1. A nurse is assessing a client who experiences occasional feelings of sadness because of the recent
death of a beloved pet. The client’s appetite,
... [Show More] sleep patterns, and daily routine have not changed.
How would the nurse interpret the client’s behaviors?
1. The client’s behaviors demonstrate mental illness in the form of depression.
2. The client’s behaviors are inappropriate, which indicates the presence of mental
illness.
3. The client’s behaviors are not congruent with cultural norms.
4. The client’s behaviors demonstrate no functional impairment, indicating no mental
illness.
____ 2. At which point would 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.
____ 3. A client has been given a diagnosis of human immunodeficiency virus (HIV). Which statement
made by the client does the nurse recognize as the bargaining stage of grief?
1. “I hate my partner for giving me this disease I will die from!”
2. “If I don’t do intravenous (IV) drugs anymore, God won’t let me die.”
3. “I am going to support groups and learn more about the disease.”
4. “Can you please re-draw the test results, I think they may be wrong?”
____ 4. A nurse notes that a client is extremely withdrawn, delusional, and emotionally exhausted. The
nurse assesses the client’s anxiety as which level?
1. Mild anxiety
2. Moderate anxiety
3. Severe anxiety
4. Panic anxiety
____ 5. A psychiatric nurse intern states, “This client’s use of defense mechanisms should be eliminated.”
Which is a correct evaluation of this nurse’s 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 completely eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered and
encouraged.
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____ 6. 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?
1. “It is 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 isn’t imperative that we complete this
section.”
____ 7. A client who is being treated for chronic kidney disease complains to the health-care provider that
he does not like the food available to him while hospitalized. The health-care provider insists that
the client strictly adhere to the diet plan. What action can be expected is the client uses the defense
mechanism of displacement?
1. The client assertively confronts the health-care provider.
2. The client insists on being discharged and goes for a long, brisk walk.
3. The client snaps at the nurse and criticizes the nursing care provided.
4. The client hides his anger by explaining the logical reasoning for the diet to his
spouse.
____ 8. A fourth-grade boy teases and makes jokes about a cute girl in his class. A nurse would recognize
this behavior as indicative of which defense mechanism?
1. Displacement
2. Projection
3. Reaction formation
4. Sublimation
____ 9. 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.
____ 10. When under stress, a client routinely uses alcohol to excess. When the client’s husband finds her
drunk, the husband yells at the client about her chronic alcohol abuse. Which action alerts the
nurse to the client’s 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 don’t drink too much!”
____ 11. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which
statement by the wife would 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
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experience.”
4. “I have a difficult time getting out of bed most days.”
____ 12. According to Maslow’s 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
____ 13. According to Maslow’s hierarchy of needs, which situation on an inpatient 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
Multiple Response
Identify one or more choices that best complete the statement or answer the question.
____ 14. Which describes a defense mechanism an individual may use to relieve anxiety in a stressful
situation? (Select all that apply.)
1. Homework
2. Smoking
3. Itching
4. Nail biting
5. Sleeping
____ 15. The nurse is reviewing the DSM-5 definition of a mental health disorder and notes the definition
includes a disturbance in which areas? (Select all that apply.)
1. Cognition
2. Physical
3. Emotional regulation
4. Behavior
5. Developmental
Completion
Complete each statement.
16. _______________________ is a diffuse apprehension that is vague in nature and is associated
with feelings of uncertainty and helplessness.
17. _______________________ is a subjective state of emotional, physical, and social responses to
the loss of a valued entity.
Other
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18. Place in order the Kübler Ross stages of grief from 1-5. (Enter the number of each step in the
proper sequence, using comma and space format, such as: 1, 2, 3, 4.)
1. Bargaining
2. Denial
3. Acceptance
4. Depression
5. Anger
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Chapter 1: Mental Health and Mental Illness
Answer Section
MULTIPLE CHOICE
1. ANS: 4
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Discuss cultural elements that influence attitudes toward mental health and mental
illness.
Page: 9
Heading: Grief
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Grief and Loss
Difficulty: Moderate
Feedback
1 The client’s behaviors are to be expected in a time of grief.
2 The client’s behaviors are appropriate. It is quite normal for an individual to
function normally but to experience periods of sadness after the loss of a pet.
3 It is expected in most cultures to experience occasional feelings of sadness
following a loss, yet not experience an alteration in normal day-to-day activities
4 The nurse should assess that the client’s daily functioning is not impaired. The
client who experiences feelings of sadness after the loss of a pet is responding
within normal expectations.
