Chapter 1: Mental Health and Mental Illness

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?
1.	The client’s behaviors demonstrate mental illness in the form of depression.	
2.	The client’s behaviors are extensive, 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 what point should 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 nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents?
1.	Reactions to stress are relative rather than absolute; individual responses to stress vary.	
2.	It is abnormal for identical twins to react differently to similar stressors.	
3.	Identical twins should share the same temperament and respond similarly to stress.	
4.	Environmental influences to stress weigh more heavily than genetic influences.	

____	4.	Which client should the nurse anticipate to be most receptive to psychiatric treatment?
1.	A Jewish, female social worker.	
2.	A Baptist, homeless male.	
3.	A Catholic, black male.	
4.	A Protestant, Swedish business executive.	

____	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 eliminated.	
4.	Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.	

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

____	8.	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?
1.	Displacement	
2.	Projection	
3.	Reaction formation	
4.	Sublimation	

____	9.	Which nursing statement about the concept of neurosis is most accurate?
1.	An individual experiencing neurosis is unaware that he or she is experiencing distress.	
2.	An individual experiencing neurosis feels helpless to change his or her situation.	
3.	An individual experiencing neurosis is aware of the psychological causes of his or her behavior.	
4.	An individual experiencing neurosis has a loss of contact with reality.	

____	10.	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.	

____	11.	When under stress, a client routinely uses alcohol to excess. Finding her drunk, her 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!”	

____	12.	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?
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 experience.”	
4.	“I still don’t have any appetite and continue to lose weight.”	

____	13.	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?
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	

____	14.	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	

____	15.	How would a nurse best complete the new DSM-5 definition of a mental disorder? “A health condition characterized by significant dysfunction in an individual’s cognitions, or behaviors that reflect a disturbance in …”  which of the following?
1.	Psychosocial, biological, or developmental process underlying mental functioning	
2.	Psychological, cognitive, or developmental process underlying mental functioning	
3.	Psychological, biological, or developmental process underlying mental functioning	
4.	Psychological, biological, or psychosocial process underlying mental functioning	

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

____	16.	A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.)
1.	Fidgeting	
2.	Laughing inappropriately	
3.	Palpitations	
4.	Nail biting	
5.	Limited attention span	

Completion
Complete each statement.

	17.	_______________________ is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness.

	18.	_______________________ is a subjective state of emotional, physical, and social responses to the loss of a valued entity.

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: Easy
	Feedback	
1	The client’s behaviors are to be expected in a time of grief.	
2	The client’s behaviors are not presented as being extensive.	
3	The client’s behaviors are to be expected after a loss.	
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: 3
Heading: Mental Illness
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
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 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:	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
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Growth and Development 
Difficulty: Easy

	Feedback	
1	The nurse should explain to the parents that, although the twins have identical DNA, there are several other factors that affect reactions to stress.	
2	It is considered normal for twins to react differently to stress.	
3	Identical twins do not necessarily respond similarly to stress, due to differences in temperament and personality.	
4	Environmental influences and temperament can affect stress reactions.	

PTS:	1	CON:	Growth and Development

	4.	ANS:	1
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Discuss cultural elements that influence attitudes toward mental health and mental illness.
Page: 4
Heading: Box 1-1 Cultural Aspects of Mental Illness
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Culture
Difficulty: Easy
	Feedback	
1	The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important to physical health.	
2	The homeless client may have difficulty accessing health care and may not place a high emphasis on mental health treatment.	
3	Women are more likely to seek treatment for mental health problems than men. 	
4	This client is not typically as receptive to psychiatric treatment as the client of Jewish culture.	

PTS:	1	CON:	Culture

	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 can 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 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 is not therapeutic to the client. 	
2	This statement is not therapeutic 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.	
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: Easy
	Feedback	
1	Confronting others is not a behavior consistent with displacement.	
2	Leaving the staff meeting is not a behavior consistent with displacement.	
3	The nurse should expect that the client using the defense mechanism displacement would criticize a coworker after being confronted by the boss.	
4	Taking the boss out to lunch is not a behavior consistent with 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.	

PTS:	1	CON:	Stress

	9.	ANS:	2
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	The client is aware that he or she is experiencing distress.	
2	The client feels helpless to change his or her situation.	
3	The client is unaware of the psychological causes of the distress.	
4	The client experiences no loss of contact with reality. 	

