ATI Mental Health Proctored Exam 3
o o o o o o
2024 o
o
A oschool onurse ois oassessing oa oschool oaged ochild owho oexperienced othe otraumatic
oloss oof oa oparent o8 omonths oago. oWhich oof othe ofollowing ofindings oshould othe
onurse oidentify oas oan oindication othat othe ochild ois oexperiencing opost otraumatic
ostress odisorder o(PTSD) o
o
1. Clinging obehaviors odirected otoward oa oteacher o
2. Increased otime ospent osleeping o
3. Intense ofocus oon oschool owork o
4. Lack oof ointerest oin oan oupcoming oholiday o- oCorrect o= o4. oLack oof ointerest oin oan
oupcoming oholiday o
o
The ochild owho ohas oPTSD owill ohave onegative omoods oand odifficulty oremembering
oaspects oof othe otraumatic oevent. oThe ochild ocan oalso ohave oa oloss oof ointerest oor
olack oof oparticipation oin osignificant oactivities oand oevents o(e.g., oHolidays) o
o
*PTSD omanifestations oseen oin ochildren oinclude odetachment oor oestrangement
ofrom o
o
others, odifficulty osleeping/distressing odreams, odifficulty oconcentrating oon
otasks
o
A onurse ois ocaring ofor oa ogroup oof oclients. oWhich oof othe ofollowing ofinding
oshould othe o
o
nurse
oreport?
o
1. A oclient owho ois otaking oclozapine oand ohas oa oWBC ocount oof o7,500 o
2. A oclient owho ois otaking olamotrigine oand ohas odeveloped oa orash o
3. A oclient owho ois otaking ovalproate oand ohas oa oplatelet ocount oof o150,000 o
4. A oclient owho ois otaking olithium oand ohas oa olithium olevel oof o1.2 o- oCorrect o= o2. oA
oclient owho ois otaking olamotrigine oand ohas odeveloped oa orash o
o
Lamotrigine ois oan oanticonvulsant omedication othat ois oused oas oa omood ostabilizer.
oThe onurse oshould oidentify othat oa orash ois oa opotentially olife othreatening oadverse
oeffect oof othe omedication oand oreport othe ofinding oimmediately o
o
A onurse ois oreviewing olaboratory oresults ofor oa oclient owho ohas oschizophrenia
oand ois o
o
taking oclozapine. oWhich oof othe ofollowing ovalues oshould othe onurse oidentify
oas
o
contraindication ofor oreceiving
oclozapine?
o
o
1. oWBC ocount
o2,500
o
o
2. oHgb
o11.5
,3. oPlatelets
o150,000
4. oRBC ocount o3.5 o- oCorrect o- o1. oWBC ocount
o2,500
o
Clozapine ocan ocause oagranulocytosis, owhich ocan obe ofatal odue oto ooverwhelming
oinfection. oThe onurse oshould oidentify oa oWBC ocount oof oless othan o3,000 oas oa
opossible omanifestation oof oagranulocytosis oand oshould owithhold othe omedication
oand onotify othe oprovider o
o
A onurse ois oplanning ocare ofor oa oclient owho ohas odepression oand ohas omade
ofrequent o
o
suicide oattempts. oWhich oof othe ofollowing ostatements oindicates othe oclient
ohas oa
o
decreased orisk ofor
osuicide?
o
1. "I'm orelieved onow othat omy ofinancial oaffairs oare oin oorder." o
2. "It ois oeasier oto otalk oabout omy ofeelings onow." o
3. "Suddenly oI ohave oenough oenergy oto odo oanything oI owant." o
4. "Thank oyou ofor oalways otaking osuch ogood ocare oof ome." o- oCorrect o- o2. o"It ois
oeasier oto otalk oabout omy ofeelings onow." o
o
When oclients oexpress otheir ofeelings, othis oindicates oa opositive otreatment ooutcome o
o
*When oclients owho ohave odepression overbalize ogetting otheir oaffairs oin oorder, oor
osuddenly ohave omore oenergy oare oat oan oincreased orisk oof osuicide. oClients owho
ohave odepression ooften oshow oan oappreciation ofor oloved oones owhen othey oare
ocontemplating osuicide o
o
During oa oclient's oinitial ointerview oin oa omental ohealth oinpatient osetting, oa onurse
oidentifies othat othe oclient ois omaintaining oeye ocontact oand oleaning oforward. oWhich
oof othe ofollowing oassumptions oshould othe onurse omake obased oon othe oclient's
ononverbal obehaviors? o
o
1. The oclient ois ointerested oin owhat othe onurse ois osaying o
2. The oclient ois oattempting oto omanipulate othe onurse o
3. The oclient ois ophysically oattracted oto othe onurse o
4. The oclient ois oseeking oacceptance oby othe onurse o- oCorrect o- o1. oThe oclient ois
ointerested oin owhat othe onurse ois osaying o
o
The oclient's oposture oand oeye ocontact odemonstrate oan ointerest oin othe ointerview
oand o
o
what othe onurse ois
osaying
o
A onurse ois oplanning ocare ofor oa oclient owho ohas oschizophrenia oand oreports oauditory
ohallucinations. oWhich oof othe ofollowing ointerventions oshould othe onurse oinclude oin
othe oplan? o
o
1. Promote ouse oof omusic oto ocompete owith othe oclient's oauditory ohallucination o
2. Inform othe oclient othat othe oauditory ohallucinations oare onot oreal o
,3. Avoid oasking othe oclient oif othey oare oexperiencing oauditory ohallucinations o4.
