Chamberlain College of Nursing :ATI PROCTORED PN MENTAL HEALTH 2020 EXAM,100% CORRECT

Chamberlain College of Nursing :ATI PROCTOREDPN MENTAL HEALTH 2020 EXAM 1. A nurse is caring for an adult client who has visible injuries as a result of intimate partner violence. Which of the following actions should the nurse take? Answer: Encourage the client to develop a safety plan 2. A nurse in an urgent care clinic is collecting data from a client whose friend reports a suspicion of cocaine use. The nurse should identify that which of the following manifestations is an indicator of the client’s use of this substance? Answer: Hypertension 3. A nurse in a mental health facility is caring for a client who has dementia. The client’s agitation is increasing. Which of the following actions should the nurse take first? Answer: Offer diversionary activities 4. 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? Answer: Determine the client’s intentions 5. A nurse is reinforcing discharge teaching with a client who has a new prescription for alprazolam. Which of the following instructions is the priority for the nurse to include? Answer: Do not drive until your reaction to the medication is determined 6. A nurse is caring for a client who is 2 days postoperative following a hip arthroplasty. When a news report about military action comes on the television, the client says to the nurse, “My youngest child died 6 months ago while serving in the military.” Which of the following responses should the nurse make? Answer: -This must be very difficult time for you -Your child’s death must be a terrible loss -Tell me something you remember about your child 7. A nurse is contributing to the plan of care for a client who has bipolar disorder and is exhibiting mania, Which of the following interventions should the nurse include to improve the nutritional status of the client? Answer: Have the client’s favorite snacks available at all times. 8. A nurse is collecting data from a client who has paranoid personality disorder. Which of the following manifestations should the nurse expect? Answer: Projects blame onto others 9. A nurse on and inpatient unit is assisting with a group therapy session. During the session, a client begins to shout using aggressive language. Which of the following statements should the nurse make to the client? Answer: When you raise your voice, it makes me feel uncomfortable and unsafe.” 10. A nurse in a mental health facility is caring for a client who has schizophrenia. The client becomes violent in the dayroom and begins throwing objects at staff and other clients. After calling for assistance. Which of the following actions should the nurse take next? Answer: Tell the client calmly to sit down 11. A nurse caring for a group of clients on a mental health unit. Which of the following client behaviors should the nurse reports to the charge nurse? Answer: A client who is manic has been pacing the unit for several hours 12. A nurse is collecting data from a client who is taking valproic acid for the treatment of bipolar disorder. The nurse should identify that which of the following findings is priority to report to the provider? Answer: Bleeding gums 13. A nurse is attempting to resolve an ethical dilemma that involves a client’s medical decisions and his own personal values. After collecting data and identifying the problem, which of the following actions should the nurse take next? Answer: Determine the benefits and consequences of respecting the client’s medical decisions 14. A LPN/LVN observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, the nurse's immediate priority of care is to: Answer: Provide safety for the client and other clients on the unit 15. Select the nursing interventions for a hospitalized client with mania who is exhibiting manipulative behavior. Select all that apply. Answer: 1) Communicate expected behaviors to the client 3) Assist the client in identifying ways of setting limits on personal behaviors 4) Follow through about the consequences of behavior in a non-punitive manner 6) Be clear with the client regarding the consequences of exceeding limits that have been set regarding behavior 16. A nurse determines that the wife of an alcoholic client is benefitting from attending an Al- Anon group when the nurse hears the wife say: Answer: "I no longer feel that I deserve the meetings my husband inflicts on me." 17. A nurse is reinforcing teaching about stress management techniques with a client who has mild anxiety. Which of the following statements should the nurse make? Answer: You should listen to music when you feel stress 18. A nurse is caring for a client who is undergoing outpatient electroconvulsive therapy (ECT) to treat rapid-cycling bipolar disorder. Following the procedure, which of the following action should the nurse take? Answer: Administer oxygen to the client 19. A nurse is caring for a client who has psychiatric symptom disorder. Which of the following actions should the nurse take? Answer: Encourage the client to examine how his illness behavior affects his family 20. A nurse is caring for a client who recently lost his child in a motor-vehicle crash. The client is expressing feelings of hopelessness. Which of the following questions is the most important for the nurse to ask? Answer: Have you had any thoughts of harming yourself 21. A nurse is caring for a client who has dementia. Which of the following actions should the nurse take? Answer: Stand in front of the client when speaking 22. A nurse is collecting data from a client who is experiencing oxycodone toxicity. Which of the following medications should the nurse anticipate the provider to prescribe? Answer: Naloxone 23. A nurse is assisting with the admission of a client who has an eating disorder. During data collection, which of the following findings should the nurse identify as manifestations of bulimia nervosa? Answer: -Tooth erosion -Hand calluses -Hypokalemia 24. A nurse is assisting with the planning of an interdisciplinary care conference for a newly admitted client who is in the acute stage of anorexia nervosa. Which of the following members of the interdisciplinary treatment team should the nurse includes? Answer: Dietitian 25. A nurse is assisting with discharge planning for a client who needs a day treatment center ad has limited community and financial support. Which of the following referrals should the nurse recommend for inclusion in the client’s discharge plan? Answer: Social worker 26. A nurse is speaking with a client who is expressing an intense disapproval of the current social worker. When the social worker approaches the nurse and client a few moments later, the client cheerfully states, “Now,here is my favorite social worker!” The nurse should identify the client is using which of the following defense mechanisms? Answer: Reaction formation 27. A nurse on an inpatient unit is collecting