mix
Question:
A client who is angry with their supervisor returns home and begins yelling at their spouse instead of addressing the conflict at work.
Which defense mechanism is the client demonstrating?
A. Projection
B. Displacement
C. Sublimation
D. Reaction formation
Correct Answer: B. Displacement
Rationale: Displacement involves redirecting emotions from the original source toward a safer or less threatening person or object.
ATI Tip: Anger at boss → yelling at spouse = displacement.
Question:
A nurse is caring for a client admitted with major depressive disorder. The client states, "I feel hopeless, and I don't see a reason to keep living."
Which action should the nurse take first?
A. Encourage the client to attend group therapy.
B. Ask the client directly about suicidal thoughts, a plan, and intent.
C. Administer the prescribed antidepressant.
D. Encourage the client to identify positive coping mechanisms.
Correct Answer: B.
Rationale: Expressions of hopelessness and not wanting to live require immediate suicide risk assessment. The nurse should directly assess suicidal thoughts, plans, and intent to determine appropriate safety interventions.
ATI Tip: Suicide warning signs = assess risk immediately. Never assume asking about suicide increases suicidal thoughts.
Question:
A nurse is assessing a client who reports persistent excessive worry, difficulty concentrating, muscle tension, and sleep disturbances for the past 8 months.
Which disorder should the nurse suspect?
A. Panic disorder
B. Generalized anxiety disorder
C. Obsessive-compulsive disorder
D. Acute stress disorder
Correct Answer: B. Generalized anxiety disorder (GAD)
Rationale: GAD involves excessive, persistent worry for at least 6 months, often accompanied by difficulty concentrating, muscle tension, and sleep disturbances.
ATI Tip: GAD = chronic excessive worry. Panic disorder = sudden episodes of intense fear.
Question:
A client diagnosed with depression tells the nurse, "I feel like nobody cares about me." Which response by the nurse demonstrates therapeutic communication?
A. "You shouldn't feel that way. Your family loves you."
B. "Why do you think nobody cares about you?"
C. "Tell me more about what makes you feel that way."
D. "Try to focus on the positive things in your life."
Correct Answer: C. "Tell me more about what makes you feel that way."
Rationale: This uses an open-ended statement that encourages the client to express feelings without judgment.
ATI Tip: Therapeutic communication = open-ended questions, reflection, empathy, and active listening.
A nurse is reviewing medications for a client diagnosed with bipolar disorder. Which medication is classified as a mood stabilizer?
A. Fluoxetine
B. Lithium
C. Sertraline
D. Venlafaxine
Correct answer: B. Lithium
Rationale: Lithium is a mood stabilizer used to manage bipolar disorder. The other medications listed are antidepressants.
Question:
A nurse is reviewing the characteristics of personality disorders. Which group of disorders belongs to Cluster A?
A. Borderline, antisocial, histrionic
B. Avoidant, dependent, obsessive-compulsive
C. Paranoid, schizoid, schizotypal
D. Narcissistic, paranoid, dependent
Correct Answer: C. Paranoid, schizoid, schizotypal
Rationale: Cluster A personality disorders are characterized by odd or eccentric behaviors.
ATI Tip:
Cluster A = Odd/eccentric
Cluster B = Dramatic/emotional/erratic
Cluster C = Anxious/fearful
Question:
A nurse is admitting a client experiencing an acute suicidal crisis to an inpatient psychiatric unit. The client denies having a current suicide plan but reports a recent attempt and states, "I don't trust myself when I'm alone."
Which nursing action is the priority?
A. Allow the client to keep personal belongings after obtaining a verbal agreement not to self-harm.
B. Remove belts, shoelaces, sharp objects, and other potential hazards; initiate the prescribed level of observation.
C. Encourage the client to remain in their room until they feel emotionally stable.
D. Explain that personal belongings will be removed only if the client demonstrates self-injurious behavior.
Correct Answer: B.
