ATI Capstone Mental Health with correct
questions and detailed answers.A+
graded already
A nurse in an acute care facility is assisting with the admission of an older adult client who has late stage
Alzheimer's disease. The nurse notes that the client's partner appears exhausted. He states that he is
finding it more and more difficult to care for his partner. Which of the following actions should the nurse
take first?
-CORRECT ANSWER- Ask the partner to talk about his difficulties in caring for the client.
The first action the nurse should take, using the nursing process priority framework, is to collect data
regarding the partner's ability to take care of the client.
A nurse is collecting data from a client who is taking bupropion. Which of the following findings indicates
the medications is effective?
- CORRECT ANSWER-Decrease in urge to smoke
Bupropion is an antidepressant that is also used for smoking cessation.
A nurse is evaluating the outcome for a client who has depression following the death of his wife 3
months ago. Which of the following client statements indicates a need for further intervention?
- CORRECT ANSWER-"I just don't feel like eating because I never like to eat alone."
At risk for malnutrition and injury.
A nurse in a long-term care setting is caring for a client who has Alzheimer's disease. The client states, "I
just came back from a hard day's work in my office." The nurse should identify this statement is an
example of which of the following coping mechanisms?
- CORRECT ANSWER-Confabulation
, Confabulation is the creation of information which is untrue to fill in gaps in memory and to protect self-
esteem in clients who have dementia.
A nurse is planning care for a new client. Which of the following actions should the nurse plan to take in
order to use the technique of presence to establish the nurse- client relationship?
- CORRECT ANSWER-Use active listening when with the client.
The nurse should use active listening to establish presence with the client. presence involves eye
contact, body language, voice tone, listening, and reflection to convay openness and understanding.
A nurse is assessing a client in the emergency department who drank alcohol while taking disulfiram.
The client states, "The nurse told me not to drink when taking the medication. I am just a social drinker.
I didn't realize that having just one drink with my friends would cause such a problem." Which of the
following defense mechanisms is the client demonstrating?
- CORRECT ANSWER-Rationalization
The client is demonstrating rationalization when he creates reasonable and acceptable explanations for
unacceptable behavior. The client is using rationalization asa defense mechanisms to justify why he had
just one drink. Even though the nurse told him not to drink alcohol.
A nurse is caring for a group of older adult clients. Which of the following client findings indicates
delirium?
- CORRECT ANSWER-A client asks when family members will be arriving after visiting 1 hr earlier.
Delirium is characterized by a change in cognition that occurs over a short period of time. It always
results from secondary physiological condition, ( infection, surgery, prolonged hospitalization, hypoxia,
fever, medication) and is a transient disorder. Although delirium can occur at any age, it is more
common in older adults. It frequently progresses in the evening hours and is sometimes called
"sundown syndrome"
A nurse is collecting data from a client newly admitted for anorexia nervousa. Which of the following
findings should the nurse expect?
- CORRECT ANSWER-Amenorrhea
questions and detailed answers.A+
graded already
A nurse in an acute care facility is assisting with the admission of an older adult client who has late stage
Alzheimer's disease. The nurse notes that the client's partner appears exhausted. He states that he is
finding it more and more difficult to care for his partner. Which of the following actions should the nurse
take first?
-CORRECT ANSWER- Ask the partner to talk about his difficulties in caring for the client.
The first action the nurse should take, using the nursing process priority framework, is to collect data
regarding the partner's ability to take care of the client.
A nurse is collecting data from a client who is taking bupropion. Which of the following findings indicates
the medications is effective?
- CORRECT ANSWER-Decrease in urge to smoke
Bupropion is an antidepressant that is also used for smoking cessation.
A nurse is evaluating the outcome for a client who has depression following the death of his wife 3
months ago. Which of the following client statements indicates a need for further intervention?
- CORRECT ANSWER-"I just don't feel like eating because I never like to eat alone."
At risk for malnutrition and injury.
A nurse in a long-term care setting is caring for a client who has Alzheimer's disease. The client states, "I
just came back from a hard day's work in my office." The nurse should identify this statement is an
example of which of the following coping mechanisms?
- CORRECT ANSWER-Confabulation
, Confabulation is the creation of information which is untrue to fill in gaps in memory and to protect self-
esteem in clients who have dementia.
A nurse is planning care for a new client. Which of the following actions should the nurse plan to take in
order to use the technique of presence to establish the nurse- client relationship?
- CORRECT ANSWER-Use active listening when with the client.
The nurse should use active listening to establish presence with the client. presence involves eye
contact, body language, voice tone, listening, and reflection to convay openness and understanding.
A nurse is assessing a client in the emergency department who drank alcohol while taking disulfiram.
The client states, "The nurse told me not to drink when taking the medication. I am just a social drinker.
I didn't realize that having just one drink with my friends would cause such a problem." Which of the
following defense mechanisms is the client demonstrating?
- CORRECT ANSWER-Rationalization
The client is demonstrating rationalization when he creates reasonable and acceptable explanations for
unacceptable behavior. The client is using rationalization asa defense mechanisms to justify why he had
just one drink. Even though the nurse told him not to drink alcohol.
A nurse is caring for a group of older adult clients. Which of the following client findings indicates
delirium?
- CORRECT ANSWER-A client asks when family members will be arriving after visiting 1 hr earlier.
Delirium is characterized by a change in cognition that occurs over a short period of time. It always
results from secondary physiological condition, ( infection, surgery, prolonged hospitalization, hypoxia,
fever, medication) and is a transient disorder. Although delirium can occur at any age, it is more
common in older adults. It frequently progresses in the evening hours and is sometimes called
"sundown syndrome"
A nurse is collecting data from a client newly admitted for anorexia nervousa. Which of the following
findings should the nurse expect?
- CORRECT ANSWER-Amenorrhea
