RN Mental Health Online Practice
2023 A ATI Exam Questions & Answers
This comprehensive study guide contains verified questions and answers for the RN Mental Health Online
Practice 2023 A exam. The content covers essential mental health nursing topics including psychiatric disorders, therapeutic communication, psychotropic medications, crisis intervention, ethical principles, and evidence-based nursing interventions. Use this guide to prepare for your ATI Mental Health assessment.
Priority Assessment & Safety
Q1. A nurse on an acute mental health facility is receiving a change-of-shift report for four clients. Which of the following clients should the nurse assess first?
A client who does not recognize familiar people, A client who cannot verbalize their needs, A client who is awake and disoriented at night, A client who is experiencing delusions of persecution ANSWER: A client who is experiencing delusions of persecution.
The presence of delusions of persecution indicates that this client is at the greatest risk for injury due to the client’s belief that a person in power is out to harm them. Therefore, the nurse should assess this client first.
Q2. A nurse is caring for a child who has conduct disorder and is behaving in a destructive manner, throwing objects, and kicking others. Which of the following therapeutic nursing interventions is the priority?
ANSWER: Reduce environmental stimuli (priority is safety – remove triggers and reduce stimulation to prevent escalation)
PTSD & Anxiety Disorders
Q3. A nurse in a community health center is working with a group of clients who have post-traumatic stress disorder. Which of the following interventions should the nurse include to reduce anxiety among the group members?
Response prevention, Guided imagery, Aversion therapy, Light therapy ANSWER: Guided imagery. Guided imagery involves assisting the client to imagine a restful and safe place. This method is effective in reducing anxiety in clients who have post-traumatic stress disorder.
Q4. A school nurse is assessing a school-aged child who experienced the traumatic loss of a parent 8 months ago. Which of the following findings should the nurse identify as an indication that the child is experiencing PTSD?
ANSWER: Lack of interest in an upcoming holiday (Manifestations of PTSD include feelings of detachment or loss of interest in previously enjoyed activities)
Q5. A nurse in a community health center is teaching families of clients who have PTSD about expected clinical manifestations. Which of the following manifestations should the nurse include?
ANSWER: Experiences feelings of isolation (Clients with PTSD feel estranged/detached from others, avoid discussing traumatic event, have difficulty sleeping, hypervigilance, and verbal aggression)
Schizophrenia
Q6. A nurse is caring for a newly admitted client. For each potential finding, click to specify if the finding is consistent with positive or negative symptoms of schizophrenia.
ANSWER: POSITIVE symptoms: Delusions of grandeur, Clang associations, Catatonia.
NEGATIVE symptoms: Alogia (poverty of speech), Withdrawal from social activities
Q7. A nurse on a mental health unit is caring for a client who has schizophrenia. After reviewing the client’s medical record (taking clozapine), the nurse should notify the provider of which of the following findings?
SELECT THE 5 UNEXPECTED FINDINGS.
ANSWER: Temperature (elevated – fever), Bowel sounds (hypoactive), ANC level (decreased absolute neutrophil count), Myalgia (muscle pain), Heart rate (increased).
These are adverse effects of clozapine that require immediate provider notification.
Q8. A nurse is reviewing laboratory results for a client who has schizophrenia and is taking clozapine. Which finding requires immediate action?
ANSWER: Decreased WBC count or decreased ANC (risk for agranulocytosis – serious adverse effect of clozapine)
Depression & Suicide Risk
Q9. A nurse is planning care for a client who has depression and has made frequent suicide attempts. Which of the following statements indicates the client has a decreased risk for suicide?
ANSWER: Statements indicating future planning, engagement in treatment, verbalization of reasons for living, improved mood and affect
Q10. A nurse is assessing a client for risk factors for the development of depression. The nurse should identify that which of the following factors places the client at an increased risk for depression?
ANSWER: The client has COPD (Chronic medical conditions, including COPD, increase risk for depression)
Q11. A nurse is teaching a newly licensed nurse about nursing care plans for clients who have depressive disorders. Which information should be included?
ANSWER: Include individualized interventions; Monitor for suicide risk; Encourage participation in activities; Assess medication effectiveness
Delirium vs. Dementia
Q12. A nurse is performing a cognitive assessment to distinguish delirium from dementia in a client whose family reports episodes of confusion. Which of the following assessment findings supports the nurse’s suspicion of delirium?
ANSWER: Easily distracted. Extreme distractibility is a hallmark manifestation of delirium. (Delirium has rapid onset, fluctuating consciousness, and is reversible.
