2025 ATI RN Mental Health Proctored
Exam – Actual Clinical Psych Q&A with
Verified Rationales | 100% Accurate
Psychiatric Assessment and Diagnosis
1. A nurse is assessing a client with suspected major depressive disorder. Which
symptom is most indicative of this diagnosis?
A. Increased energy levels
B. Persistent low mood for at least 2 weeks
C. Grandiose delusions
D. Auditory hallucinations
Correct Answer: B. Persistent low mood for at least 2 weeks
Rationale: Per DSM-5, a persistent low mood or loss of interest for at least 2
weeks, along with other symptoms like fatigue or hopelessness, is a hallmark
of major depressive disorder. Increased energy is seen in mania, grandiose
delusions in bipolar disorder, and hallucinations in schizophrenia.
2. A client reports racing thoughts and difficulty sleeping for 5 days. The nurse
suspects bipolar disorder, manic episode. What is the priority assessment?
A. Nutritional intake
B. Risk for self-harm or harm to others
C. Family history of anxiety
D. Medication adherence
Correct Answer: B. Risk for self-harm or harm to others
Rationale: During a manic episode, impulsivity and poor judgment increase
the risk for self-harm or harm to others, making this the priority assessment
per ATI mental health guidelines.
3. Case Study: A client with schizophrenia reports hearing voices commanding
self-harm. What is the nurse’s priority action?
A. Administer an antipsychotic immediately
B. Initiate one-to-one observation
C. Engage the client in group therapy
D. Teach coping strategies
Correct Answer: B. Initiate one-to-one observation
Rationale: Command hallucinations pose an immediate safety risk,
requiring one-to-one observation to prevent self-harm, per ATI safety
protocols. Medication and therapy are secondary until safety is ensured.
4. SATA: Which findings indicate a client may have generalized anxiety disorder?
(Select All That Apply)
A. Excessive worry for 6 months
B. Visual hallucinations
C. Restlessness or feeling on edge
D. Recurrent intrusive thoughts
, 2
E. Muscle tension
Correct Answers: A, C, E
Rationale: DSM-5 criteria for generalized anxiety disorder include excessive
worry for 6 months, restlessness, and physical symptoms like muscle tension.
Hallucinations are associated with psychosis, and intrusive thoughts with
OCD.
5. A client with suspected post-traumatic stress disorder (PTSD) reports nightmares
and avoidance behaviors. What is the nurse’s best response?
A. Encourage the client to discuss the trauma in detail
B. Validate the client’s feelings and offer a safe environment
C. Recommend immediate medication review
D. Refer the client to group therapy only
Correct Answer: B. Validate the client’s feelings and offer a safe
environment
Rationale: Validating feelings and ensuring safety are initial steps in PTSD
care, per ATI guidelines, to build trust before trauma-focused interventions.
6. What tool is used to assess suicide risk in a client with depression?
A. MMSE
B. CAGE questionnaire
C. SAD PERSONS scale
D. GAD-7
Correct Answer: C. SAD PERSONS scale
Rationale: The SAD PERSONS scale assesses suicide risk factors like sex,
age, and depression, per ATI mental health protocols. MMSE assesses
cognition, CAGE screens for substance use, and GAD-7 evaluates anxiety.
7. A client with obsessive-compulsive disorder (OCD) spends 3 hours daily on
rituals. What is the nurse’s priority intervention?
A. Interrupt rituals immediately
B. Teach relaxation techniques
C. Assess the impact on daily functioning
D. Administer an SSRI
Correct Answer: C. Assess the impact on daily functioning
Rationale: Assessing the impact of OCD rituals on daily functioning guides
treatment planning, per ATI guidelines. Interrupting rituals may increase
anxiety, and medication or relaxation are secondary.
Therapeutic Interventions and Medications
8. A client is prescribed sertraline for depression. What is the nurse’s priority
teaching point?
A. Take the medication at bedtime to avoid sedation
B. Monitor for signs of serotonin syndrome
C. Expect immediate symptom relief
D. Avoid all dietary restrictions
Correct Answer: B. Monitor for signs of serotonin syndrome
Rationale: Sertraline, an SSRI, carries a risk of serotonin syndrome, a
potentially life-threatening condition. Monitoring for symptoms like
agitation or fever is critical, per ATI pharmacology guidelines.