Test Bank For Psychiatric Mental Health Nursing: Concepts Of Care In Evidence-Based Practice, 8th Edition

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Chapter 1. The Concept of Stress AdaptationChapter 1. The Concept of Stress AdaptationMultiple Choice1. A client has experienced the death of a close family member and at the same time becomesunemployed. This situation has resulted in a 6-month score of 110 on the Recent Life ChangesQuestionnaire. How should the nurse evaluate this client data?A. The client is experiencing severe distress and is at risk for physical and psychological illness.B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significantthreat of stress-related illness.C. Susceptibility to stress-related physical or psychological illness cannot be estimated withoutknowledge of coping resources and available supports.D. The client may view these losses as challenges and perceive them as opportunities.ANS: CThe Recent Life Changes Questionnaire is an expanded version of the Schedule of RecentExperiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 ormore, or a year-score total of 500 or more, indicates high stress in a client’s life. However, positivecoping mechanisms and strong social support can limit susceptibility to stress-related illnesses.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Psychosocial Integrity2. A physically and emotionally healthy client has just been fired. During a routine office visit hestates to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an artdegree.” How should the nurse characterize the client’s appraisal of the job loss stressor?A. IrrelevantB. Harm/lossC. ThreateningD. Challenging

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ANS: DThe client perceives the situation of job loss as a challenge and an opportunity for growth.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity3. Which client statement should alert a nurse that a client may be responding maladaptively tostress?A. “I’ve found that avoiding contact with others helps me cope.”B. “I really enjoy journaling; it’s my private time.”C. “I signed up for a yoga class this week.”D. “I made an appointment to meet with a therapist.”ANS: AReliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It canprevent learning appropriate coping skills and can prevent access to needed support systems.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Psychosocial Integrity4. A nursing student finds that she comes down with a sinus infection toward the end of everysemester. When this occurs, which stage of stress is the student most likely experiencing?A. Alarm reaction stageB. Stage of resistanceC. Stage of exhaustionD. Fight-or-flight stageANS: CAt the stage of exhaustion, the student’s exposure to stress has been prolonged and adaptive energyhas been depleted. Diseases of adaptation occur more frequently in this stage.

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KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity5. A school nurse is assessing a female high school student who is overly concerned about herappearance. The client’s mother states, “That’s not something to be stressed about!” Which is themost appropriate nursing response?A. “Teenagers! They don’t know a thing aboutrealstress.”B. “Stress occurs only when there is a loss.”C. “When you are in poor physical condition, you can’t experience psychological well-being.”D. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”ANS: DStress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressfulas a physiological change.KEY: Cognitive Level:Application |Integrated Processes: Nursing Process: Implementation|Client Need:Psychosocial Integrity6. A bright student confides in the school nurse about conflicts related to attending college orworking to add needed financial support to the family. Which coping strategy is most appropriate forthe nurse to recommend to the student at this time?A. MeditationB. Problem-solving trainingC. RelaxationD. JournalingANS: BThe student must assess his or her situation and determine the best course of action. Problem-solvingtraining, by providing structure and objectivity, can assist in decision making.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity

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7. An unemployed college graduate is experiencing severe anxiety over not finding a teachingposition and has difficulty with independent problem-solving. During a routine physical examination,the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?A. Encourage the student to use the alternative coping mechanism of relaxation exercises.B. Complete the problem-solving process for the client.C. Work through the problem-solving process with the client.D. Encourage the client to keep a journal.ANS: CDuring times of high anxiety and stress, clients will need more assistance in problem-solving anddecision making.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity8. A school nurse is assessing a distraught female high school student who is overly concernedbecause her parents can’t afford horseback riding lessons. How should the nurse interpret thestudent’s reaction to her perceived problem?A. The problem is endangering her well-being.B. The problem is personally relevant to her.C. The problem is based on immaturity.D. The problem is exceeding her capacity to cope.ANS: BPsychological stressors to self-esteem and self-image are related to how the individual perceives thesituation or event. Self-image is of particular importance to adolescents, who feel entitled to have allthe advantages that other adolescents experience.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Psychosocial Integrity