Rationale: During an acute suicidal crisis, the nurse must provide a safe environment by removing potential weapons and ligature hazards, including belts and shoelaces, and implementing the appropriate observation level.
A client's denial of a current plan does not eliminate risk, particularly after a recent attempt.
ATI Tip: Acute suicide risk = environmental safety, removal of hazards, and appropriate observation. A verbal safety agreement is not a substitute for precautions.
Question:
A nurse is assessing a client who reports repeatedly checking that the doors are locked before leaving home. The client states, "I know the doors are locked, but I feel extremely anxious if I don't check them at least 10 times."
Which finding is most consistent with obsessive-compulsive disorder (OCD)?
A. The client experiences delusions about home security.
B. The client performs repetitive behaviors to temporarily relieve anxiety.
C. The client experiences sudden episodes of intense fear without a trigger.
D. The client avoids leaving home due to fear of being unable to escape.
Correct Answer: B.
Rationale: OCD involves obsessions (intrusive thoughts) and compulsions (repetitive behaviors) performed to reduce anxiety. The relief is temporary, which reinforces the compulsive behavior.
ATI Tip: Obsession = unwanted thought. Compulsion = repetitive behavior intended to reduce distress.
A client experiencing severe anxiety begins pacing and states, "I can't calm down! Something terrible is going to happen!" Which response by the nurse is most therapeutic?
A. "There's nothing to worry about. You're safe."
B. "You need to stop pacing and sit down."
C. "I'm here with you. Let's move to a quiet area."
D. "Why do you think something terrible will happen?"
Correct Answer: C. "I'm here with you. Let's move to a quiet area."
Rationale: During severe anxiety, the nurse should remain with the client, use short, calm statements, and reduce environmental stimuli. Asking complex questions or giving false reassurance is nontherapeutic.
ATI Tip: Severe anxiety = stay with the client, decrease stimuli, and communicate calmly.
A client taking lithium for bipolar disorder reports nausea, diarrhea, and hand tremors. What is the nurse's priority action?
A. Administer the next dose with food.
B. Encourage the client to exercise.
C. Hold the lithium and notify the provider.
D. Reassure the client that these are expected effects.
Correct Answer: C. Hold the lithium and notify the provider.
Rationale: Nausea, diarrhea, and worsening tremors can indicate lithium toxicity. The nurse should hold the medication, notify the provider, and anticipate checking the lithium level.
ATI Tip: Lithium toxicity = HOLD medication + check lithium level.
A nurse is caring for a client with histrionic personality disorder. The client frequently interrupts group therapy, exaggerates emotional responses, and becomes upset when attention is directed toward other clients.
Which nursing intervention is most appropriate?
A. Provide additional individual attention whenever the client becomes upset.
B. Confront the client about attention-seeking behaviors in front of the group.
C. Establish consistent limits while reinforcing appropriate participation in group activities.
D. Allow the client to lead group discussions to improve self-esteem.
Correct Answer: C.
Rationale: Clients with histrionic personality disorder may demonstrate excessive emotional expression and attention-seeking behaviors. Consistent boundaries and positive reinforcement of appropriate behavior promote therapeutic interactions.
ATI Tip: Histrionic personality disorder = maintain boundaries, avoid reinforcing disruptive attention-seeking behavior.
A nurse is caring for a client admitted to an inpatient psychiatric unit who states, "When I get discharged, I'm going to make my former supervisor pay for what he did to me."
The client appears calm, denies suicidal ideation, and refuses to elaborate.
Which action should the nurse take first?
A. Document the statement and reassess the client during the next shift.
B. Explain that threatening others is unacceptable and encourage anger-management techniques.
C. Assess the client's intent, specific plan, access to weapons, and ability to carry out the threat.
D. Immediately inform the former supervisor of the client's statement.
Correct Answer: C.
Rationale: A threat of violence requires immediate assessment of homicidal ideation, intent, planning, access to weapons, and potential targets. A calm appearance does not eliminate the risk of violence.
