ATI Mental Health NGN Proctored Exam (Versions A–C)
Comprehensive Psychiatric-Mental Health Nursing
Examination
QUESTION 1
A 45-year-old male with a diagnosis of major depressive disorder is admitted to the psychiatric unit. He
reports feeling hopeless, has lost 15 pounds in the past month, and has difficulty sleeping. Which nursing
intervention is the priority?
Answer: Implement suicide precautions and conduct a thorough suicide risk assessment
Rationale: The priority in caring for a patient with major depressive disorder is safety, specifically assessing
for suicide risk. Hopelessness, significant weight loss, and sleep disturbances are all risk factors for suicide.
The nurse should conduct a thorough suicide risk assessment, including asking about suicidal ideation,
plan, intent, and means. The patient should be placed on continuous observation if the risk is high. All
sharp objects and potential weapons should be removed from the environment. The nurse should establish
a therapeutic relationship, provide a safe environment, and ensure the patient's safety while addressing the
underlying depression through medication and therapy.
QUESTION 2
A 28-year-old female with borderline personality disorder is admitted after a suicide attempt. She is tearful,
demanding, and states, "Everyone always leaves me." What is the most appropriate therapeutic response?
Answer: "I am here with you now, and I want to understand what is happening for you."
Rationale: Patients with borderline personality disorder often have a fear of abandonment and difficulty
regulating emotions. The therapeutic response should validate the patient's feelings without reinforcing
maladaptive behaviors. The nurse should remain calm, set boundaries, and use a supportive, non-
judgmental approach. It is important to provide consistent, predictable care and avoid power struggles. The
nurse should also help the patient develop coping strategies and emotion regulation skills. Dialectical
behavior therapy (DBT) is the most effective treatment for borderline personality disorder, focusing on
mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
QUESTION 3
A 34-year-old male with schizophrenia is experiencing auditory hallucinations. He tells the nurse, "The
voices are telling me to hurt myself." What is the priority nursing action?
,Answer: Assess the content, frequency, and intensity of the hallucinations and implement immediate
safety measures
Rationale: Auditory hallucinations that command self-harm require immediate intervention. The nurse
should assess the specifics of the hallucinations, including what the voices are saying, how often they
occur, and the patient's ability to resist them. The priority is patient safety; the nurse should implement one-
to-one observation and ensure the environment is free from potential hazards. The patient may require
medication adjustment (antipsychotics) to reduce the hallucinations. The nurse should also use therapeutic
communication techniques, such as acknowledging the hallucinations without reinforcing them, and
redirecting the patient's attention to reality-based activities. Family education about the illness and
medication adherence is also essential.
QUESTION 4
A 52-year-old female with bipolar disorder, manic episode, is admitted to the psychiatric unit. She is
hyperactive, talks rapidly, and has poor impulse control. She is not sleeping and has grandiose beliefs.
What is the priority nursing intervention?
Answer: Provide a structured, low-stimulation environment and ensure physical safety
Rationale: During a manic episode, patients are at risk for injury due to hyperactivity, impulsivity, and poor
judgment. The priority is to provide a structured, low-stimulation environment to reduce stimulation and
prevent escalation. The nurse should maintain a calm, firm approach, set clear limits, and provide
redirection. The patient should be placed in a quiet room away from the unit's activity. Safety measures
include removing sharp objects, monitoring for signs of exhaustion, and ensuring adequate nutrition and
hydration. The patient may require medication (mood stabilizers, antipsychotics) to stabilize the mood. The
nurse should also monitor for signs of sleep deprivation and provide rest periods.
QUESTION 5
A 60-year-old male with Alzheimer's disease is becoming increasingly agitated and wandering. The nurse
notes that he is more confused and restless in the late afternoon. What is this phenomenon called?
Answer: Sundowning syndrome
Rationale: Sundowning syndrome is a common phenomenon in patients with Alzheimer's disease and other
dementias, characterized by increased confusion, agitation, and restlessness in the late afternoon and
evening. The exact cause is unknown but may be related to fatigue, changes in circadian rhythms, and
decreased environmental stimulation. Nursing interventions include maintaining a consistent daily routine,
providing a calm environment, redirecting the patient's attention, and using soothing activities. The nurse
should ensure the patient's physical needs are met (e.g., pain relief, toileting) and avoid overstimulation.
The patient may benefit from a "sundowning kit" with calming items, such as a blanket or familiar objects.
Safety measures should be implemented to prevent wandering.
,QUESTION 6
A 42-year-old female with post-traumatic stress disorder (PTSD) is experiencing flashbacks and nightmares
related to a traumatic event. What is the most effective treatment modality for PTSD?
