Mental Health Theory & Application (NUR 356) Exam 1-5 Complete Answered Blueprints 2026.
Module 1 – Introduction to Mental Health Nursing
• Mental health is “the successful adaption to stressors from the internal or external environment,
evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and
cultural norms”
• Mental illness is “maladaptive responses to stressors from the internal or external environment,
evidenced by thought, feelings, and behaviors that are incongruent with the local or cultural norms,
and that interfere with the individuals social, occupational, and/or physical functioning.”
• Social determinants of health
o Non-medical factors that influence health outcomes
• Defense mechanisms
Defense Mechanism Example
Compensation A physically disabled boy is unable to participate in
Covering up a real or perceived weakness by football, so he compensates by becoming a great scholar
emphasizing a trait one considers more desirable
Rationalization A patient tells the rehab nurse, “I drink because it's the
Attempting to make excuses or formulate logical reasons only way I can deal with my bad marriage and my worse
to justify unacceptable feelings or behaviors job.”
Denial A women drinks alcohol every day and cannot stop,
Refusing to acknowledge the existence of a real situation failing to acknowledge that she has a problem
or feelings associated with it
Reaction formation A student hates nursing and only attends nursing school
Preventing unacceptable or undesirable thoughts or to please her parents. During career day, she speaks to
behaviors from being expressed by exaggerating prospective students about the excellence of nursing as a
opposite thoughts or types of behavior career.
Displacement A patient is angry with his physician, does not express it,
The transfer of feelings from one target to another that is but becomes verbally abusive with the nurse
considered less threatening or that is neutral
Regression When a 2 yr old is hospitalized for tonsillitis, he will drink
Retreating in response to stress to an earlier level of only from a bottle, even though his mother states he has
development and the comfort measures associated with been drinking from a cup for 6 months
that level of functioning
Identification A teenager who required lengthy rehabilitation after an
An attempt to increase self-worth by acquiring certain accident decides to become a physical therapist because
attributes and characteristics of an individual one of his experiences
admires
Repression A trauma victim is unable to remember anything about
Involuntary blocking unpleasant feelings and experiences the traumatic event
from one’s awareness
Intellectualization A woman’s husband is being transferred with his job to a
An attempt to avoid expressing actual emotions city far away from her parents. She hides anxiety by
associated with a stressful situation by using the explaining to her parents the advantages associated with
intellectual processes of logic, reasoning, and analysis the move.
Sublimation A mother whose son was killed by a drunk driver
Rechanneling of drives or impulses that are personally or channels her anger and energy into being. The president
socially unacceptable into activities that are constructive of the local chapter of mothers against drunk driving
Introjection Children integrate their parents' value system into the
Integrating the beliefs and values of another individual process of conscience formation. A child says to a friend,
into one's own ego structure “Don't cheat. It's wrong.”
Suppression “I don’t want to think about that now. I’ll think about that
The voluntary blocking of unpleasant feelings and tomorrow.”
experiences from one’s awareness
Isolation A young woman describes being attacked and raped
Separating a thought or memory from the feeling, tone, or without showing any emotion
emotion associated with it
,Undoing A man is nervous about his new job and yells at his wife.
Symbolically negating or canceling out an experience On his way home he stops and buys her some flowers
that one finds intolerable
Projection A man who is addicted to alcohol blames his wife for his
Attributing feelings or impulse unacceptable to oneself to excessive drinking
another person
• Maslow’s Hierarchy of Needs
o Self-actualization
▪ Possesses a feeling of self-fulfillment and realization of his or her highest potential
o Self-esteem/ Respect of others
▪ Seeks self-respect and respect from others, works to achieve success and recognition
in work, and desires prestige from accomplishments
o Love and belonging
▪ Needs are for giving and receiving of affection, companionship, satisfactory
interpersonal relationships, and identification with a group
o Safety and security
▪ Needs at this level are for avoiding harm, maintaining comfort, order, structure,
physical safety, freedom from fear, and protection
o Physiological needs
▪ Basic fundamental needs include food, water, air, sleep, exercise, elimination, shelter,
and sexual expression
• Risk factors for developing a mental disorder
o Sleep wakefulness cycle
▪ Circadian rhythms
• Abnormal circadian rhythms have been associated with a variety of mental
illnesses including:
o Depression
o Bipolar disorder
o Seasonal affective disorder
• Sleep cycle
o Stage 0- Alpha
▪ This stage of the sleep-wakefulness cycle is characterized by a
relaxed, waking state with eyes closed. The alpha brain wave
rhythm has a frequency of 8 to 12 cycles per second
o Stage 1- Beta
▪ Characterized by the transition into sleep, a period of dozing in
which thoughts wander and the person drifts in and out of sleep.
