, Davis Advantage for Townsend's Essentials of Psychiatric Mental-Health
nn nn nn nn nn nn nn
Nursing Concepts of Care in Evidence-Based Practice 9th Edition Morgan
nn nn nn nn nn nn nn nn nn nn
Test Bank nn nn
Chapter 1. Mental Health and Mental Illness
nn nn nn pp pp nn
nn Multiple Choice nn
1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
the recent death of a beloved pet. The clients appetite, sleep patterns, and daily routine
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
nnhave not changed. How should the nurse interpret the clients behaviors?
nn nn nn nn nn nn nn nn nn nn
1. The clients behaviors demonstrate mental illness in the form of depression.
nn nn nn nn nn nn nn nn nn nn
2. The clients behaviors are extensive, which indicates the presence of mental illness.
nn nn nn nn nn nn nn nn nn nn nn
3. The clients behaviors are not congruent with cultural norms.
nn nn nn nn nn nn nn nn
4. The clients behaviors demonstrate no functional impairment, indicating no mental illness.
nn nn nn nn nn nn nn nn nn nn
ANS: 4 nn
Rationale: The nurse should assess that the clients daily functioning is not impaired. The
nn nn nn nn nn nn nn nn nn nn nn nn nn
client who experiences feelings of sadness after the loss of a pet is responding within
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
normal expectations. Without significant impairment, the clients distress does not indicate
nn nn nn nn nn nn nn nn nn nn nn
a mental illness.
nn nn nn
Cognitive Level: Analysis nn nn
Integrated Process: Assessment
nn nn nn
2. At what point should the nurse determine that a client is at risk for
nn nn nn nn nn nn nn nn nn nn nn nn nn
developing a mental illness?
nn nn nn nn
1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria.
nn nn nn nn nn nn nn nn nn nn nn
2. When maladaptive responses to stress are coupled with interference in daily functioning.
nn nn nn nn nn nn nn nn nn nn nn
3. When a client communicates significant distress.
nn nn nn nn nn
4. When a client uses defense mechanisms as ego protection.
nn nn nn nn nn nn nn nn
ANS: 2 nn
Rationale: The nurse should determine that the client is at risk for mental illness when
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
responses to stress are maladaptive and interfere with daily functioning. The DSM-5
nn nn nn nn nn nn nn nn nn nn nn nn
indicates that in order to be diagnosed with a mental illness, daily functioning must be
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
significantly impaired. The clients ability to communicate distress would be considered a
nn nn nn nn nn nn nn nn nn nn nn nn
positive attribute.
nn nn
Cognitive Level: Application nn nn
Integrated Process: Assessment
nn nn nn
3. A nurse is assessing a set of 15-year-old identical twins who respond verydifferently to
nn nn nn nn nn nn nn nn nn nn nn nn nn
stress. One twin becomes anxious and irritable, and the other withdraws and cries. How
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
should the nurse explain these different stress responses to the parents?
nn nn nn nn nn nn nn nn nn nn nn
1. Reactions to stress are relative rather than absolute; individual responses to stress vary.
nn nn nn nn nn nn nn nn nn nn n n nn
2. It is abnormal for identical twins to react differently to similar stressors.
nn nn nn nn nn nn nn nn nn nn nn
3. Identical twins should share the same temperament and respond similarly to stress.
nn nn nn nn nn nn nn nn nn nn nn
4. Environmental influences to stress weigh more heavily than genetic influences.
nn nn nn nn nn nn nn nn nn
,ANS: 1 nn
Rationale: The nurse should explain to the parents that, although the twins have identical
nn nn nn nn nn nn nn nn nn nn nn nn nn
DNA, there are several other factors that affect reactions to stress. Mental health is a state
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
of being that is relative to the individual client. Environmental influences and
nn nn nn nn nn nn nn nn nn nn nn nn
nntemperament can affect stress reactions. nn nn nn nn
Cognitive Level: Application nn nn
Integrated Process:
