MENTAL HEALTH AND PSYCHIATRIC NURSING LATEST 2023 COMPLETE SOLUTION

MENTAL HEALTH AND PSYCHIATRIC NURSING DEFENSE MECHANISMS, CRISIS INTERVENTION AND ANXIETY RELATED DISORDERS SITUATION: The term “defense mechanism” is used in two different ways. Both imply a sense of self protection, with an organism engaging in a behavior with the goal of preventing harm, which may take the form of physical harm or psychological harm. Defense mechanisms are widely used throughout the natural world and in human society, and they take a wide range of forms. 1. A teenager gets mad at parents and begins staying out late at night. What type of defense mechanism is demonstrated? a. Projection b. Dissociation c. Acting out d. Denial ANSWER: C Acting out is using actions rather than reflections or feelings during periods of emotional conflict. Projection is the unconscious blaming of unacceptable inclinations or thoughts on an external object. Dissociation isdealing with emotional conflict by a temporary alteration in consciousness or identity. Denial is the failure to acknowledge an unbearable condition; failure to admit the reality of a situation, or how one enables the problem to continue Reference: Sheila L. Videbeck. Psychiatric Mental health Nursing. 2nd edition. Page 51 2. A college student asks a teacher for help after receiving a bad grade on a test. Every suggestion the teacher has is rejected by the student. What type of defense mechanism is demonstrated? a. Displacement b. Suppression c. Rationalization d. Help-rejecting complaining ANSWER: D Complaining or making repetitious requests for help that disguise covert feelings of hostility or reproach toward others, which are then expressed by rejecting the suggestions, advice or help that others offer. Suppression is the conscious exclusion of unacceptable thoughts and feelings from conscious awareness. Displacement is ventilation of intense feelings toward persons less threatening than the one who aroused those feelings. Rationalization is excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect. Reference: Sheila L. Videbeck. Psychiatric Mental health Nursing. 2nd edition. Page 51 Reference:mary Ann Boyd. Psychiatric Nursing. 4th edition. Page 145 3. A person makes a joke right after experiencing an embarrassing situation. What type of defense mechanism is demonstrated? a. Denial b. Humor c. Compensation d. Reaction formation ANSWER: B Humor is emphasizing the amusing or ironic aspects of the conflict. Denial is failure to acknowledge an unbearable condition; failure to admit the reality of a situation, or how one enables the problem to continue. Compensation is overachievement in one area to offset real or perceived deficiencies in another area. Reaction Formation is acting the opposite of what one thinks or feels. Reference: Sheila L. Videbeck. Psychiatric Mental health Nursing. 2nd edition. Page 51 Reference:mary Ann Boyd. Psychiatric Nursing. 4th edition. Page 145 4. An adult falls in love and fails to see the negative qualities of her partner. What type of defense mechanism is demonstrated? a. Repression b. Substitution c. Idealization d. Sublimation ANSWER: C Idealization is attributing exaggerated positive qualities to others. Repression is excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness. Substitution is replacing the desired gratification with one that is more readily available. Sublimation is substituting a socially acceptable activity for an impulse that is unacceptable Reference: Sheila L. Videbeck. Psychiatric Mental health Nursing. 2nd edition. Pages 51-52 : Mary Ann Boyd. Psychiatric Nursing. 4th edition. Page 145 5. The nurse should recognize that a patient who is unable to remember being raped by her brother when she was 10 years old is using which of the following ego defense mechanisms? a. Compensation b. Regression c. Repression d. Undoing ANSWER: C This is an example of repression. It is defined as a defense mechanism which involves excluding emotionally painful or anxiety provoking thoughts and feelings from conscious awareness. Reference: Videbeck, S. L. (2004) Psychiatric Mental Health Nursing. 2nd edition. Lippincott Williams and Wilkins. 51 6. Upon returning home from work, a young man discovers that his mother has been in a serious automobile accident. Initially, he responds to the news by stating, "No, I don't believe it. It can't be true." Which defense mechanism is he using? a. Introjection b. Suppression c. Denial d. Repression ANSWER: C Denial is the avoidance of reality by ignoring or refusing to acknowledge unpleasant incidents. This defense mechanism is used to allay anxiety immediately after a stressful event. Introjection is an intense form of identification in which one incorporates the values or qualities of another person or group into one's own ego structure. Suppression is the conscious analog of repression. A person intentionally uses suppression to consciously exclude material from awareness. Repression is the unconscious exclusion of painful episodes from awareness. Reference: Videbeck, S. L. (2004) Psychiatric Mental Health Nursing. 