The nurse must promptly escalate the threat to the treatment team and follow facility protocols and applicable duty-to-protect requirements.
ATI Tip: Threats toward others = assess intent, plan, means, and immediate safety. Never dismiss a threat because the client appears calm.
Question:
A nurse is assessing a client who was found wandering in another city. The client cannot recall their name, home address, or how they arrived there. The client's family reports that the behavior began shortly after a traumatic event.
Which disorder should the nurse suspect?
A. Depersonalization/derealization disorder
B. Dissociative identity disorder
C. Dissociative amnesia with fugue
D. Somatic symptom disorder
Correct Answer: C. Dissociative amnesia with fugue
Rationale: Dissociative fugue involves unexpected travel or wandering accompanied by an inability to recall important personal information, often following significant trauma.
ATI Tip: Trauma + memory loss + unexpected travel = dissociative fugue.
A client diagnosed with borderline personality disorder tells the nurse, "You're the only nurse who cares about me. The other nurses are terrible!" Which response is most therapeutic?
A. "Thank you. I'm glad you trust me."
B. "You should tell the other nurses how you feel."
C. "All staff members are working together to provide your care."
D. "Why do you dislike the other nurses?"
Correct Answer: C. "All staff members are working together to provide your care."
Rationale: The client is demonstrating splitting, a behavior associated with borderline personality disorder. The nurse should maintain professional boundaries, reinforce team consistency, and avoid favoritism.
ATI Tip: Borderline personality disorder = consistent boundaries, team communication, and avoid staff splitting.
Question:
A nurse is providing teaching to a client who has been prescribed fluoxetine (Prozac) for depression. Which statement indicates the client needs further teaching?
A. "I should take this medication consistently."
B. "It may take several weeks to experience the full benefits."
C. "I can stop taking this medication once I start feeling better."
D. "This medication belongs to the SSRI class."
Correct Answer: C. "I can stop taking this medication once I start feeling better."
Rationale: SSRIs require consistent adherence. Stopping fluoxetine without consulting the provider can lead to relapse or discontinuation symptoms. Full therapeutic benefits may take several weeks.
ATI Tip: SSRIs = delayed therapeutic effects + consistent adherence.
A nurse is caring for a client with borderline personality disorder who is participating in dialectical behavior therapy (DBT). The client states, "When someone rejects me, I become overwhelmed and immediately want to hurt myself."
Which intervention best demonstrates the principles of DBT?
A. Encourage the client to suppress negative emotions until the urge passes.
B. Teach the client mindfulness, distress tolerance, and emotional regulation skills.
C. Encourage the client to avoid relationships that trigger emotional distress.
D. Focus exclusively on identifying unconscious childhood conflicts.
Correct Answer: B.
Rationale: DBT teaches mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. These skills help clients manage intense emotions and reduce self-destructive behaviors.
ATI Tip:Borderline personality disorder + DBT = emotional regulation and distress tolerance.
A nurse is reviewing medication orders for a client with major depressive disorder who has been taking fluoxetine (Prozac). The provider discontinues fluoxetine and prescribes phenelzine (Nardil) to begin the following day.
Which action should the nurse take first?
A. Administer phenelzine as prescribed because fluoxetine has been discontinued.
B. Hold phenelzine and clarify the prescription because a 5-week washout period is required.
C. Administer phenelzine and monitor the client's blood pressure every 4 hours.
D. Teach the client to avoid tyramine-rich foods and administer the medication.
Correct Answer: B. Hold phenelzine and clarify the prescription.
Rationale: Fluoxetine is an SSRI, and phenelzine is an MAOI. Starting phenelzine too soon after discontinuing fluoxetine increases the risk of life-threatening serotonin syndrome.
Because fluoxetine has a long half-life, at least 5 weeks must pass before starting an MAOI.
Why the others are incorrect:
A: Discontinuing fluoxetine does not immediately eliminate its effects.
