1
MENTAL HEALTH AND PSYCHIATRIC NURSING
DEFENSE MECHANISMS, CRISIS INTERVENTION AND ANXIETY
RELATED DISORDERS
2026 JUST RELEASED VERSION
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
Downloaded by jason mark ()
,2
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.
Downloaded by jason mark ()
,3
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
d. Reaction formation
ANSWER: A
Sublimation is the unconscious rechanneling of intolerable or socially impulses or behaviors into activities that are personally or socially
acceptable. Repression is excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious
awareness. Rationalization is excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of selfrespect. Reaction formation is acting the opposite of
what one thinks or feels
Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51
10. Mary, a client who attempted suicide recently, gave the following remarks to the nurse the next morning, “Let’s not think about
that now, maybe I’ll feel like thinking about it later.” The client is using which of the following defense mechanisms?
a. Blocking
b. Denial
c. Suppression
d. Repression
ANSWER: C
By definition, this is the conscious, deliberate effort to avoid talking or thinking about painful, anxiety producing experiences.
Repression is excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness.
Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51
11. A client in the psychiatric unit appears to imitate a certain nurse in the unit. The client seeks out for this particular nurse and
imitates her mannerisms. The nurse knows that the client is using which defense mechanism?
a. Sublimation
b. Identification
c. Introjection
d. Repression.
Answer: B
Identification (B) is an attempt to be like someone or emulate the personality traits of another. (A) is substituting an unacceptable feeling for
one that is more socially acceptable. (C) is incorporating the values or qualities of an admired person or group into one's own ego structure.
(D) is the involuntary exclusion of painful thoughts or memories from one's awareness.
Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51
12. While assessing the defense mechanisms used by the client, the nurse recognizes the client’s use of defense
Downloaded by jason mark ()
, 4
mechanisms as adaptive when the:
a. Mechanism used decreases anxiety.
c. Anxiety is expressed in behaviors.
b. Client seeks isolation to avoid stress.
d. Client can identify the stressor. Answer: A
Rationale: The purpose of defense mechanisms is to reduce anxiety levels and allow the client to function adequately. Seeking isolation to
avoid stress (option B) is an unhealthy adaptive strategy. Anxiety is expressed in behavior (option C); however, that behavior can be harmful
to clients or others. Recognition of a stressor (option D) is important but may not be useful in the client’s adaptive use of defense
mechanisms.
13. A female client comes with the nurse for an evaluation with a therapist. As they sit down and prepare for the interview, the client turns
to the therapist, looks at him sternly and says, “I didn’t think you would even want to see or talk to me.” The therapist responds, “How could
this be since I do not even know who you are?” The nurse understands that the client’s thinking is an example of which of the following
defense mechanisms?
a. Denial
b. Projection
c. Reaction formation
d. Rationalization
Downloaded by jason mark ()
MENTAL HEALTH AND PSYCHIATRIC NURSING
DEFENSE MECHANISMS, CRISIS INTERVENTION AND ANXIETY
RELATED DISORDERS
2026 JUST RELEASED VERSION
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
Downloaded by jason mark ()
,2
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.
Downloaded by jason mark ()
,3
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
d. Reaction formation
ANSWER: A
Sublimation is the unconscious rechanneling of intolerable or socially impulses or behaviors into activities that are personally or socially
acceptable. Repression is excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious
awareness. Rationalization is excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of selfrespect. Reaction formation is acting the opposite of
what one thinks or feels
Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51
10. Mary, a client who attempted suicide recently, gave the following remarks to the nurse the next morning, “Let’s not think about
that now, maybe I’ll feel like thinking about it later.” The client is using which of the following defense mechanisms?
a. Blocking
b. Denial
c. Suppression
d. Repression
ANSWER: C
By definition, this is the conscious, deliberate effort to avoid talking or thinking about painful, anxiety producing experiences.
Repression is excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness.
Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51
11. A client in the psychiatric unit appears to imitate a certain nurse in the unit. The client seeks out for this particular nurse and
imitates her mannerisms. The nurse knows that the client is using which defense mechanism?
a. Sublimation
b. Identification
c. Introjection
d. Repression.
Answer: B
Identification (B) is an attempt to be like someone or emulate the personality traits of another. (A) is substituting an unacceptable feeling for
one that is more socially acceptable. (C) is incorporating the values or qualities of an admired person or group into one's own ego structure.
(D) is the involuntary exclusion of painful thoughts or memories from one's awareness.
Reference: Videbeck. Psychiatric Nursing. 2nd edition. Page 51
12. While assessing the defense mechanisms used by the client, the nurse recognizes the client’s use of defense
Downloaded by jason mark ()
, 4
mechanisms as adaptive when the:
a. Mechanism used decreases anxiety.
c. Anxiety is expressed in behaviors.
b. Client seeks isolation to avoid stress.
d. Client can identify the stressor. Answer: A
Rationale: The purpose of defense mechanisms is to reduce anxiety levels and allow the client to function adequately. Seeking isolation to
avoid stress (option B) is an unhealthy adaptive strategy. Anxiety is expressed in behavior (option C); however, that behavior can be harmful
to clients or others. Recognition of a stressor (option D) is important but may not be useful in the client’s adaptive use of defense
mechanisms.
13. A female client comes with the nurse for an evaluation with a therapist. As they sit down and prepare for the interview, the client turns
to the therapist, looks at him sternly and says, “I didn’t think you would even want to see or talk to me.” The therapist responds, “How could
this be since I do not even know who you are?” The nurse understands that the client’s thinking is an example of which of the following
defense mechanisms?
a. Denial
b. Projection
c. Reaction formation
d. Rationalization
Downloaded by jason mark ()
