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Psychiatric - Mental Health II-1 exam
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Psychiatric - Mental Health II-1 exam
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Psychiatric - Mental Health II-1 examWhen interacting with patients, it is important for the nurse to recognize that defense
mechanisms:
a. keep id impulses from gaining control.
b. protect the ego from excessive anxiety.
c. access unconscious feelings and memories.
d. prevent conflict among the id, ego, and superego. - ANS-ANS: B
Theorists widely accept the Freudian concept that ego defense mechanisms operate
unconsciously to lower anxiety. The function of defense mechanisms is limited to
anxiety control, so the other options are incorrect.
A nurse plans an intervention to supports a patient's ego. This intervention is
therapeutic, because the individual's ego:
a. provides rational, logical reality testing.
b. is primarily concerned with right and wrong.
c. uses primary process imagery to meet basic needs.
d. is derived from the individual's pattern of thinking. - ANS-ANS: A
The ego focuses on the reality principle and uses secondary-process thinking, a logical,
rational operation to maintain the well-being of the individual. The superego is
concerned with right and wrong. The id uses primary process. Ego formation is
influenced by heredity, environment, and maturation
A patient asks, "Why is it important to uncover memories and conflicts hidden in the
unconscious?" A Freudian therapist would explain that bringing unconscious information
to consciousness will:
a. resolve developmental issues, fears, and crises.
b. allow an individual control over the id and superego.
c. suppress painful feelings and increase rational thinking.
d. provide insight into behavior and allow meaningful change to occur. - ANS-ANS: D
Freud believed that uncovering unconscious material generates an understanding of
behavior that enables individuals to make choices about behavior and thus improve
mental health. It will not, however, automatically resolve issues, give the patient control
over id and superego strivings, or result in rational thinking.
A patient uses defense mechanisms excessively. The nurse should expect to find
evidence that:
a. the patient has difficulty with problem solving.
b. the patient has an increased risk for psychosis.
,c. emotions are experienced with great intensity.
d. reality is denied. - ANS-ANS: A
Excessive use of defense mechanisms results in the distortion of reality. When reality is
not perceived accurately, problem solving is impaired. The other options might or might
not be experienced by the patient.
A patient experiences severe panic attacks and uses denial, repression, and
displacement. Nursing interventions should be directed toward:
a. teaching more effective coping strategies.
b. setting limits on use of the defense mechanisms.
c. assisting the patient to change values and beliefs.
d. helping the patient uncover unconscious conflicts. - ANS-ANS: A
A desired outcome would be that the patient will use more effective coping strategies.
Nursing intervention would focus on helping the patient identify and use more adaptive
coping strategies. Setting limits on the use of defense mechanisms is impossible.
Values clarification might be unnecessary. Uncovering conflicts is not a focus of nursing
intervention.
A young adult lives with his parents, has few interpersonal relationships, and says,
"Most people can't be trusted." This person makes decisions only after consulting with
his parents. Using Erikson's developmental theory, the nurse can draw which
conclusion?
a. The patient has evidence of inferiority and lacks a sense of direction.
b. Developmental deficits in early life have impaired the patient's adult functioning.
c. The patient's developmental problems will probably lead to a serious mental illness.
d. It is impossible for the patient to proceed to the next developmental stage until
mastering earlier stages. - ANS-ANS: B
The patient achieved only partial mastery of the trust-versus-mistrust stage. Deficits in
development carried from one stage to the next interfere with functioning at the adult
level. Individuals do progress from stage to stage when mastery is not attained;
however, adjustment is usually impaired. Developmental problems might lead to a
serious mental disorder but might also produce less serious results
When the nurse conducts a developmental assessment with a new patient, the
assessment can be expected to yield information regarding what?
a. The use of defense mechanisms
b. The degree of mastery of critical tasks
c. Strategies to help the patient make rational decisions
d. The mobilization of defenses against the patient's stressors - ANS-ANS: B
,According to Erikson's developmental theory, a developmental assessment is
conducted for the purpose of determining the extent to which an individual has
successfully mastered the critical task of each stage of development up to his or her
chronologic age. Lack of mastery or partial mastery will yield clues about issues to be
addressed in working with the patient. Because of its focus, the developmental
assessment might yield only minimal information about defense mechanism use and
defenses used to cope with stress. Rational decision making is not expected to be
fostered as a result of developmental assessment.
A patient diagnosed with lung cancer continues to smoke and says, "I think my cancer is
more the result of a bad gene than of smoking." The patient shows the use of which
defense mechanism?
a. Denial
b. Compensation
c. Intellectualization
d. Reaction formation - ANS-ANS: A
Denial is the unconscious refusal to admit an unacceptable idea or behavior, as shown
in this example. Compensation refers to covering a weakness by overemphasizing a
desirable trait. Intellectualization involves using a logical explanation without expressing
emotion or affect. Reaction formation is a conscious behavior that is the opposite of an
unconscious feeling.
A patient tells the nurse, "The reason I use drugs is because everybody nags me to do
things that don't interest me." The patient shows use of which defense mechanism?
a. Sublimation
b. Introjection
c. Identification
d. Rationalization - ANS-ANS: D
Rationalization is an attempt to prove that one's behaviors or feelings are justifiable and
involves making justifications of feelings or behaviors. Sublimation channels instinctual
drives into acceptable channels. The patient is not modeling after another person or
incorporating another's values.
A patient is mute, curled in a fetal position, and incontinent of urine. The patient eats
small amounts only if spoon-fed. The nurse assesses this behavior as most indicative
of:
a. displacement.
b. compensation.
c. conversion.
d. regression. - ANS-ANS: D
, Regression is defined as the return to an earlier, more comfortable developmental
state—in this case, infancy. Displacement involves discharging feelings to an object that
is less threatening. Compensation refers to covering a weakness by overemphasizing a
desirable trait. Conversion refers to the unconscious expression of conflict symbolically
through physical symptoms.
A young adult has a realistic sense of self, a commitment to reasonable career goals, a
satisfying intimate-partner relationship, and a circle of loyal friends. This person says, "I
volunteer for important projects in my community." The nurse can draw which
conclusion?
a. There is lack of mastery of critical tasks associated with the stage of industry versus
inferiority.
b. Mastery of critical tasks associated with the stage of identity versus role diffusion is
evident.
c. Fear of criticism and affection affect mastery of critical tasks associated with intimacy.
d. The person vacillates between dependence and independence. - ANS-ANS: B
Adult behavior reflecting mastery of the critical tasks associated with the stage of
identity versus role diffusion includes confident sense of self, emotional stability,
commitment to career planning, sense of having a place in society, establishing a
relationship with the opposite sex, fidelity to friends, and development of personal
values. The behaviors given in the scenario are not indicators of any of the other
options.
A young adult reports overwhelming guilt about minor social errors, feels self-pity, and
says, "I stay on the sidelines of life so I can avoid the embarrassment of being noticed."
The nurse can assess deficits in mastery of critical tasks associated with which
developmental stage?
a. Trust versus mistrust
b. Industry versus inferiority
c. Autonomy versus shame and doubt
d. Generativity versus self-absorption - ANS-ANS: B
Adult behaviors reflecting developmental problems associated with the stage of industry
versus inferiority include excessive guilt and embarrassment, passivity, apathy,
rumination and self-pity, assumption of the victim role, and underachievement of
potential. The behaviors given in the scenario reflect the critical tasks of industry versus
inferiority. Tasks of the other stages are entirely different.
An older retired executive reports, "I am unable to say 'no' when asked to help with
community causes. These projects overtax my strength, but if I don't do them, who
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