2nd edition. Lippincott Williams and Wilkins. 51 7. A client diagnosed with cancer does not talk about or acknowledge her diagnonsis. Which of the following defense mechanisms is this client using? a. Denial b. Identification c. Projection d. Rationalization ANSWER: A Failure to acknowledge the reality of the diagnosis is an example of the defense mechanism of denial. Identification is a defense mechanism that occurs when a person avoids painful thoughts and emotions by identifying with some symbolic sources of strength. Projection is a defense mechanism that occurs when people avoid a negative evaluation of themselves by seeing their own unpleasant thoughts or actions in other people. Rationalization (or making excuses) is a defense mechanism in which perceived controversial behaviors or feelings are explained in a rational or logical manner to avoid the true explanation, to differentiate from the original deterministic explanation, of the behavior or feeling in question. Reference: Norman Keltner. Psychiatric Nursing 5ht edition Page 36-37 8. A man who was released from prison for selling narcotics has been rehabilitated and now works for a youth drug prevention agency. His current behavior reflects which defense mechanism? a. Denial b. Displacement c. Identification d. Sublimation ANSWER: D Sublimation is a defense mechanism that Freud thought occurred when libidinal energy is channeled into socially acceptable, approved activities. Identification is a defense mechanism that occurs when a person avoids painful thoughts and emotions by identifying with some symbolic sources of strength. Failure to acknowledge the reality of the diagnosis is an example of the defense mechanism of denial. Displacement is unconsciously discharging pent-up feelings to a less threatening object Reference: Norman Keltner. Psychiatric Nursing 5ht edition Page 36-37 SITUATION: When anxiety occurs, the mind first responds by an increase in problem-solving thinking, seeking rational ways of escaping the situation. If this is not fruitful, a range of defense mechanisms may be triggered. 9. An angry man channels his hostilities into competitive sports in which there are many opportunities for combat. The angry man’s actions characterize which of the following defense mechanisms? a. Sublimation b. Repression c. Rationalization d. Reaction formation ANSWER: A Sublimation is the unconscious rechanneling of intolerable or socially impulses or behaviors into activities that are personally or socially acceptable. Repression is excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness. Rationalization is excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of selfrespect. Reaction formation is acting the opposite of what one thinks or feels Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51 10. Mary, a client who attempted suicide recently, gave the following remarks to the nurse the next morning, “Let’s not think about that now, maybe I’ll feel like thinking about it later.” The client is using which of the following defense mechanisms? a. Blocking b. Denial c. Suppression d. Repression ANSWER: C By definition, this is the conscious, deliberate effort to avoid talking or thinking about painful, anxiety producing experiences. Repression is excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness. Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51 11. A client in the psychiatric unit appears to imitate a certain nurse in the unit. The client seeks out for this particular nurse and imitates her mannerisms. The nurse knows that the client is using which defense mechanism? a. Sublimation b. Identification c. Introjection d. Repression. Answer: B Identification (B) is an attempt to be like someone or emulate the personality traits of another. (A) is substituting an unacceptable feeling for one that is more socially acceptable. (C) is incorporating the values or qualities of an admired person or group into one's own ego structure. (D) is the involuntary exclusion of painful thoughts or memories from one's awareness. Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51 12. While assessing the defense mechanisms used by the client, the nurse recognizes the client’s use of defense mechanisms as adaptive when the: a. Mechanism used decreases anxiety. c. Anxiety is expressed in behaviors. b. Client seeks isolation to avoid stress. d. Client can identify the stressor. Answer: A Rationale: The purpose of defense mechanisms is to reduce anxiety levels and allow the client to function adequately. Seeking isolation to avoid stress (option B) is an unhealthy adaptive strategy. Anxiety is expressed in behavior (option C); however, that behavior can be harmful to clients or others. Recognition of a stressor (option D) is important but may not be useful in the client’s adaptive use of defense mechanisms. 