Mental Health Nursing- ATI Questions and
correct answers.
A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the foll
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owing statements by the newly licensed nurse indicates an understanding of the teaching?
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(select all that apply.)
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A. "to assess cognitive ability,i should ask the client to count backward by sevens."
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B. "to assess affect, i should observe the client's facial expression."
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C. "to assess language ability, i should instruct the client to write a sentence."
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D. "to assess remote memory, i should have the client repeat a list of objects."
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E. "to assess the client's abstract thinking, i should ask the client to identify our most recent presidents
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." - (correct answer) -
gh gh gh gh
A. "to assess cognitive ability,i should ask the client to count backward by sevens."
ghgh gh gh gh gh gh gh gh gh gh gh gh gh gh
B. "to assess affect, i should observe the client's facial expression."
gh gh gh gh gh gh gh gh gh gh
C. "to assess language ability, i should instruct the client to write a sentence."
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A nurse is planning care for a client who has a mental health disorder. Which of the following actions s
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hould the nurse include as a psychobiological intervention?
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A. assist the client with systematic desensitization therapy.
gh gh gh gh gh gh gh
B. teach the client appropriate coping mechanisms.
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C. assess the client for comorbid health conditions.
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D. Monitor the client for adverse effects of medications. - (correct answer) -
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D. Monitor the client for adverse effects of medications.
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,(Not C bc assessing for comorbid health conditions is health promotion and maintenance, rather than
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a psychobiological, intervention)
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A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When c
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onducting the interview, which of the following actions should the nurse identify as the priority?
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a. coordinate holistic care with social services.
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B. identify the client's perception of her mental health status.
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c. include the client's family in the interview.
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D. teach the client about her current mental health disorder. - (correct answer) -
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B. identify the client's perception of her mental health status.
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A nurse is told during change‐of‐
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shift report that a client is stuporous. When assessing the client,which of the following findings should
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the nurse expect? gh gh
a. the client arouses briefly in response to a sternal rub.
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B. the client has a glasgow coma scale score less than 7.
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c. the client exhibits decorticate rigidity.
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D. the client is alert but disoriented to time and place. - (correct answer) -
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a. the client arouses briefly in response to a sternal rub.
ghgh gh gh gh gh gh gh gh gh gh gh
A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Diso
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rders, 5th edition (DsM‐ gh gh gh
5). Which of the following information is appropriate to include in the discussion?
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(select all that apply.)
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a. the DsM‐5 includes client education handouts for mental health disorders.
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B. the DsM‐5 establishes diagnostic criteria for individual mental health disorders.
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c. the DsM‐5 indicates recommended pharmacological treatment for mental health disorders.
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D. the DsM‐5 assists nurses in planning care for client's who have mental health disorders.
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,e. the DsM‐5 indicates expected assessment findings of mental health disorders. - (correct answer) -
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B. the DsM‐5 establishes diagnostic criteria for individual mental health disorders.
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D. the DsM‐5 assists nurses in planning care for client's who have mental health disorders.
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e. the DsM‐5 indicates
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expected assessment findings ofmental health disorders.
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A nurse in an emergency mental health facility is caring for a group of clients. the nurse should identify
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that which of the following clients requires a temporary emergency admission?
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a. a client who has schizophrenia with delusions of grandeur
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B. a client who has manifestations of depression and attempted suicide a year ago
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c. a client who has borderline personality disorder and assaulted a homelessman with a metal rod
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
d. a client who has bipolar disorder and paces quickly around the room while talking to himself -
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(correct answer) -
gh gh gh
c. a client who has borderline personality disorder and assaulted a homelessman with a metal rod
ghgh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
very short‐staffed, and the client frequently fights with other clients.
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the nurse's actions are an example of which of the following torts?
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A. invasion of privacy
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B. False imprisonment
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C. assault
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D. Battery - (correct answer) - B. False imprisonment
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A client tells a nurse, "don't tell anyone, but i hid a sharp knife under my mattress in order to protect
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
myself from my roommate, who is always yelling at me and threatening me." Which of the following a
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
ctions should the nurse take? gh gh gh gh
a. Keep the client's communication confidential, but talk to the client daily, using therapeutic communi
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
cation to convince him to admit to hiding the knife.
gh gh gh gh gh gh gh gh gh
, B. Keep the client's communication confidential, but watch the client andhis roommate closely.
gh gh gh gh gh gh gh gh gh gh gh gh
c. Tell the client that this must be reported to the health care team because it concerns the health and
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
safety of the client and others.
gh gh gh gh gh gh
d. Report the incident to the health care team, but do not inform the client of the intention to do so. -
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
(correct answer) -
gh gh gh
c. Tell the client that this must be reported to the health care team because it concerns the health an
ghgh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
d safety of the client and others.
gh gh gh gh gh gh
A nurse is caring for a client who is in mechanical restraints. Which of the following statements should
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the nurse include in the documentation? (select all that apply.)