nn nn
Implementation
4. Which client should the nurse anticipate to be most receptive to psychiatric treatment?
nn nn nn nn nn nn nn nn nn nn nn nn nn
1. A Jewish, female social worker.
nn nn nn nn
2. A Baptist, homeless male.
nn nn nn
3. A Catholic, black male.
nn nn nn
4. A Protestant, Swedish business executive.
nn nn nn nn
ANS: 1 nn
Rationale: The nurse should anticipate that the client of Jewish culture would place a high
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
importance on preventative health care and would consider mental health as equally important
nn nn nn nn nn nn nn nn nn nn nn nn nn
as physical health. Women are also more likely to seek treatment for mental
nn nn nn nn nn nn nn nn nn nn nn nn nn
nnhealth problems than men. nn nn nn
Cognitive Level: Application nn nn
Integrated Process: Planning
nn nn nn
5. A psychiatric nurse intern states, This clients use of defense mechanisms should be
nn nn nn nn nn nn nn nn nn nn nn nn
eliminated. Which is a correct evaluation of this nurses statement?
nn nn nn nn nn nn nn nn nn nn
1. Defense mechanisms can be appropriate responses to stress and need not be eliminated.
nn nn nn nn nn nn nn nn nn nn nn nn
2. Defense mechanisms are a maladaptive attempt of the ego to manage anxietyand
nn nn nn nn nn nn nn nn nn nn nn
should always be eliminated.
nn nn nn nn
3. Defense mechanisms, used byindividuals with weak ego integrity, should be discouraged
nn nn nn nn nn nn nn nn nn nn
and not eliminated.
nn nn nn
4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.
nn nn nn nn nn nn nn nn nn nn nn nn
ANS: 1 nn
Rationale: The nurse should determine that defense mechanisms can be appropriate during
nn nn nn nn nn nn nn nn pp nn nn
times of stress. The client with no defense mechanisms may have a lower tolerance for
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
stress, thus leading to anxiety disorders. Defense mechanisms should be confronted
nn nn nn nn nn nn nn nn nn nn nn
when they impede the client from developing healthy coping skills.
nn nn nn n n nn nn nn nn nn nn
Cognitive Level: Application nn nn
Integrated Process: Evaluation
nn pp nn
6. During an intake assessment, a nurse asks both physiological and psychosocial questions.
nn nn nn nn nn nn nn pp nn nn nn
The client angrily responds, Im here for my heart, not my head problems. Which
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
nnis the nurses best response?
nn nn nn nn
1. Its just a routine part of our assessment. All clients are asked these same questions.
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
2. Why are you concerned about these types of questions?
nn nn nn nn nn nn nn nn
3. Psychological factors, like excessive stress, have been found to affect medical conditions.
nn nn nn nn nn nn nn nn nn nn nn
4. We can skip these questions, if you like. It isnt imperative that we complete this section.
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
, ANS: 3 nn
Rationale: The nurse should attempt to educate the client on the negative effects of excessive
nn nn nn nn nn nn nn nn nn pp nn nn nn nn
stress on medical conditions. It is not appropriate to skip physiological and psychosocial
nn nn nn nn nn nn nn nn nn nn nn nn nn
questions, as this would lead to an inaccurate assessment.
nn nn nn nn nn nn nn nn nn
Cognitive Level: Application nn nn
Integrated Process:
nn nn
Implementation
7. An employee uses the defense mechanism of displacement when the boss
nn nn nn nn nn nn nn nn nn nn
openlydisagrees with suggestions. What behavior would be expected from this
nn nn nn nn nn nn nn nn nn nn
employee?
nn
1. The employee assertively confronts the boss.
nn nn nn nn nn
2. The employee leaves the staff meeting to work out in the gym.
nn nn nn nn nn nn nn nn nn nn nn
3. The employee criticizes a coworker.
nn nn nn nn
4. The employee takes the boss out to lunch.
nn nn nn nn nn nn nn
ANS: 3 nn
Rationale: The nurse should expect that the client using the defense mechanism displacement
nn nn nn nn nn nn nn nn nn nn nn nn
would criticize a coworker after being confronted by the boss. Displacement refers to
nn nn nn nn nn nn nn nn nn nn nn nn nn
transferring feelings from one target to a neutral or less-threatening target.
