, lOMoARcPSD|7906827
Essentials of Psychiatric Mental Health
Nursing 8th Edition Concepts of Care in
Evidence - Based Practice 8th Edition Morgan
Townsend
Chapter 1. Mental Health and
Mental Illness Multiple Choice
1. A nurse is assessing a client who is experiencing occasional feelings of
sadness because of the recent 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
mental illness.
3.The clients behaviors are not congruent with cultural norms.
4.The clients behaviors demonstrate no functional impairment, indicating no
mental illness.
ANS: 4
Rationale: The nurse should assess that the clients daily functioning is not
impaired. The client who experiences feelings of sadness after the loss of a
pet is responding within normal expectations. Without significant
impairment, the clients distress 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 a mental illness?
1.When thoughts, feelings, and behaviors are not reflective of the DSM-5
criteria.
, lOMoARcPSD|7906827
2.When maladaptive responses to stress are coupled with interference in
daily functioning.
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 responses to stress are maladaptive and interfere with daily
functioning. The DSM-5 indicates that in order to be diagnosed with a
mental illness, daily functioning must be significantly impaired. The clients
ability to communicate distress 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
responses to the parents?
1.Reactions to stress are relative rather than absolute; individual responses
to stress vary.
2.It is abnormal for identical twins to react differently to similar stressors.
3.Identical twins should share the same temperament and respond similarly
to stress.
4.Environmental influences to stress weigh more heavily than genetic
influences.
, lOMoARcPSD|7906827
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. Mental health is a state of being that is 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
psychiatric treatment?
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 as physical health. Women are
also more likely to seek treatment for mental health problems than men.
Cognitive Level:
Application Integrated
Process: Planning
5.A psychiatric nurse intern states, This clients use of defense mechanisms
should be eliminated. Which is a correct evaluation of this nurses
statement?
1.Defense mechanisms can be appropriate responses to stress and need not
be eliminated.
2.Defense mechanisms are a maladaptive attempt of the ego to
manage anxiety and should always be eliminated.
3.Defense mechanisms, used by individuals with weak ego integrity, should
be discouraged and not eliminated.
, lOMoARcPSD|7906827
ANS: 1
4.Defense mechanisms cause disintegration of the ego and should be
fostered and encouraged.
ANS: 1
Rationale: The nurse should determine that defense mechanisms can be
appropriate during times of 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
psychosocial questions. The client 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 same
questions.
2.Why are you concerned about these types of questions?
3.Psychological factors, like excessive stress, have been found to affect
medical conditions.
4.We can skip these questions, if you like. It isnt imperative that we
complete this section.
, lOMoARcPSD|7906827
ANS: 3
Rationale: The nurse should attempt to educate the client on the negative
effects of excessive stress on medical conditions. It is not appropriate to
skip physiological and psychosocial questions, as this would lead to an
inaccurate assessment.
Cognitive Level:
Application Integrated
Process: Implementation
7. An employee uses the defense mechanism of displacement when the
boss openly disagrees with suggestions. What behavior would be
expected from this employee?
1.The employee assertively confronts the boss.
2.The employee leaves the staff meeting to work out in the gym.
3.The employee criticizes a coworker.
4.The employee takes the boss out to lunch.
ANS: 3
Rationale: The nurse should expect that the client using the defense
mechanism displacement would criticize a coworker after being confronted
by the boss. Displacement refers to transferring feelings from one target to
a neutral or less-threatening target.
Cognitive Level:
Analysis Integrated
Process: Assessment
8. 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?
1.Displacement
2.Projection
3.Reaction formation
, lOMoARcPSD|7906827
4.Sublimation
ANS: 3
Rationale: The nurse should identify that the boy is using reaction
formation as a defense mechanism. Reaction formation is the attempt to
prevent undesirable thoughts from being expressed by expressing opposite
thoughts or behaviors. Displacement refers to transferring feelings from
one target to another. Rationalization refers to making excuses to justify
behavior. Projection refers to the attribution of unacceptable feelings or
behaviors to another person.
