Test Bank Health Nursing 6th Edition Psychiatric by Townsend Mental
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Mary C. Townsend DSN, PMHCNS-BC
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Mary C. Townsend DSN, PMHCNS-BC
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Chapter 2: Mental Health/Mental Illness: Historical and Theoretical Concepts
1. A newly admitted client who is homeless refuses to go to group therapy. The client is found in his room, lying on the floor, with hoards of pantry items in his pockets. According to Maslow’s theory, how should a nurse interpret this client’s behavior?
A) Some clients are inherently incapable of achieving self-actualization.
B) A degree of nonconformity is a sign of a self-actualized individual.
C) Fulfillment of basic needs, such as safety, rest, and nutrition, takes precedence over higher level needs, such as affiliation and self-actualization.
D) Psychological health is less important than physical health.
2. A newly admitted client who was injured in a bar fight, refuses to go to group therapy. Several days later, however, the client attends and participates in his first group therapy session. According to Maslow, how should the nurse interpret this client’s behavior?
A) Higher-level needs, such as affiliation and self-actualization, can be addressed after basic needs have been met.
B) This client’s need for affiliation is much stronger than his basic needs.
C) Self-actualized persons tend to desire outlets for their creativity, as afforded by group therapy sessions.
D) Psychological health is more important than physical health.
3. A client is experiencing occasional feelings of sadness because of the recent death of a pet. The client’s appetite and sleep patterns have not changed, however, and the client continues with daily routines. Should a nurse suspect that the client has a mental illness? Why?
A) Yes; the client demonstrates impaired mood.
B) Yes; the client is presently in distress.
C) No; the client’s behaviors are congruent with cultural norms.
D) No; although the client may be in distress, there has been no impairment in functioning.
4. At which point should a nurse understand that a client is experiencing a mental illness?
A) When thoughts, feelings, and behaviors are incongruent with the DSM-IV-TR criteria
B) When maladaptive responses to stress are coupled with interference in daily functioning
C) When a clinically significant pattern of distress emerges
D) When primary defense mechanisms overwhelm secondary appraisals
5. Clients A and B are identical twins. Although they look alike, they respond very differently to stress. Whereas client A tends to get irritable and uptight, client B withdraws from the situation and occasionally cries. How might this differential response to stress be best explained by a nurse?
A) Anxiety and grief are thought to be two primary psychological response patterns to stress.
B) Anger and withdrawal are thought to be two primary psychological response patterns to stress.
C) Both irritability and withdrawal are manifestations of depression.
D) Environmental influences on the stress response weigh more heavily than genetic influences.
6. A client tells a nurse that his anxiety level increased recently when he asked a woman to dance with him. Which symptoms should the nurse anticipate that the client experienced during this encounter? Select all that apply.
D) Smooth talking
7. A client drinks excessive amounts of alcohol and has subsequently lost his driver’s license. The client refuses, however, to seek treatment. The client states, “I work hard every day to provide for my family. I don’t see why I can’t relax a little.” Which defense mechanism should a nurse recognize as being used by this client?
8. A nurse is caring for four clients. Which client is least likely to seek psychiatric care?
A) Jewish female social worker
B) Catholic female accountant
C) Jewish male teacher
D) Protestant male business executive
9. A nurse is reviewing documentation in a client’s chart that was recorded by a nurse on the previous shift. The nurse on the previous shift noted, “The client uses avoidance as a defense mechanism when asked about his abusive childhood.” How should the oncoming nurse interpret this documentation?
A) Defense mechanisms are used by all individuals, are not necessarily maladaptive, and may not warrant elimination.
B) Defense mechanisms are a maladaptive attempt of the ego to manage excess anxiety.
C) Defense mechanisms are used by individuals with weak ego integrity.
D) Defense mechanisms cause disintegration of the ego and should be avoided.
10. A newly hired nurse on a medical–surgical unit is caring for a client with a cardiac condition. As the nurse is conducting the psychosocial portion of the assessment, the client states, “I’m here for my heart problem, not a mental health problem. What’s that got to do with it?” The nurse’s best reply is:
A) “It’s just a routine part of our assessment. All clients are asked these same questions.”
B) “You sound concerned about the psychological portion of the assessment. What seems to be the problem?”
C) “Psychological factors, such as excessive stress levels, have been found to affect the course of nearly every major disease, including cardiac problems.”
D) “We can skip these questions, if you like. It isn’t imperative that we complete this section.”
11. A nurse is caring for a client who questions how mental health and mental illness are defined. Which words should the nurse use to describe the concepts of mental health and mental illness?
