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