PTS:	1	CON:	Stress

	10.	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: Easy

	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

	11.	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
	Feedback	
1	This behavior does not indicate denial.	
2	Yelling at family members does not indicate denial.	
3	Burning dinner on purpose is not an action that indicates denial.	
4	The client’s statement “I don’t drink too much!” alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it.	

PTS:	1	CON:	Addiction and Behaviors

	12.	ANS:	3
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Discuss the concepts of anxiety and grief as psychological responses to stress.
Page: 10
Heading: Stages of Grief
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Analysis [Analyzing]
Concept: Grief and Loss
Difficulty: Easy
	Feedback	
1	This statement indicates denial.	
2	This statement indicates anger.	
3	The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life.	
4	This statement indicates prolonged grieving.	

PTS:	1	CON:	Grief and Loss		

	13.	ANS:	3
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Define mental health and mental illness.
Page: 3
Heading: Mental Health
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Self
Difficulty: Easy

	Feedback	
1	This option is not the highest level on Maslow’s hierarchy of needs.	
2	While this option is important, it is not the highest level on Maslow’s hierarchy of needs.	
3	The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level on Maslow’s hierarchy of needs.	
4	This option is important for the development of the client, but is not the most important on Maslow’s hierarchy of needs.	

PTS:	1	CON:	Self

	14.	ANS:	2
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Define mental health and mental illness.
Page: 3
Heading: Mental Health
Integrated Processes: Nursing Process
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Analysis [Analyzing]
Concept: Stress
Difficulty: Easy

	Feedback	
1	Clients who complain are struggling with higher-level needs, such as the need for love and belonging or the need for self-esteem. 	
2	The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower-level needs according to Maslow’s hierarchy of needs and must be fulfilled before other higher-level needs can be met.	
3	Clients who state that no one cares are struggling with higher-level needs such as the need for love and belonging or the need for self-esteem. 	
4	Clients who have feelings of failure are struggling with higher-level needs, such as the need for love and belonging or the need for self-esteem. 	

PTS:	1	CON:	Stress

	15.	ANS:	3
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: Application [Applying]
Concept:  Patient-Centered Care
Difficulty: Easy
	Feedback	
1	This option in not part of the DSM-5 definition of a mental disorder.	
2	This option does not define the DSM-5’s mental disorder definition.	
3	The new DSM-5 definition of a mental disorder is “A health condition characterized by significant dysfunction in an individual’s cognitions, or behaviors that reflect a disturbance in the psychological, biological, or developmental process underlying mental functioning.”	
4	This option is incorrect, because it does not meet the definition set by the DSM-5 for mental health disorders.	

PTS:	1	CON:	Patient-Centered Care

MULTIPLE RESPONSE

	16.	ANS:	1, 2, 4
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Discuss the concepts of anxiety and grief as psychological responses to stress.
Page: 7
Heading: Physical and Physiological Responses to Stress > Mild Anxiety
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy

	Feedback	
1. 	This symptom is a sign of anxiety.	
2. 	This is a symptom that the nurse would expect in a client experiencing anxiety.	
3. 	The nurse would not expect the client to have palpitations.	
4. 	This option indicates anxiety.	
5.	Limited attention span does not indicate anxiety.	

PTS:	1	CON:	Stress

COMPLETION

	17.	ANS:	
Anxiety
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Discuss the concepts of anxiety and grief as psychological responses to stress.
Page: 6
Heading: Core Concept > Anxiety
Integrated Processes: Teaching and Learning
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy

Feedback: The definition of anxiety is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. Townsend considers this a core concept.

PTS:	1	CON:	Stress

	18.	ANS:	
Grief
Chapter: Chapter 1, Mental Health and Mental Illness
Objective: Discuss the concepts of anxiety and grief as psychological responses to stress.
Page: 9
Heading: Physical and Psychological Responses to Stress > Psychological Responses
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Grief and Loss
Difficulty: Easy

Feedback: The definition of grief is a subjective state of emotional, physical, and social responses to the loss of a valued entity. Townsend considers this a core concept.

PTS:	1	CON:	Grief and Loss