Sublimation refers to channeling unacceptable drives or impulses into
more constructive, acceptable activities.
Cognitive Level:
Application Integrated
Process: Assessment
9. Which nursing statement about the concept of neurosis is most accurate?
1.An individual experiencing neurosis is unaware that he or she is
experiencing distress.
2.An individual experiencing neurosis feels helpless to change his or her
situation.
3.An individual experiencing neurosis is aware of psychological causes of his
or her behavior.
4.An individual experiencing neurosis has a loss of contact with reality.
ANS: 2
Rationale: The nurse should define the concept of neurosis with the following
characteristics:
,The client feels helpless to change his or her situation, the client is aware
that he or she is experiencing distress, the client is aware the behaviors are
maladaptive, the client is unaware of the psychological causes of the
distress, and the client experiences no loss of contact with reality.
Cognitive Level:
Application Integrated
Process: Assessment
10. Which nursing statement regarding the concept of psychosis is most
accurate?
1.Individuals experiencing psychoses are aware that their behaviors are
maladaptive.
2.Individuals experiencing psychoses experience little distress.
3.Individuals experiencing psychoses are aware of experiencing
psychological problems.
4.Individuals experiencing psychoses are based in reality.
ANS: 2
Rationale: The nurse should understand that the client with psychosis
experiences little distress owing to his or her lack of awareness of reality.
The client with psychosis is unaware that his or her behavior is
maladaptive or that he or she has a psychological problem.
Cognitive Level:
Application Integrated
Process: Assessment
11. When under stress, a client routinely uses alcohol to excess. Finding her
drunk, her husband yells at the client about her chronic alcohol abuse.
Which action alerts the nurse to the clients use of the defense mechanism of
denial?
1.The client hides liquor bottles in a closet.
,2.The client yells at her son for slouching in his chair.
3.The client burns dinner on purpose.
4.The client says to the spouse, I dont drink too much!
ANS: 4
Rationale: The clients statement I dont drink too much! alerts the nurse to
the use of the defense mechanism of denial. The client is refusing to
acknowledge the existence of a real situation and the feelings associated
with it.
Cognitive Level:
Application Integrated
Process: Assessment
12. 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?
1.If only we could have tried again, things might have worked out.
2.I am so mad that the children and I had to put up with him as long as we
did.
3.Yes, it was a difficult relationship, but I think I have learned from the
experience.
4.I still dont have any appetite and continue to lose weight.
ANS: 3
Rationale: The nurse should evaluate that the client is in the acceptance
stage of grief because during this stage of the grief process, the client
would be able to focus on the reality of the loss and its meaning in relation
to life.
, Cognitive Level:
Analysis Integrated
Process: Evaluation
13. A nurse is performing a mental health assessment on an adult client.
According to Maslows hierarchy of needs, which client action would
demonstrate the highest achievement in terms of mental health?1.
Maintaining a long-term, faithful, intimate relationship.2. Achieving a
sense of self-confidence.3. Possessing a feeling of self-fulfillment and
realizing full potential.4. Developing a sense of purpose and the ability to
direct activities.
ANS: 3
Rationale: The nurse should identify that the client who possesses a feeling
of self-fulfillment and realizes his or her full potential has achieved self-
actualization, the highest level on Maslows hierarchy of needs.
Cognitive Level:
Application Integrated
Process: Assessment
14. According to Maslows hierarchy of needs, which situation on an in-
patient psychiatric unit would require priority intervention by a nurse?1. A
client rudely complaining about limited visiting hours.2. A client exhibiting
aggressive behavior toward another client.3. A client stating that no one
cares.
