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Ati rn mental health 2023 retake 1
Total Questions : 71
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25-year-old client admitted with positive symptoms of schizophrenia. Client has a history of substance use, anxiety, and depression. Client demonstrates alterations in speech and persecutory delusions. Client states that they hear voices that are warning them of danger and that they should stay away from a coworker because the coworker is conspiring against them.
Day 5-Discharge:
No delusions or hallucinations noted. Speech is clear and coherent. Client has a well-groomed appearance. Group and individual therapy attended daily.
Haloperidol 3 mg PO twice daily
A nurse is caring for a client who has schizophrenia and is preparing for discharge.
The nurse is providing discharge teaching to the client. Which of the following information should the nurse include when educating the client about relapse prevention? Select all that apply.
A nurse is caring for a client who has cocaine use disorder. Which of the following manifestations should the nurse expect the client to have during withdrawal?
1400:
34-year-old client admitted to the emergency department with contusions to the face, arms, and abdomen. Lacerations noted on the cheek and left shoulder.
1500:
Bruises noted in various stages of healing to the face, bilateral arms, and abdomen. Client grimaces and moans with movement. Laceration to the left cheek cleansed and covered with an adhesive bandage. Left shoulder cleansed, antiseptic ointment applied, and covered with gauze dressing. States, "I fell getting out of the shower and scraped my face and shoulder on the bathroom counter. I tried to catch myself when I fell and that is how I fractured my arm." Client is very tearful, does not make eye contact, and only speaks when spoken to. Client requests not to notify their partner because they do not want them to have to miss work or worry.
X-ray: Spiral fracture to the left arm
A nurse is caring for a client who is in the emergency department.
The nurse is preparing to use a standardized screening tool to assess the client for partner violence. Click to highlight the actions the nurse should take during the assessment. To deselect an action, click on the action again.
Interview the client with another nurse present.
Ask questions in different ways until the client provides an answer.
Ask the client if they have been hit, slapped, or kicked within the past year.
Refrain from asking the client if they are afraid of their partner.
Ask the client to clarify the circumstances of their injuries.
Assure the client that their medical team feels sympathy for their injuries and disapproval for the person responsible for inflicting them.
Inform the client that they should have fought back.
Discuss with the client the factors that precipitate violence.
Explanation
Rationale for correct choices:
- Ask the client if they have been hit, slapped, or kicked within the past year: This question is specific and nonjudgmental, helping the client disclose abusive behaviors without feeling pressured. It's important for identifying signs of abuse that may not be immediately obvious.
- Ask the client to clarify the circumstances of their injuries: Clarifying the circumstances of the injuries helps the nurse assess the situation and detect any discrepancies in the explanation that may suggest abuse. It can also guide the next steps in care and safety planning.
- Discuss with the client the factors that precipitate violence: Identifying triggers and patterns of violence empowers the client to recognize and avoid dangerous situations, and to plan for their safety moving forward.
Rationale for incorrect choices:
- Interview the client with another nurse present: The primary goal during is to establish a private and trusting environment where the client feels safe to disclose. The presence of another person can make a client feel less comfortable and less likely to speak openly about sensitive issues like intimate partner violence.
- Ask questions in different ways until the client provides an answer: Repeating or rephrasing questions multiple times could make the client feel pressured or coerced, which may hinder trust and open communication. It’s important to respect their pace and comfort level.
- Refrain from asking the client if they are afraid of their partner: Fear of the partner is a crucial indicator of abuse, and not asking about it may prevent the client from disclosing important information. Acknowledging fear helps assess the level of risk and urgency.
- Assure the client that their medical team feels sympathy for their injuries and disapproval for the person responsible for inflicting them: While empathy is important, making value judgments about the abuser can undermine the client's trust, making them feel judged or unsupported in their decisions.
- Inform the client that they should have fought back: Telling the client what they "should have done" may inadvertently place blame on them and discourage further disclosures. It’s vital to maintain a supportive, nonjudgmental stance to ensure the client feels safe.
A nurse is reviewing the medical records for a group of clients prior to administering the clients' medications. For which of the following clients should the nurse withhold the prescribed medication and notify the provider?
A nurse in an inpatient mental health facility is caring for a client who is showing indications of becoming violent. Which of the following actions should the nurse take?
A nurse is discussing with a newly licensed nurse the mental health resources available to meet the needs of a client who has schizoaffective disorder, no transportation, and lives at home with their parents. Which of the following resources should the nurse identify as meeting the needs for the client?
A nurse is assisting a provider in obtaining informed consent from a client who has depressive disorder and is scheduled to have electroconvulsive therapy (ECT). The signature of the nurse on the consent form indicates which of the following?
A nurse is caring for a client who refuses to attend group therapy. Which of the following statements should the nurse make?
A nurse is preparing to administer methylphenidate 25 mg PO to a school-age child who has ADHD. Available is methylphenidate 10 mg/5 mL liquid. How many ml should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero)
Explanation
Desired dose = 25 mg.
Available concentration = 10 mg / 5 mL.
- Calculate the volume to administer.
Volume (mL) = Desired dose (mg) / (Available concentration (mg) / Available volume (mL))
= 25 mg / (10 mg / 5 mL)
= 25 mg × (5 mL / 10 mg)
= (25 × 5) / 10 mL
= 125 / 10 mL
= 12.5 mL.
A nurse is caring for a client who has a substance use disorder. The client states. "The state took my child away after my overdose. I don't want to go on living without them." Which of the following therapeutic responses should the nurse make?
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