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A. "Client ate most of his breakfast."
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B. "Client was offered 8 oz of water every hr."
gh gh gh gh gh gh gh gh gh
C. "Client shouted obscenities at assistive personnel."
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D. "Client received chlorpromazine 15 mg by mouth at 1000."
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E. "Client acted out after lunch." - (correct answer) - B. "Client was offered 8 oz of water every hr."
gh gh gh gh gh gh gh gh gh ghgh gh gh gh gh gh gh gh gh gh
C. "Client shouted obscenities at assistive personnel."
gh gh gh gh gh gh
D. "Client received chlorpromazine 15 mg by mouth at 1000."
gh gh gh gh gh gh gh gh gh
A nurse hears a newly licensed nurse discussing a client's hallucinationsin the hallway with another nur
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se. Which of the following actions should the nurse take first?
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A. Notify the nurse manager.
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B. Tell the nurse to stop discussing the behavior.
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C. Provide an in‐service program about confidentiality.
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D. Complete an incident report. - (correct answer) - B. Tell the nurse to stop discussing the behavior.
gh gh gh gh gh gh gh gh ghgh gh gh gh gh gh gh gh gh
A charge nurse is conducting a class on therapeutic communication toa group of newly licensed nurses
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
. Which of the following aspects
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correct answers.
A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the foll
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
owing statements by the newly licensed nurse indicates an understanding of the teaching?
gh gh gh gh gh gh gh gh gh gh gh gh
(select all that apply.)
gh gh gh gh
A. "to assess cognitive ability,i should ask the client to count backward by sevens."
gh gh gh gh gh gh gh gh gh gh gh gh gh
B. "to assess affect, i should observe the client's facial expression."
gh gh gh gh gh gh gh gh gh gh
C. "to assess language ability, i should instruct the client to write a sentence."
gh gh gh gh gh gh gh gh gh gh gh gh gh
D. "to assess remote memory, i should have the client repeat a list of objects."
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
E. "to assess the client's abstract thinking, i should ask the client to identify our most recent presidents
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
." - (correct answer) -
gh gh gh gh
A. "to assess cognitive ability,i should ask the client to count backward by sevens."
ghgh gh gh gh gh gh gh gh gh gh gh gh gh gh
B. "to assess affect, i should observe the client's facial expression."
gh gh gh gh gh gh gh gh gh gh
C. "to assess language ability, i should instruct the client to write a sentence."
gh gh gh gh gh gh gh gh gh gh gh gh gh
A nurse is planning care for a client who has a mental health disorder. Which of the following actions s
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
hould the nurse include as a psychobiological intervention?
gh gh gh gh gh gh gh
A. assist the client with systematic desensitization therapy.
gh gh gh gh gh gh gh
B. teach the client appropriate coping mechanisms.
gh gh gh gh gh gh
C. assess the client for comorbid health conditions.
gh gh gh gh gh gh gh
D. Monitor the client for adverse effects of medications. - (correct answer) -
gh gh gh gh gh gh gh gh gh gh gh gh
D. Monitor the client for adverse effects of medications.
ghgh gh gh gh gh gh gh gh gh
,(Not C bc assessing for comorbid health conditions is health promotion and maintenance, rather than
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
a psychobiological, intervention)
gh gh
A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When c
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
onducting the interview, which of the following actions should the nurse identify as the priority?
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
a. coordinate holistic care with social services.
gh gh gh gh gh gh
B. identify the client's perception of her mental health status.
gh gh gh gh gh gh gh gh gh
c. include the client's family in the interview.
gh gh gh gh gh gh gh
D. teach the client about her current mental health disorder. - (correct answer) -
gh gh gh gh gh gh gh gh gh gh gh gh gh
B. identify the client's perception of her mental health status.
ghgh gh gh gh gh gh gh gh gh gh
A nurse is told during change‐of‐
gh gh gh gh gh
shift report that a client is stuporous. When assessing the client,which of the following findings should
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
the nurse expect? gh gh
a. the client arouses briefly in response to a sternal rub.
gh gh gh gh gh gh gh gh gh gh
B. the client has a glasgow coma scale score less than 7.
gh gh gh gh gh gh gh gh gh gh gh
c. the client exhibits decorticate rigidity.
gh gh gh gh gh
D. the client is alert but disoriented to time and place. - (correct answer) -
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
a. the client arouses briefly in response to a sternal rub.
ghgh gh gh gh gh gh gh gh gh gh gh
A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Diso
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
rders, 5th edition (DsM‐ gh gh gh
5). Which of the following information is appropriate to include in the discussion?
gh gh gh gh gh gh gh gh gh gh gh gh
(select all that apply.)
