ATI RN
ATI RN Mental Custom Health Next Gen Questions
Extract:
Question 1 of 5
The nurse is using the CAGE questionnaires as a screening tool for a client who is seeking help because his wife said he had a drinking problem. What information should the nurse explore in-depth with the client based on this screening tool?
Correct Answer: D
Rationale: The correct answer is D. The CAGE questionnaire is a screening tool used to identify alcohol abuse. Each letter in CAGE stands for a key question: "Cut down," "Annoyed by criticism," "Guilty feelings," and "Eye-opener." These questions help assess the client's alcohol-related behaviors and attitudes. Exploring the client's efforts to cut down on drinking indicates acknowledgment of a potential issue. Annoyance with questions may suggest defensiveness or denial. Feelings of guilt can indicate internal conflict about drinking, and using alcohol as an "Eye-opener" can signal dependence.
Therefore, delving into these specific areas can provide valuable insights into the client's alcohol use patterns and potential problems.
Choices A, B, and C are incorrect as they do not align with the purpose of the CAGE questionnaire in identifying alcohol abuse behaviors and attitudes.
Question 2 of 5
A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?
Correct Answer: A
Rationale: The correct answer is A: Place in a side-lying position with head of bed elevated. This is the priority intervention because the client is difficult to arouse, indicating potential risk for airway compromise and aspiration due to the head injury and elevated BAL. Placing the client in a side-lying position with the head of the bed elevated helps prevent aspiration and promotes optimal airway management. Administering disulfiram (choice
B) is not indicated as the priority intervention in this acute situation. Giving lorazepam (choice
C) for signs of withdrawal may further depress the client's level of consciousness and is not the priority at this time. Providing thiamine and folate supplements (choice
D) is important for alcohol-related deficiencies but does not address the immediate risk of airway compromise.
Question 3 of 5
The nurse leading a group session of adolescent clients gives the members a handout about anger management. One of the male clients is fidgety, interrupts peers when they try to talk, and talks about his pets at home. What nursing action is best for the nurse to take?
Correct Answer: D
Rationale: The correct answer is D: Redirect him by encouraging him to read from the handout. This option addresses the client's behavior by redirecting his focus back to the group activity. By encouraging him to read from the handout, the nurse provides a constructive way for the client to engage with the material and participate in the session. This approach helps the client stay on track with the intended purpose of the group session, which is anger management.
Other choices are incorrect:
A: Giving the client permission to leave may reinforce disruptive behavior.
B: Exploring the client's feelings about his pets may not address the immediate issue of his behavior.
C: Involving peers may not effectively address the client's disruptive behavior.
Overall, option D is the most appropriate as it directly addresses the client's behavior and redirects him in a positive way.
Question 4 of 5
The nurse is preparing medications for a client with bipolar disorder and notices that the antipsychotic medication was discontinued several days ago. Which medication should also be discontinued?
Correct Answer: B
Rationale: The correct answer is B: Benztropine (Cogentin). Benztropine is a medication commonly used to treat extrapyramidal side effects caused by antipsychotic medications. If the antipsychotic medication is discontinued, there is no longer a need for Benztropine. Alprazolam (
A) is used to treat anxiety and should not be automatically discontinued. Magnesium (
C) is a laxative and unrelated to bipolar disorder treatment. Lithium (
D) is a mood stabilizer commonly used in bipolar disorder treatment and should not be discontinued without a healthcare provider's guidance.
Question 5 of 5
A male client is admitted to the psychiatric unit for recurrent negative symptoms of chronic schizophrenia and medication adjustment of risperidone (Risperdal). When the client walks to the nurse’s station in a laterally contracted position, he states that something has made his body contort into a monster. What action should the nurse take?
Correct Answer: C
Rationale: The correct action is to administer the prescribed anticholinergic benztropine (Cogentin) for dystonia. Dystonia is a side effect of antipsychotic medications like risperidone and can present as abnormal muscle contractions or postures. Benztropine is commonly used to manage dystonia by blocking excess acetylcholine in the brain. This helps to alleviate the muscle spasms and contractions that the client is experiencing. Mediating with thioridazine may not be appropriate as it is not the prescribed medication and may not effectively address the dystonia. Offering a hot pack for muscle spasms might provide temporary relief but does not address the underlying cause of dystonia. Directing the client to occupational therapy or distracting him may not effectively manage the dystonia symptoms. Administering benztropine is the most appropriate action to address the client's physical symptoms and improve his comfort and well-being.