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ATI Mental Health Proctored Exam
2023
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, The nurse should ask the client directly about what the voices are saying to determine if
there is a safety risk. The nurse should also avoid validating that the voices are real,
which promotes the client’s beliefs about the delusion.
c. "That must be very frightening."
The nurse should respond to the client’s delusion in a calm and empathetic manner. By
acknowledging to the client that the delusion must be frightening, the nurse promotes the
nurse-client relationship.
d. "Why do you think the TV is a two-way radio?"
The nurse should avoid asking the client a "why" question, which promotes a defensive
client response.
4. A nurse is planning care for a newly admitted client who has bipolar disorder and is
experiencing acute mania. Which of the following client goals should the nurse identify as the
priority?
a. Practicing problem-solving skills
The nurse should encourage the client to practice problem-solving skills during the
continuation phase of treatment; however, there is another intervention that is the priority
during the acute phase of bipolar disorder.
b. Understanding of medication regimen
The nurse should ensure that the client understands the medication regimen during the
continuation phase of treatment; however, there is another intervention that is the priority
during the acute phase of bipolar disorder.
c. Identifying indications of relapse
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