Test Bank for Kaplan and Sadocks
Synopsis of Psychiatry Edition 12 All
Chapters with Answers and Rationals.
Chapter 1: Examination and Diagnosis of the Psychiatric Patient (Questions 1-30)
Question 1: A nurse is assessing a client who is experiencing occasional feelings of sadness because of
the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not
changed. How should the nurse interpret the client's behaviors?
1. The client's behaviors demonstrate mental illness in the form of depression.
2. The client's behaviors are extensive, which indicates the presence of mental illness.
3. The client's behaviors are not congruent with cultural norms.
4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.
Answer: 4
Rationale: The nurse should assess that the client's daily functioning is not impaired. The client who
experiences feelings of sadness after the loss of a pet is responding within normal expectations. The
behaviors are to be expected in a time of grief and do not indicate mental illness .
Question 2: At what point should the nurse determine that a client is at risk for developing a mental
illness?
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.
Answer: 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 order to be
diagnosed with a mental illness, daily functioning must be significantly impaired .
,Question 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.
Answer: 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. It is considered normal for twins to react
differently to stress due to differences in temperament and personality .
Question 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.
Answer: 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 to physical health.
The homeless client may have difficulty accessing health care. Women are more likely to seek treatment
for mental health problems than men .
Question 5: A psychiatric nurse intern states, "This client's use of defense mechanisms should be
eliminated." Which is a correct evaluation of this nurse's 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 should
always be eliminated.
3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and
not eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.
Answer: 1
,Rationale: The nurse should determine that defense mechanisms can be appropriate during times of
stress. Defense mechanisms are a normal part of coping with stress. They are used by all individuals in
some way during times of stress and do not cause disintegration of the ego .
Question 6: During an intake assessment, a nurse asks both physiological and psychosocial questions.
The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best
response?
1. "It is 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 isn't imperative that we complete this section."
Answer: 3
Rationale: The nurse should attempt to educate the client on the negative effects of excessive stress on
medical conditions. This provides psychoeducation and helps the client understand the mind-body
connection. It is not appropriate to skip physiological and psychosocial questions, as this would lead to
an inaccurate assessment .
Question 7: An employee uses the defense mechanism of displacement when the boss openly disagrees
with 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.
Answer: 3
Rationale: Displacement refers to transferring feelings from one target to another. The employee who
cannot confront the boss directly displaces anger onto a safer target, such as a coworker. Confronting
the boss would be assertiveness, not displacement .
Question 8: A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior
should be identified by a nurse as indicative of which defense mechanism?
1. Displacement
2. Projection
3. Reaction formation
, 4. Sublimation
Answer: 3
Rationale: Reaction formation involves expressing the opposite of one's true feelings. The boy's teasing
masks his actual attraction to the girl. Displacement transfers feelings from one target to another,
projection attributes unacceptable feelings to another person, and sublimation channels unacceptable
drives into constructive activities .
Question 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 the psychological causes of his or her behavior.
4. An individual experiencing neurosis has a loss of contact with reality.
Answer: 2
Rationale: The client with neurosis feels helpless to change his or her situation. The client is aware of
distress but feels powerless. There is no loss of contact with reality—that indicates psychosis. The client
is typically unaware of the psychological causes of the distress .
Question 10: Which nursing statement regarding the concept of psychosis is most accurate?
1. Individuals experiencing psychoses are aware that their behaviors are maladaptive.
2. Individuals experiencing psychoses experience little distress.
3. Individuals experiencing psychoses are aware of experiencing psychological problems.
4. Individuals experiencing psychoses are based in reality.
Answer: 2
Rationale: The nurse should understand that the client with psychosis experiences little distress owing
to lack of awareness of reality. The client with psychosis is unaware that his or her behavior is
maladaptive, is unaware of having a psychological problem, and has a lack of awareness of reality .
Question 11: When under stress, a client routinely uses alcohol to excess. Finding her drunk, her
husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's
use of the defense mechanism of denial?