4. A client verbalizing feelings
of failure. ANS: 2
Rationale: The nurse should immediately intervene when a client exhibits
aggressive behavior toward another client. Safety and security are
considered lower-level needs according to Maslows hierarchy of needs
and must be fulfilled before other higher-level needs can be met. Clients
Essentials of Psychiatric Mental Health
Nursing 8th Edition Concepts of Care in
Evidence - Based Practice 8th Edition Morgan
Townsend
Chapter 1. Mental Health and
Mental Illness Multiple Choice
1. A nurse is assessing a client who is experiencing occasional feelings of
sadness because of the recent 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
mental illness.
3.The clients behaviors are not congruent with cultural norms.
4.The clients behaviors demonstrate no functional impairment, indicating no
mental illness.
ANS: 4
Rationale: The nurse should assess that the clients daily functioning is not
impaired. The client who experiences feelings of sadness after the loss of a
pet is responding within normal expectations. Without significant
impairment, the clients distress 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 a mental illness?
1.When thoughts, feelings, and behaviors are not reflective of the DSM-5
criteria.
, lOMoARcPSD|7906827
2.When maladaptive responses to stress are coupled with interference in
daily functioning.
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 responses to stress are maladaptive and interfere with daily
functioning. The DSM-5 indicates that in order to be diagnosed with a
mental illness, daily functioning must be significantly impaired. The clients
ability to communicate distress 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
responses to the parents?
1.Reactions to stress are relative rather than absolute; individual responses
to stress vary.
2.It is abnormal for identical twins to react differently to similar stressors.
3.Identical twins should share the same temperament and respond similarly
to stress.
4.Environmental influences to stress weigh more heavily than genetic
influences.
, lOMoARcPSD|7906827
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. Mental health is a state of being that is 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
psychiatric treatment?
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 as physical health. Women are
also more likely to seek treatment for mental health problems than men.
Cognitive Level:
Application Integrated
Process: Planning
5.A psychiatric nurse intern states, This clients use of defense mechanisms
should be eliminated. Which is a correct evaluation of this nurses
statement?
1.Defense mechanisms can be appropriate responses to stress and need not
be eliminated.
2.Defense mechanisms are a maladaptive attempt of the ego to
manage anxiety and should always be eliminated.
3.Defense mechanisms, used by individuals with weak ego integrity, should
be discouraged and not eliminated.
, lOMoARcPSD|7906827
ANS: 1
4.Defense mechanisms cause disintegration of the ego and should be
fostered and encouraged.
ANS: 1
Rationale: The nurse should determine that defense mechanisms can be
appropriate during times of 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
psychosocial questions. The client 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 same
questions.
2.Why are you concerned about these types of questions?
3.Psychological factors, like excessive stress, have been found to affect
medical conditions.
4.We can skip these questions, if you like. It isnt imperative that we
complete this section.
, lOMoARcPSD|7906827
ANS: 3
Rationale: The nurse should attempt to educate the client on the negative
effects of excessive stress on medical conditions. It is not appropriate to
skip physiological and psychosocial questions, as this would lead to an
inaccurate assessment.
Cognitive Level:
Application Integrated
Process: Implementation
7. An employee uses the defense mechanism of displacement when the
boss openly disagrees with suggestions. What behavior would be
expected from this employee?
1.The employee assertively confronts the boss.
2.The employee leaves the staff meeting to work out in the gym.
3.The employee criticizes a coworker.
4.The employee takes the boss out to lunch.
ANS: 3
Rationale: The nurse should expect that the client using the defense
mechanism displacement would criticize a coworker after being confronted
by the boss. Displacement refers to transferring feelings from one target to
a neutral or less-threatening target.
Cognitive Level:
Analysis Integrated
Process: Assessment
8. 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?
1.Displacement
2.Projection
3.Reaction formation
, lOMoARcPSD|7906827
4.Sublimation
ANS: 3
Rationale: The nurse should identify that the boy is using reaction
formation as a defense mechanism. Reaction formation is the attempt to
prevent undesirable thoughts from being expressed by expressing opposite
thoughts or behaviors. Displacement refers to transferring feelings from
one target to another. Rationalization refers to making excuses to justify
behavior. Projection refers to the attribution of unacceptable feelings or
behaviors to another person.
