General Mental Health

Surgery can be a very traumatic even for a child. The nurse, when performing preoperative preparation, knows that according to Piaget's stages of cognitive development, children will experience the greatest fear during the: 1. Sensorimotor stage 2. Preoperational stage 3. Formal operational stage 4. Concrete operational stage

2. Preoperational stage Children 2 to 7 years old have difficulty distinguishing reality from fantasy; this presents the greatest challenge to the nurse.

The nurse on a psychiatric unit identifies that a client has an increased ability to tolerate frustration. The nurse knows that, according to psychoanalytic theory, the ability to tolerate frustration is an example of one of the functions of the: 1. Id 2. Ego 3. Super ego 4. Unconscious

2. Ego Mediating frustration with the real world is an ego function and requires ego strengths.

The nurse understands that evidence of the existence of the unconscious is best demonstrated by: 1. Ease of recall 2. Slips of the tongue 3. Dejavu experiences 4. Free floating anxiety

2. Slips of the tongue Slips of the tongue, also called "Freudian slips," are material from the unconscious that slips out in unguarded moments.

About a month after their toddler is diagnosed as moderately retarded, the parents discuss the toddler's future, reflecting specifically on plans for their child's independent functioning. The nurse recognizes that the parents: 1. Are using denial 2. Accept the child's diagnosis 3. Are using intellectualization 4. Accept their child's limitations

1. Are using denial Use of denial involves failure to acknowledge the reality of the situation.

The nurse teaches a client that the level of anxiety that best enhances an individual's power of perception is: 1. Mild 2. Panic 3. Severe 4. Moderate

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

Incidence of child molestation often are revealed years later when the victim is an adult. The nurse teaches that this can best be explained by the ego defense mechanism of: 1. Repression 2. Regression 3. Rationalization 4. Reaction formation

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

Strict toilet training before a client is ready will cause problems in personality development because at this age a child is learning to: 1. Satisfy own needs 2. Identify own needs 3. Satisfy parent's needs 4. Live up to society's expectations

2. Identify own needs Toddlers struggle to identify their own needs. Too early and too strict toilet training results in ambivalence because toddlers' needs and physical ability are in conflict wit parental demands. Toddlers are faced with giving up these needs or risking parental disapproval.

The nurse utilizes play when interacting with children based on the understanding that play for the preschool age child is necessary for the emotional development of: 1. Projection 2. Introjection 3. Competition 4. Independence

2. Introjection Values and beliefs from the parents and society are expressed through the child's play world. These values become part of the child's system through the process of internalization (introjection).

One day a male client with the diagnosis of borderline personality disorder describes a situation that happened at work when his immediate supervisor reprimanded him for not completing an assignment. He explains that it was not his fault and states, "people get angry and take it out on me." Which defense mechanism identified by the nurse was the client using in this situation? 1. Denial 2. Projection 3. Displacement 4. Intellectualization

2. Projection Attributing unacceptable feelings or attributes to others is the mechanism known as projection; the data demonstrate use of this defense mechanism.

The nurse bases care on the generally accepted concept of personality development that states: 1. By 2 years of age the personality is firmly set 2. The personality is capable of change and modification throughout life 3. The capacity for personality change decreases rapidly after adolescence 4. By the end of the first 6 years, the personality has reached its adult parameters

2. The personality is capable of change and modification throughout life Any behavioral therapy or leaning of new methods of coping situations requires modifications of approach and attitudes; hence personality is always capable of change.

The nurse understands that Freud's phallic stage of psychosexual development, which compares with Erikson's psychosocial phase of initiative versus guilt, is seen best at: 1. Adolescence 2. 6 to 12 years 3. 3 to 5 1/2 years 4. Birth to 1 year

3. 3 to 5 1/2 years This is the age of Freud's phallic stage and Erikson's stage of initiative versus guilt.

When planning to teach about the stages of growth and development, what stage does the nurse indicate as basically concerned with role identifications? 1. Oral stage 2. Genital stage 3. Oedipal stage 4. Latency stage

3. Oedipal stage The child resolves the oedipal conflicts by learning to identify with the parent of the same sex and accomplishes this by mimicking the role of this parent.

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

3. Parent-child Children view their own worth by the response received form their parents. This sense of worth sets the basic ego strengths and is vital to the formation of the personality.

In the process of development, the individual strives to maintain, protect, and enhance the integrity of the self. The nurse understands that this usually is accomplished through the use of: 1. Affective reactions 2. Withdrawal patterns 3. Ritualistic behaviors 4. Defense mechanisms

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

The nurse identifies that a person has a mature personality when the: 1. Ego conforms to the demands of the super ego 2. Society sets demands to which the ego responds 3. Super ego has replaced and increased all of the controls of the parents 4. Ego acts as a balance between the pressures of the id and the super ego

4. Ego acts as a balance between the pressures of the id and the superego The mature personality does not respond to the immediate gratification demands of the id or the oppressive control of the superego because the ego is strong enough to maintain a balance between them.