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9. Meditation has been shown to be an effective stress management technique. When meditation iseffective, what should a nurse expect to assess?A. An achieved state of relaxationB. An achieved insight into one’s feelingsC. A demonstration of appropriate role behaviorsD. An enhanced ability to problem-solveANS: AMeditation produces relaxation by creating a special state of consciousness through focusedconcentration.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Psychosocial Integrity10. A distraught, single, first-time mother cries and asks a nurse, “How can I go to work if I can’tafford childcare?” What is the nurse’s initial action in assisting the client with theproblem-solvingprocess?A. Determine the risks and benefits for each alternative.B. Formulate goals for resolution of the problem.C. Evaluate the outcome of the implemented alternative.D. Assess the facts of the situation.ANS: DBefore any other steps can be taken, accurate information about the situation must be gathered andassessed.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity11. A nursing instructor is asking students about diseases of adaptation and when they are likely tooccur. Which student response indicates that learning has occurred?

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A. “When an individual has limited experience dealing with stress”B. “When an individual inherits maladaptive genes”C. “When an individual experiences existing conditions that exacerbate stress”D. “When an individual’s physiological and psychological resources have become depleted”ANS: DDuring the stage of exhaustion of the general adaptation syndrome, the individual loses the capacityto adapt effectively because physiological and psychological resources have become depleted. This isthe time when diseases of adaptation may occur.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Health Promotion and Maintenance12. When an individual’s stress response is sustained over a long period of time, which physiologicaleffect of the endocrine system should a nurse anticipate?A. Decreased resistance to diseaseB. Increased libidoC. Decreased blood pressureD. Increased inflammatory responseANS: AIn a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion atwhich time the body’s compensatory mechanisms no longer function effectively anddiseases ofadaptation occur. A decreased immune response is seen at this stage.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Physiological Integrity13. Which symptom should a nurse identify as typical of the “fight-or-flight” response?A. Pupil constrictionB. Increased heart rate

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C. Increased salivationD. Increased peristalsisANS: BDuring the “fight-or-flight” response, the heart rate increases in response to the release ofepinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slowsunessential functions. OKKEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Assessment|Client Need:Physiological Integrity14. A nurse is evaluating a client’s response to stress. What would indicate to the nurse that the clientis experiencing a secondary appraisal of the stressful event?A. When the individual judges the event to be benignB. When the individual judges the event to be irrelevantC. When the individual judges the resources and skills needed to deal with the eventD. When the individual judges the event to be pleasurableANS: CWhen the individual judges the resources and skills needed to deal with the event, the individual isconducting a secondary appraisal. There are three types of primary appraisals: irrelevant, benign-positive, and stressful.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Psychosocial Integrity15. Research undertaken by Miller and Rahe in 1997 demonstrated a correlation between the effectsof life change and illness. This research led to the development of the Recent Life ChangesQuestionnaire (RLCQ). Which principle most limits the effectiveness of this tool?A. Specific illnesses are not identified.B. The numerical values associated with specific life events are randomly assignedC. Stress is viewed as only a physiological response.

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D. Personal perception of the event is excluded.ANS: DIndividuals differ in response to life events. The RLCQ uses a scale that does not take thesedifferences into consideration.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Health Promotion and Maintenance16. A client who experiences stress on a regular basis asks a nurse what causes these feelings. Whichis the most appropriate nursing response?A. “Genetics have nothing to do with your temperament.”B. “How you reacted to past experiences influences how you feel now.”C.“If you’re in good physical health, your stress level will be low.”D. “Stress can always be avoided if appropriate coping mechanisms are employed.”ANS:BPast experiences are occurrences that result in learned patterns that can influence an individual’scurrent adaptation response. They include previous exposure to the stressor or other stressors ingeneral, learned coping responses, and degree of adaptation to previous stressors.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial IntegrityMultiple Response17. A nurse is interviewing a distressed client, who relates being fired after 15 years of loyalemployment. Which of the following questions would best assist the nurse to determine the client’sappraisal of the situation?Select all that apply.A. “What resources have you used previously in stressful situations?”B. “Have you ever experienced a similar stressful situation?”C. “Who do you think is to blame for this situation?”D. “Whydo you think you were fired from your job?”

