.
3. 78-year-old female with bradycardia who was given atropine and epinephrine, yet unresolved.
4. 80-year-old male in pulseless Ventricular fibrillation being coded and transferred to Intensive Care Unit.
5. 69-year-old female who arrived at the unit symptomatic and currently being coded is pulseless with Ventricular Tachycardia.
Question 3 of 5
The nurse on the step-down unit explains to the nursing student the electricity to be used for each dysrhythmia. Select the correct electricity to be used to manage the dysrhythmias listed:Transcutaneous Pacing, Defibrillation, or Synchronized cardioversion?Dysrhythmias:
| Options | Transcutaneous Pacing | Defibrillation | Synchronized cardioversion |
|---|---|---|---|
| Ventricular fibrillation | |||
| PVC-run ventricular tachycardia with a pulse | |||
| Atrial Flutter | |||
| Bradycardia |
Correct Answer:
Rationale: Ventricular fibrillation: The correct electricity is Defibrillation. Ventricular fibrillation is a life-threatening condition that requires immediate medical attention. Defibrillation is the process of delivering an electric shock to the heart to stop the fibrillation and allow the heart’s normal rhythm to resume4.
PVC-run ventricular tachycardia with a pulse: The correct electricity is Synchronized Cardioversion. This is used when the patient is hemodynamically stable. It involves the delivery of a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle5.
Atrial Flutter: The correct electricity is Synchronized Cardioversion. Atrial flutter is a type of abnormal heart rhythm, or arrhythmia. It can be treated with synchronized cardioversion, in which a controlled electric shock is delivered to the heart to restore normal rhythm5.
Bradycardia: The correct electricity is Transcutaneous Pacing. This is a temporary means of pacing a patient’s heart during a medical emergency. It should be undertaken by healthcare providers who are trained in the procedure5.
So, the correct answer is Defibrillation for Ventricular fibrillation, Synchronized Cardioversion for PVC-run ventricular tachycardia with a pulse and Atrial Flutter, and Transcutaneous Pacing for Bradycardia, after analyzing all choices.
Extract:
Question 4 of 5
A nurse is talking with a client who has schizophrenia. Suddenly the client states, 'I'm frightened. Do you hear that? The voices are telling me to do terrible things.' Which of the following responses by the nurse is appropriate?
Correct Answer: A
Rationale: Asking what the voices say assesses potential danger empathetically. Questioning why (
B), denying voices (
C), or instructing to dismiss them (
D) may invalidate or distress.
Question 5 of 5
Your patient is experiencing extrapyramidal symptoms (EPS) from antipsychotic therapy. You understand that the following medications are used to reverse EPS. (Select All that Apply.)
Correct Answer: A,B,D
Rationale: Benadryl (
A), Artane (
B), and Cogentin (
D) treat EPS. Flumazenil (
C) is for benzodiazepine overdose, and acetylcysteine (E) is for acetaminophen overdose.