ATI RN Mental Health
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Free ATI RN Mental Health Questions
A nurse is planning care for a client who has acute delirium. Which of the following instructions should the nurse include in the plan?
- A. Reinforce the client’s orientation with a calendar.
- B. Assign the client to a different caregiver each shift.
- C. Teach the client assertive techniques.
- D. Refute the client’s perception of visual hallucinations.
Explanation
Explanation
Correct Answer: A. Reinforce the client’s orientation with a calendar.Clients with acute delirium experience sudden disturbances in attention, awareness, and cognition. Providing frequent orientation cues, such as calendars, clocks, and verbal reminders of time, place, and situation, helps reduce confusion and anxiety. Consistent reorientation supports cognitive functioning and promotes safety during episodes of delirium.
Assigning different caregivers increases confusion, teaching assertive techniques is inappropriate during acute cognitive impairment, and refuting hallucinations can increase agitation. Instead, hallucinations should be acknowledged calmly and redirected without arguing.
A nurse is teaching a client who plans to take St. John's wort to treat her depression. Which of the following information should the nurse include in the teaching?
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"You should avoid driving when taking St. John's wort because it can cause drowsiness."
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"St. John's wort may cause gastrointestinal irritation."
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"You may experience vivid dreams while taking St. John's wort."
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"St. John's wort may increase your risk of developing oxalate kidney stones."
Explanation
The Correct Answer is:
A. "You should avoid driving when taking St. John's wort because it can cause drowsiness."
Explanation:
St. John's wort is a common herbal supplement used for depression. It can cause drowsiness or fatigue in some people, so it's important for clients to be cautious when engaging in activities like driving or operating heavy machinery. The sedative effect might be subtle, but it's essential to be aware of how the supplement affects them personally.
Why the other options are incorrect:
B. "St. John's wort may cause gastrointestinal irritation."
While gastrointestinal upset is a possible side effect, it is not the most notable or common issue associated with St. John's wort. The primary concern with St. John's wort is its interactions with other medications and potential for causing side effects like dizziness, dry mouth, or photosensitivity.
C. "You may experience vivid dreams while taking St. John's wort."
Vivid dreams are not a common side effect of St. John's wort. While some individuals report sleep disturbances, this is not a typical reaction to the herb.
D. "St. John's wort may increase your risk of developing oxalate kidney stones."
There is no established evidence to suggest that St. John's wort increases the risk of developing oxalate kidney stones. This side effect is not associated with St. John's wort.
A nurse is caring for a client who refuses to attend group therapy. Which of the following statements should the nurse make?
- A. “You have the right to refuse to attend group therapy.”
- B. “One of my friends went to group therapy and they improved significantly.”
- C. “If I were you, I would go to a few therapy sessions to give them a try.”
- D. “You should go to group therapy if you want to get better.”
Explanation
Explanation
Correct Answer: A. “You have the right to refuse to attend group therapy.”This statement respects the client’s autonomy and acknowledges their right to make decisions about their own care. Therapeutic communication supports self-determination without judgment, pressure, or personal opinions. By recognizing the client’s right to refuse, the nurse maintains professional boundaries, promotes trust, and keeps the interaction client-centered. The other options impose opinions, use personal examples, or apply coercion, which are non-therapeutic.
A client with a new prescription for phenelzine is receiving medication education from a nurse. Which of the following claims ought to be covered in the lesson by the nurse?
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"You should omit foods containing oxalates while taking phenelzine."
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"You should change positions slowly while taking this medication."
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"You should avoid drinking liquids after your evening meal."
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"This medication is prescribed to help overcome alcohol addiction."
Explanation
The Correct Answer is:
"You should change positions slowly while taking this medication."
Explanation:
Phenelzine is a monoamine oxidase inhibitor (MAOI), which is used to treat depression. One of the common side effects of MAOIs like phenelzine is orthostatic hypotension, which is a drop in blood pressure when changing positions from lying down to standing. To minimize the risk of dizziness or fainting, clients should be advised to change positions slowly and rise gradually from a sitting or lying position.
Why the other options are incorrect:
"You should omit foods containing oxalates while taking phenelzine."