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E. “What skills do you possess that might lead to gainful employment?”ANS: A, B, EThese questions specifically address the client’s coping resources and encourage the client to applylearning from past experiences. These questions also encourage the client to consider alternativemethods for dealing with stress. Asking who is to blame does not assess coping abilities but, rather,encourages maladaptive behavior. Requesting an explanation is a nontherapeutic block tocommunication.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity18. A nurse is working with a client who has recently been under a great deal of stress. Whichnursing recommendations would be most helpful when assisting the client in coping withstress?Select all that apply.A. “Enjoy a pet.”B. “Spend time with a loved one.”C. “Listen to music.”D. “Focus on the stressors.”E. “Journal your feelings.”ANS: A, B, C, EFocusing on the stressors is more likely to increase stress in the client’s life. However, pets, music,journaling feelings, and healthy relationships have all been shown to decrease amounts of stress.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity19. A nurse is conducting education on anxiety and stress management. Which of the followingshould be identified as the most important initial step in learning how to manage anxiety?A. Diagnostic blood testsB. Awareness of factors creating stress

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C. Relaxation exercisesD. Identifying support systemsANS: BAlthough all of the above answers may be useful in the comprehensive management of stress, theinitial step is awareness that stress is being experienced and awareness of factors that create stress.KEY: Cognitive Level:Analysis| Integrated Processes:Teaching/Learning| ClientNeed:Psychosocial Integrity20. A patient presents in the Emergency Department immediately following a shooting incident in aschool where she has been teaching. There is no evidence of physical injury, but she appears veryhyperactive and talkative. Which of these symptoms manifested by the patient are common initialbiological responses to stress?Select all that apply.A. Constricted pupilsB. Watery eyesC. Unusual food cravingsD. Increased heart rateE. Increased respirationsANS: B, D, EIncreased lacrimal secretions, increased heart rate, and increased respirations are identified as initialbiological responses to stress. Since dilated pupils rather than constricted pupils are related to “Fightor Flight” syndrome, this symptom should be assessed for other potential causes. Unusual foodcravings have not been identified as a typical biological response to stress.KEY: Cognitive Level:Analysis| Integrated Processes: Nursing Process: Assessment| ClientNeed:Physiological IntegrityChapter 2. Mental Health/Mental Illness:Historical and Theoretical ConceptsChapter 2. Mental Health/Mental Illness: Historical and Theoretical ConceptsMultiple Choice

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1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of therecent death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have notchanged.How should the nurse interpret the client’s behaviors?A. The client’s behaviors demonstrate mental illness in the form of depression.B. The client’s behaviors are extensive, which indicates the presence of mental illness.C. The client’s behaviors are not congruent with cultural norms.D. The client’s behaviors demonstrate no functional impairment, indicating no mental illness.ANS: DThe nurse should assess that the client’s daily functioning is not impaired. The client whoexperiences feelings of sadness after the loss of a pet is responding within normal expectations.Without significant impairment, the client’s distress does not indicate a mental illness.KEY: Cognitive Level:Analysis |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity2. At what point should the nurse determine that a client is at risk for developing a mental disorder?A. When thoughts, feelings, and behaviors are not reflective of theDSM-5criteriaB. When maladaptive responses to stress are coupled with interference in daily functioningC. When the client communicates significant distressD. When the client uses defense mechanisms as ego protectionANS: BThe nurse should determine that the client is at risk for mental disorder when responses to stress aremaladaptive and interfere with daily functioning. TheDSM-5indicates that in order to be diagnosedwith a mental disorder, there must be significant disturbance in cognition, emotion, regulation, orbehavior that reflects a dysfunction in the psychological, biological or developmental processesunderlying mental functioning. These disorders are usually associated with significant distress ordisability in social, occupational, or other important activities. The client’s ability to communicatedistress would be considered a positive attribute.

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KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity3. A nurse is assessing 15-year-old identical twins who respond very differently to stress. One twinbecomes anxious and irritable, while the other withdraws and cries. How should the nurse explainthese different responses to stress to the parents?A. Reactions to stress are relative rather than absolute; individual responses to stress vary.B. It is abnormal for identical twins to react differently to similar stressors.C. Identical twins should share the same temperament and respond similarly to stress.D. Environmental influences weigh more heavily than genetic influences on reactions to stress.ANS: AResponses to stress are variable among individuals and may be influenced by perception, pastexperience, and environmental factors in addition to genetic factors.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity4. A client has a history of excessive drinking, which has led to multiple arrests for driving under theinfluence (DUI). The client states, “I work hard to provide for my family. I don’t see why I can’tdrink to relax.” The nurse recognizes the use of which defense mechanism?A. ProjectionB. RationalizationC. RegressionD. SublimationANS: BThe nurse should recognize that the client is using rationalization, a common defense mechanism.The client is attempting to make excuses and create logical reasons to justify unacceptable feelings orbehaviors.