nn nn nn nn nn nn nn nn nn nn nn
Cognitive Level: Analysis nn nn
Integrated Process: Assessment
nn nn nn
8. A fourth-grade boyteases and makes jokes about a cute girl in his class. This behavior
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
should be identified by a nurse as indicative of which defense mechanism?
nn nn nn nn nn nn nn nn nn nn nn nn
1. Displacement
2. Projection
3. Reaction formation nn
4. Sublimation
ANS: 3 nn
Rationale: The nurse should identify that the boy is using reaction formation as a defense
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being
nn nn nn nn nn nn nn nn nn nn nn nn
expressed by expressing opposite thoughts or behaviors. Displacement refers to
nn nn nn nn nn nn nn nn nn nn
transferring feelings from one target to another. Rationalization refers to making excuses to
nn nn nn nn nn nn nn nn nn nn nn nn nn
justify behavior. Projection refers to the attribution of unacceptable feelings or behaviors
nn nn nn nn nn nn nn nn nn nn nn nn
to another person.
nn nn nn
Sublimation refers to channeling unacceptable drives or impulses into more constructive,
pp nn nn pp nn pp nn nn nn nn
acceptable activities.
nn nn
Cognitive Level: Application nn nn
Integrated Process: Assessment
nn nn nn
9. Which nursing statement about the concept of neurosis is most accurate?
nn nn nn nn nn nn nn nn nn nn
1. An individual experiencing neurosis is unaware that he or she is experiencing distress.
nn nn nn nn nn nn nn nn nn nn nn nn
2. An individual experiencing neurosis feels helpless to change his or her situation.
nn nn nn nn nn nn nn nn nn nn nn
3. An individual experiencing neurosis is aware of psychological causes of his or her behavior.
nn nn nn nn nn nn nn nn nn nn nn nn nn
4. An individual experiencing neurosis has a loss of contact with reality.
nn nn nn nn nn nn nn nn nn nn
ANS: 2 nn
nn nn nn nn nn nn nn
Nursing Concepts of Care in Evidence-Based Practice 9th Edition Morgan
nn nn nn nn nn nn nn nn nn nn
Test Bank nn nn
Chapter 1. Mental Health and Mental Illness
nn nn nn pp pp nn
nn Multiple Choice nn
1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
the recent death of a beloved pet. The clients appetite, sleep patterns, and daily routine
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
nnhave not changed. How should the nurse interpret the clients behaviors?
nn nn nn nn nn nn nn nn nn nn
1. The clients behaviors demonstrate mental illness in the form of depression.
nn nn nn nn nn nn nn nn nn nn
2. The clients behaviors are extensive, which indicates the presence of mental illness.
nn nn nn nn nn nn nn nn nn nn nn
3. The clients behaviors are not congruent with cultural norms.
nn nn nn nn nn nn nn nn
4. The clients behaviors demonstrate no functional impairment, indicating no mental illness.
nn nn nn nn nn nn nn nn nn nn
ANS: 4 nn
Rationale: The nurse should assess that the clients daily functioning is not impaired. The
nn nn nn nn nn nn nn nn nn nn nn nn nn
client who experiences feelings of sadness after the loss of a pet is responding within
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
normal expectations. Without significant impairment, the clients distress does not indicate
nn nn nn nn nn nn nn nn nn nn nn
a mental illness.
nn nn nn
Cognitive Level: Analysis nn nn
Integrated Process: Assessment
nn nn nn
2. At what point should the nurse determine that a client is at risk for
nn nn nn nn nn nn nn nn nn nn nn nn nn
developing a mental illness?
nn nn nn nn
1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria.
nn nn nn nn nn nn nn nn nn nn nn
2. When maladaptive responses to stress are coupled with interference in daily functioning.
nn nn nn nn nn nn nn nn nn nn nn
3. When a client communicates significant distress.
nn nn nn nn nn
4. When a client uses defense mechanisms as ego protection.
nn nn nn nn nn nn nn nn
ANS: 2 nn
Rationale: The nurse should determine that the client is at risk for mental illness when
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
responses to stress are maladaptive and interfere with daily functioning. The DSM-5
nn nn nn nn nn nn nn nn nn nn nn nn
indicates that in order to be diagnosed with a mental illness, daily functioning must be
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
significantly impaired. The clients ability to communicate distress would be considered a
nn nn nn nn nn nn nn nn nn nn nn nn
positive attribute.
