Foundations of Mental Health/Psychiatric Nursing

13. A person mowing the lawn is badly disfigured by the lawn mower blade. According to Erikson's theory, which age will demonstrate the greatest risk of longer-term psychological effects? 1. 11-year-old 2. 35-year-old 3. 55-year-old 4. 70-year-old

1 An 11-year-old child generally is in Erikson's stage of industry versus inferiority, which involves the mastery of skills; the child did not master the skill of lawn mowing. Also, the child will be entering adolescence (stage of identity versus confusion) when major physical and emotional changes occur in relation to how one is perceived by the self and by others.

7. A staff member tells a nurse that an older client gets irritable when asked to assist with activities of daily living. On what general information about older adults should the nurse base a response? 1. Decreased ability to cope 2. Loss of ability to cooperate 3. Ambivalence toward authority 4. Difficulty performing step procedures

1 Fears and anxieties about themselves and their possessions are common in older adults because of a decreased self-concept and an altered body image; these changes result in a decreased ability to cope.

26. A nurse is planning to teach a client about self-care. What level of anxiety will best enhance the client's learning abilities? 1. Mild 2. Panic 3. Severe 4. Moderate

1 Mild anxiety motivates one to action, such as learning or making changes. Higher levels of anxiety tend to blur the individual's perceptions and interfere with functioning.

18. A client with a diagnosis of borderline personality disorder has negative feelings toward the other clients on the unit and considers them all to be "bad." Which defense was the client using when this statement was made? 1. Splitting 2. Ambivalence 3. Passive aggression 4. Reaction formation

1 Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others.

17. A nurse greets a client who had been experiencing delusions of persecution and auditory hallucinations by saying, "Good evening. How are you?" The client, who has been referring to himself as "man," answers, "The man is bad." Of what is this an example? 1. Dissociation 2. Transference 3. Displacement 4. Identification

1 Talking in the third person reflects poor ego boundaries and a dissociation from the real self.

5. A client diagnosed with major depression tells a nurse, "No matter what I do, everything turns out bad." The nurse concludes that this is an example of: 1. using a cognitive distortion. 2. seeking sympathy from the nurse. 3. regressing to an earlier developmental level. 4. avoiding responsibility for previous behavior

1 The client is using the cognitive distortions of overgeneralization and pessimism. Negative events are magnified and become the focus, while contrary positive experiences are minimized and ignored. By focusing on the negative, the depressive mood is reinforced

22. An older adult tells the nurse, "I regret many of the choices I have made during my life." Which of Erikson's developmental conflicts does the nurse identify that the client has probably failed to accomplish? 1. Ego integrity versus despair 2. Identity versus role confusion 3. Generativity versus stagnation 4. Autonomy versus shame and doubt

1 The sense of ego integrity comes from satisfaction with life and acceptance of what has been and what is. Despair reflects guilt or remorse over what might have been.

16. After a child's visit to a health care provider, a parent tells the nurse, "I am very upset. An antidepressant was prescribed for my child." What is the nurse's best response? 1. "Tell me more about what's bothering you." 2. "Weren't you told why your child needs an antidepressant?" 3. "You need to speak with the health care provider about your concern." 4. "Are you sure it's an antidepressant and not a drug for attention deficit disorder?"

1 This response provides an opportunity to explore feelings.

8. The parents of a toddler who was recently diagnosed with moderate retardation discuss their child's future independent functioning. What should the nurse conclude? 1. They accept the child's diagnosis. 2. Denial is being used as a defense. 3. They want to explore their child's limitations. 4. Intellectualization helps them put the diagnosis into perspective

2 Use of denial involves failure to acknowledge the reality of a situation.

15. A nurse must consider a child's cognitive level of development when providing preoperative teaching. At which stage of Piaget's cognitive theory should the nurse anticipate a child will experience the greatest fear of surgery? 1. Sensorimotor 2. Preoperational 3. Formal operational 4. Concrete operational

2 Children 2 to 7 years old have difficulty distinguishing reality from fantasy, which may increase fears.

9. On which generally accepted concept of personality development should a nurse base care? 1. By 2 years of age the personality is firmly set. 2. The personality is capable of modification throughout life. 3. The capacity for personality change decreases rapidly after adolescence. 4. By the end of the first 6 years of life the personality has reached its adult parameters.

2 New methods of coping with situations require modifications of approach and attitudes; hence personality is always capable of change.

20. Incidents of child molestation often are revealed years later when the victim is an adult. Which defense mechanism reflects this situation? 1. Isolation 2. Repression 3. Regression 4. Introjection

2 Repression is a coping mechanism in which unacceptable feelings are kept out of conscious awareness; later, under stress or anxiety, thoughts or feelings surface and come into one's conscious awareness

11. Which individual is coping with issues concerning dependence versus independence? 1. Infant 2. Toddler 3. School-age child 4. Preschool-age child

2 The toddler is learning autonomy, but because of the nature of development, there is still physical and emotional dependence on the parents.

19. In response to a question posed during a group meeting, the nurse explains that the superego is that part of the self that says: 1. "I like what I want." 2. "I want what I want." 3. "I should not want that." 4. "I can wait for what I want."

3 Conscience and a sense of right and wrong are expressed in the superego, which acts to counterbalance the id's desire for immediate gratification.

14. A nurse is interviewing an 8-year-old girl who was admitted to the pediatric unit. Which statement by the child needs to be explored? 1. "Wow! This place has bright colors." 2. "Is my mother allowed to visit me tonight?" 3. "Those boys are so cute. I hope their room is next to mine!" 4. "I am scared about being here. Can you stay with me awhile?"