C: Blood pressure monitoring does not prevent serotonin syndrome.
D: Avoiding tyramine is important with MAOIs, but it does not eliminate the dangerous drug interaction.
ATI Tip: SSRI + MAOI = serotonin syndrome risk. Fluoxetine requires a minimum 5-week washout before starting an MAOI.
Question:
A nurse is caring for a client diagnosed with borderline personality disorder. The client becomes angry when the nurse cannot immediately fulfill a request and states, "Nobody here cares about me!" The client then begins scratching their arms and threatens further self-injury.
Which nursing intervention is the priority?
A. Encourage the client to participate in group therapy to develop interpersonal skills.
B. Explain that self-injurious behavior is unacceptable and establish consequences.
C. Assess the client's immediate risk for self-harm and implement appropriate safety precautions.
D. Encourage the client to identify triggers and practice emotional regulation techniques.
Correct Answer: C.
Rationale: Clients with borderline personality disorder may demonstrate emotional instability, impulsivity, and self-injurious behaviors. When a client threatens or engages in self-harm, immediate safety assessment and protective interventions take priority over other therapeutic approaches.
ATI Tip: Actual or threatened self-harm = prioritize safety before teaching, coping strategies, or group therapy.
A client diagnosed with major depressive disorder tells the nurse, "My family would be better off without me. I don't think I can keep doing this." Which response should the nurse make first?
A. "Your family loves you. Think about how they would feel."
B. "Are you thinking about ending your life?"
C. "Let's discuss some positive coping strategies."
D. "What makes you feel like a burden to your family?"
Correct Answer: B.
Rationale: The client's statement suggests possible suicidal ideation. The nurse must directly assess suicide risk before exploring feelings or coping strategies. If risk is identified, implement appropriate safety precautions.
ATI Tip: Suspected suicide risk = ask directly about suicidal thoughts. Safety takes priority.
Question:
A nurse is caring for an older adult prescribed lorazepam (Ativan) for anxiety. Which nursing intervention is the priority?
A. Encourage increased fluid intake.
B. Implement fall precautions.
C. Administer the medication with meals.
D. Encourage independent ambulation.
Correct Answer: B. Implement fall precautions.
Rationale: Benzodiazepines cause CNS depression, sedation, and dizziness, increasing the risk of falls in older adults.
ATI Tip: Benzodiazepines + older adults = increased fall risk.
A nurse is assessing a client who repeatedly reports abdominal pain, dizziness, fatigue, and headaches. The client has undergone multiple medical evaluations without findings that fully explain the symptoms. The provider requests the Patient Health Questionnaire-15 (PHQ-15).
Which statement by the nurse demonstrates an accurate understanding of this screening tool?
A. "The PHQ-15 determines whether the client's physical symptoms are intentionally fabricated."
B. "The PHQ-15 identifies the severity of 15 commonly reported somatic symptoms and helps assess overall somatic symptom burden."
C. "The PHQ-15 confirms a diagnosis of somatic symptom disorder when the score exceeds 10."
D. "The PHQ-15 determines whether the client's symptoms are caused by an underlying neurological disorder."
Correct Answer: B.
Rationale: The PHQ-15 assesses the severity of 15 common somatic symptoms. It helps quantify symptom burden but does not independently diagnose somatic symptom disorder, determine whether symptoms are fabricated, or establish their medical cause.
ATI Tip: PHQ-15 = somatic symptom severity screening, not a definitive diagnostic test.
A nurse on an inpatient psychiatric unit receives reports about four clients. Which client requires immediate intervention?
A. A client with major depressive disorder who has a history of self-injury and refuses to participate in group therapy.
B. A client with PTSD who becomes anxious after hearing a loud noise and requests to remain in their room.
C. A client taking sertraline who develops a temperature of 103°F (39.4°C), muscle rigidity, hyperreflexia, and severe agitation after starting phenelzine.
