Mental health test bank All questions with accurate answers. 2022/2023 update. Graded Mental health test bank EXAM 1

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Mental health test bank All questions with accurate answers. 2022/2023 update. Graded Mental health test bank EXAM 1 Unit 1 exam is ch 2 7 8-U2 bio-?U3-10,u4-13,u5-12, u6-27 29 Unit 2 exam is Cha... pter 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 signi昀椀cant 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 clients 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 昀椀red. During a routine o昀케ce visit he states to a nurse: Perhaps this was the best thing to happen. Maybe Ill look into pursuing an art degree. How should the nurse characterize the clients appraisal of the job loss stressor? A. Irrelevant B. Harm/loss C. Threatening D. Challenging 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. Ive found that avoiding contact with others helps me cope. B. I really enjoy journaling; its 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 昀椀nds 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-昀氀ight stage ANS: C At the stage of exhaustion, the students exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage. 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 clients mother states, Thats not something to be stressed about! Which is the most appropriate nursing response? A. Teenagers! They dont know a thing about real stress. B. Stress occurs only when there is a loss. C. When you are in poor physical condition, you cant 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 con昀椀des in the school nurse about con昀氀icts related to attending college or working to add needed 昀椀nancial 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 7. An unemployed college graduate is experiencing severe anxiety over not 昀椀nding a teaching position and has di昀케culty with independent problem-solving. During a routine physical examination, the graduate con昀椀des 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 cant a昀昀ord horseback riding lessons. How should the nurse interpret the students 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 9. Meditation has been shown to be an e昀昀ective stress management technique. When meditation is e昀昀ective, what should a nurse expect to assess? A. An achieved state of relaxation B. An achieved insight into ones 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, 昀椀rst-time mother cries and asks a nurse, How can I go to work if I cant a昀昀ord childcare? What is the nurses initial action in assisting the client with the problem-solving process? A. Determine the risks and bene昀椀ts 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? 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 individuals 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 e昀昀ectively 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 individuals stress response is sustained over a long period of time, which physiological e昀昀ect of the endocrine system should a nurse anticipate? A. Decreased resistance to disease B. Increased libido C. Decreased blood pressure D. Increased in昀氀ammatory response ANS: A In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at which time the bodys compensatory mechanisms no longer function e昀昀ectively 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 typical of the 昀椀ght-or-昀氀ight response? A. Pupil constriction B. Increased heart rate C. Increased salivation D. Increased peristalsis ANS: B During the 昀椀ght-or-昀氀ight 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 evaluating a clients 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 e昀昀ects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the e昀昀ectiveness of this tool? A. Speci昀椀c illnesses are not identi昀椀ed. B. The numerical values associated with speci昀椀c life events are randomly assigned C. Stress is viewed as only a physiological response. D. Personal perception of the event is excluded. ANS: D Individuals di昀昀er in response to life events. The RLCQ uses a scale that does not take these di昀昀erences 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 in昀氀uences how you feel now. C. If youre 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 in昀氀uence an individuals 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 昀椀red after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the clients 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 昀椀red from your job? E. What skills do you possess that might lead to gainful employment? ANS: A, B, E These questions speci昀椀cally address the clients 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 Focusing on the stressors is more likely to increase stress in the clients 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 identi昀椀ed as the most important initial step in learning how to manage anxiety? A. Diagnostic blood tests B. Awareness of factors creating stress 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 identi昀椀ed as initial biological responses 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 identi昀椀ed 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 Multiple Choice 1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The clients appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the clients behaviors? A. The clients behaviors demonstrate mental illness in the form of depression. B. The clients behaviors are extensive, which indicates the presence of mental illness. C. The clients behaviors are not congruent with cultural norms. D. The clients behaviors demonstrate no functional impairment, indicating no mental illness. ANS: D The nurse should assess that the clients daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations. Without signi昀椀cant impairment, the clients 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 re昀氀ective of the DSM-5 criteria B. When maladaptive responses to stress are coupled with interference in daily functioning C. When the client communicates signi昀椀cant 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 signi昀椀cant disturbance in cognition, emotion, regulation, or behavior that re昀氀ects a dysfunction in the psychological, biological or developmental processes underlying mental functioning. These disorders are usually associated with signi昀椀cant distress or disability in social, occupational, or other important activities. The clients ability to communicate distress would be considered a positive attribute. 