PTS: 1 CON: Grief and Loss
2. ANS: 2
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Define mental health and mental illness.
Page: 4
Heading: Mental Illness
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy
Feedback
1 The client with a mental illness would have symptoms that reflect the DSM-5.
2 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
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functioning must be significantly impaired.
3 The client’s ability to communicate distress would be considered a positive
attribute.
4 The use of defense mechanisms does not indicate that the client is at risk for
mental illness.
PTS: 1 CON: Stress
3. ANS: 2
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Discuss the concepts of anxiety and grief as physiological responses to stress
Page:
Heading: Stages of Grief
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Grief and Loss
Difficulty: Moderate
Feedback
1 This statement demonstrates anger.
2 The client is asking God for a longer life in exchange for ceasing drugs, which
demonstrates bargaining.
3 This client is in the acceptance stage of the grief process
4 This client is in the denial stage of the grief process
PTS: 1 CON: Grief and Loss
4. ANS: 4
Chapter: Chapter 1, Mental Health and Mental Illness
Objective:
Page:
Heading: Anxiety
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis (Analyzing)
Concept: Stress
Difficulty: Moderate
Feedback
1 Mild anxiety is not typically symptomatic for an individual.
2 An individual with moderate anxiety has difficulty focusing and may be more
restless.
3 Severe anxiety influences attention and can cause physical symptoms such as
headaches and insomnia as well as emotional symptoms such as confusion and
dread.
4 Panic anxiety leads to inability to focus, hallucinations, delusions, wild or
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desperate behavior, feeling of terror, fear of “going crazy” or losing control,
emotional exhaustion, and physical exhaustion.
PTS: 1 CON: Stress
5. ANS: 1
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Identify physiological responses to stress.
Page: 7
Heading: Physical and Psychological Responses to Stress > Mild Anxiety
Cognitive Level: Application [Applying]
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Concept: Stress
Difficulty: Moderate
Feedback
1 The nurse should determine that defense mechanisms could be appropriate
during times of stress.
2 Defense mechanisms are not maladaptive attempts of the ego to manage anxiety.
3 Defense mechanisms are a normal part of coping with stress. They are not used
by individuals with weak ego integrity. They should not be discouraged and not
completely eliminated.
4 Defense mechanisms are normal and are used by all individuals in some way
during times of stress; they do not cause disintegration of the ego.
PTS: 1 CON: Stress
6. ANS: 3
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Identify physiological responses to stress.
Page: 9
Heading: Physical and Psychological Responses to Stress > Severe Anxiety
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
Feedback
1 This statement disregards the client’s statement and is not therapeutic to the
client.
2 This statement does not address the client’s statement and may anger the client
further.
3 The nurse should attempt to educate the client on the negative effects of
excessive stress on medical conditions.
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4 It is not appropriate to skip physiological and psychosocial questions, as this
would lead to an inaccurate assessment.
PTS: 1 CON: Stress
7. ANS: 3
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Identify physiological responses to stress.
Page: 7
Heading: Table 1-1 Ego Defense Mechanisms > Displacement
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Stress
Difficulty: Difficult
Feedback
1 Confronting others is not a behavior consistent with displacement.
2 Leaving the facility is not a behavior consistent with displacement.
3 The nurse should expect that the client using the defense mechanism of
displacement would criticize nursing care after being confronted by the
health-care provider.
4 This approach exemplifies intellectualization rather than displacement.
PTS: 1 CON: Stress
8. ANS: 3
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Identify physiological responses to stress.
Page: 7
Heading: Table 1-1 Ego Defense Mechanisms > Reaction Formation
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
Feedback
1 Displacement refers to transferring feelings from one target to another.
2 Projection refers to the attribution of unacceptable feelings or behaviors to
another person.
3 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.
4 Sublimation refers to channeling unacceptable drives or impulses into more
constructive, acceptable activities.
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PTS: 1 CON: Stress
9. ANS: 2
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Identify physiological responses to stress.
Page: 6
Heading: Physical and Physiological Responses to Stress > Anxiety
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Moderate
Feedback
1 The client with psychosis is unaware that his or her behavior is maladaptive.
2 The nurse should understand that the client with psychosis experiences little
distress owing to his or her lack of awareness of reality.
3 The client with psychosis is unaware he or she has a psychological problem.
4 The client experiencing psychosis has a lack of awareness of reality.
PTS: 1 CON: Stress
10. ANS: 4
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Identify physiological responses to stress.
Page: 7
Heading: Table 1-1 Ego Defense Mechanisms > Denial
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Addiction and Behaviors
Difficulty: Easy [Show Less]