Ch. 34- ATI Mental Health Nursing (Ch. 1 & 4)

Question 1

1-1. A nurse in an outpatient mental health clinic is preparing to assist with conducting an initial client interview. When conducting the interview, which of the following actions should the nurse identify as the priority?

A. Coordinate holistic care with social services.
B. Identify the client’s perception of their mental health status.
C. Include the client’s family in the interview.
D. Teach the client about their current mental health disorder.

Answer 1

B. Identify the client’s perception of their mental health status.

Question 2

1-2. A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the following
statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply.)

A. “To assess cognitive ability, I should ask the client to count backward by sevens.”
B. “To assess affect, I should observe the client’s facial expression.”
C. “To assess language ability, I should instruct the client to write a sentence.”
D. “To assess remote memory, I should have the client repeat a list of objects.”
E. “To assess the client’s abstract thinking, I should ask the client to identify our most recent presidents.”

Answer 2

A. “To assess cognitive ability, I should ask the client to count backward by sevens.*
B. “To assess affect, I should observe the client’s facial expression.”
C. “To assess language ability, I should instruct the client to write a sentence.”

Question 3

1-3. A nurse is assisting with a peer group discussion about the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5-TR).
Which of the following information should the nurse include in the discussion? (Select all that apply.)

A. The DSM-5-TR includes client education handouts for mental health disorders.
B. The DSM-5-TR establishes diagnostic criteria for individual mental health disorders.
C. The DSM-5-TR indicates recommended pharmacological treatment for mental health disorders.
D. The DSM-5-TR assists nurses in planning care for clients who have mental health disorders.
E. The DSM-5-TR indicates expected data collection findings of mental health disorders.

Answer 3

B. The DSM-5-TR establishes diagnostic criteria for individual mental health disorders.
D. The DSM-5-TR assists nurses in planning care for clients who have mental health disorders.
E. The DSM-5-TR indicates expected data collection findings of mental health disorders.

Question 4

1-4. A nurse is assisting with the plan of care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention?

A. Assist the client with systematic desensitization therapy.
B. Teach the client appropriate coping mechanisms.
C. Assess the client for comorbid health conditions.
D. Monitor the client for adverse effects of medications.

Answer 4

D. Monitor the client for adverse effects of medications.

Question 5

4- 1. A nurse is caring for a client who smokes and has lung cancer. The client reports, “I’m coughing because I have that cold that everyone has been getting.” The nurse should identify that the client is using which of the following defense mechanisms?

A. Reaction formation
B. Denial
C. Displacement
D. Sublimation

Answer 5

B. Denial

Question 6

4-2. A nurse is reinforcing preoperative teaching with a client who was informed of the need for emergency surgery. The client has a respiratory rate 30/min, and says, “This is difficult to comprehend. I feel shaky and nervous.” The nurse should identify that the client is experiencing which of the following levels of anxiety?

A. Mild
B. Moderate
C. Severe
D. Panic

Answer 6

B. Moderate

Question 7

4-3. A nurse is caring for a client who is experiencing moderate anxiety. Which of the following actions should the nurse take when trying to reinforce necessary information to the client? (Select all that apply.)
A. Reassure the client that everything will be okay.
B. Discuss prior use of coping mechanisms with the client.
C. Ignore the client’s anxiety so that she will not be embarrassed.
D. Demonstrate a calm manner while using simple and clear directions.
E. Gather information from the client using closed-ended questions.

Answer 7

B. Discuss prior use of coping mechanisms with the client.
D. Demonstrate a calm manner while using simple and clear directions.