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Ati PN Mental Health 2023 Proctored Exam
Total Questions : 60
Showing 10 questions, Sign in for moreAdmission:
Lithium level 1.8 mEq/L (less than 1.5 mEq/L) Glucose level 90 mg/dL (74 to 106 mg/dL) Sodium 133 mEq/L (135 to 145 mEq/L)
12 hr later:
Lithium level 1.2 mEq/L (less than 1.5 mEq/L) Glucose level 80 mg/dL (74 to 106 mg/dL) Sodium 134 mEq/L (135 to 145 mEq/L)
Admission:
- Temperature 37.7° C (99.9° F)
- Respiratory rate 18/min
- Pulse rate 84/min
- BP 130/84 mm Hg
12 hr later:
- Temperature 37° C (98.6° F)
- Respiratory rate 16/min
- Pulse rate 96/min
- BP 88/50 mm Hg
Admission:
Gastrointestinal upset
Uncoordinated gait
Client fell asleep during assessment
12 hr later:
Client reports blurred vision
Pale, dry mucus membranes
Urine output 40 mL/hr
History of bipolar disorder
Water toxicity
A nurse is caring for a client.
The nurse is collecting data from the client 12 hr later. How should the nurse interpret the following findings?
For each potential finding, click to specify whether the finding is an indication of potential improvement or an indication of potential worsening condition.
Explanation
- Lithium level (1.2 mEq/L): The lithium level decreased from 1.8 mEq/L to 1.2 mEq/L. Since therapeutic toxicity is usually >1.5 mEq/L, the reduction indicates improvement in lithium toxicity.
- Urine output (40 mL/hr): Normal adult urine output is ~0.5–1 mL/kg/hr. A urine output of 40 mL/hr may be low for an adult and, combined with other findings (hypotension, dry mucus membranes), suggests worsening condition, possibly dehydration or early kidney compromise.
- Vision (blurred): Blurred vision is a classic sign of lithium toxicity or fluid/electrolyte imbalance. Since it appeared 12 hr later, it indicates worsening condition.
- Vital signs: Hypotension (88/50 mm Hg) and tachycardia (pulse 96/min) are new findings compared with admission. These are signs of worsening condition, possibly hypovolemia or lithium-related adverse effects.
- Mucus membranes (pale, dry): Dry mucus membranes suggest dehydration, which is a worsening condition.
A nurse in a substance use disorder clinic is explaining the alcohol recovery process to a client's family. Which of the following should the nurse identify as the first step toward successful recovery from alcohol use disorder?
A 76-year-old client fell at home, resulting in fractured humerus and multiple abrasions to arms. Client is unable to recall what precipitated the fall, and physical examination reveals no injury to the client's head. Client has a history of hypertension controlled with atenolol.
Client lives with partner and adult children visit client every few months.
- BP 136/88 mm Hg
- Temperature 36° C (96.8° F)
- Heart rate 84/min
- Respiratory rate 16/min
- Oxygen saturation 97% on room air
Client restless during the night, attempting to get out of bed and placing bedcovers on the floor.
Has been incontinent of urine twice. Client instructed on use of urinal and told to call for assistance by using the call light. Confuses the call light with the television remote control.
Disoriented to time, place, person, and situation. Unable to recall home address.
Was unable to assist with bath this morning; when handed the washcloth to clean their face, client asked, "Do you want me to put this in the dryer?"
A nurse is caring for a client who experienced a fall.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to collect data about the client's progress.
Explanation
Rationale for Correct Answers:
Potential Condition:
Delirium: The client has sudden onset confusion, disorientation to time, place, person, and situation. Inability to recall home address and inappropriate responses (e.g., asking if the washcloth goes in the dryer). Restlessness at night and urinary incontinence. No prior cognitive decline is reported, suggesting an acute condition. These features are consistent with delirium rather than chronic dementia or normal aging.
Actions to Take:
Monitor for an underlying infection: Delirium in older adults is often triggered by infections, such as UTI or pneumonia.
Use symbols rather than written signs for directions: Simplifying communication and providing visual cues helps reduce confusion.
Parameters to Monitor:
Ability to complete familiar tasks: Functional assessments show if delirium is improving or worsening.
Presence of agnosia: Monitoring recognition deficits helps track cognitive recovery.
Rationale for Incorrect Options:
Alzheimer’s disease: Typically presents with gradual cognitive decline, memory loss over months to years, and progressive functional deterioration. The sudden onset here makes this less likely.
Expected aging process: Normal aging can include minor forgetfulness but does not cause disorientation to time, place, person, or situation.
Major depressive disorder: While depression can cause low motivation and confusion, it does not usually cause acute disorientation or inappropriate responses.
Anticipate a prescription for duloxetine: Duloxetine is an antidepressant and not first-line for delirium; medication is directed toward underlying cause, not symptomatically prescribing antidepressants.
Determine the date of the client’s last eye examination: Visual impairment is not the immediate cause of acute delirium in this case.
Anticipate a prescription for donepezil: Donepezil is used for chronic dementia like Alzheimer’s, not acute delirium.
Oxygen saturation: The client’s Oâ‚‚ sat is normal; hypoxia is not indicated here.
Night vision: Visual problems are not the cause of the acute confusion.
Attendance at group therapy: This is not relevant for monitoring acute delirium; the client may not be ready for participation.
A nurse is reviewing the vital signs of a client who has a prescription for imipramine. Which of the following findings requires follow-up by the nurse?
A nurse is interviewing a client who was recently admitted. The client tells the nurse, "I have something to tell you, but you can't tell anyone else." Which of the following responses should the nurse make?
A nurse is caring for a client who has a terminal illness. Which of the following statements should the nurse make to reinforce teaching about anticipatory grief reactions with the client's partner?
A charge nurse overhears a staff nurse talking to a nurse from another unit in the hallway. The staff nurse says, "I heard that Mr. Smith was admitted for a suicide attempt." Which of the following responses should the charge nurse make?
A nurse is assisting with a community health education and support service for individuals who have lost loved ones to suicide. Which of the following actions should the nurse take when caring for these individuals?
A nurse is caring for a client who has agreed to a verbal safety contract following a self-mutilation attempt. Which of the following behaviors indicates that the contract has been effective?
A nurse is collecting data from a client who has anorexia nervosa. Which of the following findings should the nurse identify as an indication that the client has an impaired nutritional status?
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