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 di昀昀erently to stress. One twin becomes anxious and irritable, while the other withdraws and cries. How should the nurse explain these di昀昀erent 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 di昀昀erently to similar stressors. C. Identical twins should share the same temperament and respond similarly to stress. D. Environmental in昀氀uences weigh more heavily than genetic in昀氀uences on reactions to stress. ANS: A Responses to stress are variable among individuals and may be in昀氀uenced 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 in昀氀uence (DUI). The client states, I work hard to provide for my family. I dont see why I cant 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. 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 clients use of defense mechanisms should be eliminated. Which is a correct evaluation of this nurses 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. 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, Im here for my heart, not my head problems. Which is the nurses best response? A. Its 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 a昀昀ect medical conditions. D. We can skip these questions, if you like. It isnt imperative that we complete this section. ANS: C The nurse should attempt to educate the client on the negative e昀昀ects 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 re昀氀ects a student nurses 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 de昀椀ned. C. The concepts are universal and unchanging. D. The concepts are unidimensional and 昀椀xed. ANS: B The student nurse should understand that mental health and mental illness are multidimensional and culturally de昀椀ned. It is important for nurses to be aware of cultural norms when evaluating a clients mental state. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Safe and E昀昀ective Care Environment 9. A mental health technician asks the nurse, How do psychiatrists 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 APAs 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 patients unhealthy responses and contributing factors. D. The American Medical Association identi昀椀es 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 e昀昀ective 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 Mild anxiety sharpens the senses, increases the perceptual 昀椀eld, and results in heightened awareness of the environment. Learning is enhanced. As anxiety increases, attention span decreases and learning becomes more di昀케cult. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Planning | Client Need: Health Promotion and Maintenance 11. Which of the following are identi昀椀ed 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 sta昀昀 meeting to work out in the gym C. The employee criticizes a coworker D. The employee takes the boss out to lunch ANS: C 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 re昀氀ects which defense mechanism? A. Displacement B. Projection C. Rationalization D. Sublimation ANS: B The nurse should determine that the clients statement re昀氀ects the defense mechanism of projection. Projection refers to the attribution of ones unacceptable feelings or impulses to another person. When the client passes the blame of the 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 identi昀椀ed by a nurse as indicative of which defense mechanism? A. Displacement B. Projection C. Reaction formation D. Sublimation 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 experiencing psychoses are aware of experiencing psychological problems. D. Individuals experiencing psychoses are based in reality. 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 dont drink too much! ANS: D The nurse should associate the client statement I dont 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 di昀케cult relationship, but I think I have learned from the experience. D. I still dont have any appetite and continue to lose weight. ANS: C 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 Maslows 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-con昀椀dence C. Possessing a feeling of self-ful昀椀llment 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-ful昀椀llment and realizes his or her full potential has achieved self-actualization, the highest level on Maslows hierarchy of needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |Client Need: Psychosocial Integrity 20. According to Maslows 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 Maslows hierarchy of needs and must be ful昀椀lled 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. 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 childs failure in school.B. A teenager becomes hysterical after seeing 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 signi昀椀cant 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, e昀昀ective 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 in昀椀delity. Which situation would indicate to the nurse the husbands 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 wifes continued absence from the home.C. The husband has already admitted to having an a昀昀air with a coworker. D. The husband takes out his marital frustrations through employee abuse. ANS: C Projection is the attribution of feelings or impulses unacceptable to ones self to another person. In this situation, the husband attributes his in昀椀delity 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 identi昀椀es 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 di昀昀erence between mental health and mental illness. Which statement by the patient re昀氀ects 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 de昀椀nitions of mental health exist, but this de昀椀nition 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 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 de昀椀ne whether something is labeled mental illness. The other identi昀椀ed 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 tomorrows 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 involuntary blocking of unpleasant feelings and experiences from ones 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 e昀昀ort to relieve mild to moderate anxiety. D. They are protective devices for the superego. 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 e昀昀ort 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 昀椀dgeting, laughing inappropriately, and nail biting are indicative of heightened stress levels. The client would not be diagnosed with mental illness unless there is signi昀椀cant impairment in other areas of daily functioning. Other indicators of more serious anxiety are restlessness, di昀케culty 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 de昀椀ne 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. 