ATI RN
ATI RN Mental Custom Health Next Gen Questions
Extract:
Question 1 of 5
When developing a plan of care for a client admitted to the psychiatric unit following aspiration of a caustic material related to a suicide attempt, which nursing problem has the highest priority?
Correct Answer: C
Rationale: The correct answer is C: Ineffective breathing pattern. This is the highest priority because aspiration of a caustic material can lead to respiratory distress or compromise. Ensuring the client has a patent airway and adequate breathing is crucial for immediate stabilization and preventing further complications. Impaired comfort (choice
A) may be a concern but is secondary to ensuring the client can breathe. Risk for injury (choice
B) is important but not as immediate as addressing breathing. Ineffective coping (choice
D) is important for long-term recovery but addressing the client's breathing takes precedence in this acute situation.
Question 2 of 5
A female client on a psychiatric unit is sweating profusely while she vigorously does push-ups and then runs the length of the corridor several times before crashing into furniture in the sitting room. Picking herself up, she begins to verbally attack other clients. What intervention is most appropriate for the RN to use to manage the client’s behavior?
Correct Answer: A
Rationale: The correct answer is A: Assist the client to a safe area to avoid injury. This intervention is most appropriate because the client is engaging in potentially harmful behaviors such as vigorous physical activity and verbal aggression. By moving the client to a safe area, the nurse can prevent the client from causing harm to themselves or others. It is essential to prioritize physical safety in situations like this.
Option B, establishing clear and firm limits, may not be effective in the moment when the client is in an agitated state and may not respond well to verbal directives. Option C, offering medication, should not be the first response as it may not address the immediate safety concerns. Option D, speaking calmly, may not be enough to de-escalate the situation when the client is in a heightened state of agitation.
Overall, ensuring the physical safety of the client and others is the priority in this scenario, making option A the most appropriate intervention.
Question 3 of 5
An RN is providing education to the family of a client diagnosed with schizophrenia who is being treated with clozapine (Clozaril). The RN should instruct the family to report which symptom immediately?
Correct Answer: A
Rationale: The correct answer is A: Sore throat. Clozapine can cause agranulocytosis, a potentially life-threatening condition characterized by a decrease in white blood cells. Sore throat could indicate an infection, necessitating immediate medical attention to monitor for agranulocytosis. Weight loss (
B) and constipation (
C) are common side effects of clozapine but do not require immediate reporting. Lightheadedness (
D) may be a side effect but not as urgent as a sore throat in this case.
Question 4 of 5
A client with obsessive-compulsive disorder (OCD) repeatedly checks to see if the door is locked and asks for reassurance that it is locked. What is the most appropriate intervention by the RN to address this behavior?
Correct Answer: A
Rationale: The correct answer is A: Set a specific limit on the number of times the client can check the door. This intervention helps establish boundaries and structure for the client, which can assist in reducing compulsive behaviors. By setting a specific limit, the client is encouraged to gradually decrease the checking behavior and learn to cope with the anxiety associated with uncertainty. This approach promotes independence and empowerment for the client.
Choice B is incorrect because finding an alternative activity does not directly address the obsessive checking behavior.
Choice C is incorrect as providing consistent reassurance reinforces the compulsive behavior.
Choice D is incorrect because ignoring the behavior does not actively address or help decrease the compulsive checking.
Question 5 of 5
A client with an eating disorder tells the RN, "I’ve been eating only 400 calories per day and have been taking diuretics to lose weight.” What is the RN’s best response?
Correct Answer: D
Rationale: The correct response is D: “The diuretics could be causing your body to lose essential nutrients.” This response addresses both the client’s low-calorie diet and the use of diuretics, highlighting the potential harm caused by the diuretics in depleting essential nutrients from the body. By focusing on the specific issue of nutrient loss, the nurse can educate the client on the dangers of using diuretics for weight loss and encourage seeking professional help. Options A, B, and C do not address the potential harm of diuretics and may not adequately address the severity of the situation. Option C is more general and may not directly address the issue of nutrient loss.