Dementia has slow, progressive onset.)
Q13. A nurse is caring for an older adult client who has dementia and has wandered into the day room looking for their deceased partner. Which action should the nurse take?
ANSWER: Talk with the client about activities they enjoyed with their partner (validation therapy and redirection)
Therapeutic Communication & Relationships
Q14. A nurse is performing an admission assessment on a client and notices that the client appears withdrawn and fearful. To establish a trusting
nurse-client relationship, which of the following actions should the nurse take first?
ANSWER: Inform the client that this admission is confidential (establish trust through confidentiality during orientation phase)
Q15. During a client’s initial interview in a mental health inpatient setting, a nurse identifies that the client is maintaining eye contact and leaning forward.
Which of the following assumptions should the nurse make based on the client’s nonverbal behaviors?
ANSWER: The client is interested in what the nurse is saying. The client’s posture and eye contact demonstrate an interest in the interview and what the nurse is saying.
Q16. A nurse is caring for an older adult client who begins to cry and states, ‘I knew God would punish me and I deserve this horrible sickness!’ Which of the following responses should the nurse make?
ANSWER: Use therapeutic communication – acknowledge feelings, explore spiritual concerns, avoid dismissing the client’s beliefs
Ethical Principles
Q17. A nurse on a mental health unit is caring for a group of clients. Which of the following actions by the nurse is an example of the ethical principle of justice?
ANSWER: Spending adequate time with a client who is verbally abusive. By spending adequate time with a client who is verbally abusive, the nurse demonstrates justice.
When the nurse spends appropriate time with each client regardless of their behavior and in keeping with their individual needs, the nurse guarantees that all clients receive equal care.
Medications – Antidepressants & MAOIs
Q18. A nurse is caring for a client in an outpatient psychiatric clinic who has been applying a selegiline 12 mg transdermal patch once daily. Complete the following sentence: The client is at risk for developing _______ due to _______.
ANSWER: Hypertensive crisis due to consuming foods high in tyramine. Selegiline is an MAOI, and consuming tyramine-rich foods (aged cheese, cured meats, fermented foods)
can cause dangerous hypertensive crisis.
Q19. A nurse is caring for a client who has PTSD and a new prescription for sertraline. The nurse is monitoring the client who began taking sertraline 3 days ago. Which findings should the nurse report as potential adverse effects?
ANSWER: Increased anxiety, agitation, or suicidal ideation (especially in first few weeks); GI disturbances; insomnia
Medications – Antipsychotics
Q20. A nurse in a mental health clinic is planning care for a client who has a new prescription for olanzapine. Which intervention should the nurse identify as the priority?
ANSWER: Instruct the client to avoid driving during initial therapy. The greatest risk is injury from drowsiness/dizziness. Priority is to instruct client to avoid activities requiring mental alertness during initial medication therapy.
Q21. A nurse is caring for a group of clients. Which of the following findings should the nurse report? A client taking clozapine with WBC 7,500; A client taking lamotrigine who has developed a rash; A client taking valproate with platelet count 150,000; A client taking lithium with lithium level 1.2 ANSWER: A client who is taking lamotrigine and has developed a rash.
Lamotrigine can cause Stevens-Johnson syndrome, a life-threatening condition. Rash development requires immediate provider notification and medication discontinuation.
Medications – Lithium
Q22. A nurse in a mental health clinic is caring for a client who has bipolar disorder and reports that they stopped taking lithium 2 weeks ago. The nurse should recognize which of the following as an expected adverse effect that might have caused the client to stop taking the medication?
ANSWER: Hand tremors. Fine hand tremors are an expected adverse effect of lithium and can interfere with performance of ADLs, causing the client to stop taking the medication.
Alcohol Use Disorder & Substance Abuse
Q23. A nurse is preparing to administer diazepam 7.5 mg IV bolus to a client for alcohol withdrawal. Available is diazepam injection 5 mg/1 mL. How many mL should the nurse administer?
ANSWER: 1.5 mL (Formula: 7.5 mg ÷ 5 mg/mL = 1.5 mL)
Q24. A nurse is discussing a 12-step program with a client who has alcohol use disorder and is in an acute facility undergoing detoxification. Which information should the nurse include in the teaching?
ANSWER: The client should obtain a sponsor before discharge for an increased chance of recovery
Q25. A nurse is caring for a client who has alcohol use disorder. After reviewing the medical record, what findings should be reported to the provider?
