ATI Mental Health Proctored Exam Test Bank

ATI Mental Health Proctored Exam Test Bank ATI Mental Health Proctored Exam Test Bank (Questions and Answers, 100% Correct) Latest 2023/2024 The client is responsive and able to fully respond by opening their eyes and attending to a normal tone of voice and speech. What is the level of consciousness? Alert The client is able to open their eyes and respond but is drowsy and falls asleep readily. What is the level of consciousness? Lethargic The client requires vigorous or painful stimuli (pinching a tendon or rubbing the sternum) to elicit a brief response. They might not be able to respond verbally. What is the level of consciousness? Stuporous The client is unconscious and does not respond to painful stimuli. What is the level of consciousness? Comatose How to test a client's immediate memory Ask the client to repeat a series of numbers or a list of objects How to test a client's recent memory Ask the client to recall recent events, such as visitors from the current day, or the purpose of the current mental health appointment or admission How to test a client's remote memory Ask the client to state a fact from his past that is verifiable, such as his birth date or his mother's maiden name How to assess a client's ability to calculate Ask the client to count backward from 100 in sevens How to assess a client's ability to think abstractly Ask the client to interpret something complex such as, "A bird in the hand is worth two in the bush." Glasgow coma scale Used to obtain a baseline assessment of a client's level of consciousness; highest score is 15 and indicates that the client is awake and responding appropriately; a score of 7 or less indicates that the client is in a coma Serious mental illness Includes disorders classified as severe and persistent mental illnesses; clients often have difficulty with ADLs; can be chronic or recurrent A charge nurse is discussing mental status exams with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply) A. "To assess cognitive ability, I should ask the client to count backward by sevens." B. "To assess affect, I should observe the client's facial expression." C. "To assess language ability, I should instruct the client to write a sentence." D. "To assess remote memory, I should have the client repeat a list of objects." E. "To assess the client's abstract thinking, I should ask the client to identify our most recent presidents." A. Counting backward by sevens is an appropriate technique to assess a client's cognitive ability. B. Observing a client's facial expression is appropriate when assessing affect. C. Writing a sentence is an indication of language ability. Remote language is tested by asking the client to state a fact from his past that his verifiable (date of birth). Abstract thinking is tested by asking the client to interpret something. A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention? A. Assist the client with systematic desensitization therapy. B. Teach the client appropriate coping mechanisms. C. Assess the client for comorbid health conditions. D. Monitor the client for adverse effects of the medications. D. Monitoring for adverse effects of medications is an example of a psychobiological intervention. Systematic desensitization is cognitive and behavioral. Teaching coping mechanisms is a counseling or health teaching. Assessing for comorbid conditions is health promotion and maintenance. A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following actions should the nurse identify as the priority? A. Coordinate holistic care with social services. B. Identify the client's perception of her mental health status. C. Include the client's family in the interview. D. Teach the client about her current mental health disorder. B. Assessment is the priority action. Identifying the client's perception of her mental health status provides important information about the client's psychosocial history. A nurse is told during change of shift report that a client is stuporous. When assessing the client, which of the following findings should the nurse expect? A. The client arouses briefly in response to a sternal rub. B. The client has a glasgow coma scale score less than 7. C. The client exhibits decorticate rigidity. D. The client is alert but disoriented to time and place. A. A client who is stuporous requires vigorous or painful stimuli to elicit a response. B & C occur with comatose patients. A nurse is planning a peer group discussion about the DSM-5. Which of the following information is appropriate to include in the discussion? (Select all that apply) A. The DSM-5 includes client education handouts for mental health disorders. B. The DSM-5 establishes diagnostic criteria for individual mental health disorders. C. The DSM-5 indicates recommended pharmacological treatment for mental health disorders. D. The DSM-5 assists nurses in planning care for client's who have mental health disorders. E. The DSM-5 indicates expected assessment findings of mental health disorders. B, D, & E. The DSM-5 establishes diagnostic criteria, assists nurses in planning care, and identifies expected findings for mental health disorders. The DSM-5 does not contain client education handouts or recommended pharmacological treatment. Beneficence The quality of doing good, can be described as charity Autonomy The client's right to make their own decisions Justice Fair and equal treatment for all Fidelity Loyalty and faithfulness to the client and to one's duty Veracity Honesty when dealing with a client Requirements for restraining a patient Provider must prescribe the restraint in