Beta brain wave rhythm has a frequency of 18 to 25 cycles per
second
o Stage 2- Theta
▪ This stage comprises about one half of the time spent sleeping.
Eye movement and muscular activity are minimal. Theta brain
wave rhythm has a frequency of 4 to 7 cycles per sound.
o Stage 3- Delta
▪ This is a period of deep and restful sleep. Muscles are relaxed,
heart rate and blood pressure fall, and breathing slows. No eye
movement occurs. Delta brain wave rhythm has a frequency of 1.5
- 3 cycles per second
o Stage 4- Delta
▪ This is the stage of deepest sleep. Individuals with insomnia or
other sleep disorders often do not experience this stage of sleep.
, Eye movement and muscular activity are minimal. Delta waves
predominate.
o REM stage- Beta
▪ The dream cycle occurs during REM sleep. Eyes dart about
beneath closed eyelids, moving more rapidly then when awake.
The brain wave pattern is similar to that of stage 1 sleep. Heart
and respiration rates increase, and blood pressure may increase
or decrease. Muscles are hypotonic during REM sleep.
o Stages 2 through REM repeat throughout the cycle of sleep. One is more
likely to experience longer periods of stages 3 and 4 sleep early in the
cycle and longer periods of REM sleep later in the sleep cycle. Most
people experience REM sleep
o Genetics
o Environment
• Client rights
o Right to treatment
o Right to refuse treatment (including medication)
▪ 3 criteria need to be met before forcing medications
• Must exhibit behavior that is dangerous to self or others
• Must have a reasonable chance of providing help to pt
• Pt who refuses med must be judged incompetent to evaluate the benefits of the
treatment in question
o Right to the least restrictive treatment alternative
• Confidentiality
o HIPAA- Health insurance portability and accountability act protects patients' privacy
o Refuse to give any information to the caller/visitor, if not consented by patient/guardian, and
site confidentiality
o Professionals can break confidentiality under the duty to warn and protect third parties, and
the reporting of child and adult abuse
o A nurse can take action immediately to stop violation if a client right to privacy is being
violated
o Right to privacy
• Mental health settings
• Six indicators of mental health
o A positive attitude toward self
o Growth, development, and ability to achieve self-actualization
o Integration
o Autonomy
o Perception of reality
o Enviromental mastery
• Stages of grief
Grief is a subjective feeling of sorrow and sadness accompanied by emotional, physical, and social responses
to the loss of a loved person or thing.
Kubler-Ross (1969), during extensive research with terminally ill patients, identified five stages of feelings
and behaviors that individuals experience in response to a real, perceived, or anticipated loss:
o Stage 1- Denial: Shock and disbelief. Response may be one of “No, it can't be true!” The reality
of the loss is not acknowledged. Denial is a protective mechanism that allows the individual to
cope in an immediate time frame while organizing more effective defense strategies.
, o Stage 2- Anger: “Why me?” and “It's not fair!” are comments often expressed during the anger
stage. Envy and resentment toward individuals not affected by the loss are common. Anger
may be directed at the self or displaced on loved ones, caregivers, or even God. There may be
a preoccupation with an idealized image of the lost entity.
o Stage 3- Bargaining: Usually not visible or evident to others, a “bargain” is made with God in an
attempt to reverse or postpone the loss: “If god will help me through this, I promise I will go to
church every Sunday and volunteer my time to help other.” Sometimes the promise is
associated with feelings of guilt for not having performed satisfactorily, appropriately, or
sufficiently
o Stage 4- Depression: Full impact of the loss is experienced. The sense of loss is intense, and
feelings of sadness and depression prevail. This is a time of quiet desperation and
disengagement from all association with the lost entity. It differs from pathological depression,
which occurs when an individual becomes fixed in an earlier stage of the grief process. Rathe,
stage 4 of the grief response represents advancement toward resolution
o Stage 5- Acceptance: Brings a feeling of peace regarding the loss that has occurred. IT is a
time of quiet expectation and resignation. The focus is on the reality of the loss and its meaning
for the individuals affected by it
• Documentation
Module 2- Legal and Ethical Issues
• Therapeutic communication
o Using silence
o Accepting
o Giving recognition
o Offering self
o Giving broad openings
o Offering general leads
o Placing the event in time or sequence
o Making observations
o Encouraging description of perceptions
o Encouraging comparison
o Restating
o Reflecting Focusing
o Exploring
o Seeking clarification and validation
o Presenting reality
o Voicing doubt
o Vernalizing the implied
o Attempting to translate words into feelings
o Formulating a plan of action
• Non-therapeutic communication
o Giving false reassurance
o Rejecting
o Approving or disapproving
o Agreeing or disagreeing
o Giving advice
o Probing
o Defending
o Requesting an explanation
o Indicating the existence of an external source of power
Module 1 – Introduction to Mental Health Nursing
• Mental health is “the successful adaption to stressors from the internal or external environment,
evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and
cultural norms”
• Mental illness is “maladaptive responses to stressors from the internal or external environment,
evidenced by thought, feelings, and behaviors that are incongruent with the local or cultural norms,
and that interfere with the individuals social, occupational, and/or physical functioning.”
