,Chapter 1. MentalHealth and MentalIllness
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Multiple Choice r
1. Anurse is assessing a client who is experiencing occasionalfeelings ofsadness because ofthe
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recent death of a beloved pet. The clients appetite, sleep patterns, and daily routine have not
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changed. How should the nurse interpret the clients behaviors?
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1. The clients behaviors demonstrate mental illness inthe formofdepression.
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2. The clients behaviors are extensive, which indicates the presence of mental illness.
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3. Theclientsbehaviors are not congruent withculturalnorms.
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4. Theclientsbehaviorsdemonstratenofunctionalimpairment, indicatingno mentalillness.
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ANS: 4 r
Rationale: Thenurseshould assessthattheclientsdailyfunctioning isnot impaired. Theclientwho
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experiences feelings of sadness after the loss of a pet is responding within normal expectations.
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Without significant impairment, the clients distress does not indicate a mental illness.
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Cognitive Level: Analysis r r
IntegratedProcess:Assessment
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2. Atwhat point shouldthenursedeterminethat aclient is at risk fordevelopinga mentalillness?
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1. Whenthoughts, feelings, and behaviors are not reflective ofthe DSM-5 criteria.
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2. When maladaptive responses to stress are coupled with interference indaily functioning.
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3. Whena client communicates significant distress.
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4. Whenaclient usesdefense mechanismsasego protection.
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ANS: 2 r
Rationale: The nurse should determine that the client is at risk for mental illness when responsesto
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stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in orderto be
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diagnosed with a mental illness, daily functioning must be significantly impaired. The clients
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ability to communicate distress would be considered a positive attribute.
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Cognitive Level: Application r r
IntegratedProcess:Assessment
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3. A nurse is assessing a set of15-year-old identicaltwins who respond verydifferently to stress.
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One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse
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explain these different stress responses to the parents?
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1. Reactionsto stress arerelative ratherthanabsolute;individualresponsesto stress vary.
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2. It is abnormalfor identicaltwins toreact differentlyto similar stressors.
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3. Identicaltwins should share the same temperament and respond similarlyto stress. r r r r r r r r r
4. Environmentalinfluences to stress weigh moreheavilythangenetic influences. r r r r r r r r r
,ANS: 1 r
Rationale: The nurse should explain to the parents that, although the twins have identical DNA, there
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are severalother factorsthat affect reactions to stress. Mentalhealth is astateofbeing thatis relative to
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the individual client. Environmental influences and temperament can affect stress reactions.
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Cognitive Level: Application r r
Integrated Process: Implementation
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4. Whichclient should the nurseanticipateto bemost receptiveto psychiatrictreatment?
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1. AJewish, female socialworker.
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2. ABaptist, homeless male. r r
3. ACatholic, black male. r r
4. AProtestant, Swedish business executive.
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ANS: 1 r
Rationale: The nurse should anticipate that the client of Jewish culture would place a high
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importance on preventative health care and would consider mental health as equally important as
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physical health. Women are also more likely to seek treatment for mental health problems than
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men.
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CognitiveLevel: Application r r
Integrated Process: Planning
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5. Apsychiatricnurse internstates,This clients use ofdefense mechanisms should beeliminated.
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Which is a correct evaluation of this nurses statement?
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1. Defense mechanisms can be appropriate responses to stress and need not be eliminated.
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2. Defense mechanisms are a maladaptive attempt ofthe egoto manage anxietyand should
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always be eliminated.
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3. Defense mechanisms, used byindividualswithweak ego integrity, should be discouraged and
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not eliminated.
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4. Defense mechanismscausedisintegrationofthe ego and should be fostered and encouraged.
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ANS: 1 r
Rationale:Thenurseshould determinethat defense mechanisms canbeappropriateduring timesof
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stress. The client with no defense mechanisms may have a lower tolerance for stress, thus leading to
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anxiety disorders. Defense mechanisms should be confronted when they impede the client from
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developing healthy coping skills.
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Cognitive Level: Application r r
Integrated Process: Evaluation
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6. During an intake assessment, anurseasks bothphysiologicaland psychosocialquestions. The
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client angrily responds, Im here for my heart, not my head problems. Which is the nurses best
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response?
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1. Itsjust a routine part ofour assessment. Allclients are asked these same questions.
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2. Whyare you concerned aboutthese types ofquestions?
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3. Psychologicalfactors, like excessive stress, have been found to affect medicalconditions. r r r r r r r r r r
4. Wecanskip thesequestions, ifyou like. It isnt imperativethat wecompletethissection.
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, ANS: 3 r
Rationale: The nurseshould attempt to educatethe client onthe negative effects ofexcessivestress on
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medical conditions. It is not appropriate to skip physiological and psychosocial questions, as this
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would lead to an inaccurate assessment.
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Cognitive Level: Application r r
Integrated Process: Implementation
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7. Anemployeeuses the defense mechanismofdisplacement whenthe boss openlydisagreeswith
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suggestions. What behavior would be expected from this employee?
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1. The employee assertively confronts the boss.
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2. The employee leaves the staff meeting to workout inthe gym.
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3. The employee criticizes a coworker.
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4. Theemployeetakesthe bossout tolunch.
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ANS: 3 r
Rationale: The nurse should expect that the client using the defense mechanism displacement would
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criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings
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from one target to a neutral or less-threatening target.
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Cognitive Level: Analysis r r
IntegratedProcess:Assessment
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8. Afourth-grade boyteases and makes jokesabout acutegirlin his class. This behavior shouldbe
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identified bya nurse as indicative of which defense mechanism?
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1. Displacement
2. Projection
3. Reaction formation r
4. Sublimation
ANS: 3 r
Rationale: The nurse should identify that the boy is using reaction formation as a defense
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mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being
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expressed by expressing opposite thoughts or behaviors. Displacement refers to transferring
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feelings fromonetargetto another. Rationalization refers to making excusesto justifybehavior.
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Projection refers to the attribution ofunacceptable feelings or behaviors to another person.
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Sublimationrefersto channeling unacceptabledrivesorimpulses into moreconstructive, acceptable r r r r r r r r r r
activities.
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Cognitive Level: Application r r
IntegratedProcess:Assessment
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9. Whichnursing statement about the conceptofneurosis is most accurate?
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1. An individualexperiencing neurosis is unaware that he orshe is experiencing distress.
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2. Anindividualexperiencingneurosis feelshelplessto change hisorhersituation.
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3. An individualexperiencing neurosis is aware ofpsychologicalcauses ofhis or her behavior.
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4. An individualexperiencing neurosis has a lossofcontact withreality.
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ANS: 2 r
Rationale: The nurse should define the concept ofneurosiswiththe following characteristics:
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