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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 Adaptation Chapter 1. The Concept of Stress Adaptation Multiple Choice 1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Recent Life Changes Questionnaire. 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 significant threat of stress-related illness. C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports. D. The client may view these losses as challenges and perceive them as opportunities. ANS: C The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year- score total of 500 or more, indicates high stress in a client’s life. However, positive coping mechanisms and strong social support can limit susceptibility to stress-related illnesses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 2. A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an a rt degree.” How should the nurse characterize the client’s appraisal of the job loss stressor? A. Irrelevant B. Harm/loss C. Threatening D. Challenging

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    ANS: D The client perceives the situation of job loss as a challenge and an opportunity for growth. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 3. Which client statement should alert a nurse that a client may be responding maladaptively to stress? 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: A Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learning appropriate coping skills and can prevent access to needed support systems. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 4. A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs, which stage of stress is the student most likely experiencing? A. Alarm reaction stage B. Stage of resistance C. Stage of exhaustion D. Fight-or-flight stage ANS: C At the stage of exhaustion, the student’s exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage.

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    KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 5. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client’s mother states, “That’s not something to be stressed about!” Which is the most appropriate nursing response? A. “Teenagers! They don’t know a thing about real stress.” 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: D Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change. KEY: Cognitive Level: Application | Integrated Processes : Nursing Process: Implementation | Client Need: Psychosocial Integrity 6. A bright student confides in the school nurse about conflicts related to attending college or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time? A. Meditation B. Problem-solving training C. Relaxation D. Journaling ANS: B The student must assess his or her situation and determine the best course of action. Problem-solving training, 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 teaching position 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: C During times of high anxiety and stress, clients will need more assistance in problem-solving and decision making. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 8. A school nurse is assessing a distraught female high school student who is overly concerned because her parents can’t afford horseback riding lessons. How should the nurse interpret the student’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: B Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation or event. Self-image is of particular importance to adolescents, who feel entitled to have all the advantages that other adolescents experience. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

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    9. Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess? A. An achieved state of relaxation B. An achieved insight into one’s feelings C. A demonstration of appropriate role behaviors D. An enhanced ability to problem-solve ANS: A Meditation produces relaxation by creating a special state of consciousness through focused concentration. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 10. A distraught, single, first- time mother cries and asks a nurse, “How can I go to work if I can’t afford childcare?” What is the nurse’s initial action in assisting the client with the problem-solving process? 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: D Before any other steps can be taken, accurate information about the situation must be gathered and assessed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 11. A nursing instructor is asking students about diseases of adaptation and when they are likely to occur. 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: D During the stage of exhaustion of the general adaptation syndrome, the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is the time when diseases of adaptation may occur. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance 12. When an individual’s stress response is sustained over a long period of time, which physiological effect of the endocrine system should a nurse anticipate? A. Decreased resistance to disease B. Increased libido C. Decreased blood pressure D. Increased inflammatory response ANS: A In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at which time the body’s compensatory mechanisms no longer function effectively and diseases of adaptation occur. A decreased immune response is seen at this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity 13. Which symptom should a nurse identify as typic al of the “fight -or- flight” response? A. Pupil constriction B. Increased heart rate

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    C. Increased salivation D. Increased peristalsis ANS: B During the “fight -or- flight” response, the heart rate increases in response to the release of epinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slows unessential functions. OK KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Physiological Integrity 14. A nurse is evaluati ng a client’s response to stress. What would indicate to the nurse that the client is experiencing a secondary appraisal of the stressful event? A. When the individual judges the event to be benign B. When the individual judges the event to be irrelevant C. When the individual judges the resources and skills needed to deal with the event D. When the individual judges the event to be pleasurable ANS: C When the individual judges the resources and skills needed to deal with the event, the individual is conducting a secondary appraisal. There are three types of primary appraisals: irrelevant, benign- positive, and stressful. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 15. Research undertaken by Miller and Rahe in 1997 demonstrated a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (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 assigned C. Stress is viewed as only a physiological response.

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    D. Personal perception of the event is excluded. ANS: D Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration . KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance 16. A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is 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 : B Past experiences are occurrences that result in learned patterns that can influence an individual’s current adaptation response. They include previous exposure to the stressor or other stressors in general, learned coping responses, and degree of adaptation to previous stressors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity Multiple Response 17. A nurse is interviewing a distressed client, who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine t he client’s appraisal 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. “Why do 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, E These questions specifically address the client’s coping resources and encourage the client to apply learning from past experiences. These questions also encourage the client to consider alternative methods 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 to communication. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 18. A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful when assisting the client in coping with stress? 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, E Focusin g 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 Integrity 19. A nurse is conducting education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety? A. Diagnostic blood tests B. Awareness of factors creating stress