• Social determinants of health
o Non-medical factors that influence health outcomes
• Defense mechanisms
Defense Mechanism Example
Compensation A physically disabled boy is unable to participate in
Covering up a real or perceived weakness by football, so he compensates by becoming a great scholar
emphasizing a trait one considers more desirable
Rationalization A patient tells the rehab nurse, “I drink because it's the
Attempting to make excuses or formulate logical reasons only way I can deal with my bad marriage and my worse
to justify unacceptable feelings or behaviors job.”
Denial A women drinks alcohol every day and cannot stop,
Refusing to acknowledge the existence of a real situation failing to acknowledge that she has a problem
or feelings associated with it
Reaction formation A student hates nursing and only attends nursing school
Preventing unacceptable or undesirable thoughts or to please her parents. During career day, she speaks to
behaviors from being expressed by exaggerating prospective students about the excellence of nursing as a
opposite thoughts or types of behavior career.
Displacement A patient is angry with his physician, does not express it,
The transfer of feelings from one target to another that is but becomes verbally abusive with the nurse
considered less threatening or that is neutral
Regression When a 2 yr old is hospitalized for tonsillitis, he will drink
Retreating in response to stress to an earlier level of only from a bottle, even though his mother states he has
development and the comfort measures associated with been drinking from a cup for 6 months
that level of functioning
Identification A teenager who required lengthy rehabilitation after an
An attempt to increase self-worth by acquiring certain accident decides to become a physical therapist because
attributes and characteristics of an individual one of his experiences
admires
Repression A trauma victim is unable to remember anything about
Involuntary blocking unpleasant feelings and experiences the traumatic event
from one’s awareness
Intellectualization A woman’s husband is being transferred with his job to a
An attempt to avoid expressing actual emotions city far away from her parents. She hides anxiety by
associated with a stressful situation by using the explaining to her parents the advantages associated with
intellectual processes of logic, reasoning, and analysis the move.
Sublimation A mother whose son was killed by a drunk driver
Rechanneling of drives or impulses that are personally or channels her anger and energy into being. The president
socially unacceptable into activities that are constructive of the local chapter of mothers against drunk driving
Introjection Children integrate their parents' value system into the
Integrating the beliefs and values of another individual process of conscience formation. A child says to a friend,
into one's own ego structure “Don't cheat. It's wrong.”
Suppression “I don’t want to think about that now. I’ll think about that
The voluntary blocking of unpleasant feelings and tomorrow.”
experiences from one’s awareness
Isolation A young woman describes being attacked and raped
Separating a thought or memory from the feeling, tone, or without showing any emotion
emotion associated with it
,Undoing A man is nervous about his new job and yells at his wife.
Symbolically negating or canceling out an experience On his way home he stops and buys her some flowers
that one finds intolerable
Projection A man who is addicted to alcohol blames his wife for his
Attributing feelings or impulse unacceptable to oneself to excessive drinking
another person
• Maslow’s Hierarchy of Needs
o Self-actualization
▪ Possesses a feeling of self-fulfillment and realization of his or her highest potential
o Self-esteem/ Respect of others
▪ Seeks self-respect and respect from others, works to achieve success and recognition
in work, and desires prestige from accomplishments
o Love and belonging
▪ Needs are for giving and receiving of affection, companionship, satisfactory
interpersonal relationships, and identification with a group
o Safety and security
▪ Needs at this level are for avoiding harm, maintaining comfort, order, structure,
physical safety, freedom from fear, and protection
o Physiological needs
▪ Basic fundamental needs include food, water, air, sleep, exercise, elimination, shelter,
and sexual expression
• Risk factors for developing a mental disorder
o Sleep wakefulness cycle
▪ Circadian rhythms
• Abnormal circadian rhythms have been associated with a variety of mental
illnesses including:
o Depression
o Bipolar disorder
o Seasonal affective disorder
• Sleep cycle
o Stage 0- Alpha
▪ This stage of the sleep-wakefulness cycle is characterized by a
relaxed, waking state with eyes closed. The alpha brain wave
rhythm has a frequency of 8 to 12 cycles per second
o Stage 1- Beta
▪ Characterized by the transition into sleep, a period of dozing in
which thoughts wander and the person drifts in and out of sleep.