Answer: Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and
reprocessing (EMDR)
Rationale: Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and
reprocessing (EMDR) are the most effective evidence-based treatments for PTSD. TF-CBT helps patients
process the traumatic event and change maladaptive thoughts and behaviors associated with the trauma.
EMDR uses bilateral stimulation to help the patient reprocess traumatic memories. Medications such as
SSRIs (sertraline, paroxetine) are also effective. Nursing care includes providing a safe environment,
helping the patient develop coping strategies, and promoting a sense of safety and trust. The nurse should
assess for suicidal ideation and provide education on the disorder and treatment options.
QUESTION 7
A 38-year-old male with alcohol use disorder is admitted to a detoxification unit. He reports drinking a fifth
of vodka daily for the past year. He is tremulous, anxious, and diaphoretic. What is the priority nursing
intervention?
Answer: Initiate withdrawal management with CIWA-Ar protocol and benzodiazepines
Rationale: Alcohol withdrawal can be life-threatening, with symptoms ranging from tremors and anxiety to
seizures and delirium tremens. The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-
Ar) scale is used to assess withdrawal severity and guide medication administration. Benzodiazepines
(e.g., lorazepam, chlordiazepoxide) are the mainstay of treatment, titrated based on CIWA-Ar scores. The
nurse should provide a quiet, low-stimulation environment, monitor vital signs, and ensure adequate
hydration and nutrition. Thiamine and folic acid should be administered to prevent Wernicke-Korsakoff
syndrome. Seizure precautions should be implemented. The patient should be assessed for co-occurring
medical and psychiatric conditions.
QUESTION 8
A 25-year-old female with anorexia nervosa is admitted to the psychiatric unit. She is significantly
underweight, has a BMI of 15.5, and refuses to eat. What is the priority nursing intervention?
Answer: Initiate nutritional rehabilitation with a structured meal plan and monitor for refeeding syndrome
Rationale: Anorexia nervosa is a life-threatening eating disorder. The priority is nutritional rehabilitation to
restore weight and prevent medical complications. The nurse should implement a structured meal plan with
small, frequent meals, and monitor for refeeding syndrome (electrolyte imbalances, especially
hypophosphatemia, hypokalemia, and hypomagnesemia), which can be fatal. The patient should be
weighed regularly, and laboratory values (electrolytes, glucose, liver function) should be monitored. The
, nurse should provide a supportive environment, set clear limits, and use behavioral contracts. The patient
may also require psychotherapy and family therapy to address the underlying psychological issues. The
nurse should monitor for signs of medical instability, including bradycardia, hypotension, and orthostatic
changes.
QUESTION 9
A 65-year-old male with major neurocognitive disorder (dementia) is becoming increasingly agitated and is
hitting staff when they approach him. What is the most appropriate nursing intervention?
Answer: Identify and address underlying causes of agitation, such as pain, hunger, or discomfort
Rationale: Agitation in dementia patients often indicates an unmet need or underlying cause. The nurse
should assess for physical discomfort (pain, hunger, thirst, need for toileting), medication side effects, and
environmental triggers. Interventions should be non-pharmacological first: providing a calm environment,
redirecting the patient, and using therapeutic communication. The patient should not be restrained;
restraints should only be used as a last resort. Pharmacological interventions (antipsychotics) may be
considered if non-pharmacological interventions are ineffective, but they should be used cautiously due to
the increased risk of adverse effects in elderly patients. The nurse should monitor for signs of infection,
which can cause acute confusion.
QUESTION 10
A 30-year-old male with schizophrenia is experiencing negative symptoms, including alogia, avolition, and
affective flattening. Which medication class is most effective for these symptoms?
Answer: Atypical antipsychotics (e.g., risperidone, olanzapine, aripiprazole)
Rationale: Atypical (second-generation) antipsychotics are more effective than typical antipsychotics for
treating the negative symptoms of schizophrenia, including alogia (poverty of speech), avolition (lack of
motivation), and affective flattening (reduced emotional expression). They also have a lower risk of
extrapyramidal side effects. The nurse should educate the patient about medication adherence and monitor
for side effects (metabolic syndrome, weight gain). The patient may also benefit from cognitive-behavioral
therapy (CBT) and social skills training to address negative symptoms. The nurse should encourage the
patient to engage in structured activities and provide a supportive environment.
QUESTION 11
A 22-year-old female with generalized anxiety disorder (GAD) is prescribed buspirone. The nurse is
educating the patient about this medication. Which statement indicates the patient understands the
teaching?
Answer: "Buspirone may take several weeks to become effective, and I should not stop taking it abruptly."