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KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity5. Which client should the nurse anticipate to be most receptive to psychiatric treatment?A. A Jewish, female journalistB. A Baptist, homeless maleC. A Catholic, black maleD. A Protestant, Swedish business executiveANS: AThe nurse should anticipate that the client of Jewish culture would place a high importance onpreventative health care and would consider mental health as equally important as physical health.Women are also more likely than men to seek treatment for mental health problems.KEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Planning |ClientNeed:Psychosocial Integrity6. A new psychiatric nurse states, “This client’s use of defense mechanisms should be eliminated.”Which is a correct evaluation of this nurse’s statement?A. Defense mechanisms can be self-protective responses to stress and need not be eliminated.B. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should alwaysbe eliminated.C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and noteliminated.D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.ANS: AThe nurse should know that defense mechanisms serve the purpose of reducing anxiety during timesof stress. A client with no defense mechanisms may have a lower tolerance for stress, predisposinghim or her to anxiety disorders. Defense mechanisms should be confronted when they impede theclient from developing healthy coping skills.

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KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity7. During an intake assessment, a nurse asks both physiological and psychosocial questions. Theclient angrily responds, “I’m here for my heart, not my head problems.” Which is the nurse’s bestresponse?A. “It’s just a routine part of our assessment. All clients are asked these same questions.”B. “Why are you concerned about these types of questions?”C. “Psychological factors, like excessive stress, have been found to affect medical conditions.”D. “We can skip these questions, if you like. It isn’t imperative that we complete this section.”ANS: CThe nurse should attempt to educate the client on the negative effects of excessive stress on medicalconditions. It is not appropriate to skip either physiological or psychosocial questions, as this wouldlead to an inaccurate assessment.KEY: Cognitive Level:Analysis |Integrated Processes:Nursing Process: Implementation |ClientNeed:Health Promotion and Maintenance8. Which statement reflects a student nurse’s accurate understanding of the concepts of mental healthand mental illness?A. “The concepts are rigid and religiously based.”B. “The concepts are multidimensional and culturally defined.”C. “The concepts are universal and unchanging.”D. “The concepts are unidimensional and fixed.”ANS: BThe student nurse should understand that mental health and mental illness are multidimensional andculturally defined. It is important for nurses to be awareof cultural norms when evaluating a client’smental state.

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KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Safe and Effective Care Environment9. A mental health technician asks the nurse, “How do psychiatrists determine which diagnosis togive a patient?” Which of these responses by the nurse would be most accurate?A. Psychiatrists use pre-established criteria from the APA’s Diagnostic and Statistical Manual ofMental Disorders (DSM-5).B. Hospital policy dictates how psychiatrists diagnose mental disorders.C. Psychiatrists assess the patient and identify diagnoses based on the patient’s unhealthy responsesand contributing factors.D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choosefrom.ANS: ATheDSM-5is an organized manual describing mental disorders and the criteria that determinewhether a given diagnosis is appropriate. It is published by the American Psychiatric Association(APA). It intends to facilitate accurate and reliable medical diagnosis and treatment. Item C describesnursing rather than medical diagnosis.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity10. The nurse is preparing to provide medication instruction for a patient. Which of the followingunderstandings about anxiety will be essential to effective instruction?A. Learning is best when anxiety is moderate to severe.B. Learning is enhanced when anxiety is mild.C. Panic level anxiety helps the nurse teach better.D. Severe anxiety is characterized by intense concentration and enhances the attention span.ANS: B

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Mild anxiety sharpens the senses, increases the perceptual field, and results in heightened awarenessof the environment. Learning is enhanced. As anxiety increases, attention span decreases andlearning becomes more difficult.KEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Planning |ClientNeed:Health Promotion and Maintenance11. Which of the following are identified as psychoneurotic responses to severe anxiety as theyappear in theDSM-5?A. Somatic symptom disordersB. Grief responsesC. PsychosisD. Bipolar disorderANS: ASomatic symptom disorder is characterized by preoccupation with physical symptoms for whichthere is no demonstrable organic pathology. One of the diagnostic criteria is a high level of anxietyabout health concerns or illness.KEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Assessment|Client Need:Psychosocial Integrity12. An employee uses the defense mechanism of displacement when the boss openly disagrees withsuggestions. What behavior would be expected from this employee?A. The employee assertively confronts the bossB. The employee leaves the staff meeting to work out in the gymC. The employee criticizes a coworkerD. The employee takes the boss out to lunchANS: C