3 A 8-year-old child should be more concerned with same-gender relationships. A child demonstrating a strong attraction to opposite gender relations should be questioned further regarding the possibility of sexual abuse.

6. A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. What defense mechanism should the nurse determine that the client is using? 1. Introjection 2. Sublimation 3. Compensation 4. Reaction formation

3 By developing skills in one area, the individual compensates for a real or imagined deficiency, thereby maintaining a positive selfimage.

27. A client is scheduled for several diagnostic studies. Which behavior best indicates to the nurse that the client has received adequate preparation? 1. Requests that the tests be reexplained 2. Checks the appointment card repeatedly 3. Arrives early and waits quietly to be called for the tests 4. Paces up and down the hallway the morning of the tests

3 The client's early arrival indicates an expected degree of anxiety; the quiet waiting indicates that the client has been told what to expect.

29. What should a nurse conclude that a client is doing when using the defense mechanism of sublimation? 1. Acting out in reverse something already done or thought 2. Returning to an earlier, less mature stage of development 3. Channeling unacceptable impulses into socially approved behavior 4. Excluding from consciousness thoughts that are psychologically disturbing

3 The individual using sublimation attempts to fulfill desires by selecting a socially acceptable activity rather than one that is socially unacceptable.

24. A psychiatric unit uses a behavioral approach to determine a client's level of privileges. Which factor should a nurse use to determine an increase in privileges? 1. Statements that the depression is lifting 2. An improvement in short-term memory 3. Performing hygiene activities independently 4. Verbalizing a desire to change the response to stress

3 These behaviors are evidence of the client's ability to act responsibly.

1. At what age does Freud's phallic stage of psychosexual development compare with Erikson's psychosocial phase of initiative versus guilt? 1. Adolescence 2. 6 to 12 years 3. 3 to 5 1/2 years 4. Birth to 1 year

3 This is the age of Freud's phallic stage and Erikson's stage of initiative versus guilt

28. Before discharge of an anxious client, the nurse should teach the family that anxiety can be recognized as: 1. a totally unique feeling. 2. fears specifically related to the total environment. 3. consciously motivated actions, thoughts, and wishes. 4. a pattern of emotional and behavioral responses to stress.

4 Anxiety is a human response, causing both physical and emotional changes that everyone experiences when faced with stressful situations.

2. Which relationship is of most concern to the nurse because of its importance in the formation of the personality? 1. Peer 2. Sibling 3. Spousal 4. Parent-child

4 Children view their own worth by the response received from their parents. This sense of worth sets the basic ego strengths and is vital to the formation of the personality

25. A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? 1. Repression 2. Transference 3. Manipulation 4. Displacement

4 Displacement is a defense mechanism in which one's pent-up feelings toward a threatening person are discharged on lessthreatening others.

21. A client with diabetes mellitus is able to discuss in detail the diabetic metabolic process while eating a piece of chocolate cake. What defense mechanism does the nurse identify when evaluating this behavior? 1. Projection 2. Dissociation 3. Displacement 4. Intellectualization

4 Intellectualization occurs when a painful emotion is avoided by means of a rational explanation that removes the event from any personal significance.

10. A 6-year-old child is diagnosed with type 1 diabetes. Considering the child's cognitive developmental level, which explanation of the illness is most appropriate? 1. "Diabetes is caused by not having any insulin in your body." 2. "Diabetes will require you to take insulin shots for the rest of your life." 3. "You will be taught how to give yourself insulin now that you have diabetes." 4. "Taking insulin for your diabetes is like getting new batteries for your superhero toys."

4 The child is in Piaget's stage of preoperational thought, which is manifested by magical thinking; therefore, teaching should also use magical thinking.

3. A nurse concludes that a client is using displacement. Which behavior has the nurse identified? 1. Ignoring unpleasant aspects of reality 2. Resisting any demands made by others 3. Using imaginative activity to escape reality 4. Directing pent-up emotions to other than the primary source

4 When acting out against the primary source of anxiety creates even further anxiety or danger, the individual may use displacement to express feelings toward a safer person or object.

4. In the process of development the individual strives to maintain, protect, and enhance the integrity of the self. The nurse determines that this usually is accomplished through the use of: 1. affective reactions. 2. withdrawal patterns. 3. ritualistic behaviors. 4. defense mechanisms.

4 When the individual experiences a threat to self-esteem, anxiety increases and defense mechanisms are used to protect the self.

12. A 17-year-old teenager is diagnosed with leukemia. Which statements by the teenager reflect Piaget's cognitive processes associated with adolescence? Select all that apply. 1. "My smoking pot probably caused the leukemia." 2. "I'm going to do my best to fight this terrible disease." 3. "Now I can't go to the prom because I have this stupid illness." 4. "I know I got sick because I've been causing a lot of problems at home." 5. "This illness is serious, but with treatment I think I will have a chance to get better."

Answer: 2, 3, 5.

23. A client states, "I get down on myself when I make a mistake." When a cognitive therapy approach is used, which nursing interventions are most appropriate? Select all that apply. 1. Teaching the client relaxation exercises to diminish stress 2. Exploring with the client past experiences that caused distress 3. Providing the client with mastery experiences to boost self-esteem 4. Encouraging the client to replace negative thoughts with positive thoughts 5. Helping the client to modify the belief that anything less than perfection is unacceptable

Answer: 4, 5.