data from a group of clients. Which of the following findings should the nurse report to the provider? Answer: A client who has borderline personality disorder and is pacing restlessly 28. A nurse is reinforcing teaching about expected withdrawal manifestations with a client who has enrolled in a smoking cessation course. Which of the following client statement indicates an understanding of the information? Answer: I will probably feel irritable within 24 hours of my last cigarette 29. A nurse is preparing to administer clozapine for the first time to a client who has schizophrenia. The nurse explains the therapeutic and adverse effects of the medication to the client prior to administration. Which of the following ethical concepts is the nurse demonstrating? Answer: Veracity 30. A LPN/LVN is preparing to care for a dying client, and several family members are at the client' bedside. Select the therapeutic techniques that the nurse would use when communicating with the family. Select all that apply. Answer: 3) Encourage expression of feelings, concerns, and fears 5) Touch and hold the client's or family member's hands if appropriate 6) Be honest and let the client and family know that they will not be abandoned by the nurse 31. A client's medication sheet contains a prescription for sertraline (Zoloft). To ensure safe administration of the medication, a nurse would administer the dose: Answer: At the same time each evening 32. A LPN/LVN is preforming a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side effects of the medication? Answer: Gastrointestinal dysfunctions 33. A LVN/LPN is caring for a client with anorexia nervosa. The nurse is monitoring the behavior of the client and understands that a client with anorexia nervosa manages anxiety by: Answer: Observing rigid rules and regulations 34. A LPN/LVN is caring for a suicidal client. The appropriate nursing intervention in dealing with this client is to: Answer: Provide authority, action, and participation 35. A nurse is caring for a client who is experiencing opioid withdrawal. Which of the following medications should the nurse expect to administer? Answer: Naltrexone 36. A nurse on a mental health unit is reinforcing teaching about informed consent with a newly licensed nurse. Which of the following statements indicates and understanding of the teaching? Answer: The consent form should have the name of the provider who is performing the procedure on the form 37. A nurse is caring for a client who is undergoing behavioral therapy for posttraumatic stress disorder (PTSD). The nurse identify that which of the following findings indicates an improvement in the client’s condition? Answer: The client report about techniques she uses to promote sleep 38. A nurse is talking with a client who has borderline personality disorder, the client states she is lonely and thinks the other nurses avoid her, but she is afraid to share this concern with the other staff. Which of the following actions should the nurse take? Answer: Role-paly this situation so the client can gain confidence in expressing her feelings 39. A nurse is collecting data from a client who has a history of cocaine use, which of the following manifestations is an indication that the client is experiencing cocaine toxicity? Answer: Seizures 40. The LPN/LVN is assessing a client who is taking an antipsychotic medication. Which of the following symptoms is uniquely indicative of neuroleptic malignant syndrome (NMS) and requires immediate attention? Answer: Very high temperature 41. A client diagnosed with undifferentiated schizophrenia is being discharged on aripiprazole (Ability) 5 mg every night. When developing the teaching plan about the most common adverse effects, which of the following should the nurse include? Select all that apply. Answer: 4) Pill rolling movements 1) Headaches that will subside in a few weeks 2) Transient mild anxiety 3) Insomnia 42. A nurse is attempting to establish a therapeutic relationship with a newly admitted client. Which of the following actions should the nurse plan to take during the working phase of the nurse- client relationship? Answer: Promote The development of problem-solving skills 43. A nurse is collecting data from a client who has major depressive disorder. Which of the following findings is the priority for the nurse to report to the provider? Answer: Feeling of hopelessness 44. A nurse on a mental health unit is prioritizing care for a group of clients. Which of the following actions should the nurse take first? Answer: Administer haloperidol to a client who has schizophrenia and is yelling at other clients. 45. The wife of a male client recently diagnosed with schizophrenia asks the nurse, "What exactly is schizophrenia? Is my husband all right?" Which response is best for the LPN/LVN to provide to this family member? Answer: It is a chemical imbalance in the brain that causes disorganized thinking. 46. The community health nurse talks to a male client who has bipolar disorder. The client explains that he sleeps 4 to 5 hours a night and is working with his partner to start two new businesses and build an empire. The client stopped taking his medications several days ago. What nursing problem has the highest priority? Answer: Medication management. 47. At a support meeting of parents of a teenager with polysubstance dependency, a parent states, "Each time my son tries to quit taking drugs, he gets so depressed that I'm afraid he will commit suicide." The nurse's response should be based on which information? Answer: Careful monitoring should be provided during withdrawal from the drugs. 48. The LPN/LVN observes a female client with schizophrenia watching the news on TV. She begins to laugh softly and says, "Yes, my love, I'll do it." When the nurse questions the client about her comment she states, "The news commentator is my lover and he speaks to me each evening. Only I can understand what he says." What is the best response for the nurse to make? Answer: What do you believe the news commentator said to you? 49. At the first meeting of a group of older adults at a daycare center for the elderly, the LPN/LVN asks one of the members what kinds of things she would like to do with the group. The older woman shrugs her shoulders and says, "You tell me, you're the leader." What is the best response for the nurse to make? Answer: Yes, I will be leading this group. What would you like to accomplish during this time? 50. The LPN/LVN should include which interventions in the plan of care for a severely depressed client with neurovegetative symptoms? (Select all that apply.) 1) Permit rest periods as needed. 2) Speaking slowly and simply. 3) Place the client on suicide precautions. 4) Allow the client extra time to complete tasks. 5) Observe and encourage food and fluid intake. 6) Encourage mild exercise and short walks on the Answer(s): 1, 2, 4, 5, 6