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
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