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 mindbody. 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 E昀昀ective Care Environment Chapter 3. Theoretical Models of Personality Development Multiple Choice 1. According to Eriksons 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-con昀椀dence and recognition from others C. To re昀氀ect 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 Eriksons theory of personality development, a nurse should recognize a de昀椀cit 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 e昀昀ort. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 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 othersB. Learning to delay satisfactionC. Identifying oneselfD. 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 Peplaus 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 Mahlers developmental theory, this childs development is at which phase?A. The autistic phase B. The symbiotic phaseC. The di昀昀erentiation subphase of the separationindividuation phase D. The rapprochement subphase of the separationindividuation phase ANS: C The nurse should understand that this client is in the di昀昀erentiation subphase of the separationindividuation phase. This subphase begins with the childs initial physical movements away from the mothering 昀椀gure. 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 Peplaus interpersonal theory, in which stage of development should the nurse identify a need for improvement?A. Learning to count on othersB. Learning to delay satisfactionC. Identifying oneself D. Developing skills in participation ANS: D The nurse should identify that this client needs to improve in the Developing skills in participation stage of Peplaus 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 Peplaus interpersonal theory. A surrogate serves as a substitute for another personin this case, the childs 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 Peplaus 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 nurseclient interaction and ensures that actions are taken to achieve goals. 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 di昀昀erent 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 e昀昀ects of social processes on personality development B. The e昀昀ects of unconscious processes and personality structures C. The e昀昀ects on thoughts and perceptual processes D. The e昀昀ects of chemical and genetic in昀氀uences ANS: A The nurse should associate interpersonal theory with the underlying concept of e昀昀ects of social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their e昀昀ect on personality and individual behavior. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 10. A physically healthy, 35-year-old single client lives with parents who provide total 昀椀nancial support. According to Eriksons 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 infants history, in which phase of development according to Mahlers theory should a nurse expect to see a potential de昀椀cit? 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 infants focus is on basic needs and comfort. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 12. A 6-year-old boy uses his fathers 昀氀ashlight to explore his 3-year-old sisters genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal? A. Oral B. Anal C. Phallic D. Latency ANS: C The nurse should identify this behavior as normal because the 6-year-old client who focuses on genital organs is in the phallic stage of Freuds stages of psychosexual stages of development. Children in the phallic stage of development focus on genital organs and develop a sense of sexual identity. Identi昀椀cation with the same-sex parent also occurs at this stage. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 13. A married, 26-year-old client works as a schoolteacher. She and her husband have just had their 昀椀rst child. A nurse should recognize that this client is successfully accomplishing which stage of Eriksons developmental theory?A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation ANS: C The nurse should recognize that a 26-year-old client who is married and has a child has successfully accomplished the intimacy versus isolation stage of Eriksons developmental theory. The intimacy versus isolation stage of young adulthood involves forming lasting relationships. Achievement of this task results in the capacity for mutual love and respect. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 14. A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Eriksons developmental theory?A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation ANS: A The nurse should recognize that a 10-year-old child who is successful in school both academically and socially has successfully accomplished the industry versus inferiority developmental stage of Eriksons psychosocial theory. The industry versus inferiority stage of development usually occurs between 6 and 12 years of age, at which time individuals achieve a sense of self-con昀椀dence by learning, competing, performing successfully, and receiving recognition from others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 15. A client has 昀氀ashbacks of sexual abuse by her uncle. She had not been aware of these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivans concept of the self-system?A. The good meB. The bad meC. The not meD. The bad you ANS: C The nurse should identify a client remembering sexual abuse when becoming sexually active with her boyfriend as experiencing the not me part of the personality. According to Sullivan, the not me part of the personality develops in response to situations that produced intense anxiety in childhood. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 16. According to Freud, which statement should a nurse associate with predominance of the superego? A. No one is looking, so I will take three cigarettes from Moms pack.B. I dont ever cheat on tests; it is wrong.C. If I skip school I will get in trouble and fail my test.D. Dad wont miss this little bit of vodka. ANS: B The nurse should associate the statement I dont ever cheat on tests; it is wrong as indicative of the predominance of the superego. Freud described the superego as the part of the personality that internalizes the values and morals set forth by primary caregivers. The superego can be referred to as the perfection principle. