TEST BANK FOR
DAVIS ADVANTAGE FOR TOWNSEND'S PSYCHIATRIC MENTAL HEALTH NURSING, 11TH
EDITION
BY KARYN I. MORGAN|| ALL CHAPTERS||WITH RATIONALE
,Table of Contents
Chapter 1. Mental Health And Mental Illness ................................................................................................. 3
Chapter 2. Biological Implications .................................................................................................................... 10
Chapter 3. Ethical And Legal Issues ................................................................................................................ 18
Chapter 4. Psychopharmacology ..................................................................................................................... 26
Chapter 5. Relationship Development And Therapeutic Communication ........................................... 37
Chapter 6. The Nursing Process In Psychiatric/Mental Health Nursing ............................................. 46
Chapter 7. Milieu Therapy - Therapeutic Community ................................................................................ 53
Chapter 8. Intervention In Groups ................................................................................................................... 58
Chapter 9. Crisis Intervention ........................................................................................................................... 66
Chapter 10. The Recovery Model ...................................................................................................................... 74
Chapter 11. Suicide Prevention.......................................................................................................................... 82
Chapter 12. Caring For Patients With Mental Illness And Substance Use Disorders In General
Practice Settings................................................................................................................................................... 90
Chapter 13. Neurocognitive Disorders ........................................................................................................... 99
Chapter 14. Substance Use And Addictive Disorders ...............................................................................107
Chapter 15. Schizophrenia Spectrum And Other Psychotic Disorders ...............................................120
Chapter 16. Depressive Disorders ................................................................................................................. 134
Chapter 17. Bipolar And Related Disorders ................................................................................................ 147
Chapter 18. Anxiety, Obsessive-Compulsive, And Related Disorders ............................................... 155
Chapter 19. Trauma- And Stressor-Related Disorders ........................................................................... 167
Chapter 20. Somatic Symptom And Dissociative Disorders ................................................................. 180
Chapter 21. Eating Disorders ........................................................................................................................... 188
Chapter 22. Personality Disorders ................................................................................................................ 194
Chapter 23. Children And Adolescents ....................................................................................................... 208
Chapter 24. The Aging Individual ................................................................................................................... 218
Chapter 25. Survivors Of Abuse And Neglect ............................................................................................ 225
Chapter 26. Community Mental Health Nursing........................................................................................234
Chapter 27. The Bereaved Individual ............................................................................................................ 241
Chapter 28. Military Families ......................................................................................................................... 248
Chapter 29. Concepts Of Personality Development ................................................................................. 252
Chapter 30. Complementary And Psychosocial Therapies ...................................................................258
Chapter 31. Cultural And Spiritual Concepts Relevant To Psychiatric Mental Health Nursing .. 265
Chapter 32. Issues Related To Human Sexuality And Gender Dysphoria ......................................... 274
,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.
ANSWER: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.
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.
ANSWER: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.
ANSWER: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.
ANSWER: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.
4. Defense Mechanisms Cause Disintegration Of The Ego And Should Be Fostered And
Encouraged.
ANSWER: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.
ANSWER: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.
ANSWER: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
4. Sublimation
ANSWER: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.
,ANSWER: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.
ANSWER: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!
ANSWER: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.
ANSWER: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.
ANSWER: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.
ANSWER: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 Who Complain, Have Feelings Of Failure, Or State That No One
Cares Are Struggling With Higher-Level Needs Such As The Need For Love And Belonging Or
The Need For Self-Esteem.
Cognitive Level: Analysis Integrated Process: Evaluation
15. How Would A Nurse Best Complete The New Dsm-5 Definition Of A Mental Disorder? A
Health Condition Characterized By Significant Dysfunction In An Individuals Cognitions, Or
Behaviors That Reflects A Disturbance In The
1. Psychosocial, Biological, Or Developmental Process Underlying Mental Functioning.
2. Psychological, Cognitive, Or Developmental Process Underlying Mental Functioning.
3. Psychological, Biological, Or Developmental Process Underlying Mental Functioning.
4. Psychological, Biological, Or Psychosocial Process Underlying Mental Functioning.
ANSWER:3
RATIONALE: A Health Condition Characterized By Significant Dysfunction In An Individuals
Cognitions, Or Behaviors That Reflects A Disturbance In The Psychological, Biological, Or
Developmental Process Underlying Mental Functioning, Is The New Dsm 5 Definition Of A
Mental Disorder.
Cognitive Level: Application Integrated Process: Assessment
16. A Nurse Is Assessing A Client Who Appears To Be Experiencing Some Anxiety During
Questioning. Which Symptoms Might The Client Demonstrate That Would Indicate Anxiety?