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The client using the defense mechanism of displacement would criticize a coworker after beingconfronted by the boss. Displacement refers to transferring feelings from one target to a neutral orless-threatening target.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity13. A teenage boy is attracted to a female teacher. Without objective evidence, a school nurseoverhears the boy state, “I know she wants me.” This statement reflects which defense mechanism?A. DisplacementB. ProjectionC. RationalizationD. SublimationANS: BThe nurse should determine that the client’s statement reflects the defense mechanism of projection.Projection refers to the attribution of one’s unacceptable feelings or impulses to another person.When the client “passes the blame” of the undesirable feelings, anxiety is reduced. Displacementrefers to transferring feelings from one target to another. Rationalization refers to making excuses tojustify behavior. Sublimation refers to channeling unacceptable drives or impulses into moreconstructive, acceptable activities.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity14. A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should beidentified by a nurse as indicative of which defense mechanism?A. DisplacementB. ProjectionC. Reaction formationD. Sublimation

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ANS: CThe nurse should identify that the boy is using reaction formation as a defense mechanism. Reactionformation is the attempt to prevent undesirable thoughts from being expressed by expressing oppositethoughts or behaviors. Displacement refers to transferring feelings from one target to another.Rationalization refers to making excuses to justify behavior. Projection refers to the attribution ofunacceptable feelings or behaviors to another person. Sublimation refers to channeling unacceptabledrives or impulses into more constructive, acceptable activities.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity15. Which nursing statement about the concept of neuroses is most accurate?A. “An individual experiencing neurosis is unaware that he or she is experiencing distress.”B. “An individual experiencing neurosis feels helpless to change his or her situation.”C. “An individual experiencing neurosis is aware of psychological causes of his or her behavior.”D. “An individual experiencing neurosis has a loss of contact with reality.”ANS: BThe nurse should understand that the concept of neuroses includes the following characteristics. Theclient feels helpless to change his or her situation, the client is aware that he or she is experiencingdistress, the client is aware the behaviors are maladaptive, the client is unaware of the psychologicalcauses of the distress, and the client experiences no loss of contact with reality.KEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Assessment|Client Need:Psychosocial Integrity16. Which nursing statement about the concept of psychoses is most accurate?A. “Individuals experiencing psychoses are aware that their behaviors are maladaptive.”B. “Individuals experiencing psychoses experience little distress.”C.“Individuals experiencing psychoses are aware of experiencing psychological problems.”D. “Individuals experiencing psychoses are based in reality.”

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ANS: BThe nurse should understand that the client with psychoses experiences little distress, because of hisor her lack of awareness of reality. The client with psychoses is unaware that his or her behavior ismaladaptive or that he or she has a psychological problem.KEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Assessment|Client Need:Psychosocial Integrity17. When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, herhusband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize asthe use of the defense mechanism of denial?A. Hiding liquor bottles in a closetB. Yelling at their son for slouching in his chairC. Burning dinner on purposeD. Saying to the spouse, “I don’t drink too much!”ANS: DThe nurse should associate the client statement “I don’t drink too much!” withthe use of the defensemechanism of denial. The client who refuses to acknowledge the existence of a real situation and thefeelings associated with it is using the defense mechanism of denial.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity18. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Whichstatement by the wife should indicate to a nurse that the client is in the acceptance stage of grief?A. “If only we could have tried again, things might have worked out.”B. “I am so mad that the children and I had to put up with him as long as we did.”C. “Yes, it was a difficult relationship, but I think I have learned from the experience.”D. “I still don’t have any appetite and continue to lose weight.”ANS: C

