a nurse is providing care for a client experiencing alcohol withdrawal which intervention should be included in the plan of care
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Nursing Elites

ATI RN

ATI Mental Health Proctored Exam 2019

1. A client is experiencing alcohol withdrawal. Which intervention should be included in the plan of care?

Correct answer: A

Rationale: Administering benzodiazepines as prescribed is a crucial intervention in managing alcohol withdrawal. Benzodiazepines help alleviate symptoms such as anxiety, agitation, and seizures commonly seen in alcohol withdrawal. Monitoring vital signs is important to assess the client's physiological stability, but addressing the withdrawal symptoms with benzodiazepines is a priority to prevent severe complications. Providing a high-protein diet and encouraging fluid intake are important for overall health but do not directly manage alcohol withdrawal symptoms.

2. A client with post-traumatic stress disorder (PTSD) is experiencing flashbacks. Which of the following interventions should the nurse implement?

Correct answer: B

Rationale: During a flashback, it is essential for the nurse to stay with the client and offer reassurance. This approach can help the client feel safe and supported during a distressing experience. Encouraging the client to ignore the flashbacks may lead to increased anxiety and distress. Instructing the client to avoid discussing the traumatic event can hinder the therapeutic process of addressing and processing the trauma. While group therapy can be beneficial, it may not be the immediate intervention needed during a flashback.

3. A healthcare professional is assessing a client who has been diagnosed with schizophrenia and is exhibiting negative symptoms. Which of the following is an example of a negative symptom?

Correct answer: C

Rationale: Apathy is a negative symptom of schizophrenia characterized by a lack of interest or motivation. Negative symptoms involve a decrease or absence of normal functions, such as emotions, motivation, or socialization, rather than the presence of abnormal behaviors like hallucinations or delusions. Hallucinations (choice A) and delusions (choice B) are positive symptoms, which involve the presence of abnormal behaviors. Disorganized speech (choice D) is an example of a disorganized symptom, not a negative symptom.

4. A healthcare professional is assessing a client diagnosed with anorexia nervosa. Which of the following findings shouldn't the professional expect?

Correct answer: D

Rationale: When assessing a client diagnosed with anorexia nervosa, healthcare professionals should expect findings such as amenorrhea, lanugo, hypotension, and bradycardia. Hyperkalemia is not typically associated with anorexia nervosa; instead, hypokalemia, which is low potassium levels, is more commonly seen in these individuals due to malnutrition and other factors.

5. A nurse is caring for a client who has been diagnosed with schizoaffective disorder. The client states, 'I am the president of the United States.' Which of the following responses should the nurse make?

Correct answer: C

Rationale: The nurse should avoid challenging the client's delusions directly. Asking for more information can help the nurse understand the client's experience and build rapport.

Similar Questions

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