Test Bank Evidence Concepts in Nursing Psychiatric Edition Townsend Based 7th Practice of Health Mental Care

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Chapter 2: Mental Health/Mental Illness: Historical and Theoretical Concepts

Multiple Choice
Identify the choice that best completes the statement or answers the 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?
A. The client’s behaviors demonstrate mental illness in the form of depression.
B. The client’s behaviors are extensive which indicates the presence of mental illness.
C. The client’s behaviors are not congruent with cultural norms.
D. The client’s behaviors demonstrate no functional impairment, indicating no mental illness.

____ 2. At what point should the nurse determine that a client is at risk for developing a mental illness?
A. When thoughts, feelings, and behaviors are not reflective of the DSM-IV-TR criteria
B. When maladaptive responses to stress are coupled with interference in daily functioning
C. When a client communicates significant distress
D. When a client uses defense mechanisms as ego protection

____ 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, while the other withdraws and cries. How should the nurse explain these different responses to stress to the parents?
A. Reactions to stress are relative rather than absolute; individual responses to stress vary.
B. It is abnormal for identical twins to react differently to similar stressors.
C. Identical twins should share the same temperament and respond similarly to stress.
D. Environmental influences to stress weigh more heavily than genetic influences.

____ 4. A client has a history of excessive drinking which has led to multiple driving under the influence (DUI) arrests. 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?
A. Projection
B. Rationalization
C. Regression
D. Sublimation

____ 5. Which client should the nurse anticipate to be most receptive to psychiatric treatment?
A. A Jewish, female journalist
B. A Baptist, homeless male
C. A Catholic, black male
D. A Protestant, Swedish business executive

____ 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?
A. Defense mechanisms can be appropriate responses to stress and need not be eliminated.
B. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated.
C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated.
D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

____ 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?
A. “It’s just a routine part of our assessment. All clients are asked these same questions.”
B. “Why are you concerned about these types of questions?”
C. “Psychological factors, like excessive stress, have been found to affect medical conditions.”
D. “We can skip these questions, if you like. It isn’t imperative that we complete this section.”

____ 8. Which statement reflects a student nurse’s accurate understanding of the concepts of mental health and mental illness?
A. “The concepts are rigid and religiously based.”
B. “The concepts are multidimensional and culturally defined.”
C. “The concepts are universal and unchanging.”
D. “The concepts are unidimensional and fixed.”

____ 9. Looking at a client’s history and physical examination, a nurse notices that a diagnosis of rheumatoid arthritis has not been placed on any axis. Based on knowledge of the DSM-IV-TR, where should the nurse anticipate the coding of this assessment?
A. Axis I
B. Axis II
C. Axis III
D. Axis IV
E. Axis V

____ 10. A nurse understands that “financial and legal difficulties” are to Axis IV of the DSM-IV-TR as “bipolar disorder” is to which axis?
A. Axis I
B. Axis II
C. Axis III
D. Axis V

____ 11. Which statement should a nurse identify as the most accurate description of the DSM-IV-TR’s definition of a mental disorder?
A. A mental disorder is said to exist when an individual’s behavior deviates from the group norm.
B. A mental disorder results when an individual is unable to cope with the stressors of everyday life.
C. A mental disorder exists when subjective distress causes the individual to fail at many tasks.
D. A mental disorder is a clinically significant behavioral or psychological pattern that is associated with present distress or disability.

____ 12. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee?
A. The employee assertively confronts the boss
B. The employee leaves the staff meeting to work out in the gym
C. The employee criticizes a coworker
D. The employee takes the boss out to lunch

____ 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?
A. Displacement
B. Projection
C. Rationalization
D. Sublimation

____ 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?
A. Displacement
B. Projection
C. Reaction formation
D. Sublimation

____ 15. Which nursing statement about the concept of neuroses is most accurate?
A. “An individual experiencing neurosis is unaware that he or she is experiencing distress.”
B. “An individual experiencing neurosis feels helpless to change his or her situation.”
C. “An individual experiencing neurosis is aware of psychological causes of his or her behavior.”
D. “An individual experiencing neurosis has a loss of contact with reality.”

____ 16. Which nursing statement about the concept of psychoses is most accurate?
A. “Individuals experiencing psychoses are aware that their behaviors are maladaptive.”
B. “Individuals experiencing psychoses experience little distress.”
C. “Individuals experiencing psychoses are aware of experiencing psychological problems.”
D. “Individuals experiencing psychoses are based in reality.”

____ 17. When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at the client about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial?
A. Hiding liquor bottles in a closet
B. Yelling at their son for slouching in his chair
C. Burning dinner on purpose
D. Saying to the spouse, “I don’t drink too much!”

____ 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?
A. “If only we could have tried again, things might have worked out.”
B. “I am so mad that the children and I had to put up with him as long as we did.”
C. “Yes, it was a difficult relationship, but I think I have learned from the experience.”
D. “I still don’t have any appetite and continue to lose weight.”

____ 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?
A. Maintaining a long-term, faithful, intimate relationship
B. Achieving a sense of self-confidence
C. Possessing a feeling of self-fulfillment and realizing full potential
D. Developing a sense of purpose and the ability to direct activities

____ 20. According to Maslow’s hierarchy of needs, which situation on an in-patient psychiatric unit would require priority intervention by a nurse?
A. A client rudely complaining about limited visiting hours
B. A client exhibiting aggressive behavior toward another client
C. A client stating that no one cares
D. A client verbalizing feelings of failure

____ 21. Which is an example of the ego defense mechanism of regression?
A. A mother blames the teacher for her child’s failure in school.
B. A teenager becomes hysterical after seeing a friend killed in a car accident.
C. A woman wants to marry a man exactly like her beloved father.
D. An adult throws a temper tantrum when he does not get his own way.

____ 22. Which is the most significant consequence of the excessive use of defense mechanisms?
A. The superego will be suppressed.
B. Emotions will be experienced intensely.
C. There will be negative psychological and physiological protection.
D. Problem solving will be limited.

____ 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?
A. The husband cries and stamps his feet, demanding that his wife be true to her marriage vows.
B. The husband ignores the wife’s continued absence from the home.
C. The husband has already admitted to having an affair with a coworker.
D. The husband takes out his marital frustrations through employee abuse.

____ 24. Which should the nurse recognize as a DSM-IV-TR Axis II disorder?
A. Obesity
B. Major depressive disorder
C. Hypertension
D. Borderline personality disorder

____ 25. A nurse is caring for a client who is status post–coronary artery bypass surgery and has recently been diagnosed with major depressive disorder. A nurse should recognize that the DSM-IV-TR places these diagnoses on which two axes?
A. Axes I and IV
B. Axes II and V
C. Axes I and III
D. Axes III and V

____ 26. A nurse should recognize that the diagnostic and statistical manual of mental disorders (DSM-IV-TR) is based on which model of health-care delivery?
A. The holistic nursing model
B. The eclectic model
C. Freud’s psychoanalytic model
D. The medical model

____ 27. Which should the nurse recognize as an example of the defense mechanism of repression?
A. A student aware of the need to study for tomorrow’s test goes to a movie instead.
B. A woman whose son was killed in Iraq does not believe the military report.
C. A man who is unhappily married goes to school to become a marriage counselor.
D. A woman was raped when she was 12 and no longer remembers the incident.

Multiple Response
Identify one or more choices that best complete the statement or answer the 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.

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