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The nurse should recognize that the client is in the acceptance stage of grief. During this stage of thegrief process, the client would be able to focus on the reality of the loss and its meaning in relation tolife.KEY: Cognitive Level:Analysis |Integrated Processes:Nursing Process: Evaluation |ClientNeed:Psychosocial Integrity19. A nurse is performing a mental health assessment on an adult client. According to Maslow’shierarchy of needs, which client action would demonstrate the highest achievement in terms ofmental health?A. Maintaining a long-term, faithful, intimate relationshipB. Achieving a sense of self-confidenceC. Possessing a feeling of self-fulfillment and realizing full potentialD. Developing a sense of purpose and the ability to direct activitiesANS: CThe nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his orher full potential has achieved self-actualization, the highest level on Maslow’s hierarchy of needs.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity20. According to Maslow’s hierarchy of needs, which situation on an inpatient psychiatricunit wouldrequire priority intervention by a nurse?A. A client rudely complaining about limited visiting hoursB. A client exhibiting aggressive behavior toward another clientC. A client stating that no one caresD. A client verbalizing feelings of failureANS: BThe nurse should immediately intervene when a client exhibits aggressive behavior toward anotherclient. Safety and security are considered lower-level needs according to Maslow’s hierarchy ofneeds and must be fulfilled before other, higher-level needs can be met. Clients who complain, havefeelings of failure, or state that no one cares are struggling with higher-level needs such as the needfor love and belonging or the need for self-esteem.

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KEY: Cognitive Level:Analysis |Integrated Processes:Nursing Process: Implementation |ClientNeed:Psychosocial Integrity21. Which is an example of the ego defense mechanism of regression?A. A mother blames theteacher for her child’s failure in school.B. A teenager becomes hysterical after seeing a friend killedin a car accident.C. A woman wants to marry a man exactly like her beloved father.D. An adult throws a temper tantrum when he does not get his own way.ANS: DRegression is the retreating to an earlier level of development and the comfort measures associatedwith that level of functioning.KEY: Cognitive Level:Analysis |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity22. Which is the most significant consequence of the excessive use of defense mechanisms?A. Thesuperego will be suppressed.B. Emotions will be experienced intensely.C. Learning and the ability to grow will be enhanced.D. Problem-solving will be limited.ANS: DDefense mechanisms become maladaptive when they are used by an individual to such a degree thatthere is interference with the ability to deal with reality, effective interpersonal relations, oroccupational performance.KEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Evaluation|Client Need:Psychosocial Integrity23. A husband accuses his wife of infidelity. Which situation would indicate to the nurse thehusband’s use of the ego defense mechanism of projection?A. The husband cries and stamps his feet,demanding that his wife be true to her marriage vows. B. The husband ignores the wife’s continuedabsence from the home.C. The husband has already admitted to having an affair with a coworker.D. The husband takes out his marital frustrations through employee abuse.ANS: C

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Projection is the attribution of feelings or impulses unacceptable to one’s self to another person. Inthis situation, the husband attributes his infidelity to his wife.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity24. Which should the nurse recognize as aDSM-5 disorder?A. ObesityB. Generalized anxiety disorderC. HypertensionD. GriefANS: BTheDSM-5identifies several disorders that are related to anxiety, including generalized anxietydisorder, somatic symptom disorder, and dissociative disorders.KEY: Cognitive Level:Knowledge |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity25. A nurse is educating a patient about the difference between mental health and mental illness.Which statement by the patient reflects an accurate understanding of mental health?A. Mental health is the absence of any stressors.B. Mental health is successful adaptation to stressors in the internal and external environment.C. Mental health is incongruence between thoughts, feelings, and behaviorD. Mental health is a diagnostic category in theDSM-5.ANS: BSeveral definitions of mental health exist, but this definition highlights concepts of successfuladaptation to stressors, including thoughts, feelings, and behaviors that are age-appropriate andcongruent with cultural and societal norms.KEY: Cognitive Level:Analysis |Integrated Processes:Teaching/Learning |Client Need:HealthPromotion and Maintenance26. Most cultures label behavior as mental illness on the basis of which of the following criteria?A. Incomprehensibility and cultural relativity

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B. Strength of character and ethicsC. Goal directedness and high energyD. Creativity and good coping skillsANS: AIncomprehensibility and cultural relativity are most often the criteria used to define whethersomething is labeled mental illness. The other identified behaviors would be more associated withhealth than illness.KEY: Cognitive Level:Comprehension |Integrated Processes:Nursing Process: Assessment|Client Need:Psychosocial Integrity27. Which should the nurse recognize as an example of the defense mechanism of repression?A. Astudent aware of the need to study for tomorrow’s test goes to a movie instead.B. A woman whose son was killed in Iraq does not believe the military report.C. A man who is unhappily married goes to school to become a marriage counselor.D. A woman was raped when she was 12 and no longer remembers the incident.ANS: DRepression is the involuntary blocking of unpleasant feelings and experiences from one’s awareness.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial IntegrityMultiple Response28. Which of the following statements should a nurse recognize as true about defensemechanisms?Select all that apply.A. They are employed when there is a threat to biological or psychological integrity.B. They are controlled by the id and deal with primal urges.C. They are used in an effort to relievemild to moderate anxiety.D. They are protective devices for the superego.

