ANSWER AND RATIONALE

MENTAL HEALTH AND

PSYCHIATRIC NURSING
Level II-Comprehensive Review
November !!"
1. A client with depression who attempted
suicide says to the nurse, I should have
died, Ive always been a failure. Nothing
ever goes right for me. he most
therapeutic response by the nurse is!
a. I dont see you as a failure.
b. "eeling li#e this is part of being ill.
c. $ouve been feeling li#e a failure for a
while%
d. $ou have everything to live for
&. A client state to the nurse, I havent slept at
all last couple of nights. he most
therapeutic response by the nurse is!
a. 'o on(..
b. )leeping%
c. he last couple of nights%
d. $oure having difficulty sleeping%
*. A nurse is assigned to care for a client who is
e+periencing altered thought processes. he
nurse is told that the client believes that the
food is being poisoned. ,hich
communication techni-ue does the nurse
plan to use to encourage the client to eat!
a. .pen ended -uestions and silence
b. .ffering opinions about the necessity of
ade-uate nutrition
c. Identifying the reasons that the client may
not want to eat
d. "ocusing on self disclosure regarding
food preferences
/. A client who has 0ust been se+ually assaulted
is very -uiet and calm. he nurse identifies
this behavior as indicative of which defense
mechanism!
a. 1enial c.
2ationali3ation
b. 4ro0ection d. Intellectuali3ation
5. A client is admitted to a psychiatric clinic for
treatment of psychotic behavior. he client is
at the loc#ed e+it door, and is shouting, 6et
me out. heres nothing wrong with me. I
dont belong here. he nurse identifies this
behavior as!
a. 4ro0ection c. 2egression
b. 1enial d. 2ationali3ation
1. Answer C 2esponding to the feelings
e+pressed by the client is an effective
therapeutic communication techni-ue. he
coorect option is an e+ample of the use of
restating. .ptions A,7 and 1 bloc#
communication because they minimi3e the
clients e+perience and do not facilitate
e+ploration of the clients e+pressed feelings.
&. Answer D .ption 1 identifies the therapeutic
communication techni-ue of restatement.
Although it is a techni-ue that has
aprompting component to it, it repeats the
clients ma0or theme and provides the
perception of the problem form the clients
perspective. .ption A allows the client to
direct the discussion when it needs to be
more focused at this point. .ption 7 uses
reflection that simply repeats the clients last
words to prompt further discussion. .ption 8
focuses on the number of nights rather than
the specific problem of sleep.
*. Answer A .pen ended -uestions and
silence are strategies used to encourage
clients to discuss their problem. .ption 7 and
8 do not encourage the client to e+press their
feelings. he nurse should not offer opinions
and should encouarge the client to identify
the reasons for the behavior. .ption 1 is not
a client center intervention.
/. Answer A 1enial is a response of a victim of
child abuse. It is described as an adaptive
and protective reaction. 4ro0ection is blaming
or scapegoating rationali3ation is 0ustifying
the unacceptable attributes about himself or
herself. Intellectuali3ation is the e+cessive
use of abstract thin#ing or generali3ations to
decrease painful stimuli.
5. Answer # 1enial is refusal to admit painful
reality, which is treated as if it does not e+ist.
In pro0ection, a person unconsciously re0ects
emotionally unacceptable features and
attributes them to other people, ob0ects, or
situations. In regression, the client returns to
an earlier, more comforting, although less
mature way of behaving. 2ationali3ation is
0ustifying the unacceptable attributes about
oneself.
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?. A client says to the nurse, Im going to die,
and I wish my family would stop hoping for a
cure@ I get so angry when they carry on li#e
this@ After all Im the one whos dying. he
most therapeutic response by the nurse is!
a. $oure feeling angry that your family
continues to hope for you to be cured
b. I thin# we should tal# more about your
anger with your family
c. ,ell, it sounds li#e youre being pretty
pessimistic. After all, years ago people
died of pneumonia.
d. Aave you shared your feelings with your
family%B
>. A nurse is caring for a client who is
scheduled for electroconvulsive therapy. he
nurse notes an informed consent has not
been obtained for the procedure. .n review
of the record, the nurse notes that the
admission was an involuntary hospitali3ation.
7ased on this information, the nurse
determines that!
a. An informed consent does not need to be
obtained
b. An informed consent should be obtained
from the family
c. An informed consent needs to be
obtained from the client
d. he physician will obtain the informed
consent
<. A nurse is preparing a client for the
termination phase of the nurse client
relationship. ,hich of the following nursing
tas#s would the nurse appropriately plan for
this phase!
a. Identify e+pected outcomes
b. 4lan short term goals
c. Assist in ma#ing appropriate referrals
d. Assist in developing realistic solutions
C. 1uring the termination phase of the nurse9
client relationship, the clinic nurse observes
that the client continuously demonstrates
bursts of anger. he most appropriate
interpretation of the behavior is that the
client!
a. 2e-uires further treatment and is not
ready to be discharged
b. Is displaying behaviors that can occur
during termination
c. Needs to be admitted to the hospital
d. Needs to be referred to a psychiatrist as
soon as possible
$% Answer A
2eflection is the therapeutic
communication techni-ue that redirects
the clients feelings bac# in order to
validate what the client is saying. In option
7, the nurse attempts to use focusing, but
the attempt to discuss central issues
seems premature. In option 8, the nurse
ma#es a 0udgment and is non therapeutic
in the one9on9one relationships. In option
1, the nurse is attempting to asses the
cliens ability to openly discuss feelings
with family members. Although thismay
be appropriate, the timing is somewhat
premature and closes off the clients
facilitation of the clients feelings.
&% Answer C
8lients who are involuntarily admitted do
not lose their right to informed consent.
he informed consent needs to be
obtained from the client. .ptions A, 7 and
1 are incorrect.