(Select All That Apply.)
1. Fidgeting
2. Laughing Inappropriately
3. Palpitations
4. Nail Biting
5. Limited Attention Span
ANSWER:1, 2, 4
, RATIONALE: The Nurse Should Assess That Fidgeting, Laughing Inappropriately, And Nail
Biting Are Indicative Of Heightened Stress Levels. The Client Would Not Be Diagnosed With
Mental Illness Unless There Is Significant Impairment In Other Areas Of Daily Functioning.
Other Indicators Of More Serious Anxiety Are Restlessness, Difficulty Concentrating, Muscle
Tension, And Sleep Disturbance.
Cognitive Level: Application Integrated Process: Assessment
Fill-In-The-Blank
17._________Is A Diffuse Apprehension That Is Vague In Nature And Is Associated With Feelings
Of Uncertainty And Helplessness.
ANSWER: Anxiety
RATIONALE: The Definition Of Anxiety Is A Diffuse Apprehension That Is Vague In Nature And
Is Associated With Feelings Of Uncertainty And Helplessness. Townsend Considers This A Core
Concept.
Cognitive Level: Application Integrated Process: Assessment
18._________Is A Subjective State Of Emotional, Physical, And Social Responses To The Loss Of
A Valued Entity.
ANSWER: Grief
RATIONALE: The Definition Of Grief Is A Subjective State Of Emotional, Physical, And Social
Responses To The Loss Of A Valued Entity. Townsend Considers This A Core Concept.
Chapter 2. Biological Implications
MULTIPLE CHOICE
1. A Depressed Client States, I Have A Chemical Imbalance In My Brain. I Have No Control Over
My Behavior. Medications Are My Only Hope To Feel Normal Again. Which Nursing Response Is
Appropriate?
1. Medications Only Address Biological Factors. Environmental And Interpersonal Factors Must
Also Be Considered.
2. Because Biological Factors Are The Sole Cause Of Depression, Medications Will Improve
Your Mood.
3. Environmental Factors Have Been Shown To Exert The Most Influence In The Development
Of Depression.
4. Researchers Have Been Unable To Demonstrate A Link Between Nature (Biology And
Genetics) And Nurture (Environment).
DAVIS ADVANTAGE FOR TOWNSEND'S PSYCHIATRIC MENTAL HEALTH NURSING, 11TH
EDITION
BY KARYN I. MORGAN|| ALL CHAPTERS||WITH RATIONALE
,Table of Contents
Chapter 1. Mental Health And Mental Illness ................................................................................................. 3
Chapter 2. Biological Implications .................................................................................................................... 10
Chapter 3. Ethical And Legal Issues ................................................................................................................ 18
Chapter 4. Psychopharmacology ..................................................................................................................... 26
Chapter 5. Relationship Development And Therapeutic Communication ........................................... 37
Chapter 6. The Nursing Process In Psychiatric/Mental Health Nursing ............................................. 46
Chapter 7. Milieu Therapy - Therapeutic Community ................................................................................ 53
Chapter 8. Intervention In Groups ................................................................................................................... 58
Chapter 9. Crisis Intervention ........................................................................................................................... 66
Chapter 10. The Recovery Model ...................................................................................................................... 74
Chapter 11. Suicide Prevention.......................................................................................................................... 82
Chapter 12. Caring For Patients With Mental Illness And Substance Use Disorders In General
Practice Settings................................................................................................................................................... 90
Chapter 13. Neurocognitive Disorders ........................................................................................................... 99
Chapter 14. Substance Use And Addictive Disorders ...............................................................................107
Chapter 15. Schizophrenia Spectrum And Other Psychotic Disorders ...............................................120
Chapter 16. Depressive Disorders ................................................................................................................. 134
Chapter 17. Bipolar And Related Disorders ................................................................................................ 147
Chapter 18. Anxiety, Obsessive-Compulsive, And Related Disorders ............................................... 155
Chapter 19. Trauma- And Stressor-Related Disorders ........................................................................... 167
Chapter 20. Somatic Symptom And Dissociative Disorders ................................................................. 180
Chapter 21. Eating Disorders ........................................................................................................................... 188
Chapter 22. Personality Disorders ................................................................................................................ 194
Chapter 23. Children And Adolescents ....................................................................................................... 208
Chapter 24. The Aging Individual ................................................................................................................... 218
Chapter 25. Survivors Of Abuse And Neglect ............................................................................................ 225
Chapter 26. Community Mental Health Nursing........................................................................................234
Chapter 27. The Bereaved Individual ............................................................................................................ 241
Chapter 28. Military Families ......................................................................................................................... 248
Chapter 29. Concepts Of Personality Development ................................................................................. 252
Chapter 30. Complementary And Psychosocial Therapies ...................................................................258
Chapter 31. Cultural And Spiritual Concepts Relevant To Psychiatric Mental Health Nursing .. 265
Chapter 32. Issues Related To Human Sexuality And Gender Dysphoria ......................................... 274
,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.
