ATI Mental Health Exam
1. A nurse is planning a menu for a client with bipolar disorder who was admitted for an acute manic episode. Which of the
... [Show More] following is an appropriate meal for this client?
a. Spaghetti and meat balls, salad, banana.
b. Beef and vegetable stew, bread, vanilla pudding.
c. Chicken nuggets, ear of corn, apple
d. Fish fillets, stewed tomatoes, cake
2. A nurse is caring for a client who was admitted to the psychiatric hospital for an evaluation. The client has been unable to leave the house for the past 10 years without accompaniment. When attempting to go out alone, the client becomes very anxious and must quickly return inside. The nurse identifies the problem as which of the following?
a. Agoraphobia
b. Conversion disorder
c. Panic disorder
d. OCD
3. A nurse is caring for a client who is experiencing the early phase of alcohol withdrawal. Which of the following should be the primary focus of nursing care?
a. Education about alcohol abuse and treatment
b. Assessing coping skills
c. Confronting the use of denial and other defense mechanisms
d. Rest and nutrition.
4. Four days after admission, a client who is taking haloperidol (Haldol) is pacing up and down the hallway. The nurse observes and assesses further by asking how the client feels. The client replies “I am very restless and can’t seem to sit still.” The nurse should understand that the client is experiencing which of the following extrapyramidal side effects?
a. Dystonia
b. Parkinsonism
c. Tardive dyskinesia
d. Akathisia – an extrapyramidal side effect characterized by the client’s complaint of a sense of inner restlessness and observable behaviors like pacing and fidgeting.
5. A client is admitted for the 3rd time to a psychiatric hospital with a diagnosis of schizophrenia. During the admission procedure, the nurse notices that the client’s appearance is unkempt, and the client seems to be actively hallucinating. Which of the following should be the nurse’s priority nursing assessment?
a. Perception of reality
b. Ability to follow direction
c. Physical needs – the client’s appearance and behavior may be due to a physical illness or injury, or to a fluid and electrolyte imbalance. Assessing the client’s physical health needs should be the initial priority for the nurse.
d. Mental status
6. A nurse plans to teach important information about the anxiolytic agent diazepam (Valium) to a client for whom it has just been prescribed. The nurse should include in the teaching plan which of the following?
a. Side effects include insomnia and seizures
b. Valium can be habit forming.
c. This medication is administered solely by mouth
d. It takes 2 to 3 weeks to reach full therapeutic effect.
7. An emergency room nurse is assessing a client for cocaine intoxication. The nurse should know that which of the following is associated with cocaine intoxication?
a. Pinpoint pupils – dilated pupils are associated with cocaine intoxication
b. Drowsiness – hyperactivity and hyper-alertness are common effects of cocaine intoxication
c. Nystagmus – frequently occurs with the use of phencyclidine (PCP, “angel dust”), not cocaine
d. Paranoia – symptom associated with cocaine intoxication
8. A client is receiving lorazepam (Ativan) for anxiety. In reviewing the client’s discharge plans, the nurse should emphasize that lorazepam.
a. Should not be taken during pregnancy.
b. Must be discontinued by gradual tapering over time.
c. Is contraindicated for clients with asthma.
d. Is a safe medication with no known adverse effects.
Rapid withdrawal from lorazepam has been associated with withdrawal symptoms (anxiousness, sleeplessness, and irritability). As a general rule, it is discontinued by gradually tapering it off over time to avoid any adverse responses.
9. A nurse is administering the neuroleptic medication thioridazine hydrochloride (Mellaril) 150 mg four times a day. The client reports hand tremors, drooling, and restlessness. Which of the following is an appropriate nursing action?
a. Chart observations and reassure the client that these manifestations are normal.
b. Administer diazepam (Valium) 5mg PO (ordered PRN).
c. Encourage deep breathing and relaxation
d. Administer benztropine Mesylate (Cogentin) 1mg PO (ordered PRN). – this client is experiencing extrapyramidal system effects of Mellaril. Benztropine Mesylate (Cogentin) is the drug of choice to counteract this adverse effect.