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    C. Relaxation exercises D. Identifying support systems ANS: B Although all of the above answers may be useful in the comprehensive management of stress, the initial step is awareness that stress is being experienced and awareness of factors that create stress. KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need: Psychosocial Integrity 20. A patient presents in the Emergency Department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physical injury, but she appears very hyperactive and talkative. Which of these symptoms manifested by the patient are common initial biological responses to stress? Select all that apply. A. Constricted pupils B. Watery eyes C. Unusual food cravings D. Increased heart rate E. Increased respirations ANS: B, D, E Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological re sponses to stress. Since dilated pupils rather than constricted pupils are related to “Fight or Flight” syndrome, this symptom should be assessed for other potential causes. Unusual food cravings have not been identified as a typical biological response to stress. KEY: Cognitive Level: Analysis | Integrated Processes : Nursing Process: Assessment | Client Need: Physiological Integrity Chapter 2. Mental Health/Mental Illness: Historical and Theoretical Concepts Chapter 2. Mental Health/Mental Illness: Historical and Theoretical Concepts Multiple Choice

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    1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have not changed. 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 n ot congruent with cultural norms. D. The client’s behaviors demonstrate no functional impairment, indicating no mental illness. ANS: D The nurse should assess that the client’s daily functioning is not impaired. The client who experiences 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 | Client Need: Psychosocial Integrity 2. 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 the DSM-5 criteria B. When maladaptive responses to stress are coupled with interference in daily functioning C. When the client communicates significant distress D. When the client uses defense mechanisms as ego protection ANS: B The nurse should determine that the client is at risk for mental disorder when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental disorder, there must be significant disturbance in cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. These disorders are usually associated with significant distress or disability in social, occupational, or other important activities. The client’s ability to commun icate distress would be considered a positive attribute.

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    KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 3. A nurse is assessing 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, while the other withdraws and cries. How should the nurse explain these 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: A Responses to stress are variable among individuals and may be influenced by perception, past experience, and environmental factors in addition to genetic factors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 4. A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, “I work hard to provide for my family. I don’t see why I can’t drink to relax.” The nurse recognizes the use of which defense mechanism? A. Projection B. Rationalization C. Regression D. Sublimation ANS: B The 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 or behaviors.

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    KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 5. Which client should the nurse anticipate to be most receptive to psychiatric treatment? A. A Jewish, female journalist B. A Baptist, homeless male C. A Catholic, black male D. A Protestant, Swedish business executive ANS: A The nurse should anticipate that the client of Jewish culture would place a high importance on preventative 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 | Client Need: Psychosocial Integrity 6. 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 always be eliminated. C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged. ANS: A The nurse should know that defense mechanisms serve the purpose of reducing anxiety during times of stress. A client with no defense mechanisms may have a lower tolerance for stress, predisposing him or her to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthy coping skills.

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    KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 7. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, “I’m here for my heart, not my head problems.” Which is the nurse’s best response? 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: C The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions. It is not appropriate to skip either physiological or psychosocial questions, as this would lead to an inaccurate assessment. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Health Promotion and Maintenance 8. Which statement reflects a student nurse’s accurate understanding of the concepts of mental health and 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: B The student nurse should understand that mental health and mental illness are multidimensional and culturally defined. It is important for nurses to be aware of cultural norms when evaluating a client’s mental state.

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    KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Safe and Effective Care Environment 9. A mental health technician asks the nurse, “How do psych iatrists determine which diagnosis to give 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 of Mental 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 responses and contributing factors. D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from. ANS: A The DSM-5 is an organized manual describing mental disorders and the criteria that determine whether 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 describes nursing rather than medical diagnosis. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 10. The nurse is preparing to provide medication instruction for a patient. Which of the following understandings 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 awareness of the environment. Learning is enhanced. As anxiety increases, attention span decreases and learning becomes more difficult. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Planning | Client Need: Health Promotion and Maintenance 11. Which of the following are identified as psychoneurotic responses to severe anxiety as they appear in the DSM-5? A. Somatic symptom disorders B. Grief responses C. Psychosis D. Bipolar disorder ANS: A Somatic symptom disorder is characterized by preoccupation with physical symptoms for which there is no demonstrable organic pathology. One of the diagnostic criteria is a high level of anxiety about health concerns or illness. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 12. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? A. The employee assertively confronts the boss B. The employee leaves the staff meeting to work out in the gym C. The employee criticizes a coworker D. The employee takes the boss out to lunch ANS: C

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    The client using the defense mechanism of displacement would criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings from one target to a neutral or less-threatening target. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 13. A teenage boy is attracted to a female teacher. Without objective evidence, a school nurse overhears the boy state, “I know she wants me.” This statement reflects which defense mechanism? A. Displacement B. Projection C. Rationalization D. Sublimation ANS: B The 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 t he undesirable feelings, anxiety is reduced. Displacement refers to transferring feelings from one target to another. Rationalization refers to making excuses to justify behavior. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 14. A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? A. Displacement B. Projection C. Reaction formation D. Sublimation