writing; time limits are based on age, 4 hr for adults, 2 hr for ages 9-17, 1 hr for age 8 and younger; must be reviewed every 24 hr; documentation must be done every 15-30 min False imprisonment Confining a client to a specific area if the reason for such confinement is for the convenience of the staff Assault Making a threat to a client's person Battery Touching a client in a harmful or offensive way A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency admission? A. A client who has schizophrenia with delusions of grandeur B. A client who has manifestations of depression and attempted suicide a year ago C. A client who has borderline personality disorder and assaulted a homeless man with a metal rod D. A client who has bipolar disorder and paces quickly around the room while talking to himself C. A client who is a current danger to self or others is a candidate for a temporary emergency admission. A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is very short-staffed, and the client frequently fights with other clients. The nurse's actions are an example of which of the following torts? A. Invasion of privacy B. False imprisonment C. Assault D. Battery B. Secluding a client for the convenience of the staff is false imprisonment. A client tells a nurse, "Don't tell anyone but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." Which of the following actions should the nurse take? A. Keep the client's communication confidential, but talk to the client daily, using therapeutic communication to convince him to admit to hiding the knife. B. Keep the client's communication confidential, but watch the client and his roommate closely. C. Tell the client that this must be reported to the health care team because it concerns the health and safety of the client and others. D. Report the incident to the health care team, but do not inform the client of the intention to do so. C. The information presented by the client is a serious safety issue that the nurse must report to the health care team, using the ethical principle of veracity. A nurse is caring for a client who is in mechanical restraints. Which of the following statements should the nurse include in the documentation? (Select all that apply) A. "Client ate most of his breakfast." B. "Client was offered 8 oz of water every hr." C. "Client shouted obscenities at assistive personnel." D. "Client received chlorpromazine 15 mg by mouth at 1000." E. "Client acted out after lunch." B, C, & D. Documentation must include how much water was offered and how often, a description of the client's verbal communication, and the dosage and time of medication administration. Intake and behavior should be documented in the client's medical record. A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first? A. Notify the nurse manager. B. Tell the nurse to stop discussing the behavior. C. Provide an in-service program about confidentiality. D. Complete an incident report. B. The greatest risk to this client is invasion of privacy through the sharing of confidential information in a public place. The first action the nurse should take is to tell the newly licensed nurse to stop discussing the client's hallucinations in a public location. A nurse is caring for the parents of a child who has demonstrated changes in behavior and mood. When the mother of the child asks the nurse for reassurance about her son's condition, which of the following responses should the nurse make? A. "I think your son is getting better. What have you noticed." B. "I'm sure everything will be okay. It just takes time to heal." C. "I'm not sure whats wrong. Have you asked the doctor about your concerns?" D. "I understand you're concerned. Let's discuss what concerns you specifically." D. This reflects upon and accepts the parents' feelings and allows them to clarify what they are feeling. A interjects the nurse's opinion. B provides false reassurance. C avoids addressing the parent's concerns directly and indicates disinterest. Altruism Dealing with anxiety by reaching out to others Sublimation Dealing with unacceptable feelings or impulses by unconsciously substituting acceptable forms of expression Suppression Voluntarily denying unpleasant thoughts and feelings Repression Unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness Regression Sudden use of childlike or primitive behaviors that do not correlate with the person's current developmental level Displacement Shifting feelings related to an object, person, or situation to another less threatening object, person, or situation Reaction formation Overcompensating or demonstrating the opposite behavior of what is felt Undoing Performing an act to make up for prior behavior Rationalization Creating reasonable and acceptable explanations for unacceptable behavior Dissociation Creating a temporary compartmentalization or lack of connection between the person's identity, memory, or how they perceive the environment Denial Pretending the truth is not reality to manage the anxiety of acknowledging what is real Compensation Emphasizing strengths to make up for weaknesses Identification Conscious or unconscious assumption of the characteristics of another individual or group Intellectualization Separation of emotional and logical facts when analyzing or coping with a situation or event Conversion Responding to stress through the unconscious development of physical manifestations not caused by a physical illness Splitting Demonstrating an inability to reconcile negative and positive attributes of self or others Projection Attributing one's unacceptable thoughts and feelings onto another who does not have them