Sublimation refers to channeling unacceptable drives or impulses into
more constructive, acceptable activities.
Cognitive Level:
Application Integrated
Process: Assessment
9. Which nursing statement about the concept of neurosis is most accurate?
1.An individual experiencing neurosis is unaware that he or she is
experiencing distress.
2.An individual experiencing neurosis feels helpless to change his or her
situation.
3.An individual experiencing neurosis is aware of psychological causes of his
or her behavior.
4.An individual experiencing neurosis has a loss of contact with reality.
ANS: 2
Rationale: The nurse should define the concept of neurosis with the following
characteristics:
,The client feels helpless to change his or her situation, the client is aware
that he or she is experiencing distress, the client is aware the behaviors are
maladaptive, the client is unaware of the psychological causes of the
distress, and the client experiences no loss of contact with reality.
Cognitive Level:
Application Integrated
Process: Assessment
10. Which nursing statement regarding the concept of psychosis is most
accurate?
1.Individuals experiencing psychoses are aware that their behaviors are
maladaptive.
2.Individuals experiencing psychoses experience little distress.
3.Individuals experiencing psychoses are aware of experiencing
psychological problems.
4.Individuals experiencing psychoses are based in reality.
ANS: 2
Rationale: The nurse should understand that the client with psychosis
experiences little distress owing to his or her lack of awareness of reality.
The client with psychosis is unaware that his or her behavior is
maladaptive or that he or she has a psychological problem.
Cognitive Level:
Application Integrated
Process: Assessment
11. When under stress, a client routinely uses alcohol to excess. Finding her
drunk, her husband yells at the client about her chronic alcohol abuse.
Which action alerts the nurse to the clients use of the defense mechanism of
denial?
1.The client hides liquor bottles in a closet.
,2.The client yells at her son for slouching in his chair.
3.The client burns dinner on purpose.
4.The client says to the spouse, I dont drink too much!
ANS: 4
Rationale: The clients statement I dont drink too much! alerts the nurse to
the use of the defense mechanism of denial. The client is refusing to
acknowledge the existence of a real situation and the feelings associated
with it.
Cognitive Level:
Application Integrated
Process: Assessment
12. 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?
1.If only we could have tried again, things might have worked out.
2.I am so mad that the children and I had to put up with him as long as we
did.
3.Yes, it was a difficult relationship, but I think I have learned from the
experience.
4.I still dont have any appetite and continue to lose weight.
ANS: 3
Rationale: The nurse should evaluate that the client is in the acceptance
stage of grief because during this stage of the grief process, the client
would be able to focus on the reality of the loss and its meaning in relation
to life.
, Cognitive Level:
Analysis Integrated
Process: Evaluation
13. A nurse is performing a mental health assessment on an adult client.
According to Maslows hierarchy of needs, which client action would
demonstrate the highest achievement in terms of mental health?1.
Maintaining a long-term, faithful, intimate relationship.2. Achieving a
sense of self-confidence.3. Possessing a feeling of self-fulfillment and
realizing full potential.4. Developing a sense of purpose and the ability to
direct activities.
ANS: 3
Rationale: The nurse should identify that the client who possesses a feeling
of self-fulfillment and realizes his or her full potential has achieved self-
actualization, the highest level on Maslows hierarchy of needs.
Cognitive Level:
Application Integrated
Process: Assessment
14. According to Maslows hierarchy of needs, which situation on an in-
patient psychiatric unit would require priority intervention by a nurse?1. A
client rudely complaining about limited visiting hours.2. A client exhibiting
aggressive behavior toward another client.3. A client stating that no one
cares.
4. A client verbalizing feelings
of failure. ANS: 2
Rationale: The nurse should immediately intervene when a client exhibits
aggressive behavior toward another client. Safety and security are
considered lower-level needs according to Maslows hierarchy of needs
and must be fulfilled before other higher-level needs can be met. Clients