ANSWER: Vital sign changes (hypertension, tachycardia, fever), altered speech patterns, hallucinations (possible delirium tremens – medical emergency)
Bipolar Disorder
Q26. A client who has a recent diagnosis of bipolar disorder is placed in a room with a client who has severe depression. The client who has depression reports to the nurse, ‘My roommate never sleeps and keeps me up, too.’ Which action should the nurse take?
ANSWER: Move the client who has bipolar disorder to a private room (client with mania needs reduced stimulation; client with depression needs adequate sleep)
Q27. A nurse on a mental health unit is admitting a client who has bipolar disorder. Complete the sentence: The first action the nurse should take is to address the client’s ______ due to the client’s ______.
ANSWER: Cardiovascular status due to constant psychomotor activity. Client is pacing, moving arms/hands dramatically, unable to sit still. This increases BP and HR, indicating risk for cardiovascular injury.
Crisis Intervention & De-escalation
Q28. A nurse on a mental health unit observes a client who has acute mania hit another client. Which action should the nurse take first?
ANSWER: Ensure safety of all clients; Call for assistance; Use least restrictive intervention
Q29. A nurse in an inpatient mental health facility is caring for a client. The client begins pacing with fists clenched and is verbally abusing staff. Which action should the nurse take?
ANSWER: Ensure security personnel are available in the background to assist if the client’s behavior escalates (anticipate need for support while attempting verbal de-escalation)
Restraints & Legal Issues
Q30. A nurse is teaching a group of newly licensed nurses about the use of mechanical restraints. Which information should the nurse include?
ANSWER: Complete documentation about the client’s status every hour while they are in restraints; Provider must make in-person evaluation within 1 hour of initiating restraints; Use least restrictive intervention first
Personality Disorders
Q31. A nurse is establishing a therapeutic relationship with a client who has antisocial personality disorder. Which strategy should the nurse use when communicating with this client?
ANSWER: Set clear boundaries; Be consistent; Confront manipulative behavior directly; Maintain professional relationship
Q32. A nurse is caring for a client who has antisocial personality disorder and is receiving behavioral therapy through operant conditioning. Which client behavior indicates effectiveness of therapy?
ANSWER: Refrains from manipulating others to earn dining room privileges (operant conditioning provides positive reinforcement for desired behavior)
Key Medication Information
• Clozapine (Antipsychotic): Monitor WBC and ANC – risk for agranulocytosis.
Adverse effects: fever, hypoactive bowel sounds, myalgia, tachycardia
• Lamotrigine (Mood Stabilizer): REPORT RASH IMMEDIATELY – risk for Stevens-Johnson syndrome (life-threatening)
• Lithium (Mood Stabilizer): Therapeutic level 0.6-1.2 mEq/L. Side effects: hand tremors, polyuria, weight gain. Toxicity: diarrhea, vomiting, confusion
• Selegiline (MAOI): Avoid tyramine-rich foods (aged cheese, cured meats, fermented foods) – risk for hypertensive crisis
• Sertraline (SSRI): Monitor for increased anxiety/agitation in first few weeks; assess for suicidal ideation, especially in young adults
• Olanzapine (Antipsychotic): Priority: avoid driving during initial therapy due to drowsiness/dizziness. Also causes weight gain, dry mouth
• Diazepam (Benzodiazepine): Used for alcohol withdrawal; monitor respiratory status; taper slowly to prevent withdrawal
Essential Nursing Priorities
• Safety First: Always prioritize client safety – delusions of persecution, violent behavior, suicide risk require immediate assessment
• Delirium vs. Dementia: Delirium = rapid onset, easily distracted, fluctuating consciousness, REVERSIBLE. Dementia = slow onset, progressive, irreversible
• Therapeutic Communication: Establish trust through confidentiality; use active listening; validate feelings; avoid false reassurance
• Ethical Principle of Justice: Spend adequate time with ALL clients regardless of behavior – ensures equal care for all
• Crisis De-escalation: Reduce stimuli, ensure safety, call for assistance, use least restrictive intervention first
• Medication Monitoring: Know critical side effects requiring immediate action (rash with lamotrigine, decreased WBC with clozapine)
• Positive vs. Negative Symptoms: Positive = delusions, hallucinations, disorganized speech. Negative = flat affect, alogia, social withdrawal
IMPORTANT DISCLAIMER: This study guide is compiled from publicly available ATI practice materials for the RN Mental Health Online Practice 2023 A exam. It should be used as a supplemental study tool only. Always refer to official ATI testing materials, current evidence-based practice guidelines, and your nursing program’s resources. This information is for educational purposes and may not reflect the most current updates to mental health nursing standards.
