a client diagnosed with paranoid schizophrenia states the fbi is watching me i see their agents everywhere which is the nurses most appropriate respon
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Nursing Elites

ATI RN

ATI Mental Health Proctored Exam 2019

1. A client diagnosed with paranoid schizophrenia states, 'The FBI is watching me. I see their agents everywhere.' Which is the nurse's most appropriate response?

Correct answer: B

Rationale: Validating the client's feelings without reinforcing the delusion is important. This response acknowledges the client's fear without agreeing with the delusion. It shows empathy and understanding towards the client's emotions while not validating the delusional belief.

2. The healthcare provider is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the healthcare provider stress to the patient? Select one that does not apply.

Correct answer: C

Rationale: Early signs of lithium toxicity include gastrointestinal upset, tremors, increased urination, and increased thirst. Improved vision is not a typical early sign of lithium toxicity and should be ruled out as a symptom to watch for.

3. A client has been diagnosed with post-traumatic stress disorder (PTSD). Which intervention should the nurse implement to reduce the client's anxiety?

Correct answer: C

Rationale: Engaging in relaxation techniques, such as deep breathing, mindfulness, or progressive muscle relaxation, can help reduce anxiety for clients with PTSD. These techniques promote relaxation and help manage stress responses, contributing to a sense of calmness and improved coping mechanisms in dealing with anxiety triggers associated with PTSD. Avoiding discussing the traumatic event (Choice A) may hinder the client's progress in processing and coping with the trauma. While group therapy (Choice B) can be beneficial, relaxation techniques are more specific for reducing anxiety in this context. Maintaining a daily journal (Choice D) may be helpful for some clients but might not directly address anxiety reduction as effectively as relaxation techniques.

4. Which of the following interventions should be implemented for a client with anorexia nervosa? Select one that does not apply.

Correct answer: C

Rationale: Interventions for a client with anorexia nervosa include monitoring daily caloric intake and weight, establishing a structured eating plan, providing liquid supplements as prescribed, and offering rewards for weight gain. However, encouraging the client to exercise is not appropriate as it may exacerbate the condition by increasing caloric expenditure and reinforcing unhealthy behaviors associated with the disorder. Exercise may further contribute to excessive weight loss and worsen the client's physical health in the context of anorexia nervosa.

5. Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?

Correct answer: B

Rationale: During the prodromal phase of schizophrenia, individuals may exhibit subtle changes in behavior or interests. An unusual interest in numbers and specific topics may be a sign of cognitive disturbances that can precede the onset of schizophrenia. While the other choices may also be observed in adolescents, an unusual interest in numbers and specific topics is more specifically linked to potential prodromal symptoms of schizophrenia.

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