ATI Practice Mental Health Nursing Test B

A nurse is caring for a client who is in an abusive relationship and is assisting in the development of a safety plan. Which of the following actions is the first component of a safety plan? - Identify signs of escalation of violence. A nurse is caring for a child who has conduct disorder and is behaving in a destructive manner, throwing objects, and kicking others. Which of the following therapeutic nursing interventions is the priority? - Reduce environmental stimuli A nurse is updating the plan of care for a client who had bulimia nervosa and is 5% above their ideal body weight. Which of the following interventions should the nurse include in the plan? - Identify the client's trigger foods. A nurse is assisting a client who has a terminal illness adjust to progressive loss of independence. Which of the following statements by the client indicates acceptance of her illness? - "I am going to order a wheelchair for when I'm unable to walk." A nurse is reviewing the medication administration record for a client who is experiencing adverse effects of chlorpromazine. The nurse should administer benztropine to relieve which of the following adverse effects? - Acute dystonia A nurse is caring for an older adult client who is experiencing delirium. Which of the following interventions should the nurse include in the client's plan of care. - Permit the client to preform daily rituals to decrease anxiety. A nurse is receiving change-of-shift report for four clients. Which of the following clients should the nurse plan to see first? - A client who is taking clozapine and reports a sore throat and chills A nurse is planning care for a client who has made repeated physical treats toward others on the unit. Although the client does not want to leave the unit, the nurse requests the provider to transfer the client to a unit that is equipped to manage violent behavior. Which of the following ethical principles should the nurse apply in this situation? - Nonmaleficence A nurse is performing a cognitive assessment to distinguish delirium from dementia in a client whose family reports episodes for confusion. Which of the following assessment findings supports the nurse's suspicion of delirium? - Easily distracted A nurse is creating a plan of care for a client who has been placed in seclusion after threatening to harm others on the unit. Which of the following interventions should the nurse include in the plan? - Renew the prescription for the client every 4 hr. A client who has a recent diagnosis of bipolar disorder is placed in a room with a client who has severe depression. The client who has depression reports to the nurse, "My roommate neve sleeps and keeps me up, too." Which of the following actions should the nurse take? - Move the client who has bipolar disorder to a private room. A nurse is teaching the partner of a client who has bipolar disorder how to identify manifestations of acute mania. Which of the following findings should the client's partner report to the provider? - Inability to sleep A nurse is teaching coping strategies to a client who is experiencing depression related to partner violence. Which of the following statements by the client indicates an understanding of the teaching? - "I will talk about my feelings with a close friend." The nurse is providing teaching to the client. Which of the following statements should the nurse include in the teaching? (Select all that apply.) - - "You should seek help if you have thoughts of self-harm." - "A support group might be helpful to you during this time." - "It is common for people who survived a traumatic event to experience feelings of anxiety." A nurse is discussing a 12-step program with a client who has alcohol use disorder and is in an acute care facility undergoing detoxification. Which of the following information should the nurse include in the teaching? - The client should obtain a sponsor before discharge for an increased chance of recovery. A nurse is assessing a client for risk factors for the development of depression. The nurse should identify that which of the following factors places the client at an increased risk for depression? - The client has COPD A nurse on a medical-surgical unit is assessing a client who sustained injuries 12 hr ago following a motor-vehicle crash. The client's admission blood alcohol level was 325 mg/dL. Which of the following findings should indicate to the nurse that the client is experiencing alcohol withdrawal? - Blood pressure 154/96 mm Hg A nurse on a mental health unit observes a client who has acute mania hit another client. Which of the following actions should the nurse take first? - Call for a team of staff members to help with the situation. A nurse is planning discharge teaching for a client who has severe schizoaffective disorder. The nurse should identify that which of the following treatment options can offer interdiscplinary services for the client at home? - Assertive community treatment A nurse is planning care for a client who has generalized anxiety disorder. At which of the following levels of anxiety should the nurse plan to teach the client relaxation techniques? - Mild A nurse is assessing a client who is displaying manifestations of delirium. Which of the following information from the client's medical record are risk factors for delirium? (Select all that apply.) - - Fever - Hospital Environment - Client's age - Postoperative Which of the following findings should the nurse report to the provider immediately? Select the 5 findings that require immediate follow-up. - - Cognitive awareness - Blood pressure - Sleep/wake cycle is correct - I&O - Temperature For each potential provider's prescription, click to specify if the potential prescription is anticipated, nonessential, or contraindicated for the client. - Restraints - Contraindicated Urinalysis with culture - Anticipated Insert Indwelling catheter - Contraindicated Melatonin - Anticipated MRI - Nonessential IV FLuids - Anticipated The nurse is planning care for the client who has delirium and new prescriptions. Complete the following sentence by using the lists of options. - The nurse should first 1. Initiate IV fluids, followed by 2. administering acetaminophen. The nurse is caring for the client. Which of the following actions should the nurse take for this client? (Select all that apply.) - - Offer the client warm milk at bedtime - Approach the client from the front and speak slowly - Maintain a low-stimulation environment for the client The nurse is evaluating the client's response to treatments. For each assessment finding, click to specify if the finding is an improvement, no change, or a decline in the client's condition. - Sleep/wake cycle - no change vital signs - improvement Daytime orientation - improvement Glucose - no change I&O - improvement Pain Level - improvement Ambulation - decline in condition A nurse is educating the parent of a child who has a new diagnosis of autism spectrum disorder. Which of the following manifestations of this disorder should the nurse include in the teaching? - Language delay A nurse in a mental health facility is caring for a client who has schizophrenia. Which of the following findings places the client at the greatest risk for selfdirected injury or injuring others? - Command Hallucinations A nurse on a mental health unit is caring for a group of clients. Which of the following actions by the nurse is an example of the ethical principle of justice? - Spending adequate time with a client who is verbally abusive A nurse is providing teaching to the partner of a client who is in a rehabilitation program for alcohol use disorder. The nurse should identify that which of the following statements by the client's partner indicates an understanding of the teaching? - "I will not take charge of my partner's work responsibilities." A nurse is talking with a group of parents who have recently experienced the death of a child. Which of the following actions should the nurse take? - Suggest forming a weekly support group for parents who have experienced the death of a child.