a client with schizophrenia is experiencing delusions which intervention should the nurse implement to address this symptom
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Nursing Elites

ATI RN

ATI Mental Health Proctored Exam 2019

1. A client with schizophrenia is experiencing delusions. Which intervention should the nurse implement to address this symptom?

Correct answer: B

Rationale: When a client with schizophrenia is experiencing delusions, providing reality-based feedback is considered an effective intervention to address this symptom. This approach helps the client differentiate between what is real and what is not real, assisting them in managing their delusions and promoting their overall well-being. Choice A is incorrect because ignoring the delusions does not help the client in distinguishing reality from delusions. Choice C is incorrect as distraction may only provide temporary relief but does not address the underlying issue. Choice D is incorrect because encouraging the client to discuss the delusions may reinforce or intensify them rather than help in managing them effectively.

2. When assessing a client's behavior for potential aggression, what behavior would be recognized as the highest predictor of future violence?

Correct answer: C

Rationale: A history of violence is considered the highest predictor of future violence. Clients who have a history of violent behavior are more likely to engage in violent acts in the future compared to those who exhibit other behaviors such as pacing, making verbal threats, or having substance abuse issues. Understanding a client's history of violence is crucial in assessing the risk of potential aggression and violence. Pacing and restlessness, verbal threats, and substance abuse can be concerning behaviors but do not carry the same predictive value for future violence as a documented history of violent behavior.

3. A client has been prescribed lithium for the treatment of bipolar disorder. Which of the following instructions should the nurse include?

Correct answer: A

Rationale: The correct instruction for the nurse to provide is to advise the client to avoid driving until they know how the medication affects them. Lithium can lead to side effects like dizziness and drowsiness, which could impair one's ability to drive safely. Choice B is incorrect because lithium is usually taken on an empty stomach. Choice C may be true but is not as critical as the potential side effects affecting driving. Choice D is important but not as immediate as ensuring the client's safety while driving.

4. Which of the following therapies is considered the most effective for treating phobias?

Correct answer: A

Rationale: Cognitive-behavioral therapy (CBT) is widely recognized as the most effective treatment for phobias. CBT helps individuals identify and change negative thought patterns and behaviors associated with their phobias, leading to long-lasting improvement and symptom reduction. Unlike psychoanalysis, which focuses on exploring unconscious conflicts, CBT provides practical strategies to address phobias directly. Medication management may be used in conjunction with therapy but is not typically considered a standalone treatment for phobias. Group therapy can be beneficial for some individuals, but CBT is specifically tailored to target and alleviate phobia symptoms effectively.

5. During a mental health assessment on an adult client, which client action would demonstrate the highest achievement in terms of mental health according to Maslow's hierarchy of needs?

Correct answer: C

Rationale: In Maslow's hierarchy of needs, self-actualization is the highest level. Possessing a feeling of self-fulfillment and realizing full potential reflects self-actualization. This level represents achieving personal growth, self-improvement, and reaching one's full potential, indicating optimal mental health. Choices A, B, and D represent lower levels of needs according to Maslow's hierarchy. Maintaining a long-term relationship indicates belongingness and love needs, achieving self-confidence pertains to esteem needs, and developing a sense of purpose relates to self-esteem and self-actualization needs, but they are not at the pinnacle of self-actualization as in choice C.

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