nn nn
Cognitive Level: Application nn nn
Integrated Process: Assessment
nn nn nn
3. A nurse is assessing a set of 15-year-old identical twins who respond verydifferently to
nn nn nn nn nn nn nn nn nn nn nn nn nn
stress. One twin becomes anxious and irritable, and the other withdraws and cries. How
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
should the nurse explain these different stress responses to the parents?
nn nn nn nn nn nn nn nn nn nn nn
1. Reactions to stress are relative rather than absolute; individual responses to stress vary.
nn nn nn nn nn nn nn nn nn nn n n nn
2. It is abnormal for identical twins to react differently to similar stressors.
nn nn nn nn nn nn nn nn nn nn nn
3. Identical twins should share the same temperament and respond similarly to stress.
nn nn nn nn nn nn nn nn nn nn nn
4. Environmental influences to stress weigh more heavily than genetic influences.
nn nn nn nn nn nn nn nn nn
,ANS: 1 nn
Rationale: The nurse should explain to the parents that, although the twins have identical
nn nn nn nn nn nn nn nn nn nn nn nn nn
DNA, there are several other factors that affect reactions to stress. Mental health is a state
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
of being that is relative to the individual client. Environmental influences and
nn nn nn nn nn nn nn nn nn nn nn nn
nntemperament can affect stress reactions. nn nn nn nn
Cognitive Level: Application nn nn
Integrated Process:
nn nn
Implementation
4. Which client should the nurse anticipate to be most receptive to psychiatric treatment?
nn nn nn nn nn nn nn nn nn nn nn nn nn
1. A Jewish, female social worker.
nn nn nn nn
2. A Baptist, homeless male.
nn nn nn
3. A Catholic, black male.
nn nn nn
4. A Protestant, Swedish business executive.
nn nn nn nn
ANS: 1 nn
Rationale: The nurse should anticipate that the client of Jewish culture would place a high
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
importance on preventative health care and would consider mental health as equally important
nn nn nn nn nn nn nn nn nn nn nn nn nn
as physical health. Women are also more likely to seek treatment for mental
nn nn nn nn nn nn nn nn nn nn nn nn nn
nnhealth problems than men. nn nn nn
Cognitive Level: Application nn nn
Integrated Process: Planning
nn nn nn
5. A psychiatric nurse intern states, This clients use of defense mechanisms should be
nn nn nn nn nn nn nn nn nn nn nn nn
eliminated. Which is a correct evaluation of this nurses statement?
nn nn nn nn nn nn nn nn nn nn
1. Defense mechanisms can be appropriate responses to stress and need not be eliminated.
nn nn nn nn nn nn nn nn nn nn nn nn
2. Defense mechanisms are a maladaptive attempt of the ego to manage anxietyand
nn nn nn nn nn nn nn nn nn nn nn
should always be eliminated.
nn nn nn nn
3. Defense mechanisms, used byindividuals with weak ego integrity, should be discouraged
nn nn nn nn nn nn nn nn nn nn
and not eliminated.
nn nn nn
4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.
nn nn nn nn nn nn nn nn nn nn nn nn
ANS: 1 nn
Rationale: The nurse should determine that defense mechanisms can be appropriate during
nn nn nn nn nn nn nn nn pp nn nn
times of stress. The client with no defense mechanisms may have a lower tolerance for
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
stress, thus leading to anxiety disorders. Defense mechanisms should be confronted
nn nn nn nn nn nn nn nn nn nn nn
when they impede the client from developing healthy coping skills.
nn nn nn n n nn nn nn nn nn nn
Cognitive Level: Application nn nn
Integrated Process: Evaluation
nn pp nn
6. During an intake assessment, a nurse asks both physiological and psychosocial questions.
nn nn nn nn nn nn nn pp nn nn nn
The client angrily responds, Im here for my heart, not my head problems. Which
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
nnis the nurses best response?
