ATI RN Mental Health 2025 Proctored Exam
A nurse is assessing a client who has a new diagnosis of alcohol use
disorder. Which of the following client statements should the nurse expect if
the client is in denial about their diagnosis?
Answer:
"I can quit drinking at any time, I don't need anyone's help."
Explanation:
This statement reflects denial because the client is minimizing the severity of
the problem and overestimating their ability to control their drinking without
assistance. Denial is a common defense mechanism in substance use
disorders, where the individual avoids acknowledging the extent of their issue
or need for help.
, A
nurse is discussing the treatment plan with a client who is being admitted for treatment of
severe anorexia nervosa. Which of the following statements by the client indicates that
communication was effective?
Answer:
"I will be monitored for an hour after eating a meal or snack."
Explanation:
For a client with severe anorexia nervosa, a core component of the treatment plan is
managing behaviors that can prevent weight gain or cause harm, such as self-induced
vomiting or excessive exercise after eating. Therefore, post-meal monitoring is a standard
and essential nursing intervention. The other options describe privileges or levels of control
that are not typically granted in the initial stages of treatment for severe anorexia, as they
could enable the eating disorder behaviors.
, A
nurse in the emergency department is caring for a client who has
tetanus. The nurse should monitor for which of the following
manifestations?
Answer:
Hyperpyrexia
Explanation:
Tetany (likely a typo for "tetanus") is caused by the
bacterium Clostridium tetani. A key and severe manifestation of
tetanus is hyperpyrexia (extremely high fever), which can occur
due to uncontrolled muscle contractions and autonomic nervous
system dysfunction. While other symptoms like paresthesia
(tingling) or bradycardia (slow heart rate) are not hallmark signs,
, A
nurse is caring for a client in a mental health facility. The client is agitated and threatens to
harm herself and others. Which of the following is the nurse’s priority intervention?
Answer:
Set limits on the client’s behavior.
Explanation:
The priority intervention for an agitated client is to use the least restrictive intervention first.
Setting clear, firm limits is a verbal, de-escalation technique that can often prevent the
situation from escalating to the point where physical restraints, seclusion, or emergency
medication are necessary. These more restrictive measures are only used when a client
poses an imminent danger to self or others and less restrictive interventions have failed.
Therefore, setting behavioral limits is the appropriate first-line, priority action
A nurse is assessing a client who has a new diagnosis of alcohol use
disorder. Which of the following client statements should the nurse expect if
the client is in denial about their diagnosis?
Answer:
"I can quit drinking at any time, I don't need anyone's help."
Explanation:
This statement reflects denial because the client is minimizing the severity of
the problem and overestimating their ability to control their drinking without
assistance. Denial is a common defense mechanism in substance use
disorders, where the individual avoids acknowledging the extent of their issue
or need for help.
, A
nurse is discussing the treatment plan with a client who is being admitted for treatment of
severe anorexia nervosa. Which of the following statements by the client indicates that
communication was effective?
Answer:
"I will be monitored for an hour after eating a meal or snack."
Explanation:
For a client with severe anorexia nervosa, a core component of the treatment plan is
managing behaviors that can prevent weight gain or cause harm, such as self-induced
vomiting or excessive exercise after eating. Therefore, post-meal monitoring is a standard
and essential nursing intervention. The other options describe privileges or levels of control
that are not typically granted in the initial stages of treatment for severe anorexia, as they
could enable the eating disorder behaviors.
, A
nurse in the emergency department is caring for a client who has
tetanus. The nurse should monitor for which of the following
manifestations?
Answer:
Hyperpyrexia
Explanation:
Tetany (likely a typo for "tetanus") is caused by the
bacterium Clostridium tetani. A key and severe manifestation of
tetanus is hyperpyrexia (extremely high fever), which can occur
due to uncontrolled muscle contractions and autonomic nervous
system dysfunction. While other symptoms like paresthesia
(tingling) or bradycardia (slow heart rate) are not hallmark signs,
, A
nurse is caring for a client in a mental health facility. The client is agitated and threatens to
harm herself and others. Which of the following is the nurse’s priority intervention?
Answer:
Set limits on the client’s behavior.
Explanation:
The priority intervention for an agitated client is to use the least restrictive intervention first.
Setting clear, firm limits is a verbal, de-escalation technique that can often prevent the
situation from escalating to the point where physical restraints, seclusion, or emergency
medication are necessary. These more restrictive measures are only used when a client
poses an imminent danger to self or others and less restrictive interventions have failed.
Therefore, setting behavioral limits is the appropriate first-line, priority action