D. A client with borderline personality disorder who threatens to scratch their arms after being informed that visiting hours have ended.
Correct Answer: C.
Rationale: The client is exhibiting signs of serotonin syndrome, a potentially life-threatening reaction caused by excessive serotonergic activity.
Combining an SSRI (sertraline) with an MAOI (phenelzine) can cause severe serotonin toxicity.
Priority nursing actions:
Stop serotonergic medications and notify the provider or rapid response team immediately.
Assess airway, breathing, circulation, vital signs, and neurological status.
Prepare for emergency supportive treatment and cooling measures.
Why the others are incorrect:
A: Requires further assessment for suicide risk, but no immediate physiological instability is described.
B: Requires trauma-informed support, but the client is not exhibiting an immediate life-threatening complication.
D: Requires prompt self-harm assessment and safety precautions, but client C has signs of an active medical emergency.
ATI Tip: Serotonin syndrome = hyperthermia + agitation + hyperreflexia/clonus + autonomic instability. Recognize it as a medical emergency.
A nurse is caring for four clients on an inpatient psychiatric unit. Which client should the nurse assess first?
A. A client with obsessive-compulsive disorder who becomes distressed when prevented from completing a handwashing ritual.
B. A client with bipolar I disorder who has slept 2 hours in the past 3 days and is pacing continuously, refusing food and fluids.
C. A client with PTSD who reports nightmares and refuses to participate in group therapy.
D. A client with avoidant personality disorder who refuses to interact with peers because of fear of rejection.
Correct Answer: B.
Rationale: The client experiencing severe mania is at immediate risk for dehydration, exhaustion, and physiological instability due to prolonged sleep deprivation, excessive activity, and inadequate intake.
Why the others are incorrect:
A: The client's distress requires intervention but is not the most immediate physiological threat.
C: PTSD symptoms require therapeutic support, but no immediate danger is identified.
D: Social withdrawal requires intervention but is not an immediate safety concern.
ATI Tip: When prioritizing psychiatric clients, use ABCs, physiological needs, and safety. Physical instability can take priority over behavioral symptoms.
Question:
A nurse is caring for a client diagnosed with borderline personality disorder who has a history of self-injury. After being informed that visiting hours have ended, the client becomes tearful and states, "Everyone always abandons me! If you make my family leave, I'll cut myself, and it'll be your fault!"
Which response by the nurse demonstrates the best therapeutic communication and clinical judgment?
A. "I understand you're upset, but threatening self-harm will not change the visiting hours."
B. "I can see you're feeling abandoned. Let's talk about those feelings while we work together to keep you safe."
C. "I'll ask the charge nurse to extend visiting hours so you don't hurt yourself."
D. "You have a history of manipulating staff, so we need to maintain consistent boundaries."
Correct Answer: B.
Rationale: The nurse validates the client's feelings without reinforcing threatening behavior. The response also prioritizes safety and maintains therapeutic engagement.
The nurse should follow up immediately with a direct self-harm and suicide risk assessment, implement appropriate precautions, and maintain consistent boundaries.
Why the others are incorrect:
A: Focuses on the threat without sufficiently addressing the client's emotional distress or safety.
C: Reinforces threatening behavior by changing boundaries.
D: Uses judgmental language and damages the therapeutic relationship.
ATI Tip: Borderline personality disorder + self-harm threats = validate feelings, assess safety, and maintain consistent limits.
Question:
A nurse is caring for a client taking phenelzine (Nardil) for depression. Which food selection requires immediate intervention?
A. Grilled chicken with steamed broccoli
B. Fresh apple slices and oatmeal
C. Aged cheddar cheese and salami
D. Baked salmon with brown rice
Correct Answer: C. Aged cheddar cheese and salami.
Rationale: Phenelzine is an MAOI. Tyramine-rich foods, including aged cheeses and cured meats, can trigger a life-threatening hypertensive crisis.
ATI Tip: MAOIs + tyramine = hypertensive crisis.