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity 17. A female complains that her husband only meets his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husbands actions? A. The id B. The superid C. The ego D. The superego ANS: A The nurse should identify that the husbands actions are driven by the predominance of the id. According to Freud, the id is the part of the personality that is identi昀椀ed as the pleasure principle. The id is the locus of instinctual drives. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity 18. A father of a 5-year-old demeans and curses at his child for disobedience. In turn, when upset, the child uses swear words in kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development according to Peplau?A. Learning to count on othersB. Learning to delay satisfactionC. Identifying oneselfD. Developing skills in participation ANS: C The nurse should identify that the child using swear words in kindergarten has not successfully completed the identifying oneself stage according to Peplaus interpersonal theory. During this stage of early childhood, a child learns to structure self-concept by observing how others interact with him or her. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity 19. A nurse is caring for a hospitalized client who is quarrelsome and opinionated and has little regard for others. According to Sullivans interpersonal theory, the nurse should associate the clients behaviors with a previous de昀椀cit in which stage of development?A. Infancy B. Childhood C. Early adolescence D. Late adolescence ANS: B The nurse should associate the clients behavior with a de昀椀cit in the childhood stage of Sullivans interpersonal theory. The childhood stage in Sullivans interpersonal theory typically occurs from the ages of 18 months to 6 years of age, during which the child learns to experience a delay in personal grati昀椀cation without undue anxiety. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity 20. According to psychoanalytic theory, treatment of symptoms should involve which nursing action?A. Modifying client behaviors by manipulating the environment B. Expressing empathy and presenting reality C. Encouraging the client to note cause and e昀昀ects of actions D. Recognizing and discussing the clients use of ego defense mechanisms ANS: D From a psychoanalytic perspective, understanding the use of ego defense mechanisms is important in making determinations about maladaptive behaviors, in planning care for clients to assist in creating change, or in helping clients accept themselves as unique individuals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 21. A 29-year-old client living with parents has few interpersonal relationships. The client states, I have trouble trusting people. Based on Eriksons developmental theory, which should the nurse recognize as a true statement about this client? A. The client has not progressed beyond the trust versus mistrust developmental stage. B. Developmental de昀椀cits in earlier life stages have impaired the clients adult functioning. C. The client cannot move to the next developmental stage until mastering all earlier stages. D. The clients developmental problems began in the intimacy versus isolation stage. ANS: B Many individuals with mental health problems are still struggling to achieve tasks from a number of developmental stages. Nurses can plan care to assist these individuals to complete these tasks and move on to a higher developmental level. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity 22. Which statement is most likely to be made by a nurse practitioner who shares the philosophy of an interpersonal theorist?A. Lets discuss your use of defense mechanisms.B. We need to examine how your relationships a昀昀ect your ability to cope.C. It is important that you take the medications that I have prescribed for you. D. Your genetic background is a factor in your predisposition to mental illness. ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity 23. Which statement describes achievement of Eriksons generativity versus stagnation developmental stage?A. Ive been a girl scout leader for troop 259 for 7 years.B. I feel great that I could pay for my bike with my paper route money.C. My parents are so pleased that John and I are going to be married. D. Ive had a very full life. Im not afraid to leave this world. ANS: A The major task of generativity versus stagnation is to achieve the life goals established for oneself while also considering the welfare of future generations. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 24. A psychiatric nurse uses Sullivans theories in group and individual therapy. According to Sullivan and other theorists like him, how are client symptoms viewed?A. Client symptoms are viewed as learned behaviors that are maintained because they are reinforced. B. Client symptoms are viewed as responses to anxiety arising from interpersonal relationships. C. Client symptoms are viewed as internal con昀氀icts arising from early childhood trauma. D. Client symptoms are viewed as the misinterpretations of experiences. ANS: B Sullivan believed that anxiety is the chief disruptive force in interpersonal relations and the main factor in the development of serious di昀케culty in living. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity 25. A nursing instructor is teaching about the application of Peplaus theory to nursing care. Which student statement indicates that learning has occurred?A. The nurse assumes the role of a parenting 昀椀gure, instructing the client in good health practices. B. The nurse is concerned more about psychosocial functioning than physiological functioning. C. The nurse bases the client care plan on standardized nursing approaches and physician orders. D. The nurse applies principles of human relations to the problems that arise at all levels of experience. ANS: D Peplau applied interpersonal theory to nursing practice and, most speci昀椀cally, to nurseclient relationship development. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity 26. According to Peplau, treatment of client symptoms should involve which nursing action?A. Establishing a therapeutic nurseclient relationship B. Using the technique of desensitization C. Challenging clients negative thoughts D. Uncovering clients past experiences ANS: A Peplau applied interpersonal theory to nursing practice and, most speci昀椀cally, to nurseclient relationship development. [Show More]

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