ANSWER: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.
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.
ANSWER: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.
ANSWER: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.
ANSWER: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.
4. Defense Mechanisms Cause Disintegration Of The Ego And Should Be Fostered And
Encouraged.
ANSWER: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.
ANSWER: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.
ANSWER: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
4. Sublimation
ANSWER: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.
,ANSWER: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.
ANSWER: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!
ANSWER: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.
ANSWER: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.
ANSWER: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.
ANSWER: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 Who Complain, Have Feelings Of Failure, Or State That No One
Cares Are Struggling With Higher-Level Needs Such As The Need For Love And Belonging Or
The Need For Self-Esteem.
Cognitive Level: Analysis Integrated Process: Evaluation
15. How Would A Nurse Best Complete The New Dsm-5 Definition Of A Mental Disorder? A
Health Condition Characterized By Significant Dysfunction In An Individuals Cognitions, Or
Behaviors That Reflects A Disturbance In The
1. Psychosocial, Biological, Or Developmental Process Underlying Mental Functioning.
2. Psychological, Cognitive, Or Developmental Process Underlying Mental Functioning.
3. Psychological, Biological, Or Developmental Process Underlying Mental Functioning.
4. Psychological, Biological, Or Psychosocial Process Underlying Mental Functioning.
ANSWER:3
RATIONALE: A Health Condition Characterized By Significant Dysfunction In An Individuals
Cognitions, Or Behaviors That Reflects A Disturbance In The Psychological, Biological, Or
Developmental Process Underlying Mental Functioning, Is The New Dsm 5 Definition Of A
Mental Disorder.
Cognitive Level: Application Integrated Process: Assessment
16. A Nurse Is Assessing A Client Who Appears To Be Experiencing Some Anxiety During
Questioning. Which Symptoms Might The Client Demonstrate That Would Indicate Anxiety?
(Select All That Apply.)
1. Fidgeting
2. Laughing Inappropriately
3. Palpitations
4. Nail Biting
5. Limited Attention Span
ANSWER:1, 2, 4
, RATIONALE: The Nurse Should Assess That Fidgeting, Laughing Inappropriately, And Nail
Biting Are Indicative Of Heightened Stress Levels. The Client Would Not Be Diagnosed With
Mental Illness Unless There Is Significant Impairment In Other Areas Of Daily Functioning.
Other Indicators Of More Serious Anxiety Are Restlessness, Difficulty Concentrating, Muscle
Tension, And Sleep Disturbance.
Cognitive Level: Application Integrated Process: Assessment
Fill-In-The-Blank
17._________Is A Diffuse Apprehension That Is Vague In Nature And Is Associated With Feelings
Of Uncertainty And Helplessness.
ANSWER: Anxiety
RATIONALE: The Definition Of Anxiety Is A Diffuse Apprehension That Is Vague In Nature And
Is Associated With Feelings Of Uncertainty And Helplessness. Townsend Considers This A Core
Concept.
Cognitive Level: Application Integrated Process: Assessment
18._________Is A Subjective State Of Emotional, Physical, And Social Responses To The Loss Of
A Valued Entity.
ANSWER: Grief
RATIONALE: The Definition Of Grief Is A Subjective State Of Emotional, Physical, And Social
Responses To The Loss Of A Valued Entity. Townsend Considers This A Core Concept.
Chapter 2. Biological Implications
MULTIPLE CHOICE
1. A Depressed Client States, I Have A Chemical Imbalance In My Brain. I Have No Control Over
My Behavior. Medications Are My Only Hope To Feel Normal Again. Which Nursing Response Is
Appropriate?
1. Medications Only Address Biological Factors. Environmental And Interpersonal Factors Must
Also Be Considered.
2. Because Biological Factors Are The Sole Cause Of Depression, Medications Will Improve
Your Mood.
3. Environmental Factors Have Been Shown To Exert The Most Influence In The Development
Of Depression.
4. Researchers Have Been Unable To Demonstrate A Link Between Nature (Biology And
Genetics) And Nurture (Environment).