Comprehensive Psychiatric-Mental Health Nursing
Examination
QUESTION 1
A 45-year-old male with a diagnosis of major depressive disorder is admitted to the psychiatric unit. He
reports feeling hopeless, has lost 15 pounds in the past month, and has difficulty sleeping. Which nursing
intervention is the priority?
Answer: Implement suicide precautions and conduct a thorough suicide risk assessment
Rationale: The priority in caring for a patient with major depressive disorder is safety, specifically assessing
for suicide risk. Hopelessness, significant weight loss, and sleep disturbances are all risk factors for suicide.
The nurse should conduct a thorough suicide risk assessment, including asking about suicidal ideation,
plan, intent, and means. The patient should be placed on continuous observation if the risk is high. All
sharp objects and potential weapons should be removed from the environment. The nurse should establish
a therapeutic relationship, provide a safe environment, and ensure the patient's safety while addressing the
underlying depression through medication and therapy.
QUESTION 2
A 28-year-old female with borderline personality disorder is admitted after a suicide attempt. She is tearful,
demanding, and states, "Everyone always leaves me." What is the most appropriate therapeutic response?
Answer: "I am here with you now, and I want to understand what is happening for you."
Rationale: Patients with borderline personality disorder often have a fear of abandonment and difficulty
regulating emotions. The therapeutic response should validate the patient's feelings without reinforcing
maladaptive behaviors. The nurse should remain calm, set boundaries, and use a supportive, non-
judgmental approach. It is important to provide consistent, predictable care and avoid power struggles. The
nurse should also help the patient develop coping strategies and emotion regulation skills. Dialectical
behavior therapy (DBT) is the most effective treatment for borderline personality disorder, focusing on
mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.
QUESTION 3
A 34-year-old male with schizophrenia is experiencing auditory hallucinations. He tells the nurse, "The
voices are telling me to hurt myself." What is the priority nursing action?
,Answer: Assess the content, frequency, and intensity of the hallucinations and implement immediate
safety measures
Rationale: Auditory hallucinations that command self-harm require immediate intervention. The nurse
should assess the specifics of the hallucinations, including what the voices are saying, how often they
occur, and the patient's ability to resist them. The priority is patient safety; the nurse should implement one-
to-one observation and ensure the environment is free from potential hazards. The patient may require
medication adjustment (antipsychotics) to reduce the hallucinations. The nurse should also use therapeutic
communication techniques, such as acknowledging the hallucinations without reinforcing them, and
redirecting the patient's attention to reality-based activities. Family education about the illness and
medication adherence is also essential.
QUESTION 4
A 52-year-old female with bipolar disorder, manic episode, is admitted to the psychiatric unit. She is
hyperactive, talks rapidly, and has poor impulse control. She is not sleeping and has grandiose beliefs.
What is the priority nursing intervention?
Answer: Provide a structured, low-stimulation environment and ensure physical safety
Rationale: During a manic episode, patients are at risk for injury due to hyperactivity, impulsivity, and poor
judgment. The priority is to provide a structured, low-stimulation environment to reduce stimulation and
prevent escalation. The nurse should maintain a calm, firm approach, set clear limits, and provide
redirection. The patient should be placed in a quiet room away from the unit's activity. Safety measures
include removing sharp objects, monitoring for signs of exhaustion, and ensuring adequate nutrition and
hydration. The patient may require medication (mood stabilizers, antipsychotics) to stabilize the mood. The
nurse should also monitor for signs of sleep deprivation and provide rest periods.
QUESTION 5
A 60-year-old male with Alzheimer's disease is becoming increasingly agitated and wandering. The nurse
notes that he is more confused and restless in the late afternoon. What is this phenomenon called?
Answer: Sundowning syndrome
Rationale: Sundowning syndrome is a common phenomenon in patients with Alzheimer's disease and other
dementias, characterized by increased confusion, agitation, and restlessness in the late afternoon and
evening. The exact cause is unknown but may be related to fatigue, changes in circadian rhythms, and
decreased environmental stimulation. Nursing interventions include maintaining a consistent daily routine,
providing a calm environment, redirecting the patient's attention, and using soothing activities. The nurse
should ensure the patient's physical needs are met (e.g., pain relief, toileting) and avoid overstimulation.
The patient may benefit from a "sundowning kit" with calming items, such as a blanket or familiar objects.
Safety measures should be implemented to prevent wandering.
,QUESTION 6
A 42-year-old female with post-traumatic stress disorder (PTSD) is experiencing flashbacks and nightmares
related to a traumatic event. What is the most effective treatment modality for PTSD?