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    ANS: C The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts 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 of unacceptable feelings or behaviors to another person. Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 15. 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: B The nurse should understand that the concept of neuroses includes the following characteristics. The client feels helpless to change his or her situation, the client is aware that he or she is experiencing distress, the client is aware the behaviors are maladaptive, the client is unaware of the psychological causes 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 Integrity 16. 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 experie ncing psychoses are aware of experiencing psychological problems.” D. “Individuals experiencing psychoses are based in reality.”

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    ANS: B The nurse should understand that the client with psychoses experiences little distress, because of his or her lack of awareness of reality. The client with psychoses is unaware that his or her behavior is maladaptive or that he or she has a psychological problem. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 17. When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial? A. Hiding liquor bottles in a closet B. Yelling at their son for slouching in his chair C. Burning dinner on purpose D. Saying to the spouse, “I don’t drink too much!” ANS: D The nurse should associate the client statement “I don’t drink too much!” with the use of the defense mechanism of denial. The client who refuses to acknowledge the existence of a real situation and the feelings associated with it is using the defense mechanism of denial. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 18. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement 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 the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 19. A nurse is performing a mental health assessment on an adult client. According to Maslow’s hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health?A. Maintaining a long-term, faithful, intimate relationship B. Achieving a sense of self-confidence C. Possessing a feeling of self-fulfillment and realizing full potential D. Developing a sense of purpose and the ability to direct activities ANS: C The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the hig hest level on Maslow’s hierarchy of needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 20. According to Maslow’s hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse?A. A client rudely complaining about limited visiting hours B. A client exhibiting aggressive behavior toward another client C. A client stating that no one cares D. A client verbalizing feelings of failure ANS: B The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower- level needs according to Maslow’s hierarchy of needs and must be fulfilled before other, higher-level needs can be met. Clients who complain, have feelings of failure, or state that no one cares are struggling with higher-level needs such as the need for love and belonging or the need for self-esteem.

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    KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 21. Which is an example of the ego defense mechanism of regression?A. A mother blames the teacher for her child’s failure in school.B. A teenager becomes hysterical after se eing a friend killed in 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: D Regression is the retreating to an earlier level of development and the comfort measures associated with that level of functioning. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 22. Which is the most significant consequence of the excessive use of defense mechanisms?A. The superego 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: D Defense mechanisms become maladaptive when they are used by an individual to such a degree that there is interference with the ability to deal with reality, effective interpersonal relations, or occupational performance. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 23. A husband accuses his wife of infidelity. Which situation would indicate to the nurse the husband’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 m arriage vows. B. The husband ignores the wife’s continued absence 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 attr ibution of feelings or impulses unacceptable to one’s self to another person. In this situation, the husband attributes his infidelity to his wife. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 24. Which should the nurse recognize as a DSM- 5 disorder?A. Obesity B. Generalized anxiety disorder C. Hypertension D. Grief ANS: B The DSM-5 identifies several disorders that are related to anxiety, including generalized anxiety disorder, somatic symptom disorder, and dissociative disorders. KEY: Cognitive Level: Knowledge | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 25. 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 behavior D. Mental health is a diagnostic category in the DSM-5. ANS: B Several definitions of mental health exist, but this definition highlights concepts of successful adaptation to stressors, including thoughts, feelings, and behaviors that are age-appropriate and congruent with cultural and societal norms. KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need: Health Promotion and Maintenance 26. 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 ethics C. Goal directedness and high energy D. Creativity and good coping skills ANS: A Incomprehensibility and cultural relativity are most often the criteria used to define whether something is labeled mental illness. The other identified behaviors would be more associated with health than illness. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 27. Which should the nurse recognize as an example of the defense mechanism of repression?A. A student 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: D Repression is the invo luntary blocking of unpleasant feelings and experiences from one’s awareness. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity Multiple Response 28. Which of the following statements should a nurse recognize as true about defense mechanisms? 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 relieve mild 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, E Defense mechanisms are employed by the ego in the face of threats to biological and psychological integrity, in an effort to relieve mild to moderate anxiety. Because they redirect focus, they are characteristically self-deceptive. KEY: Cognitive Level: Analysis | Integrated Processes : Nursing Process: Assessment | Client Need: Psychosocial Integrity 29. A nurse is assessing a client who appears to be experiencing moderate anxiety during questioning. Which symptoms might the client demonstrate? Select all that apply. A. Fidgeting B. Laughing inappropriately C. Palpitations D. Nail biting E. Extremely limited attention span ANS: A, B, D The nurse should assess that fidgeting, laughing inappropriately, and nail biting are indicative of heightened stress levels. The client would not be diagnosed with mental illness unless there is significant impairment in other areas of daily functioning. Other indicators of more serious anxiety are restlessness, difficulty concentrating, muscle tension, and sleep disturbance. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 30. 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 the illness will be treated with sensitivity and compassion. ANS: A, B, C The fewer ties that a group has with mainstream society, the greater the likelihood of a negative response by society to mental illness. Coercive treatments and involuntary hospitalizations are more common in this population. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity . 31. How is the DSM-5 useful 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, C The DSM-5 is useful in the practice of psychiatric nursing because it facilitates comprehensive evaluation of the client. In addition, it encourages a holistic view and provides a framework for interdisciplinary communication. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment Chapter 3. Theoretical Models of Personality Development Chapter 3. Theoretical Models of Personality Development Multiple Choice

