ATI PN Mental Health Practice 2020 A with
NGN Version 1| Questions and Verified
Answers| 100% Correct| Grade A
QUESTION
A nurse is contributing
... [Show More] to the plan of care for a client who has obsessive-compulsive disorder
and continually washes their hands. Which of the following interventions should the nurse
recommend including in the plan?
A. Inform the client that excessive handwashing is a negative behavior.
B. Do not allow the client to use a private restroom.
C. Schedule times for the client to wash their hands during the day.
D. Explain that unit privileges will be taken away if excessive handwashing continues.
Answer:
C. Schedule times for the client to wash their hands during the day.
Rationale:
Providing a schedule is a type of response prevention and can decrease anxiety by allowing the
client to know in advance when handwashing can be performed.
**A. Telling the client that excessive handwashing is a negative behavior can increase anxiety,
rather than decrease the need for handwashing, and is not an effective intervention for the nurse
to include in the plan of care. B. Not allowing the client to use a private restroom can increase
anxiety, rather than decrease the need for handwashing, and is not an effective intervention for
the nurse to include in the plan of care. D. Telling the client that privileges will be taken away is
a negative intervention, which can increase anxiety, and is not an effective intervention to
include in the plan of care.
QUESTION
A nurse is caring for a client who has bipolar disorder. The client suddenly appears agitated and
begins pacing at the end of the hallway with clenched fists. Which of the following actions
should the nurse take first?
A. Call for assistance to place the client in restraints.
B. Administer a sedative to the client.
C. Determine the client's intentions.
D. Place the client into the assigned seclusion room.
Answer:
C. Determine the client's intentions.
Rationale:
The first action the nurse should take when using the nursing process is to collect data from the
client. By determining the client's intentions, the nurse can de-escalate the situation by talking to
the client in a calm manner. This intervention will assist the nurse in establishing a trusting
relationship with the client.
**A. The nurse should identify that the client might need to be placed in restraints if all other
means of de-escalation are ineffective. However, there is another action that is the priority. B.
The nurse should identify that the client might need medication to decrease aggression and
anxiety if other means of de-escalation are ineffective. However, there is another action that is
the priority. D. The nurse should identify that the client might need to be placed into the assigned
seclusion room and monitored one-on-one to prevent self-endangerment if other actions are
ineffective. However, there is another action that is the priority.
QUESTION
A nurse is reinforcing teaching with a client whose provider has prescribed electroconvulsive
therapy (ECT). Which of the following information should the nurse include?
A. The client will receive continuous oxygen during the electrical stimulation intervals.
B. A benzodiazepine will be administered prior to the procedure.
C. ECT is an option for clients after medication has been unsuccessful.
D. Confusion is expected for the first 2 days after treatment.
Answer:
C. ECT is an option for clients after medication has been unsuccessful.
Rationale:
Medication is the first-line of treatment for depression. ECT is prescribed when medication has
been unsuccessful.
**A. The client will receive oxygen throughout the procedure. However, the oxygen will be
removed during the brief electrical stimulation intervals.
B. A benzodiazepine should not be administered because it interferes with the seizure process. A
short-acting anesthetic, such as propofol, will be administered. D. Clients who receive ECT can
have confusion and disorientation for several hours after treatment.
QUESTION
A nurse is reinforcing teaching with a newly admitted client who has generalized anxiety
disorder. Which of the following statements should the nurse make?
A. "We will demonstrate for you how to use relaxation techniques."
B. "Someone will be here to work with you when you experience flashbacks."
C. "Aversion therapy will be used to decrease your anxiety level."
D. "Response prevention therapy will help you control your impulses."
Answer:
A. "We will demonstrate for you how to use relaxation techniques."
Rationale:
The nurse should explain and demonstrate the use of relaxation techniques to decrease feelings
of anxiety in clients who have generalized anxiety disorder. Examples of these techniques are
progressive relaxation and deep breathing exercises.
**B. Clients who have posttraumatic stress disorder, not generalized anxiety disorder, experience
flashbacks, and, therefore, receive therapy that includes treatment for flashbacks. C. Aversion
therapy is not used for the treatment of generalized anxiety disorders. D. Response prevention
therapy is used to limit ritualistic acts for clients who have obsessive-compulsive disorder.
QUESTION
A nurse is caring for an adult client who has visible injuries as a result of partner violence.
Which of the following actions should the nurse take?
A. Insist that the client report the incident to the authorities before beginning treatment.
B. Encourage the client to develop a safety plan.
C. Recommend that the partner remain in the room during the interview with the client.
D. Advise the client to obtain an order of protection from the court.
Answer:
B. Encourage the client to develop a safety plan.
Rationale:
The nurse should encourage the client to develop a safety plan to aid in escaping further violence
if necessary.
**A. Client safety, including treatment for the client's injuries, should be the nurse's priority. The
nurse should support the client's decision to seek treatment, and the nurse should ask the client if
they need assistance with making a report. However, it is the client's choice whether or not to
report the incident to authorities. Members of the health care team might be required to report
partner violence themselves if the client has been assaulted by a weapon or if rape has occurred,
depending on individual state laws. C. The nurse should interview the client privately without the [Show Less]