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E. They are mechanisms that are characteristically self-deceptive.ANS: A, C, EDefense mechanisms are employed by the ego in the face of threats to biological and psychologicalintegrity, in an effort to relieve mild to moderate anxiety. Because they redirect focus, they arecharacteristically self-deceptive.KEY: Cognitive Level:Analysis |Integrated Processes: Nursing Process: Assessment |ClientNeed:Psychosocial Integrity29. A nurse is assessing a client who appears to be experiencing moderate anxiety duringquestioning. Which symptoms might the client demonstrate?Select all that apply.A. FidgetingB. Laughing inappropriatelyC. PalpitationsD. Nail bitingE. Extremely limited attention spanANS: A, B, DThe nurse should assess that fidgeting, laughing inappropriately, and nail biting are indicative ofheightened stress levels. The client would not be diagnosed with mental illness unless there issignificant impairment in other areas of daily functioning. Other indicators of more serious anxietyare restlessness, difficulty concentrating, muscle tension, and sleep disturbance.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity30. Which of the following are cultural aspects of mental illness?Select all that apply.A. Local or cultural norms define pathological behavior.B. The higher the social class the greater the recognition of mental illness behaviors.C. Psychiatrists typically see patients when the family can no longer deny the illness.

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D. The greater the cultural distance from the mainstream of society, the greater the likelihood that theillness will be treated with sensitivity and compassion.ANS: A, B, CThe fewer ties that a group has with mainstream society, the greater the likelihood of a negativeresponse by society to mental illness. Coercive treatments and involuntary hospitalizations are morecommon in this population.KEY: Cognitive Level:Analysis |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity.31. How is theDSM-5useful in the practice of psychiatric nursing?Select all that apply.A. It informs the nurse of accurate and reliable medical diagnosis.B. It represents progress toward a more holistic view of mind–body.C. It provides a framework for interdisciplinary communication.D. It provides a template for nursing care plans.E. It provides a framework for communication with the client.ANS: A, B, CTheDSM-5is useful in the practice of psychiatric nursing because it facilitates comprehensiveevaluation of the client. In addition, it encourages a holistic view and provides a framework forinterdisciplinary communication.KEY: Cognitive Level:Analysis |Integrated Processes:Nursing Process: Assessment |ClientNeed:Safe and Effective Care EnvironmentChapter 3. Theoretical Models of PersonalityDevelopmentChapter 3. Theoretical Models of Personality DevelopmentMultiple Choice

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1. According to Erikson’s developmental theory, when planning care for a 47-year-old client, whichdevelopmental task should a nurse identify as appropriate for this client?A. To develop a basic trustin othersB. To achieve a sense of self-confidence and recognition from othersC. To reflect back on life events to derive pleasure and meaningD. To achieve established life goals and consider the welfare of future generationsANS: DThe nurse should identify that an appropriate developmental task for a 47-year-old client would be toachieve established life goals and consider the welfare of future generations. According to Erikson,the client would be in the generativity versus stagnation stage of development.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Planning |ClientNeed:Psychosocial Integrity2. A jilted college student is admitted to a hospital following a suicide attempt and states, “No onewill ever love a loser like me.” According to Erikson’s theory of personality development, a nurseshould recognize a deficit in which developmental stage?A. Trust versus mistrustB. Initiative versus guiltC. Intimacy versus isolationD. Ego integrity versus despairANS: CThe nurse should recognize that the client whostates, “No one will ever love a loser like me” has notadequately completed the intimacy versus isolation stage of development. The intimacy versusisolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. Themajor developmental task in this stage is to establish intense, lasting relationships or commitment toanother person, cause, institution, or creative effort.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity