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    1. According to Erikson’s developmental theory, when planning care for a 47 -year-old client, which developmental task should a nurse identify as appropriate for this client?A. To develop a basic trust in others B. To achieve a sense of self-confidence and recognition from others C. To reflect back on life events to derive pleasure and meaning D. To achieve established life goals and consider the welfare of future generations ANS: D The nurse should identify that an appropriate developmental task for a 47-year-old client would be to achieve 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 | Client Need: Psychosocial Integrity 2. A jilted college student is admitted to a hospital following a suicide attempt and states, “No one will ever love a loser like me.” According to Erikson’s theory of pe rsonality development, a nurse should recognize a deficit in which developmental stage?A. Trust versus mistrust B. Initiative versus guilt C. Intimacy versus isolation D. Ego integrity versus despair ANS: C The nurse should recognize that the client who states, “No one will ever love a loser like me” has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: 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 has completed?A. “Learning to count on others”B. “Learning to delay satisfaction”C. “Identifying oneself”D. “Developing skills in participation” ANS: B The nurse should recognize that this client has completed the “Learning to delay satisfaction” stage of development according to Peplau’s interpersonal theory . This stage typically occurs in toddlerhood when one learns the satisfaction of pleasing others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 4. When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycare caregiver. The nurse should recognize that according to Mahler’s developmental theory, this child’s development is at which phase?A. The autistic phase B. The symbiotic phaseC. The differentiation subphase of the separation – individuation phase D. The rapprochement subphase of the separation – individuation phase ANS: C The nurse should understand that this client is in the differentiation subphase of the separation – individuation phase. This subpha se begins with the child’s initial physical movements away from the mothering figure. A primary recognition of separateness commences. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 5. A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller- skating, or loses when playing games. According to Peplau’s interpersonal theory, in which stage of development should the nurse identify a need for improvement?A. “Learning to count on others”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” s tage 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 | Client Need: Health Promotion and Maintenance 6. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role?A. The role of technical expert B. The role of resource person C. The role of surrogate D. The role of leader ANS: C The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate according to Peplau’s interpersonal theory. A surrogate serves as a substitute for another person —in this case, the child’s parent. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 7. A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplau’s framework for psychodynamic nursing, what therapeutic role is this nurse assuming? A. The role of technical expert B. The role of resource person C. The role of teacher D. The role of leader ANS: D The 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 to achieve goals.

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    KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 8. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? A. A possible genetic basis for the client problems B. The structure and dynamics of the personality C. Behavioral responses to stressors D. Maladaptive cognitions ANS: B The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, ego, and superego. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 9. Which underlying concept should a nurse associate with interpersonal theory when assessing clients? A. The effects of social processes on personality development B. The effects of unconscious processes and personality structures C. The effects on thoughts and perceptual processes D. The effects of chemical and genetic influences ANS: A The nurse should associate interpersonal theory with the underlying concept of effects of social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their effect on personality and individual behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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    10. A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson’s theory, which developmental task should a nurse assist the client to accomplish?A. Establishing the ability to control emotional reactions B. Establishing a strong sense of ethics and character structure C. Establishing and maintaining self-esteem D. Establishing a career, personal relationships, and societal connections ANS: D The nurse should assist the client in establishing a career, personal relationships, and societal connections. According to Erikson, nonachievement in the generativity versus stagnation stage results in self-absorption, including withdrawal from others and having no capacity for giving of the self to others. KEY: Cognitive Level: Application | Integrated Processes : Nursing Process: Assessment | Client Need: Health Promotion and Maintenance 11. A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant’s history, in which phase of development according to Mahler’s theory should a nurse expect to see a potential deficit? A. The symbiotic phase B. The autistic phase C. The consolidation phase D. The rapprochement phase ANS: B The 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 of development usually occurs from birth to 1 month, at which time the infant’s foc us is on basic needs and comfort. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

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