13. A female client comes with the nurse for an evaluation with a therapist. As they sit down and prepare for the interview, the client turns to the therapist, looks at him sternly and says, “I didn’t think you would even want to see or talk to me.” The therapist responds, “How could this be since I do not even know who you are?” The nurse understands that the client’s thinking is an example of which of the following defense mechanisms? a. Denial b. Projection c. Reaction formation d. Rationalization Answer: B Rationale: Projection is a process in which blame is attached to others or the environment for unacceptable desires, thoughts, shortcomings, and mistakes. This client does not feel the therapist will care about her. Denial (option A) is an attempt to screen or ignore unacceptable realities by refusing to acknowledge them. Reaction formation (option C) is a mechanism that causes people to act exactly opposite to the way they feel. Rationalization (option D) is the justification of certain behaviors by faulty logic and ascription of motives that are socially acceptable but did not, in fact, inspire the behavior. 14. The nursing intervention for action-level defense mechanisms, such as conversion and regression, is to: a. Teach the client to deal with impulses by taking constructive action. b. Encourage the client to continue such defense mechanisms, as they are adaptive. c. Listen to the client and encourage expression of feelings. d. Orient client to reality and encourage participation in social activities. Answer: A Rationale: Conversion and regressive behavior impair the client’s ability to function in society. Teaching the client constructive ways to cope would be helpful. These defense mechanisms are not adaptive and impair the client’s function (option B). Listening to the client’s expression of feelings (option C) and orienting the client to reality (option D) are therapeutic but will not assist the client in coping with maladaptive defense mechanisms and may only increase the client’s anxiety level. 15. When talking to the nurse about his decision to drop out of school and marry his girlfriend who is pregnant, a young college student says, “It’s really the best decision. It is important for a child to have two parents.” The nurse recognizes that the client is using the defense mechanism known as: a. Projection b. Introspection c. Displacement d. Intellectualization ANSWER: D This is an example of intellectualization. It is the separation of the emotions of a painful event or situation from the facts involved. There is an acknowledgment of the facts but not the emotions. Projection is unconscious blaming of unacceptable inclinations on an external object. Displacement is the ventilation of intense feelings toward a less threatening person than the one who aroused those feelings. Reference: Videbeck, S. (2004) Psychiatric Mental health Nursing. 2nd edition. Lippincott Williams and Wilkins. Page 51 16. A 7-year-old has been diagnosed as having acute myelogenous leukemia. The physician has discussed the diagnosis with the parents and told them that their son has only a few months to live. While the parents are sitting in the lounge after visiting their child, they both have a severe argument over something trivial. The nurse should help them recognize that they are using the defense mechanism of: a. Denial b. Projection c. Displacement d. Compensation ANSWER: C This is an example of displacement. They were angry at the physician for the diagnosis and telling them that their son has only a few months to live. There was a ventilation or transfer of intense feelings toward a person less threatening than the person who aroused those feelings. Reference: Videbeck, S. (2004) Psychiatric Mental health Nursing. 2nd edition. Lippincott Williams and Wilkins. Page 51 17. A woman is brutally attacked and raped by her date following a party. She comes to the emergency department for attention to her physical injuries. The nurse asks the client what happened to her and she replies “I don’t know. I went to a party with my date and I don’t remember anything until I got home and my room mate brought me here”. This is an example of which of the following defense mechanisms? a. Rationalization b. Reaction formation c. Regression d. Repression ANSWER: D The client is repressing the incident in order to avoid feelings of anxiety. Repression is the unconscious exclusion of a painful thought, impulse or memory from awareness. Reference: Videbeck, S. (2004) Psychiatric Mental health Nursing. 2nd edition. Lippincott Williams and Wilkins. Page 51 SITUATION: Freud believed the self or ego used ego defense mechanisms, which are methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events. 