A nursing assistant complains to the nurse that an older female client with dementia will complete tasks, but only when she feels like it, and wonders how one can deal with this. The nurse's response to the staff member should be based on the understanding that in addition to the dementia in this client, older adults: 1. Lose their ability to cooperate 2. Cannot perform step procedures 3. Are ambivalent toward authority 4. Have a decreased ability to cope

4. Have a decreased ability to cope 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.

A client states, "I get down on myself when I make a mistake." Using a cognitive therapy approach, what intervention is most appropriate by the nurse? 1. Teach the client relaxation exercises to diminish stress 2. Provide the client with mastery experience to boost self esteem 3. Explore the client's past experience that cause the client's distress 4. Help the client modify the belief that anything less than perfection is horrible

4. Help the client modify the belief that anything less than perfection is horrible Cognitive therapy seeks to find underlying self-defeating beliefs and replace them with more reality-based positive beliefs.

Before discharge, the nurse should teach the family of an anxious client that anxiety can be recognized as: 1. A totally unique feeling 2. Consciously motivated thoughts and wishes 3. Fears that are related to the total environment 4. The behavior pattern observed in ourselves and others

4. The behavior patter observed in ourselves and others Anxiety is a human response, causing both physical and emotional changes that everyone experiences when faced with stressful situations.

A client attending a mental health daycare unit is scheduled for several diagnostic studies. Which client behavior best indicates to the nurse that the client has received adequate preparation for these studies? 1. The client requests that the tests be reexplained 2. The client checks the appointment card repeatedly 3. The client paces the hallway the morning before the test 4. The client arrives early, waiting quietly to be called for the test

4. The client arrives early, waiting quietly to be called of the test The client's early arrival indicates an expected degree of anxiety; the quiet waiting indicates that he client has been told what to expect.

A male client experiencing delusion of persecution and auditory hallucinations is admitted for psychiatric evaluation. Later the nurse on the unit greets the client by say, "Good evening, how are you?" The client, who has been referring to himself as "Man", answers, "The man is bad." This is an example of: 1. Dissociation 2. Transference 3. Displacement 4. Reaction formation

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

A client with a diagnosis of borderline personality disorder has negative feelings towards the other clients on the unit and considers them all to be bad. Which defense was being used by the client, when the client made this statement: 1. Splitting 2. Ambivalence 3. Passive-agression 4. Reaction formation

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

A client is habitually expressing anxiety through physical symptoms. Which defense mechanism identified by the nurse is being used by this client? 1. Projection 2. Regression 3. Conversion 4. Hypochondriasis

3. Conversion The development of physical symptoms without a physical cause is an anxiety-reducing mechanism known as conversion.

The nurse understands that the super ego is part of the psyche that: 1. Contains the instinctual drives 2. Is the source of creative energy 3. Develops from internalizing the concepts of parents and significant others 4. Operates on the pleasure principle and demands immediate gratification

3. Develops from internalizing the concepts of parents and significant others The superego incorporates all experiences and learning from external environments (society, family, etc.) into the internal environment.

The nurse knows that the resolution of the oedipus complex takes place when the child: 1. Rejects the parent of the same sex 2. Introjects behaviors of both parents 3. Identifies with the parent of the same sex 4. Identifies with the parent of the opposite sex

3. Identifies with the parent of the same sex The child realizes the the parent of the same sex cannot be bested in a struggle for the affection of the parent of the opposite sex. The role and behavior of the same-sex parent are therefore assumed by the child to attract he parent of the opposite sex.

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

3. Performing hygiene activities independently These behaviors are evidence of the client's ability to act responsibly.

Which of these techniques should the nurse teach a client to eliminate intrusive, unwanted thoughts? 1. Reflecting 2. Clouding/ fogging 3. Thought stopping 4. Verbalizing the implied

3. Thought stopping Thought-stopping was developed by Joseph Wolpe for this purpose.

The nurse understands that problems with dependence versus independence develop during the sage of growth and development known as: 1. Infancy 2. School age 3. Toddlerhood 4. Preschool age

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

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

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

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. The nurse identifies this as an example of the defense mechanism of: 1. Introjection 2. Sublimation 3. Compensation 4. Reaction formation

3. Compensation By developing skills in one area, the individual compensates or makes up for a real or imagined deficiency, thereby maintaining a positive self-image.

When teaching about child abuse, the nurse includes the fact that the defense mechanism most often used by the physically abusive individual is: 1. Transference 2. Manipulation 3. Displacement 4. Reaction formation

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

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

1. Ego integrity vs. despair The sense of ego integrity comes form satisfaction with life and acceptance of what has been and what is. Despair is due to guild or remorse over what might have been.

A client diagnosed with major depression tells the nurse, "No matter what I do, everything turns out bad." The nurse understands that this is an example of the client: 1. Utilizing a cognitive distortion 2. Seeking sympathy from the nurse 3. Looking to avoid responsibility for actions 4. Regressing to an earlier developmental level

1. Utilizing a cognitive distortion This client is using the cognitive distortion of overgeneralization and pessimism. Negative events are magnified and become the focus while country positive experiences are minimized and ignored. By focusing on the negative, the depressive mood is reinforced.

The nurse knows that sublimation is a defense mechanism that helps the individual: 1. Act out in reverse something already done or thought 2. Return to an early, less mature stage of development 3. Chanel unacceptable impulses into socially approved behavior 4. Exclude from consciousness things that are psychologically disturbing

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

In response to a question pose in a group meeting, the nurse explains that the super ego 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. "I should not want that." Conscience and a sense of right and wrong are expressed in the superego, which acts to counterbalance the id's desire to immediate gratification.

The nurse identifies that a client is using displacement. Which client 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. Directing pent-up emotions to other than the primary source When acting-out against the primary source of anxiety creates even further anxiety or danger, the individual may use displacement to express feelings on a safer person or object.