**Theme Selected:** ATI RN Mental
Health Proctored Exam 2024 (NGN)
**Target Question Count:** 68
**The Therapeutic Alliance: NGN Mental Health Mastery**
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1. Borderline personality disorder, self-cutting. Priority nursing intervention?
💫RATIONALE✔️✔️: Safety first. Remove sharps, 1:1 observation, no-harm contract is insufficient.
💫ANSWER✔️✔️: B. Initiate constant observation and remove environmental hazards
---
2. Major depression, started fluoxetine 20 mg. Day 4, pt reports more energy but still sad. Action?
💫RATIONALE✔️✔️: Fluoxetine takes 4-6 weeks. Increased energy before mood lift increases suicide
risk.
💫ANSWER✔️✔️: C. Assess for suicidal ideation and plan
---
3. Alcohol withdrawal, CIWA-Ar score 22. Priority intervention?
💫RATIONALE✔️✔️: Score >15 = severe withdrawal. Symptom-triggered benzodiazepines prevent
seizures.
💫ANSWER✔️✔️: D. Administer lorazepam per PRN protocol
---
, 4. Paranoid schizophrenia, refuses meds stating "they poison me." Best response?
💫RATIONALE✔️✔️: Validate feeling, not delusion. Offer long-acting injectable as alternative.
💫ANSWER✔️✔️: C. "I understand you're scared. Would you consider a monthly shot?"
---
5. Bipolar mania, acute. Lithium level 0.6 mEq/L. Symptoms: press speech, poor sleep, agitation.
Action?
💫RATIONALE✔️✔️: Lithium level subtherapeutic (0.8-1.2 acute). Increase dose or add atypical
antipsychotic.
💫ANSWER✔️✔️: A. Notify provider for dose adjustment
---
6. PTSD, combat veteran. Nightmares and hypervigilance. Which med is first-line?
💫RATIONALE✔️✔️: SSRIs (sertraline, paroxetine) are FDA-approved for PTSD. Reduce core symptoms.
💫ANSWER✔️✔️: B. Sertraline
---
7. Bulimia nervosa, purging 3x daily. Most critical lab finding?
💫RATIONALE✔️✔️: Hypokalemia from vomiting leads to cardiac arrhythmias. Potassium <3.0 is
emergency.
💫ANSWER✔️✔️: D. Potassium 2.8 mEq/L
---
8. Neuroleptic malignant syndrome (NMS). Which finding supports this diagnosis?
💫RATIONALE✔️✔️: Triad: fever, rigidity, autonomic instability. Elevated CPK and leukocytosis.
💫ANSWER✔️✔️: C. Temp 103°F, muscle rigidity, CPK 5,000
---
9. Generalized anxiety disorder, buspirone prescribed. Teaching includes?
Health Proctored Exam 2024 (NGN)
**Target Question Count:** 68
**The Therapeutic Alliance: NGN Mental Health Mastery**
---
1. Borderline personality disorder, self-cutting. Priority nursing intervention?
💫RATIONALE✔️✔️: Safety first. Remove sharps, 1:1 observation, no-harm contract is insufficient.
💫ANSWER✔️✔️: B. Initiate constant observation and remove environmental hazards
---
2. Major depression, started fluoxetine 20 mg. Day 4, pt reports more energy but still sad. Action?
💫RATIONALE✔️✔️: Fluoxetine takes 4-6 weeks. Increased energy before mood lift increases suicide
risk.
💫ANSWER✔️✔️: C. Assess for suicidal ideation and plan
---
3. Alcohol withdrawal, CIWA-Ar score 22. Priority intervention?
💫RATIONALE✔️✔️: Score >15 = severe withdrawal. Symptom-triggered benzodiazepines prevent
seizures.
💫ANSWER✔️✔️: D. Administer lorazepam per PRN protocol
---
, 4. Paranoid schizophrenia, refuses meds stating "they poison me." Best response?
💫RATIONALE✔️✔️: Validate feeling, not delusion. Offer long-acting injectable as alternative.
💫ANSWER✔️✔️: C. "I understand you're scared. Would you consider a monthly shot?"
---
5. Bipolar mania, acute. Lithium level 0.6 mEq/L. Symptoms: press speech, poor sleep, agitation.
Action?
💫RATIONALE✔️✔️: Lithium level subtherapeutic (0.8-1.2 acute). Increase dose or add atypical
antipsychotic.
💫ANSWER✔️✔️: A. Notify provider for dose adjustment
---
6. PTSD, combat veteran. Nightmares and hypervigilance. Which med is first-line?
💫RATIONALE✔️✔️: SSRIs (sertraline, paroxetine) are FDA-approved for PTSD. Reduce core symptoms.
💫ANSWER✔️✔️: B. Sertraline
---
7. Bulimia nervosa, purging 3x daily. Most critical lab finding?
💫RATIONALE✔️✔️: Hypokalemia from vomiting leads to cardiac arrhythmias. Potassium <3.0 is
emergency.
💫ANSWER✔️✔️: D. Potassium 2.8 mEq/L
---
8. Neuroleptic malignant syndrome (NMS). Which finding supports this diagnosis?
💫RATIONALE✔️✔️: Triad: fever, rigidity, autonomic instability. Elevated CPK and leukocytosis.
💫ANSWER✔️✔️: C. Temp 103°F, muscle rigidity, CPK 5,000
---
9. Generalized anxiety disorder, buspirone prescribed. Teaching includes?
