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