10. A nurse should understand that clients who are diagnosed with agoraphobia display which defense mechanism?
a. Displacement – the unconscious defense mechanism characterized by transferring of painful feelings to a neutral object. In agoraphobia, a phobic disorder, the anxiety is displaced from the original source to another object or situation, resulting in the phobia.
b. Isolation – Separating or blocking the feelings associated with a memory of a situation or person.
c. Denial – the avoidance of disagreeable realities by ignoring or refusing to recognize them.
d. Undoing – an act or communication that reverses or negates a previous act that was unacceptable.
11. A nurse is providing discharge teaching for a client who takes lithium (Lithane). The nurse should inform the client that which of the following could precipitate lithium toxicity?
a. Increasing sodium intake.
b. Mild exercise
c. Fasting
d. Carbamazepine (Tegretol) therapy.
12. A nurse is caring for a client who has been diagnosed with bipolar disorder. The client is pregnant. Which of the following medications is appropriate for this client to take?
a. Carbamazepine (Tegretol)
b. Valproic acid (Depakote)
c. Paroxetine (Paxil)
d. Lithium (Lithane)
13. Which of the following is the best approach for a nurse to take initially with a client who is experiencing severe anxiety?
a. Move the client to a calm, nonstimulating environment
b. Encourage expression of feelings
c. Lower the client’s level of anxiety by offering medication
d. Suggest the client engage in some automatic behavior, such as pacing, to reduce anxiety levels.
14. A nurse is planning care for a client with panic disorder who is taking alprazolam (Xanax) 0.25mg t.i.d.. Which of the following instructions should the nurse give the client?
a. “You should increase your fluid intake to prevent dry mouth.”
b. “You should take this medication with food to prevent GI upset.”
c. “You will need to watch your caloric intake to prevent weight gain.”
d. “You will have to read food labels careful to eliminate tyramine from your diet.”
15. A nurse is caring for a client who is taking a tricyclic antidepressant. Which of the following side effects should the nurse report promptly to the client’s provider?
a. Fine hand tremor
b. Constipation
c. Drowsiness
d. Urinary retention – a potentially serious side effect. In addition to monitoring the client’s I&O, the nurse should check for abdominal distention, hold the next dose of the antidepressant, and report the client’s condition to the provider. Urinary retention can lead to bladder infection and loss of bladder tone.
16. A client with a hx of psychosis is prescribed quetiapine fumarate (Seroquel) 150mg four times a day. Which of the following statements should the nurse include when providing the client education about this medication?
a. “You will need to be careful of exposure to the sun and wear a sunscreen when outdoors.”
b. “While you are taking Seroquel, you will need to have weekly blood counts.”
c. “Weight gain is less common with Seroquel than with other atypical antipsychotics.”
d. “Seroquel is effective in managing rapid-cycling manic episodes.”
Seroquel is a newer antipsychotic that targets both the positive and negative manifestations of schizophrenia with fewer side effects than other antipsychotics. Seroquel does not have the adverse effect of weight gain common in other antipsychotics.
17. A nurse is caring for a client diagnosed with OCD. Initially, which of the following actions should the nurse consider in dealing with the client’s ritualistic behaviors?
a. Plan the client’s schedule to allow extra time to perform the rituals to keep anxiety within manageable levels.
b. Set strict limits on the behaviors so the client can better conform to the unit rules and schedules.
c. Isolate the client for a period of time to lower anxiety about offending others.
d. Confront the client about the senseless nature of the ritualistic behaviors.
18. A nurse is caring for a client in the day treatment program who is diagnosed with hypochondriasis. The client constantly reports physical problems, and the other clients in the unit are beginning to avoid the client. Which of the following should be the nurse’s primary intervention to decrease social isolation?
a. Ask other clients to be more sympathetic of complaining client.
b. Encourage the client to participate in group diversional activities.
c. Ask the client to stop talking about physical complaints.
d. Encourage the client to rest alone when upset.