oInstruct othe oclient oon othe ouse oof ovoice orecognition oregarding othe oauditory
ohallucinations o- oCorrect o= o1. oPromote othe ouse oof omusic oto ocompete owith othe
oclient's oauditory ohallucinations o
o
Competing oreality obased ostimulating osuch oas othe ouse oof omusic oor otelevision
oduring oauditory ohallucinations ocan oassist oin olimiting othe oeffect othe ohallucinations
ohave oon othe oclient's ostress olevel o
o
*The onurse oshould oacknowledge othat othe oclient ois ohearing oauditory ohallucinations,
obut oshould otell othe oclient othat oothers ocannot ohear oanything oto oreinforce oreality.
oThe onurse oshould oask othe oclient oif othey oare ohearing ovoices oto oevaluate owhether
othese oare ocommand ohallucinations, owhich ocan oplace othe oclient oor oothers oat orisk
ofor oharm. oThe onurse oshould oassist othe oclient oto odevelop othe oskill oof ovoice
odismissal owhen oauditory o
hallucinations ooccur. oThis oinvolves ocommanding othe ovoices oto ostop, owhich ogives
othe o
o
client oa osense oof
ocontrol
o
A onurse ois ocaring ofor oa oclient owho ohas oimpaired ocognition o
o
A onurse ois oupdating othe oclient's oplan oof ocare. oFor oeach oof othe ofollowing
opotential o
nursing ointerventions, oclick oto ospecify oif othe opotential ointervention ois
oanticipated, o
o
nonessential, oor ocontraindicated ofor othe
oclient
o
Potential oIntervention: o
1. When oaddressing othe oclient, oapproach othem ofrom othe ofront owhen opossible o
2. Use oa ovest orestrain oto okeep othe oclient oin oa omedical orecliner o
3. Ensure othe obed ois okept oat oa oworking oheight ofor othe onurse o
4. Provide othe oclient owith ohigh-calorie oprotein odrinks ohourly o
5. Give odirections oto othe oclient oslowly oand oin oa omoderate otone oof ovoice o
6. Decrease othe osensory ostimulation o
7. Keep othe olights ooff oin othe oclient's obedroom oand obathroom oat onight o
8. Assign othe oclient oto oa oroom onear othe onurses' ostation o
o
o
Exhibit
o1:
o
Medical
oHistory
o
Day o1, o0800: oClient otreated ofor oUTI o8 omonths
oago
Day o3, o0830: oClient ofell ogetting oout oof obed oto ogo oto othe oba o-
oCorrect o=
o
1. When oaddressing othe oclient, oapproach othem ofrom othe ofront owhen opossible o=
oAnticipated. o o
, *A oclient owho ois ounexpectantly oapproached oor otouched ofrom osomeone oout oof
oview ois oeasily ostartled, owhich ocan opromote oaggressive obehavior oin othe oclient. o
