Chapter 2

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?

Answer 1

D. The client’s behaviors demonstrate no functional impairment, indicating no mental illness.

Question 2

At what point should the nurse determine that a client is at risk for developing a mental disorder?

Answer 2

B. When maladaptive responses to stress are coupled with interference in daily functioning

Question 3

A nurse is assessing 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, while the other withdraws and cries. How should the nurse explain these different responses to stress to the parents?

Answer 3

A. Reactions to stress are relative rather than absolute; individual responses to stress vary.

Question 4

A client has a history of excessive drinking, which has led to multiple arrests for driving under the influence (DUI). The client states, “I work hard to provide for my family. I don’t see why I can’t drink to relax.” The nurse recognizes the use of which defense mechanism?

Answer 4

B. Rationalization

Question 5

Which client should the nurse anticipate to be most receptive to psychiatric treatment?

Answer 5

A. A Jewish, female journalist

Question 6

A new psychiatric nurse states, “This client’s use of defense mechanisms should be eliminated.” Which is a correct evaluation of this nurse’s statement?

Answer 6

A. Defense mechanisms can be self-protective responses to stress and need not be eliminated.

Question 7

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?

Answer 7

C. “Psychological factors, like excessive stress, have been found to affect medical conditions.”

Question 8

Which statement reflects a student nurse’s accurate understanding of the concepts of mental health and mental illness?

Answer 8

B. “The concepts are multidimensional and culturally defined.”

Question 9

A mental health technician asks the nurse, “How do psychiatrists determine which diagnosis to give a patient?” Which of these responses by the nurse would be most accurate?

Answer 9

A. Psychiatrists use pre-established criteria from the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Question 10

The nurse is preparing to provide medication instruction for a patient. Which of the following understandings about anxiety will be essential to effective instruction?

Answer 10

B. Learning is enhanced when anxiety is mild.

Question 11

Which of the following are identified as psychoneurotic responses to severe anxiety as they appear in the DSM-5?

Answer 11

A. Somatic symptom disorders

Question 12

An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee?

Answer 12

C. The employee criticizes a coworker

Question 13

A teenage boy is attracted to a female teacher. Without objective evidence, a school nurse overhears the boy state, “I know she wants me.” This statement reflects which defense mechanism?

Answer 13

B. Projection

Question 14

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?

Answer 14

C. Reaction formation

Question 15

Which nursing statement about the concept of neuroses is most accurate?

Answer 15

B. “An individual experiencing neurosis feels helpless to change his or her situation.”

Question 16

Which nursing statement about the concept of psychoses is most accurate?

Answer 16

B. “Individuals experiencing psychoses experience little distress.”

Question 17

When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial?

Answer 17

D. Saying to the spouse, “I don’t drink too much!”

Question 18

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief?

Answer 18

C. “Yes, it was a difficult relationship, but I think I have learned from the experience.”

Question 19

A nurse is performing a mental health assessment on an adult client. According to Maslow’s hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health?

Answer 19

C. Possessing a feeling of self-fulfillment and realizing full potential

Question 20

According to Maslow’s hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse?

Answer 20

B. A client exhibiting aggressive behavior toward another client

Question 21

Which is an example of the ego defense mechanism of regression?

Answer 21

D. An adult throws a temper tantrum when he does not get his own way.

Question 22

Which is the most significant consequence of the excessive use of defense mechanisms?

Answer 22

D. Problem-solving will be limited.

Question 23

A husband accuses his wife of infidelity. Which situation would indicate to the nurse the husband’s use of the ego defense mechanism of projection?

Answer 23

C. The husband has already admitted to having an affair with a coworker.

Question 24

Which should the nurse recognize as a DSM-5 disorder?

Answer 24

B. Generalized anxiety disorder

Question 25

A nurse is educating a patient about the difference between mental health and mental illness. Which statement by the patient reflects an accurate understanding of mental health?

Answer 25

B. Mental health is successful adaptation to stressors in the internal and external environment.

Question 26

Most cultures label behavior as mental illness on the basis of which of the following criteria?

Answer 26

A. Incomprehensibility and cultural relativity

Question 27

Which should the nurse recognize as an example of the defense mechanism of repression?

Answer 27

D. A woman was raped when she was 12 and no longer remembers the incident.

Question 28

Which of the following statements should a nurse recognize as true about defense mechanisms? Select all that apply.

A. They are employed when there is a threat to biological or psychological integrity.
B. They are controlled by the id and deal with primal urges.
C. They are used in an effort to relieve mild to moderate anxiety.
D. They are protective devices for the superego.
E. They are mechanisms that are characteristically self-deceptive.

Answer 28

A, C, E

Question 29

A nurse is assessing a client who appears to be experiencing moderate anxiety during questioning. Which symptoms might the client demonstrate? Select all that apply.

A. Fidgeting
B. Laughing inappropriately
C. Palpitations
D. Nail biting
E. Extremely limited attention span

Answer 29

A, B, D

Question 30

Which of the following are cultural aspects of mental illness? Select all that apply.

A. Local or cultural norms define pathological behavior.
B. The higher the social class the greater the recognition of mental illness behaviors.
C. Psychiatrists typically see patients when the family can no longer deny the illness.
D. The greater the cultural distance from the mainstream of society, the greater the likelihood that the illness will be treated with sensitivity and compassion.

Answer 30

A, B, C

Question 31

How is the DSM-5 useful in the practice of psychiatric nursing? Select all that apply.

A. It informs the nurse of accurate and reliable medical diagnosis.
B. It represents progress toward a more holistic view of mind–body.
C. It provides a framework for interdisciplinary communication.
D. It provides a template for nursing care plans.
E. It provides a framework for communication with the client.

Answer 31

A, B, C