Essentials of Psychiatric Mental Health
Nursing: Concepts of Care in Evidence-
Based Practice, 9th Edition
Chapter 1. Mental Health and MentalIllness
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 mentalillness.
3. The clients behaviors are not congruent with cultural norms.
4. The clients behaviors demonstrate no functional impairment, indicating no mentalillness.
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 clientsdistress 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 amentalillness?
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 dailyfunctioning.
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
responsesto stress are maladaptive and interfere with daily functioning. TheDSM-5 indicates
that in orderto be diagnosed with a mental illness, daily
,functioning must be significantly impaired. The clients ability to communicatedistress 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 responsesto the parents?
1. Reactions to stress are relative rather than absolute; individual responses to stressvary.
2. It is abnormal for identical twins to react differently to similar stressors.
3. Identical twins should share the same temperament and respond similarly tostress.
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. Mentalhealth 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 psychiatrictreatment?
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
asphysical health. Women are also more likely to seek treatment for mental health problems than
men.
Cognitive Level:
ApplicationIntegrated
Process: Planning
5. A psychiatric nurse intern states, This clients use of defense mechanisms shouldbe
eliminated.Which is a correct evaluation of this nurses statement?
1. Defense mechanisms can be appropriate responses to stress and need not beeliminated.
2. Defense mechanisms are a maladaptive attempt of the ego to manageanxiety and
shouldalways be eliminated.
3. Defense mechanisms, used by individuals with weak ego integrity, should bediscouraged
andnot eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered andencouraged.
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 psychosocialquestions.
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 samequestions.
2. Why are you concerned about these types of questions?
3. Psychological factors, like excessive stress, have been found to affect medicalconditions.
4. We can skip these questions, if you like. It isnt imperative that we complete thissection.
Nursing: Concepts of Care in Evidence-
Based Practice, 9th Edition
Chapter 1. Mental Health and MentalIllness
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 mentalillness.
3. The clients behaviors are not congruent with cultural norms.
4. The clients behaviors demonstrate no functional impairment, indicating no mentalillness.
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 clientsdistress 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 amentalillness?
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 dailyfunctioning.
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
responsesto stress are maladaptive and interfere with daily functioning. TheDSM-5 indicates
that in orderto be diagnosed with a mental illness, daily
,functioning must be significantly impaired. The clients ability to communicatedistress 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 responsesto the parents?
1. Reactions to stress are relative rather than absolute; individual responses to stressvary.
2. It is abnormal for identical twins to react differently to similar stressors.
3. Identical twins should share the same temperament and respond similarly tostress.
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. Mentalhealth 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 psychiatrictreatment?
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
asphysical health. Women are also more likely to seek treatment for mental health problems than
men.
Cognitive Level:
ApplicationIntegrated
Process: Planning
5. A psychiatric nurse intern states, This clients use of defense mechanisms shouldbe
eliminated.Which is a correct evaluation of this nurses statement?
1. Defense mechanisms can be appropriate responses to stress and need not beeliminated.
2. Defense mechanisms are a maladaptive attempt of the ego to manageanxiety and
shouldalways be eliminated.
3. Defense mechanisms, used by individuals with weak ego integrity, should bediscouraged
andnot eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered andencouraged.
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 psychosocialquestions.
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 samequestions.
2. Why are you concerned about these types of questions?
3. Psychological factors, like excessive stress, have been found to affect medicalconditions.
4. We can skip these questions, if you like. It isnt imperative that we complete thissection.