There is no need to omit foods containing oxalates while taking phenelzine. However, clients on MAOIs must avoid foods that contain high levels of tyramine (such as aged cheeses, cured meats, and fermented foods), not oxalates, to prevent hypertensive crises.
"You should avoid drinking liquids after your evening meal."
There is no need to avoid drinking liquids after the evening meal when taking phenelzine. The main dietary restriction for clients on MAOIs is avoiding tyramine-rich foods, but no restrictions on liquids are necessary.
"This medication is prescribed to help overcome alcohol addiction."
Phenelzine is not used to treat alcohol addiction. It is an antidepressant used primarily to treat major depressive disorder, particularly when other medications have been ineffective. Treatment for alcohol addiction typically involves other approaches, such as counseling, support groups, and medications like disulfiram or acamprosate.
A nurse is caring for a group of clients. The nurse should recognize that which of the following clients is at risk for a vitamin B6 deficiency?
-
A client who has asthma.
-
A client who takes heparin to prevent deep vein thrombosis.
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A client who takes gabapentin as part of treatment for phenytoin for a seizure disorder.
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A client who has chronic alcohol use disorder.
Explanation
The Correct Answer is:
D. A client who has chronic alcohol use disorder.
Explanation:
Chronic alcohol use disorder significantly increases the risk of vitamin B6 deficiency. Alcohol interferes with the absorption and metabolism of vitamin B6, making it more difficult for the body to maintain adequate levels of this essential nutrient. Vitamin B6 plays a key role in enzyme function, neurotransmitter production, and the formation of red blood cells. Deficiency can lead to symptoms like irritability, depression, confusion, and peripheral neuropathy.
Why the other options are incorrect:
A. A client who has asthma.
Asthma itself does not directly impact vitamin B6 levels. While medications used to treat asthma (such as corticosteroids) can affect nutritional status, asthma alone does not predispose individuals to vitamin B6 deficiency.
B. A client who takes heparin to prevent deep vein thrombosis.
Heparin, an anticoagulant used to prevent deep vein thrombosis, does not directly cause a vitamin B6 deficiency. Although certain anticoagulants may have an effect on other nutrients, heparin is not known to impact vitamin B6 metabolism.
C. A client who takes gabapentin as part of treatment for phenytoin for a seizure disorder.
While both gabapentin and phenytoin are associated with other potential nutritional deficiencies (such as vitamin D and folate), they do not directly cause vitamin B6 deficiency. This makes the client taking these medications less likely to be at risk for vitamin B6 deficiency than those with chronic alcohol use.
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?
- A. Seizures
- B. Hand tremors
- C. Rapid speech
- D. Fatigue
Explanation
Explanation
Correct Answer: D. FatigueCocaine withdrawal is characterized primarily by psychological and energy-related symptoms rather than severe physical complications. Common manifestations include profound fatigue, depression, increased sleep, increased appetite, and decreased concentration. Fatigue occurs because cocaine is a powerful stimulant, and withdrawal results in a rebound decrease in central nervous system activity. Seizures, hand tremors, and rapid speech are more commonly associated with intoxication or withdrawal from other substances, not cocaine.
A charge nurse in an emergency department is assigning tasks. Which of the following tasks should the nurse delegate to an assistive personnel?
- A. Insert an NG tube for a client who has acetaminophen toxicity.
- B. Obtain a list of current medications from a client who is experiencing a manic episode.
- C. Transfer a client who has delirium from a bed to a wheelchair.
- D. Inform a client who has schizophrenia about available community services.
Explanation
Explanation
Correct Answer: C. Transfer a client who has delirium from a bed to a wheelchair.Assistive personnel can perform routine, noninvasive tasks that do not require assessment, clinical judgment, or patient teaching. Assisting with transfers is within their scope of practice, even for clients with delirium, as long as the nurse has assessed the client’s stability and provided appropriate instructions or supervision. The other options involve invasive procedures, assessment of mental status, or client education, all of which require nursing judgment and must be performed by a licensed nurse.
A nurse is caring for a client who has schizophrenia and is preparing for discharge.