2. Use oa ovest orestraint oto okeep othe oclient oin oa omedical orecliner o= oContraindicated.
o o
*The oclient ohas othe oright oto obe ofree ofrom othe ouse oof orestraints oexcept oin othe ocase
oof oan oemergency. o o
3. Ensure othe obed ois okept oat oa oworking oheight ofor othe onurse o= oContraindicated. o
o*The oclient's obed oshould obe oplaced oin othe olowest oposition oto odecrease othe orisk
ofor ofalls, oor olessen oinjury oseverity oif othe oclient odoes ofall. o
4. Provide othe oclient owith ohigh-calorie oprotein odrinks ohourly o= oNonessential. o
o*This ois ononessential ofor othis oclient obecause othey oare otaking oin onutrition. oThe
onurse oshould oprovide othe oclient owho ohas omania owith othis otype oof odietary
osupplement. o5. oGive odirections oto othe oclient oslowly oand oin oa omoderate otone oof
ovoice o= oAnticipated. o o*Providing odirections oslowly oand oin oa omoderate otone oof
ovoice owill oincrease oclient ocomprehension. oLoud ovoices ocan ocause othe oclient oto
ofeel ouncomfortable oand ocan oeven ocause ofeelings oof oanger. o
6. Decrease osensory ostimulation o= oAnticipated. o o
*A ohighly ostimulating oenvironment ocan ocause othe oclient oto obecome oanxious oand
ofurther odisoriented, owhich ocan oimpair oclient osafety. o
7. Keep othe olights ooff oin othe oclient's obedroom oand obathroom oat onight o=
oContraindicated. o o
*This ocan oincrease othe oclient's orisk ofor ofalls. oKeeping oa olight oon ocan odecrease
owandering. o
8. Assign othe oclient oto oa oroom onear othe onurses' ostation o= oAnticipated. o o
*This opromotes oclient osafety oby oallowing ostaff oto oobserve othe oclient ofrequently. o
o
A onurse ois oplanning odischarge oteaching owith oa ofamily omember oof oa oclient owho
ohas oa o
o
new odiagnosis oof odepression. oWhich oof othe ofollowing oinformation oabout
orelapse
o
should othe onurse
oinclude?
o
1. oAdditional oacute oepisodes oof odepression oare ounlikely ofollowing oinpatient
ocare. o2. oEarly oidentification oof ochanges, osuch oas odecreased osocial
oinvolvement, ois oimportant. o
3. Medication ocompliance owill oprevent ofurther oneed ofor oinpatient ohospitalization. o
4. It ois ohelpful oto oregularly oreinforce oto othe oclient othat othings owill oget obetter. o-
oCorrect o= o2. oEarly oidentification oof ochanges, osuch oas odecreased osocial
oinvolvement, ois oimportant. o
o
Decrease osocial oinvolvement ois oa omanifestation oof odepression, oand oearly
oidentification o
o
of ofindings ocan olead oto oearly
ointervention
o
A onurse ois oestablishing oa otherapeutic orelationship owith oa oclient owho ohas oantisocial
opersonality odisorder. oWhich oof othe ofollowing ostrategies oshould othe onurse ouse
owhen ocommunicating owith othis oclient? o
o
o o o o o o
2024 o
o
A oschool onurse ois oassessing oa oschool oaged ochild owho oexperienced othe otraumatic
oloss oof oa oparent o8 omonths oago. oWhich oof othe ofollowing ofindings oshould othe
onurse oidentify oas oan oindication othat othe ochild ois oexperiencing opost otraumatic
ostress odisorder o(PTSD) o
o
1. Clinging obehaviors odirected otoward oa oteacher o
2. Increased otime ospent osleeping o
3. Intense ofocus oon oschool owork o
4. Lack oof ointerest oin oan oupcoming oholiday o- oCorrect o= o4. oLack oof ointerest oin oan
oupcoming oholiday o
o
The ochild owho ohas oPTSD owill ohave onegative omoods oand odifficulty oremembering
oaspects oof othe otraumatic oevent. oThe ochild ocan oalso ohave oa oloss oof ointerest oor
olack oof oparticipation oin osignificant oactivities oand oevents o(e.g., oHolidays) o
o
*PTSD omanifestations oseen oin ochildren oinclude odetachment oor oestrangement
ofrom o
o
others, odifficulty osleeping/distressing odreams, odifficulty oconcentrating oon
otasks
o
A onurse ois ocaring ofor oa ogroup oof oclients. oWhich oof othe ofollowing ofinding
oshould othe o
o
nurse
oreport?
o
1. A oclient owho ois otaking oclozapine oand ohas oa oWBC ocount oof o7,500 o
2. A oclient owho ois otaking olamotrigine oand ohas odeveloped oa orash o
3. A oclient owho ois otaking ovalproate oand ohas oa oplatelet ocount oof o150,000 o
4. A oclient owho ois otaking olithium oand ohas oa olithium olevel oof o1.2 o- oCorrect o= o2. oA
oclient owho ois otaking olamotrigine oand ohas odeveloped oa orash o
o
Lamotrigine ois oan oanticonvulsant omedication othat ois oused oas oa omood ostabilizer.
oThe onurse oshould oidentify othat oa orash ois oa opotentially olife othreatening oadverse
oeffect oof othe omedication oand oreport othe ofinding oimmediately o
o
A onurse ois oreviewing olaboratory oresults ofor oa oclient owho ohas oschizophrenia
oand ois o
o
taking oclozapine. oWhich oof othe ofollowing ovalues oshould othe onurse oidentify
oas
o
contraindication ofor oreceiving
oclozapine?