Hypochondriasis is an exaggerated preoccupation with physical health. This option addresses the stem by attending to the issue of social interaction. Remember to identify key words in the stem before looking at available options.
19. A nurse is caring for a client diagnosed with a severe anxiety disorder. The client is in a state of panic in the dayroom. Which of the following actions should the nurse implement initially for the client?
a. Speak in a calm manner.
b. Leave the client alone regain control
c. Encourage the client to express her feelings.
d. Ask the client to describe what occurred before the panic.
20. The admitting nurse asks a client what factors, such as recent life changes, have contributed to the need for hospitalization. The client replies, “Change…change the range, manage the change.” The nurse should recognize this response as an example of which of the following?
a. Flight of ideas
b. Echolalia
c. Perseveration
d. Clanging – Speech in which sounds, rather than conceptual relationships, influence word choice. It is commonly associated with schizophrenia and mania.
21. A nurse is caring for a client diagnosed with somatization disorder. The nurse should understand that a client with this disorder will use which of the following defense mechanism?
a. Displacement
b. Repression
c. Undoing
d. Suppression
22. A nurse asks an older adult client, “Did you have any visitors, yesterday?” The client responds, “Yes, several members of my church choir came to see me.” The nurse knows that only the client’s child visited the day before. Which of the following is the client demonstrating?
a. Illusion – misinterpretation of a real sensory experience. It is a misperception and is not associated with a memory problem.
b. Confabulation – Filling in gaps in memory by fabrication. The client will make up responses that are inaccurate but sound appropriate. It is done to avoid the embarrassment about memory loss.
c. Delusion – A false, fixed belief. Delusional thinking is most often associated with schizophrenia and other psychotic disorders.
d. Projection – An unconscious defense mechanism in which the client attributes his/her own thoughts, actions, or impulses to another individual.
23. A client on the psychiatric unit is confirmed to have hypochondriacal disorder. The nurse is aware that the client is likely to exhibit which of the following?
a. Preoccupation with physical health.
b. Loss of a physical function without pathology
c. Attention seeking by deliberately causing harm to his child
d. Ritualistic handwashing as a way to avoid contact with germs.
24. A nurse in the outpatient mental health clinic is interviewing a client with schizophrenia who appears to be experiencing auditory hallucinations. Which of the following should be the nurse’s initial action?
a. Teach the client strategies to decrease the hallucinations.
b. Check that the client is on antipsychotic medications
c. Establish rapport with the client.
d. Explore what the voices are saying to the client.
25. A nurse can evaluate the progress of a client with agoraphobia as having improved when the client is able to attend which of the following?
a. A unit picnic in a local park
b. Occupational therapy
c. The hospital gift shop
d. Daily group therapy
26. Which of the following defense mechanisms does a client with OCD exhibit when performing rituals?
a. Projection
b. Undoing
c. Rationalization
d. Sublimation
27. A nurse is caring for a client experiencing anxiety at the panic level. Which of the following should be the nurse’s primary goal?
a. Identify the cause of the anxiety
b. Reduce the client’s immediate anxiety.
c. Investigate the situation that preceded the attack.
d. Explain the physical manifestations of anxiety to the client.
28. A nurse is providing medication teaching to a client who is prescribed the monoamine oxidase inhibitor (MAOI) Phenelzine (Nardil). The nurse should caution the client against concurrent use of which of the following over the counter medications?
a. Acetaminophen (Tylenol) – Pain reliever
b. Ranitidine (Zantac) – Gastric Ulceration
c. Benztropine (Cogentin) – Anticholinergic medications
d. Pseudoephedrine (Sudafed)
29. A client is hospitalized for an OCD with recurring thoughts of mouth odors that are offensive to others. The client also has mouth care rituals that occupy a good deal of the client’s waking hours and caused him to be fired from his last job. The nurse understands that these manifestations most likely represent which of the following?
a. Method of reducing anxiety
b. Form of manipulation to avoid work
c. Strategy to get attention
d. Rationalization for avoiding social contact.