gh gh gh gh
a. the DsM‐5 includes client education handouts for mental health disorders.
gh gh gh gh gh gh gh gh gh gh
B. the DsM‐5 establishes diagnostic criteria for individual mental health disorders.
gh gh gh gh gh gh gh gh gh gh
c. the DsM‐5 indicates recommended pharmacological treatment for mental health disorders.
gh gh gh gh gh gh gh gh gh gh
D. the DsM‐5 assists nurses in planning care for client's who have mental health disorders.
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
,e. the DsM‐5 indicates expected assessment findings of mental health disorders. - (correct answer) -
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
B. the DsM‐5 establishes diagnostic criteria for individual mental health disorders.
ghgh gh gh gh gh gh gh gh gh gh gh
D. the DsM‐5 assists nurses in planning care for client's who have mental health disorders.
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
e. the DsM‐5 indicates
gh gh gh gh
expected assessment findings ofmental health disorders.
gh gh gh gh gh
A nurse in an emergency mental health facility is caring for a group of clients. the nurse should identify
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
that which of the following clients requires a temporary emergency admission?
gh gh gh gh gh gh gh gh gh gh gh
a. a client who has schizophrenia with delusions of grandeur
gh gh gh gh gh gh gh gh gh
B. a client who has manifestations of depression and attempted suicide a year ago
gh gh gh gh gh gh gh gh gh gh gh gh gh
c. a client who has borderline personality disorder and assaulted a homelessman with a metal rod
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
d. a client who has bipolar disorder and paces quickly around the room while talking to himself -
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
(correct answer) -
gh gh gh
c. a client who has borderline personality disorder and assaulted a homelessman with a metal rod
ghgh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
very short‐staffed, and the client frequently fights with other clients.
gh gh gh gh gh gh gh gh gh
the nurse's actions are an example of which of the following torts?
gh gh gh gh gh gh gh gh gh gh gh
A. invasion of privacy
gh gh gh gh
B. False imprisonment
gh gh gh
C. assault
gh
D. Battery - (correct answer) - B. False imprisonment
gh gh gh gh gh ghgh gh gh
A client tells a nurse, "don't tell anyone, but i hid a sharp knife under my mattress in order to protect
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
myself from my roommate, who is always yelling at me and threatening me." Which of the following a
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
ctions should the nurse take? gh gh gh gh
a. Keep the client's communication confidential, but talk to the client daily, using therapeutic communi
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
cation to convince him to admit to hiding the knife.
gh gh gh gh gh gh gh gh gh
, B. Keep the client's communication confidential, but watch the client andhis roommate closely.
gh gh gh gh gh gh gh gh gh gh gh gh
c. Tell the client that this must be reported to the health care team because it concerns the health and
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
safety of the client and others.
gh gh gh gh gh gh
d. Report the incident to the health care team, but do not inform the client of the intention to do so. -
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
(correct answer) -
gh gh gh
c. Tell the client that this must be reported to the health care team because it concerns the health an
ghgh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
d safety of the client and others.
gh gh gh gh gh gh
A nurse is caring for a client who is in mechanical restraints. Which of the following statements should
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
the nurse include in the documentation? (select all that apply.)
gh gh gh gh gh gh gh gh gh
A. "Client ate most of his breakfast."
gh gh gh gh gh gh
B. "Client was offered 8 oz of water every hr."
gh gh gh gh gh gh gh gh gh
C. "Client shouted obscenities at assistive personnel."
gh gh gh gh gh gh
D. "Client received chlorpromazine 15 mg by mouth at 1000."
gh gh gh gh gh gh gh gh gh
E. "Client acted out after lunch." - (correct answer) - B. "Client was offered 8 oz of water every hr."
gh gh gh gh gh gh gh gh gh ghgh gh gh gh gh gh gh gh gh gh
C. "Client shouted obscenities at assistive personnel."
gh gh gh gh gh gh
D. "Client received chlorpromazine 15 mg by mouth at 1000."
gh gh gh gh gh gh gh gh gh
A nurse hears a newly licensed nurse discussing a client's hallucinationsin the hallway with another nur
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
se. Which of the following actions should the nurse take first?
gh gh gh gh gh gh gh gh gh gh
A. Notify the nurse manager.
gh gh gh gh
B. Tell the nurse to stop discussing the behavior.
gh gh gh gh gh gh gh gh
C. Provide an in‐service program about confidentiality.
gh gh gh gh gh gh
D. Complete an incident report. - (correct answer) - B. Tell the nurse to stop discussing the behavior.
gh gh gh gh gh gh gh gh ghgh gh gh gh gh gh gh gh gh
A charge nurse is conducting a class on therapeutic communication toa group of newly licensed nurses
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
. Which of the following aspects
gh gh gh gh gh