o
o
1. oWBC ocount
o2,500
o
o
2. oHgb
o11.5
,3. oPlatelets
o150,000
4. oRBC ocount o3.5 o- oCorrect o- o1. oWBC ocount
o2,500
o
Clozapine ocan ocause oagranulocytosis, owhich ocan obe ofatal odue oto ooverwhelming
oinfection. oThe onurse oshould oidentify oa oWBC ocount oof oless othan o3,000 oas oa
opossible omanifestation oof oagranulocytosis oand oshould owithhold othe omedication
oand onotify othe oprovider o
o
A onurse ois oplanning ocare ofor oa oclient owho ohas odepression oand ohas omade
ofrequent o
o
suicide oattempts. oWhich oof othe ofollowing ostatements oindicates othe oclient
ohas oa
o
decreased orisk ofor
osuicide?
o
1. "I'm orelieved onow othat omy ofinancial oaffairs oare oin oorder." o
2. "It ois oeasier oto otalk oabout omy ofeelings onow." o
3. "Suddenly oI ohave oenough oenergy oto odo oanything oI owant." o
4. "Thank oyou ofor oalways otaking osuch ogood ocare oof ome." o- oCorrect o- o2. o"It ois
oeasier oto otalk oabout omy ofeelings onow." o
o
When oclients oexpress otheir ofeelings, othis oindicates oa opositive otreatment ooutcome o
o
*When oclients owho ohave odepression overbalize ogetting otheir oaffairs oin oorder, oor
osuddenly ohave omore oenergy oare oat oan oincreased orisk oof osuicide. oClients owho
ohave odepression ooften oshow oan oappreciation ofor oloved oones owhen othey oare
ocontemplating osuicide o
o
During oa oclient's oinitial ointerview oin oa omental ohealth oinpatient osetting, oa onurse
oidentifies othat othe oclient ois omaintaining oeye ocontact oand oleaning oforward. oWhich
oof othe ofollowing oassumptions oshould othe onurse omake obased oon othe oclient's
ononverbal obehaviors? o
o
1. The oclient ois ointerested oin owhat othe onurse ois osaying o
2. The oclient ois oattempting oto omanipulate othe onurse o
3. The oclient ois ophysically oattracted oto othe onurse o
4. The oclient ois oseeking oacceptance oby othe onurse o- oCorrect o- o1. oThe oclient ois
ointerested oin owhat othe onurse ois osaying o
o
The oclient's oposture oand oeye ocontact odemonstrate oan ointerest oin othe ointerview
oand o
o
what othe onurse ois
osaying
o
A onurse ois oplanning ocare ofor oa oclient owho ohas oschizophrenia oand oreports oauditory
ohallucinations. oWhich oof othe ofollowing ointerventions oshould othe onurse oinclude oin
othe oplan? o
o
1. Promote ouse oof omusic oto ocompete owith othe oclient's oauditory ohallucination o
2. Inform othe oclient othat othe oauditory ohallucinations oare onot oreal o
,3. Avoid oasking othe oclient oif othey oare oexperiencing oauditory ohallucinations o4.
oInstruct othe oclient oon othe ouse oof ovoice orecognition oregarding othe oauditory
ohallucinations o- oCorrect o= o1. oPromote othe ouse oof omusic oto ocompete owith othe
oclient's oauditory ohallucinations o
o
Competing oreality obased ostimulating osuch oas othe ouse oof omusic oor otelevision
oduring oauditory ohallucinations ocan oassist oin olimiting othe oeffect othe ohallucinations
ohave oon othe oclient's ostress olevel o
o
*The onurse oshould oacknowledge othat othe oclient ois ohearing oauditory ohallucinations,
obut oshould otell othe oclient othat oothers ocannot ohear oanything oto oreinforce oreality.