nn nn nn nn
1. Its just a routine part of our assessment. All clients are asked these same questions.
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
2. Why are you concerned about these types of questions?
nn nn nn nn nn nn nn nn
3. Psychological factors, like excessive stress, have been found to affect medical conditions.
nn nn nn nn nn nn nn nn nn nn nn
4. We can skip these questions, if you like. It isnt imperative that we complete this section.
nn nn nn nn nn nn nn nn nn nn nn nn nn nn nn
, ANS: 3 nn
Rationale: The nurse should attempt to educate the client on the negative effects of excessive
nn nn nn nn nn nn nn nn nn pp nn nn nn nn
stress on medical conditions. It is not appropriate to skip physiological and psychosocial
nn nn nn nn nn nn nn nn nn nn nn nn nn
questions, as this would lead to an inaccurate assessment.
nn nn nn nn nn nn nn nn nn
Cognitive Level: Application nn nn
Integrated Process:
nn nn
Implementation
7. An employee uses the defense mechanism of displacement when the boss
nn nn nn nn nn nn nn nn nn nn
openlydisagrees with suggestions. What behavior would be expected from this
nn nn nn nn nn nn nn nn nn nn
employee?
nn
1. The employee assertively confronts the boss.
nn nn nn nn nn
2. The employee leaves the staff meeting to work out in the gym.
nn nn nn nn nn nn nn nn nn nn nn
3. The employee criticizes a coworker.
nn nn nn nn
4. The employee takes the boss out to lunch.
nn nn nn nn nn nn nn
ANS: 3 nn
Rationale: The nurse should expect that the client using the defense mechanism displacement
nn nn nn nn nn nn nn nn nn nn nn nn
would criticize a coworker after being confronted by the boss. Displacement refers to
nn nn nn nn nn nn nn nn nn nn nn nn nn
transferring feelings from one target to a neutral or less-threatening target.
nn nn nn nn nn nn nn nn nn nn nn
Cognitive Level: Analysis nn nn
Integrated Process: Assessment
nn nn nn
8. A fourth-grade boyteases and makes jokes about a cute girl in his class. This behavior
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
should be identified by a nurse as indicative of which defense mechanism?
nn nn nn nn nn nn nn nn nn nn nn nn
1. Displacement
2. Projection
3. Reaction formation nn
4. Sublimation
ANS: 3 nn
Rationale: The nurse should identify that the boy is using reaction formation as a defense
nn nn nn nn nn nn nn nn nn nn nn nn nn nn
mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being
nn nn nn nn nn nn nn nn nn nn nn nn
expressed by expressing opposite thoughts or behaviors. Displacement refers to
nn nn nn nn nn nn nn nn nn nn
transferring feelings from one target to another. Rationalization refers to making excuses to
nn nn nn nn nn nn nn nn nn nn nn nn nn
justify behavior. Projection refers to the attribution of unacceptable feelings or behaviors
nn nn nn nn nn nn nn nn nn nn nn nn
to another person.
nn nn nn
Sublimation refers to channeling unacceptable drives or impulses into more constructive,
pp nn nn pp nn pp nn nn nn nn
acceptable activities.
nn nn
Cognitive Level: Application nn nn
Integrated Process: Assessment
nn nn nn
9. Which nursing statement about the concept of neurosis is most accurate?
nn nn nn nn nn nn nn nn nn nn
1. An individual experiencing neurosis is unaware that he or she is experiencing distress.
nn nn nn nn nn nn nn nn nn nn nn nn
2. An individual experiencing neurosis feels helpless to change his or her situation.
nn nn nn nn nn nn nn nn nn nn nn
3. An individual experiencing neurosis is aware of psychological causes of his or her behavior.
nn nn nn nn nn nn nn nn nn nn nn nn nn
4. An individual experiencing neurosis has a loss of contact with reality.
nn nn nn nn nn nn nn nn nn nn
ANS: 2 nn