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3. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau,which psychological stage of development should the nurse recognize that this child hascompleted?A. “Learning to count on others”B. “Learning to delay satisfaction”C. “Identifyingoneself”D. “Developing skills in participation”ANS: BThe nurse should recognize that this client has completed the “Learning to delay satisfaction” stageof development according to Peplau’s interpersonal theory. This stage typically occurs intoddlerhood when one learns the satisfaction of pleasing others.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity4. When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycarecaregiver. The nurse should recognize that according to Mahler’s developmental theory, this child’sdevelopment is at which phase?A. The autistic phaseB. The symbiotic phaseC. The differentiation subphase of the separation–individuation phaseD. The rapprochement subphase of the separation–individuation phaseANS: CThe nurse should understand that this client is in the differentiation subphase of the separation–individuation phase. This subphase begins with the child’s initial physical movements away from themothering figure. A primary recognition of separateness commences.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity5. A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down whenroller-skating, or loses when playing games. According to Peplau’s interpersonal theory, in whichstage of development should the nurse identify a need forimprovement?A. “Learning to count onothers”B. “Learning to delay satisfaction”C. “Identifying oneself”D. “Developing skills in participation”ANS: D

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The nurse should identify that this client needs to improve in the “Developing skills in participation”stage of Peplau’s interpersonal theory. Older children in this phase learn the skills of compromise,competition, and cooperation with others.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Health Promotion and Maintenance6. According to Peplau, a nurse who provides an abandoned child with parental guidance and praisefollowing small accomplishments is serving which therapeutic role?A. The role of technical expertB. The role of resource personC. The role of surrogateD. The role of leaderANS: CThe nurse who provides an abandoned child with parental guidance and praise is serving the role ofthe surrogate according to Peplau’s interpersonal theory. A surrogate serves as a substitute foranother person—in this case, the child’s parent.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity7. A nurse directs the client interaction and plans for interventions to achieve client goals. Accordingto Peplau’s framework for psychodynamic nursing, what therapeutic role is this nurse assuming?A. The role of technical expertB. The role of resource personC. The role of teacherD. The role of leaderANS: DThe nurse who directs client interaction and plans for interventions is assuming the role of leader.According to Peplau, a leader directs the nurse–client interaction and ensures that actions are taken toachieve goals.

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KEY: Cognitive Level:Application| Integrated Processes:Nursing Process: Implementation|Client Need:Psychosocial Integrity8. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is basedon which underlying concept?A. A possible genetic basis for the client problemsB. The structure and dynamics of the personalityC. Behavioral responses to stressorsD. Maladaptive cognitionsANS: BThe nurse should understand that psychoanalytic theory is based on the underlying concepts of thestructure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud andexplains the structure of personality in three different components: the id, ego, and superego.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity9. Which underlying concept should a nurse associate with interpersonal theory when assessingclients?A. The effects of social processes on personality developmentB. The effects of unconscious processes and personality structuresC. The effects on thoughts and perceptual processesD. The effects of chemical and genetic influencesANS: AThe nurse should associate interpersonal theory with the underlying concept of effects of socialprocess on personality development. Sullivan developed stages of personality development based onhis theory of interpersonal relationships and their effect on personality and individual behavior.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity

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10. A physically healthy, 35-year-old single client lives with parents who provide total financialsupport. According to Erikson’s theory, which developmental task should a nurse assist the client toaccomplish?A. Establishing the ability to control emotional reactionsB. Establishing a strong sense of ethics and character structureC. Establishing and maintaining self-esteemD. Establishing a career, personal relationships, and societal connectionsANS: DThe nurse should assist the client in establishing a career, personal relationships, and societalconnections. According to Erikson, nonachievement in the generativity versus stagnation stageresults in self-absorption, including withdrawal from others and having no capacity for giving of theself to others.KEY: Cognitive Level:Application |Integrated Processes: Nursing Process: Assessment |ClientNeed:Health Promotion and Maintenance11. A 1-month-old infant is left alone for extended periods, has little physical stimulation, and ismalnourished. Based onthis infant’s history, in which phase of development according to Mahler’stheory should a nurse expect to see a potential deficit?A. The symbiotic phaseB. The autistic phaseC. The consolidation phaseD. The rapprochement phaseANS: BThe nurse should expect that a 1-month-old infant who is left alone, has little physical stimulation,and is malnourished would not meet the autistic phase of development. The autistic phase ofdevelopment usually occurs from birth to 1 month, at which time the infant’s focus is on basic needsand comfort.KEY: Cognitive Level:Application |Integrated Processes:Nursing Process: Assessment |ClientNeed:Psychosocial Integrity

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