Nurses' Notes
Admission:
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.
Medication Administration Record
Haloperidol 3 mg PO twice daily
A nurse is caring for a client who has schizophrenia and is preparing for discharge. Which of the following information should the nurse include when educating the client about relapse prevention? Select all that apply.
- A. Report any adverse effects of the medication to the provider immediately.
- B. Take a dose of the medication as soon as delusions or hallucinations begin.
- C. Limit alcohol consumption to no more than two drinks per week.
- D. Notify your provider within 48 hr of manifestations of a relapse.
- E. Ask a trusted person to watch for manifestations of illness.
- F. Go for a walk to decrease anxiety during times of increased stress.
Explanation
Explanation
Correct Answers:A. Report any adverse effects of the medication to the provider immediately.
D. Notify your provider within 48 hr of manifestations of a relapse.
E. Ask a trusted person to watch for manifestations of illness.
F. Go for a walk to decrease anxiety during times of increased stress.
A. Report any adverse effects of the medication to the provider immediately.
Early recognition and reporting of adverse effects improves medication adherence and prevents complications that can lead to relapse. Antipsychotics such as haloperidol can cause extrapyramidal symptoms, sedation, and other effects that require prompt provider evaluation to maintain treatment effectiveness.
D. Notify your provider within 48 hr of manifestations of a relapse.
Early warning signs such as sleep disturbance, anxiety, social withdrawal, or changes in thinking often precede a full relapse. Promptly notifying the provider allows early intervention, medication adjustment, or additional support to prevent symptom escalation and rehospitalization.
E. Ask a trusted person to watch for manifestations of illness.
Clients may not always recognize early symptoms of relapse themselves. Involving a trusted family member or friend provides an added layer of monitoring and support. This strategy improves early detection of symptom changes and supports ongoing stability in the community.
F. Go for a walk to decrease anxiety during times of increased stress.
Stress is a common trigger for relapse in schizophrenia. Encouraging healthy coping strategies such as walking helps reduce anxiety, improve mood, and promote emotional regulation. Nonpharmacologic stress management is an important component of relapse prevention.
A nurse is preparing to administer methylphenidate 25 mg PO to a school-age child who has ADHD. The available medication is methylphenidate 10 mg/5 mL liquid. How many milliliters should the nurse administer?
(Round to the nearest tenth. Use a leading zero if applicable. Do not use a trailing zero.)
- A. 10 mL
- B. 11.5 mL
- C. 12.5 mL
- D. 15 mL
Explanation
Explanation
Correct Answer: C. 12.5 mLFirst determine the concentration: 10 mg in 5 mL equals 2 mg per mL. Next, divide the prescribed dose by the concentration: 25 mg ÷ 2 mg/mL = 12.5 mL. Rounded to the nearest tenth, the nurse should administer 12.5 mL.
A nurse is caring for a client who is taking amitriptyline. The nurse should monitor for which of the following adverse effects?
-
Drooling
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Orthostatic hypotension
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Diarrhea
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Metallic taste in mouth
Explanation
The Correct Answer is:
Orthostatic hypotension
Explanation:
Amitriptyline is a tricyclic antidepressant (TCA), and one of its common adverse effects is orthostatic hypotension. This occurs due to the medication's anticholinergic and sedative effects, which can lead to a drop in blood pressure when the client changes positions, such as moving from sitting to standing. It is important for the nurse to monitor the client for signs of dizziness, lightheadedness, or fainting, and encourage slow position changes.
Why the other options are incorrect:
Drooling
Drooling is not a common side effect of amitriptyline. In fact, anticholinergic effects from this medication (such as dry mouth) are more common, which can lead to difficulty swallowing, rather than excessive drooling.
Diarrhea
Diarrhea is not a typical side effect of amitriptyline. TCAs often cause anticholinergic effects like constipation due to slowed gastrointestinal motility, rather than diarrhea.
Metallic taste in mouth
A metallic taste in the mouth is not a common side effect of amitriptyline. This symptom is more commonly associated with medications like certain antibiotics or zinc supplements, but not with TCAs.
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