18. Mr. Delvalle, an account manager, loses an important advertising account and gets a flat tire while driving home. That evening, he begins to find fault with everyone. Which defense mechanism is he using? a. Displacement b. Projection c. Regression d. Sublimation ANSWER: A This person is using displacement, a mechanism by which feelings of anger and rejection are discharged in an indirect way that is perceived as safe (in this situation, by displacing anger related work and car problems onto others). Projecting involves attributing one’s own emotions to or blaming them on others. Regression is a retreat to an earlier level of developmental behavior in an attempt to relieve anxiety. Sublimation is the social acceptable discharge or anger through such behavior as exercise or other productive activity. Reference: Videbeck. S.L. Psychiatric Mental Health Nursing 3rd edition Page 51 19. Which term refers to the primary unconscious defense mechanism that blocks intense, anxiety-producing situations from a person’s awareness? a. Introjection b. Regression c. Repression d. Denial ANSWER: C Repression, the unconscious exclusion from awareness of painful or conflicting thoughts, impulses, or memories, is the primary ego defense. Other defense mechanisms tend to reinforce anxiety. Introjection is an intense identification in which one incorporates values or qualities of another person or group into one’s own ego structure. Regression is a retreat, during a time of stress, to an earlier level of developmental behavioral. Denial is avoiding unpleasant realities by ignoring them. Reference: Videbeck. S.L. Psychiatric Mental Health Nursing 3rd edition Page 51 20. A college student is outraged by the recent end of his long-term relationship. For his creative writing class, he writes an essay on anger management. Which defense mechanism is he using? a. Repression b. Introjection c. Undoing d. Sublimation ANSWER: D Sublimation involves redirecting socially unacceptable behavior and needs into acceptable actions. This client is exhibiting sublimation because he is redirecting his anger in an acceptable way. Repression is the unconscious blocking out of unacceptable feelings or thoughts. Undoing involves attempting to “undo” harm a person feels he may have done to another. Introjection is the process of absorbing the values or characteristics of another person or group into one’s own ego. Reference: Videbeck. S.L. Psychiatric Mental Health Nursing 3rd edition Page 51 21. A client becomes angry and belligerent toward the nurse after speaking on the phone with his mother. Nurse Isabel recognizes this as what defense mechanism? a. Rationalization b. Repression c. Displacement d. Suppression ANSWER: C Displacement is a defense mechanism in which the client transfers his feelings for one person toward another person who is less threatening. Rationalization is a defense mechanism in which the client makes excuses to justify unacceptable feelings or behaviors. Repression is characterized an involuntary blocking of unpleasant experiences form ones consciousness. Suppression is the conscious blocking of unpleasant experiences from one’s awareness. Reference: Videbeck. S.L. Psychiatric Mental Health Nursing 3rd edition Page 51 22. A female client is admitted to the emergency department after being sexually assaulted. Nurse Hannah notes that the client is sitting calmly and quietly in the examination room and recognizes this behavior as a protective defense mechanism. What defense mechanism is the client exhibiting? a. Intellectualization b. Denial c. Regression d. Displacement ANSWER: B Denial is a protectiveand adaptive reaction to increased anxiety. It involves consciously disowning intolerable thoughts and impulses. This response is commonly seen in victims of sexual abuse. In intellectualization, the client attempts to avoid expressing emotions associated with the stressful situation by using logic, analysis, and reasoning. A client who uses regression reverts to an earlier developmental level in response to stress. With displacement, the client transfers his feelings for one person toward another, less-threatening person. Reference: Videbeck. S.L. Psychiatric Mental Health Nursing 3rd edition Page 51 23. Nurse Isabel is assessing a client who is talking about her son's recent death but who shows no emotion of any kind. She recognizes this behavior as which of the following defense mechanisms? a. Dissociation b. Displacement c. Intellectualization d. Suppression ANSWER: C In intellectualization, the client attempts to avoid expressing emotions associated with the stressful situation by using logic, analysis, and reasoning. Dissociation is dealing with emotional conflict by a temporary alteration in consciousness or identity. With displacement, the client transfers his feelings for one person toward another, less-threatening person. Suppression is conscious exclusion of unacceptable thoughts and feelings from conscious awareness.