Answer: Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and
reprocessing (EMDR)
Rationale: Trauma-focused cognitive-behavioral therapy (TF-CBT) and eye movement desensitization and
reprocessing (EMDR) are the most effective evidence-based treatments for PTSD. TF-CBT helps patients
process the traumatic event and change maladaptive thoughts and behaviors associated with the trauma.
EMDR uses bilateral stimulation to help the patient reprocess traumatic memories. Medications such as
SSRIs (sertraline, paroxetine) are also effective. Nursing care includes providing a safe environment,
helping the patient develop coping strategies, and promoting a sense of safety and trust. The nurse should
assess for suicidal ideation and provide education on the disorder and treatment options.
QUESTION 7
A 38-year-old male with alcohol use disorder is admitted to a detoxification unit. He reports drinking a fifth
of vodka daily for the past year. He is tremulous, anxious, and diaphoretic. What is the priority nursing
intervention?
Answer: Initiate withdrawal management with CIWA-Ar protocol and benzodiazepines
Rationale: Alcohol withdrawal can be life-threatening, with symptoms ranging from tremors and anxiety to
seizures and delirium tremens. The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-
Ar) scale is used to assess withdrawal severity and guide medication administration. Benzodiazepines
(e.g., lorazepam, chlordiazepoxide) are the mainstay of treatment, titrated based on CIWA-Ar scores. The
nurse should provide a quiet, low-stimulation environment, monitor vital signs, and ensure adequate
hydration and nutrition. Thiamine and folic acid should be administered to prevent Wernicke-Korsakoff
syndrome. Seizure precautions should be implemented. The patient should be assessed for co-occurring
medical and psychiatric conditions.
QUESTION 8
A 25-year-old female with anorexia nervosa is admitted to the psychiatric unit. She is significantly
underweight, has a BMI of 15.5, and refuses to eat. What is the priority nursing intervention?
Answer: Initiate nutritional rehabilitation with a structured meal plan and monitor for refeeding syndrome
Rationale: Anorexia nervosa is a life-threatening eating disorder. The priority is nutritional rehabilitation to
restore weight and prevent medical complications. The nurse should implement a structured meal plan with
small, frequent meals, and monitor for refeeding syndrome (electrolyte imbalances, especially
hypophosphatemia, hypokalemia, and hypomagnesemia), which can be fatal. The patient should be
weighed regularly, and laboratory values (electrolytes, glucose, liver function) should be monitored. The
, nurse should provide a supportive environment, set clear limits, and use behavioral contracts. The patient
may also require psychotherapy and family therapy to address the underlying psychological issues. The
nurse should monitor for signs of medical instability, including bradycardia, hypotension, and orthostatic
changes.
QUESTION 9
A 65-year-old male with major neurocognitive disorder (dementia) is becoming increasingly agitated and is
hitting staff when they approach him. What is the most appropriate nursing intervention?
Answer: Identify and address underlying causes of agitation, such as pain, hunger, or discomfort
Rationale: Agitation in dementia patients often indicates an unmet need or underlying cause. The nurse
should assess for physical discomfort (pain, hunger, thirst, need for toileting), medication side effects, and
environmental triggers. Interventions should be non-pharmacological first: providing a calm environment,
redirecting the patient, and using therapeutic communication. The patient should not be restrained;
restraints should only be used as a last resort. Pharmacological interventions (antipsychotics) may be
considered if non-pharmacological interventions are ineffective, but they should be used cautiously due to
the increased risk of adverse effects in elderly patients. The nurse should monitor for signs of infection,
which can cause acute confusion.
QUESTION 10
A 30-year-old male with schizophrenia is experiencing negative symptoms, including alogia, avolition, and
affective flattening. Which medication class is most effective for these symptoms?
Answer: Atypical antipsychotics (e.g., risperidone, olanzapine, aripiprazole)
Rationale: Atypical (second-generation) antipsychotics are more effective than typical antipsychotics for
treating the negative symptoms of schizophrenia, including alogia (poverty of speech), avolition (lack of
motivation), and affective flattening (reduced emotional expression). They also have a lower risk of
extrapyramidal side effects. The nurse should educate the patient about medication adherence and monitor
for side effects (metabolic syndrome, weight gain). The patient may also benefit from cognitive-behavioral
therapy (CBT) and social skills training to address negative symptoms. The nurse should encourage the
patient to engage in structured activities and provide a supportive environment.
QUESTION 11
A 22-year-old female with generalized anxiety disorder (GAD) is prescribed buspirone. The nurse is
educating the patient about this medication. Which statement indicates the patient understands the
teaching?
Answer: "Buspirone may take several weeks to become effective, and I should not stop taking it abruptly."