Beta brain wave rhythm has a frequency of 18 to 25 cycles per
second
o Stage 2- Theta
▪ This stage comprises about one half of the time spent sleeping.
Eye movement and muscular activity are minimal. Theta brain
wave rhythm has a frequency of 4 to 7 cycles per sound.
o Stage 3- Delta
▪ This is a period of deep and restful sleep. Muscles are relaxed,
heart rate and blood pressure fall, and breathing slows. No eye
movement occurs. Delta brain wave rhythm has a frequency of 1.5
- 3 cycles per second
o Stage 4- Delta
▪ This is the stage of deepest sleep. Individuals with insomnia or
other sleep disorders often do not experience this stage of sleep.
, Eye movement and muscular activity are minimal. Delta waves
predominate.
o REM stage- Beta
▪ The dream cycle occurs during REM sleep. Eyes dart about
beneath closed eyelids, moving more rapidly then when awake.
The brain wave pattern is similar to that of stage 1 sleep. Heart
and respiration rates increase, and blood pressure may increase
or decrease. Muscles are hypotonic during REM sleep.
o Stages 2 through REM repeat throughout the cycle of sleep. One is more
likely to experience longer periods of stages 3 and 4 sleep early in the
cycle and longer periods of REM sleep later in the sleep cycle. Most
people experience REM sleep
o Genetics
o Environment
• Client rights
o Right to treatment
o Right to refuse treatment (including medication)
▪ 3 criteria need to be met before forcing medications
• Must exhibit behavior that is dangerous to self or others
• Must have a reasonable chance of providing help to pt
• Pt who refuses med must be judged incompetent to evaluate the benefits of the
treatment in question
o Right to the least restrictive treatment alternative
• Confidentiality
o HIPAA- Health insurance portability and accountability act protects patients' privacy
o Refuse to give any information to the caller/visitor, if not consented by patient/guardian, and
site confidentiality
o Professionals can break confidentiality under the duty to warn and protect third parties, and
the reporting of child and adult abuse
o A nurse can take action immediately to stop violation if a client right to privacy is being
violated
o Right to privacy
• Mental health settings
• Six indicators of mental health
o A positive attitude toward self
o Growth, development, and ability to achieve self-actualization
o Integration
o Autonomy
o Perception of reality
o Enviromental mastery
• Stages of grief
Grief is a subjective feeling of sorrow and sadness accompanied by emotional, physical, and social responses
to the loss of a loved person or thing.
Kubler-Ross (1969), during extensive research with terminally ill patients, identified five stages of feelings
and behaviors that individuals experience in response to a real, perceived, or anticipated loss:
o Stage 1- Denial: Shock and disbelief. Response may be one of “No, it can't be true!” The reality
of the loss is not acknowledged. Denial is a protective mechanism that allows the individual to
cope in an immediate time frame while organizing more effective defense strategies.
, o Stage 2- Anger: “Why me?” and “It's not fair!” are comments often expressed during the anger
stage. Envy and resentment toward individuals not affected by the loss are common. Anger
may be directed at the self or displaced on loved ones, caregivers, or even God. There may be
a preoccupation with an idealized image of the lost entity.
o Stage 3- Bargaining: Usually not visible or evident to others, a “bargain” is made with God in an
attempt to reverse or postpone the loss: “If god will help me through this, I promise I will go to
church every Sunday and volunteer my time to help other.” Sometimes the promise is
associated with feelings of guilt for not having performed satisfactorily, appropriately, or
sufficiently
o Stage 4- Depression: Full impact of the loss is experienced. The sense of loss is intense, and
feelings of sadness and depression prevail. This is a time of quiet desperation and
disengagement from all association with the lost entity. It differs from pathological depression,
which occurs when an individual becomes fixed in an earlier stage of the grief process. Rathe,
stage 4 of the grief response represents advancement toward resolution
o Stage 5- Acceptance: Brings a feeling of peace regarding the loss that has occurred. IT is a
time of quiet expectation and resignation. The focus is on the reality of the loss and its meaning
for the individuals affected by it
• Documentation
Module 2- Legal and Ethical Issues
• Therapeutic communication
o Using silence
o Accepting
o Giving recognition
o Offering self
o Giving broad openings
o Offering general leads
o Placing the event in time or sequence
o Making observations
o Encouraging description of perceptions
o Encouraging comparison
o Restating
o Reflecting Focusing
o Exploring
o Seeking clarification and validation
o Presenting reality
o Voicing doubt
o Vernalizing the implied
o Attempting to translate words into feelings
o Formulating a plan of action
• Non-therapeutic communication
o Giving false reassurance
o Rejecting
o Approving or disapproving
o Agreeing or disagreeing
o Giving advice
o Probing
o Defending
o Requesting an explanation
o Indicating the existence of an external source of power