A) Rigid and existential
B) Multidimensional and culturally defined
C) Universal and unchanging
D) Unidimensional and fixed
12. On which DSM-IV-TR axis should a nurse expect “bipolar illness: manic phase” to be coded?
A) Axis I
B) Axis II
C) Axis III
D) Axis IV
E) Axis V
13. On which DSM-IV-TR axis should a nurse expect “rheumatoid arthritis” to be coded?
A) Axis I
B) Axis II
C) Axis III
D) Axis IV
E) Axis V
14. On which DSM-IV-TR axis should a nurse expect “financial and legal difficulties” to be coded?
A) Axis I
B) Axis II
C) Axis III
D) Axis IV
E) Axis V
15. Which item is not coded on a DSM-IV-TR axis?
A) Physical disorders
B) Psychosocial stressors
C) Treatment recommendations
D) Global assessment of functioning
E) Clinical disorders
16. A nursing assistant asks a nurse why the DSM-IV-TR is useful to psychiatric nursing practice. The best response by the nurse is that the DSM-IV-TR:
Select all that apply.
A) Considers strengths and problems.
B) Represents progress toward a more holistic view of mind–body.
C) Provides a framework for interdisciplinary communication.
D) Recommends treatment regimens for each psychiatric diagnosis.
17. Which statement should a nurse recognize to most accurately reflect the DSM-IV-TR definition of a mental disorder?
A) A mental disorder is said to exist when an individual’s overall 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.
18. A client tends to use the defense mechanism of displacement in a group meeting. Another group member openly disagrees with the client’s suggestions. When using the defense mechanism of displacement, the client is most likely to react by:
A) Assertively confronting the other group member.
B) Angrily leaving the group meeting.
C) Criticizing a different group member.
D) Asking the group member to sit by her at lunch.
19. A teenage boy is attracted to a female classmate. As he is standing with his friends in the hall, she walks by. He says, “I know she likes me.” Which defense mechanism is demonstrated?
20. A teenage girl is attracted to a male classmate. As the male classmate walks by, the teenage girl makes jokes about him and taunts him. Which defense mechanism is the teenage girl demonstrating?
C) Reaction formation
21. A psychiatric nurse is caring for several clients. One client is considered neurotic and another is considered psychotic. The main difference that the nurse should understand between neurotic and psychotic behavior is that neurotic individuals:
A) Are unaware that they are experiencing distress.
B) Are unaware that their behaviors are maladaptive.
C) Are aware of possible psychological causes of their behavior.
D) Experience no loss of contact with reality.
22. A client tends to use the defense mechanism of displacement. The client’s husband, whom she loves very much, yells at her for not having dinner ready when he comes home from work. Knowing that the client uses displacement as a defense mechanism, a nurse should anticipate that the client would most likely react by:
A) Telling her husband he has no right to yell at her.
B) Yelling at their son for slouching in his chair.
C) Burning dinner.
D) Saying to her husband, “I’ll try to do better tomorrow.”
23. A nurse is working with a couple who have recently divorced. The wife is devastated by the divorce and becomes very depressed. She sought counseling at the community mental health center. Which client statement should indicate to the nurse that the wife has resolved the grief over the loss of her marriage?
A) “I know things would be different if we could only try again.”
B) “He will be back. I know he will.”
C) “I’m sure I did lots of things to provoke his anger.”
D) “Yes, it was a difficult relationship, and he abused the children and me.”
24. A client tells a nurse that she hates her mother, who paid little attention to her when she was growing up. The nurse is documenting the client’s use of the defense mechanism of reaction formation. Which client statement represents this defense mechanism?
A) “I don’t like to talk about my relationship with my mother.”
B) “It’s my mother’s fault that I feel this way.”
C) “I have a very wonderful mother whom I love very much.”
D) “My mom always loved my sister more than she loved me.”
25. A psychiatric nurse is caring for a client whose husband died 23 years ago. The client has not changed a thing in their house since he died. She still has all of her husband’s clothing in the closet, and his house slippers are still beside the bed where they were when he died. The client talks about her husband unceasingly to anyone who will listen. Which of the following pathological grief responses does the nurse recognize is being demonstrated by this client?
26. A nurse is caring for a client with panic-level anxiety. Which symptoms should the nurse anticipate?
A) Decreased attention span, hypotension, mild muscle tension
B) Frequent posture changes, feeling of nervousness, enhanced learning
C) Narrow perceptual field, decreased problem-solving ability, mild gastric upset
D) Feeling of losing control, misperceptions of the environment
27. A client tells a nurse that he gets anxious before examinations. His heart rate speeds up a bit, and his palms get sweaty. Once he starts taking the test, however, the client states that he begins to feel better and usually performs well. Which type of anxiety should the nurse recognize that this client is experiencing?
28. A client is experiencing persistent mild anxiety. The client is an introverted person who likes to stay indoors. Which method of decreasing anxiety should a nurse recommend?
A) Taking a long walk in the woods
B) Having a drink to unwind a bit
C) Talking with a trusted friend
D) Sleeping as much as possible to avoid the problem
29. A 39-year-old Italian American client lives in an ethnic community of Italian immigrants. He, and most of his peers, are of lower-socioeconomic income. Recently, the client was charged with an act of voyeurism. Which individual would be most likely to label the client’s behavior as mental illness?
A) The client’s parents, who are ashamed of his behavior
B) The client’s friends from his “Sons of Italy” social club
C) The client’s employer, who owns the company where he works
D) The client’s wife, who believes she must protect their children
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