30. A nurse is caring for a client who has OCD. The client engages in repeated hand washing. Which of the following is the purpose of the client’s behavior?
a. Relief the anxiety
b. Gaining attention
c. Avoiding daily responsibilities
d. Controlling a phobia for germs
31. A nurse is caring for a client diagnosed with schizophrenia. The client spends a great deal time rhyming syllables such as, “Me, see, bee, tree.” The nurse should recognize that the client is demonstrating use of which of the following?
a. Clang association
b. Echolalia
c. Pressured speech
d. Word salad.
32. An eyewitness to a violent crime is unable to give police an account of the crime and complains of blindness and a severe headache when asked to view “mug shots.” Which of the following defense mechanisms is the client using?
a. Rationalization – offering a socially acceptable or logical explation for otherwise unacceptable impulses, feelings, and behaviors.
b. Denial
c. Conversion – a physical manifestation or complaint without organic impairment
d. Regression – Going back to an earlier level of emotional development
33. What information about diet should a nurse give all clients taking lithium?
a. Sodium and fluid intake should be increased
b. Fluid intake should not exceed 100mL per day
c. Sodium intake should be restricted to 1200mg per day.
d. An adequate daily intake of sodium and fluids should be maintained.
34. The nurse discovers that a client who is depressed is an expert at crewel embroidery. After gathering some embroidery materials, the client is asked to teach the nurse this skill. Which of the following is the best rationale for this nursing intervention?
a. Assess the client’s ability to communicate clearly.
b. Discourage the client from focusing on personal problems
c. Reinforce the client’s identity as a homemaker.
d. Use the client’s personal strengths to build self-esteem.
35. A manic client tells the nurse that his lastest computer project is revolutionizing the industry. He also states, “IBM and Apple are both going under because their products cannot compete with mine.” In choosing how to respond, the nurse is best guided by the knowledge that this statement represents which of the following?
a. An illusion
b. Paranoia
c. Confabulation
d. Grandiose delusion
36. An emergency room nurse is admitting a client who is complaining of CP and dyspnea. The client is also flushed and perspiring profusely, screaming, “I am going to die! This is it! I am having a heart attack!” The medical exam and lab work are negative. The client is diagnosed with anxiety. The nurse should assess the client’s level of anxiety to be which of the following?
a. Moderate
b. Panic
c. Severe
d. Mild
37. A nurse should understand that a common side effect of benzodiazepine antianxiety medications is which of the following?
a. Seizures
b. Dizziness
c. Flatulence
d. Insomnia
38. A client is admitted with a diagnosis of acute schizophrenia. The client is started on chlorpromazine (Thorazine) 100mg 3 times a day for agitation. When the client is calmer, the nurse begins client teaching about the medication. The nurse knows it is appropriate to state which of the following?
a. “Thorazine is an antipsychotic that can cure your disorder.”
b. “Thorazine is a sedative that helps to calm you down.”
c. “Thorazine will help to control the symptoms of your illness.”
d. “Thorazine controls the side effects of antipsychotic drugs.”
39. An client taking a TCA is seen at the clinic. The client reports experiencing several side effects from the medication. Which of the following is the most common side effect associated with TCA?
a. Skin rashes
b. Excessive sweating
c. Drowsiness
d. Muscle breakdown.
40. A client has been taking an antipsychotic medication for 6 years, and his provider has begun tapering off the dosage. During this process, the nurse should watch for which of the following early manifestations of tardive dyskinesia?
a. Jerky, choreiform movements of the U.E.
b. Slow, involuntary athetoid movement of the arms and legs
c. Involuntary grimacing, lip smacking, and tongue protrusion.
d. Tonic contractions of the neck and back. [Show Less]