ATI questions, Assessment 5
Which of the following would the nurse expect to find when assessing a 12 year old client who has a diagnosis of conduct disorder? Select all that apply. A. Bullying others B. Threats of suicide C. Law-breaking activities D. Narcissistic behavior E. Flat affect
A, B, C
What should be included in teaching about imipramine related to toxicity? A. Seizures B. Agitation C. Photophobia D. Dry mouth E. Irregular pulse
A, B, E
A home health nurse is making a visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following suggestions should the nurse make to decrease the client's risk for injury? Select all that apply. A. Install extra locks at the top of exit doors B. Place rugs over electrical cords C. Put cleaning supplies on the top shelf D. Place the client's mattress on the floor E. Install light fixtures above stairs
A, D, E
A nurse is assessing a 4 year old child for autism spectrum disorder. Which of the following should the nurse assess? A. Impulsive behavior B. Repetitive counting C. Destructiveness D. Somatic Problems
B
A nurse is caring for a client who has early stage Alzheimer's disease and a new prescription for donepezil. The nurse should include which of the following statements when teaching the client about the medication? A. You should avoid taking over the counter acetaminophen while on donepezil. B. You should take this medication before going to bed at the end of the day. C. You will be screened for underlying kidney disease prior to starting donepezil. D. You should stop taking donepezil if you experience nausea or diarrhea.
B
A nurse is caring for a school age child who has new prescription for a methylphendidate patch to treat ADHD. Which of the following should the nurse teach the client and family about this medication? A. Apply the patch once daily at bedtime B. Remove the patch each day after 9 hours C. Take an oral dose with food after removing the patch D. Take a second dose of the medication orally at bedtime
B
A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection. Which of the following findings should the nurse expect? Select all that apply A. History of gradual memory loss B. Family report of personality changes C. Hallucinations D. Unaltered level of consciousness E. Restlessness
B, C, E
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? Select all that apply. A. Bradycardia B. Fine tremors in both hands C. Hypotension D. Vomiting E. Restlessness
B, D, E
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates an understanding of the teaching? Select all that apply. A. We need to understand that our sibling is responsible for their disorder. B. Eliminating codependent behavior will promote recovery. C. Our sibling should participate in an Al-Anon group to assist with recovery. D. The primary goal of treatment is abstinence from substance use. E. Our sibling needs to discuss personal feelings about substance use to help with recovery.
B, D, E
The client has been prescribed fluoxetine for intermittent explosive disorder. Which of the following should be included in patient teaching? Select all that apply. A. An adverse effect of his medication is CNS depression B. Take the medication in the morning C. Monitor for weight loss while taking this medication D. Therapeutic effects will take 1-3 weeks to fully develop E. This medication blocks the re-uptake of serotonin in the brain
B, D, E
What should be included in teaching about adverse effects of atomoxetine for ADHD? Select all that apply. A. Somnolence B. Yellowing skin C. Increased appetite D. Fever E. Malaise
B, D, E
Which of the following would the nurse expect to find when assessing a depressed adolescent? Select all that apply. A. Fear of being alone B. Substance use C. Weight gain D. Irritability E. Aggressiveness
B, D, E
A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A. Chlordiazepoxide B. Bupropion C. Disulfiram D. Carbamazepine
C
A nurse is making a home visit to a client who has Alzheimer's disease. The client's partner, who is the primary caregiver, wishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following actions should the nurse take? A. Verify that a current power of attorney document is on file. B. Instruct the client's partner to offer finger foods to increase oral intake. C. Provide information on resources for respite care. D. Schedule the client for placement of an enteral feeding tube.
C
A nurse is planning a staff education program on substance use in older adults. Which of the following information should the nurse include in the presentation? A. Older adults require higher doses of a substance to achieve a desired effect. B. Older adults commonly use rationalization to cope with a substance use disorder. C. Older adults are at an increased risk for substance use following retirement. D. Older adults develop substance use to mask manifestations of dementia.
C
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? A. Orient the client frequently, to time, place, and person. B. Offer fluids and nourishing diet as tolerated. C. Implement seizure precautions. D. Encourage participation in group therapy sessions.
C
A nurse is teaching an adolescent client who has a new prescription for clomipramine (Anafranil) for OCD. Which of the following should the nurse teach to the client to minimize one of the adverse effects of the medication? A. Check temperature daily B. Take medication first thing in the morning C. Eat a diet high in fiber D. Add extra calories to the diet as between meal snacks
C
Which of the following are appropriate strategies to use with the child who has oppositional defiant disorder? Select all that apply. A. Allow the child to choose consequences for negative behavior B. Use role-playing to act out unacceptable behavior C. Develop a reward system for acceptable behavior D. Encourage the child to participate in sports E. Be consistent when addressing unacceptable behavior
C, D, E
A nurse in a long term care facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, " I have to get home." Which of the following statements should the nurse make? A. You have forgotten that this is your home B. You cannot go outside without a staff member C. Why would you want to leave? Aren't you happy with your care? D. I am your nurse. Let's walk together in your room
D
A nurse is teaching parents about ADHD. Which of the following statements should the nurse include in the teaching? A. Behaviors associated with ADHD must be present prior to age 3 B. This disorder is characterized by argumentativeness C. Below-average intellectual functioning is associated with it D. Because of this disorder, your child is at increased risk for injury
D