oThe onurse oshould oask othe oclient oif othey oare ohearing ovoices oto oevaluate owhether
othese oare ocommand ohallucinations, owhich ocan oplace othe oclient oor oothers oat orisk
ofor oharm. oThe onurse oshould oassist othe oclient oto odevelop othe oskill oof ovoice
odismissal owhen oauditory o
hallucinations ooccur. oThis oinvolves ocommanding othe ovoices oto ostop, owhich ogives
othe o
o
client oa osense oof
ocontrol
o
A onurse ois ocaring ofor oa oclient owho ohas oimpaired ocognition o
o
A onurse ois oupdating othe oclient's oplan oof ocare. oFor oeach oof othe ofollowing
opotential o
nursing ointerventions, oclick oto ospecify oif othe opotential ointervention ois
oanticipated, o
o
nonessential, oor ocontraindicated ofor othe
oclient
o
Potential oIntervention: o
1. When oaddressing othe oclient, oapproach othem ofrom othe ofront owhen opossible o
2. Use oa ovest orestrain oto okeep othe oclient oin oa omedical orecliner o
3. Ensure othe obed ois okept oat oa oworking oheight ofor othe onurse o
4. Provide othe oclient owith ohigh-calorie oprotein odrinks ohourly o
5. Give odirections oto othe oclient oslowly oand oin oa omoderate otone oof ovoice o
6. Decrease othe osensory ostimulation o
7. Keep othe olights ooff oin othe oclient's obedroom oand obathroom oat onight o
8. Assign othe oclient oto oa oroom onear othe onurses' ostation o
o
o
Exhibit
o1:
o
Medical
oHistory
o
Day o1, o0800: oClient otreated ofor oUTI o8 omonths
oago
Day o3, o0830: oClient ofell ogetting oout oof obed oto ogo oto othe oba o-
oCorrect o=
o
1. When oaddressing othe oclient, oapproach othem ofrom othe ofront owhen opossible o=
oAnticipated. o o
, *A oclient owho ois ounexpectantly oapproached oor otouched ofrom osomeone oout oof
oview ois oeasily ostartled, owhich ocan opromote oaggressive obehavior oin othe oclient. o
2. Use oa ovest orestraint oto okeep othe oclient oin oa omedical orecliner o= oContraindicated.
o o
*The oclient ohas othe oright oto obe ofree ofrom othe ouse oof orestraints oexcept oin othe ocase
oof oan oemergency. o o
3. Ensure othe obed ois okept oat oa oworking oheight ofor othe onurse o= oContraindicated. o
o*The oclient's obed oshould obe oplaced oin othe olowest oposition oto odecrease othe orisk
ofor ofalls, oor olessen oinjury oseverity oif othe oclient odoes ofall. o
4. Provide othe oclient owith ohigh-calorie oprotein odrinks ohourly o= oNonessential. o
o*This ois ononessential ofor othis oclient obecause othey oare otaking oin onutrition. oThe
onurse oshould oprovide othe oclient owho ohas omania owith othis otype oof odietary
osupplement. o5. oGive odirections oto othe oclient oslowly oand oin oa omoderate otone oof
ovoice o= oAnticipated. o o*Providing odirections oslowly oand oin oa omoderate otone oof
ovoice owill oincrease oclient ocomprehension. oLoud ovoices ocan ocause othe oclient oto
ofeel ouncomfortable oand ocan oeven ocause ofeelings oof oanger. o
6. Decrease osensory ostimulation o= oAnticipated. o o
*A ohighly ostimulating oenvironment ocan ocause othe oclient oto obecome oanxious oand
ofurther odisoriented, owhich ocan oimpair oclient osafety. o
7. Keep othe olights ooff oin othe oclient's obedroom oand obathroom oat onight o=
oContraindicated. o o
*This ocan oincrease othe oclient's orisk ofor ofalls. oKeeping oa olight oon ocan odecrease
owandering. o
8. Assign othe oclient oto oa oroom onear othe onurses' ostation o= oAnticipated. o o
*This opromotes oclient osafety oby oallowing ostaff oto oobserve othe oclient ofrequently. o
o
A onurse ois oplanning odischarge oteaching owith oa ofamily omember oof oa oclient owho
ohas oa o
o
new odiagnosis oof odepression. oWhich oof othe ofollowing oinformation oabout
orelapse
o
should othe onurse
oinclude?
o
1. oAdditional oacute oepisodes oof odepression oare ounlikely ofollowing oinpatient
ocare. o2. oEarly oidentification oof ochanges, osuch oas odecreased osocial
oinvolvement, ois oimportant. o
3. Medication ocompliance owill oprevent ofurther oneed ofor oinpatient ohospitalization. o
4. It ois ohelpful oto oregularly oreinforce oto othe oclient othat othings owill oget obetter. o-
oCorrect o= o2. oEarly oidentification oof ochanges, osuch oas odecreased osocial
oinvolvement, ois oimportant. o
o
Decrease osocial oinvolvement ois oa omanifestation oof odepression, oand oearly
oidentification o
o
of ofindings ocan olead oto oearly
ointervention
o
A onurse ois oestablishing oa otherapeutic orelationship owith oa oclient owho ohas oantisocial
opersonality odisorder. oWhich oof othe ofollowing ostrategies oshould othe onurse ouse
owhen ocommunicating owith othis oclient? o
o
