ATI RN
ATI Mental Health Proctored Exam 2019
1. A client with schizophrenia is experiencing auditory hallucinations. Which nursing intervention is most appropriate to address this symptom?
- A. Encourage the client to discuss the voices.
- B. Instruct the client to listen to music to drown out the voices.
- C. Tell the client that the voices are not real.
- D. Distract the client from the voices.
Correct answer: A
Rationale: Encouraging the client to discuss the voices is the most appropriate nursing intervention when a client with schizophrenia is experiencing auditory hallucinations. By discussing the voices, the client can feel heard, understood, and supported. It allows the client to express their experiences, which can help in processing and coping with the hallucinations. This intervention promotes therapeutic communication and builds a trusting nurse-client relationship, which is essential in providing effective care for individuals with schizophrenia. Choice B is incorrect because instructing the client to listen to music to drown out the voices does not address the underlying issue and may not be effective in managing auditory hallucinations. Choice C is incorrect because telling the client that the voices are not real can invalidate the client's experiences and feelings, leading to further distress. Choice D is incorrect as solely distracting the client from the voices does not help in addressing the hallucinations or supporting the client in dealing with their symptoms.
2. How should a healthcare professional monitor a patient with a central line for infection?
- A. Monitor the dressing site daily
- B. Check for redness and swelling
- C. Monitor for fever
- D. Flush the central line
Correct answer: A
Rationale: Monitoring the dressing site daily is crucial for detecting early signs of infection in patients with central lines. Checking for redness and swelling (choice B) is important but may indicate a more advanced stage of infection. Monitoring for fever (choice C) can also be a sign of infection, but it is a later manifestation. Flushing the central line (choice D) is necessary for maintaining patency but does not directly monitor for infection.
3. A client is starting a new prescription for furosemide. Which of the following instructions should the nurse include?
- A. Weigh yourself daily.
- B. Limit sodium intake.
- C. Increase potassium intake.
- D. Avoid potassium-rich foods.
Correct answer: A
Rationale: The correct instruction to include when starting furosemide is to weigh yourself daily. Daily weighing helps monitor for fluid loss or retention, which is crucial when taking a diuretic like furosemide. Choices B, C, and D are incorrect because although monitoring sodium intake and potassium levels are important when taking furosemide, the most immediate and direct way to assess the medication's effectiveness and the body's response is through daily weight monitoring.
4. A 40-year-old man has been living with HIV for several years but experienced a significant decrease in his CD4+ levels a few months ago. The patient has just been diagnosed with Mycobacterium avium complex disease. The nurse should anticipate administering which of the following medications?
- A. Clarithromycin
- B. Pyrazinamide
- C. Rifapentine (Priftin)
- D. Azithromycin
Correct answer: A
Rationale: The correct answer is A: Clarithromycin. In the case of Mycobacterium avium complex disease, a common treatment regimen includes a macrolide antibiotic like clarithromycin or azithromycin in combination with other antimicrobials. Clarithromycin is a key component of the treatment due to its effectiveness against Mycobacterium avium complex. Choice B (Pyrazinamide) is not typically part of the standard treatment for this condition. Choice C (Rifapentine) is mainly used in tuberculosis treatment and is not a primary agent for Mycobacterium avium complex disease. Choice D (Azithromycin) is another suitable macrolide antibiotic for treating Mycobacterium avium complex disease but is not the medication typically used first-line.
5. A nurse is assessing a client who is experiencing auditory hallucinations. What question should the nurse ask?
- A. Do you understand the voices are not real?
- B. Why do you think the voices are talking to you?
- C. Have you tried going to a quiet place when this occurs?
- D. What helps you ignore the voices?
Correct answer: D
Rationale: Exploring strategies to ignore the hallucinations can help clients manage symptoms.
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