1. The client hides liquor bottles in a closet.
2. The client yells at her son for slouching in his chair.
Synopsis of Psychiatry Edition 12 All
Chapters with Answers and Rationals.
Chapter 1: Examination and Diagnosis of the Psychiatric Patient (Questions 1-30)
Question 1: A nurse is assessing a client who is experiencing occasional feelings of sadness because of
the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not
changed. How should the nurse interpret the client's behaviors?
1. The client's behaviors demonstrate mental illness in the form of depression.
2. The client's behaviors are extensive, which indicates the presence of mental illness.
3. The client's behaviors are not congruent with cultural norms.
4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.
Answer: 4
Rationale: The nurse should assess that the client's daily functioning is not impaired. The client who
experiences feelings of sadness after the loss of a pet is responding within normal expectations. The
behaviors are to be expected in a time of grief and do not indicate mental illness .
Question 2: At what point should the nurse determine that a client is at risk for developing a mental
illness?
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.
Answer: 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 order to be
diagnosed with a mental illness, daily functioning must be significantly impaired .
,Question 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.
Answer: 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. It is considered normal for twins to react
differently to stress due to differences in temperament and personality .
Question 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.
Answer: 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 to physical health.
The homeless client may have difficulty accessing health care. Women are more likely to seek treatment
for mental health problems than men .
Question 5: A psychiatric nurse intern states, "This client's use of defense mechanisms should be
eliminated." Which is a correct evaluation of this nurse's 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 should
always be eliminated.
3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and
not eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.
Answer: 1
,Rationale: The nurse should determine that defense mechanisms can be appropriate during times of
stress. Defense mechanisms are a normal part of coping with stress. They are used by all individuals in
some way during times of stress and do not cause disintegration of the ego .
Question 6: During an intake assessment, a nurse asks both physiological and psychosocial questions.
The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best
response?
1. "It is 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 isn't imperative that we complete this section."
Answer: 3
Rationale: The nurse should attempt to educate the client on the negative effects of excessive stress on
medical conditions. This provides psychoeducation and helps the client understand the mind-body
connection. It is not appropriate to skip physiological and psychosocial questions, as this would lead to
an inaccurate assessment .
Question 7: An employee uses the defense mechanism of displacement when the boss openly disagrees
with 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.
Answer: 3
Rationale: Displacement refers to transferring feelings from one target to another. The employee who
cannot confront the boss directly displaces anger onto a safer target, such as a coworker. Confronting
the boss would be assertiveness, not displacement .
Question 8: A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior
should be identified by a nurse as indicative of which defense mechanism?
1. Displacement
2. Projection
3. Reaction formation
, 4. Sublimation
Answer: 3
Rationale: Reaction formation involves expressing the opposite of one's true feelings. The boy's teasing
masks his actual attraction to the girl. Displacement transfers feelings from one target to another,
projection attributes unacceptable feelings to another person, and sublimation channels unacceptable
drives into constructive activities .
Question 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 the psychological causes of his or her behavior.
4. An individual experiencing neurosis has a loss of contact with reality.
Answer: 2
Rationale: The client with neurosis feels helpless to change his or her situation. The client is aware of
distress but feels powerless. There is no loss of contact with reality—that indicates psychosis. The client
is typically unaware of the psychological causes of the distress .
Question 10: Which nursing statement regarding the concept of psychosis is most accurate?
1. Individuals experiencing psychoses are aware that their behaviors are maladaptive.
2. Individuals experiencing psychoses experience little distress.
3. Individuals experiencing psychoses are aware of experiencing psychological problems.
4. Individuals experiencing psychoses are based in reality.
Answer: 2
Rationale: The nurse should understand that the client with psychosis experiences little distress owing
to lack of awareness of reality. The client with psychosis is unaware that his or her behavior is
maladaptive, is unaware of having a psychological problem, and has a lack of awareness of reality .
Question 11: When under stress, a client routinely uses alcohol to excess. Finding her drunk, her
husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's
use of the defense mechanism of denial?
1. The client hides liquor bottles in a closet.
2. The client yells at her son for slouching in his chair.