"% Answer C
as# of the termination phase include
evaluating clients performance,
evaluating achievement of e+pected
outcomes, evaluating future needs,
ma#ing appropriate referrals, and dealing
with the common behaviors associated
with termination. .ptions A,7 and 1
identify tas# of the wor#ing phase of the
relationship.
'% Answer #
In the termination phase of the
relationship, it is normal for the client to
demonstrate a number of regressive
behaviors. ypical behaviors include
return of symptoms, anger, withdrawal
and minimi3ing the relationship. he
anger that the client is e+periencing is
normal behavior during the termination
phase and does not necessarily indicate
the need for hospitali3ation or treatment.
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1;. Dilieu therapy is prescribed for a client. he
nurse understands that this type of therapy
can best be described as which of the
following!
a. A form of behavior modification therapy
b. A cognitive approach in changing
behavior
c. he client is involved in setting goals
d. A behavioral approach to changing
behavior
11. 1isulfiram :Antabuse= is prescribed for a
client with a problem related to alcohol. he
nurse understands that this medication wor#s
on the principle of which of the following
therapies%
a. 1esensiti3ation
b. )elf9control therapy
c. Dilieu therapy
d. Aversion therapy
1&. A client with eating disorder is attending
group meetings with overeaters anonymous.
,hich of the following is not a characteristic
of this form of self9help group%
a. 4eople who have a similar problem are
able to help others
b. It is designed to serve people who have a
common problem
c. he members provide support to each
other
d. he leader is a nurse or a psychiatrist
1*. A nurse collects data on a client with an
admitting diagnosis of bipolar affective
disorder9mania. he symptom presentation
that re-uires the nurses immediate
intervention is!
a. he clients outlandish behaviors and
inappropriate dress
b. he clients grandiose delusions of being
a royal descendent of Eing Arthur
c. he clients non stop physical activity and
poor nutritional inta#e
d. he clients constant, incessant tal#ing
that includes se+ual innuendoes and
teasing the staff
1/. A nurse reviews the activity scheduled for the
day and determines that the best activity that
a manic client could participate in is!
a. A brown bag luncheon and a boo# review
b. etherball
c. A paint9by9number activity
d. A deep breathing and progressive
rela+ation group
1;. Answer C Dilieu thearpy provides a safe
environment that is adapted to the
individual clients needs and also provides
greater comfort and freedom of
e+pression that has been e+perinced in
the past by the client. All members
contribute to the planning and functioning
of the setting.
11. Answer D Aversion therapy, also #nown
as aversion conditioning or negative
reinforcement, is a techni-ue use to
change behavior. In this theraoy, a
stimulus :alcohol= attractive to the client is
paired with an unpleasant event in hopes
of instituting the stimulus with negative
properties. 1esensiti3ation is the
reduction of intense reactions to a
stimulus by repeated e+posure to the
stimulus with a wea#er and milder form.
Dilieu therapy provides positive
environmental manipulation, both physical
and social, to affect a positive change in
the client. )elf control therapy combines
cognitive and behavioral approaches and
is useful to deal with stress.
1&. Answer D he sponsor of the self help
group is an e+perienced member of the
group. A nurse or a psychiatrist may be
as# by the group to serve as a resource
but would not be the leader of the group.
.ptions A, 7 and 8 are characteristics of
a self help group.
1*. Answer C Dania is a mood characteri3ed
by e+citement, euphoria, hyperactivity,
e+cessive energy, decreased need for
sleep and impaired ability to concentrate
or complete a single train of thought. It is
a period when the mood is predominantly
elevated, e+pansive or irritable. .ption 8
identifies a physiological need re-uiring
immediate intervention.
()% Answer #
A person who is e+periencing mania is
overactive, full of energy, lac#s
concentration and has poor impulse
control. he client needs an activity that
will allow him or her to use e+cess
energy, yet not endanger others during
the process. .ptions A, 8 and 1 are
relatively sedate activities that re-uire
concentration, a -uality that is lac#ing in
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the manic state. )uch activities may lead
to increased frustrations and an+iety for
the client. etherball is an e+ercise that
uses the large muscle groups of the body
and is a great way to e+pend the
increased energy this client is
e+periencing.
15. A woman comes into the emergency room in
a severe state of an+iety after a car accident.
he most important nursing intervention is to!
a. 2emain with the client
b. 4ut the client in a -uiet room
c. each the client deep breathing
d. Fncourage the client to tal# about her
"eelings and concerns
1?. A male client with delirium becomes agitated
and confused in his room at night. he best
initial intervention by the nurse is to!
a. Gse a night light and turn off the television
b. Eeep the television and a soft light on
during the night
c. Dove the client ne+t to the nurse station
d. 4lay soft music during the night, and
maintain a well lit room
1>. A nurse is collecting data on a client who is
actively hallucinating. ,hich of the following
nursing statements would be most
therapeutic at this time%
a. I tal#ed to the voices youre hearing and
they wont hurt you now
b. I can hear the voice and she wants you
to come to dinner
c. sometimes people hear things or voices
other cant hear
d. I #now you feel Hthey are out to get you
but its not true
1<. A nurse is caring for a client who has been
treated with long term anti9psychotic
medication. As part of the nursing care plan,
the nurse monitors for tardive dys#inesia
:1=. In the event that 1 occurs, the nurse
would most li#ely to observe!
a. Abnormal movements and involuntary
movements of the mouth, tongue and
face
b. Abnormal breathing through the nostrils
c. )evere headache, flushing, tremor and
ata+ia
d. )evere hypertension, migraine headache,
and marbles in the mouth syndrome
(*% Answer A
If a client is left alone with severe an+iety,
he or she may feel abandoned and
become overwhelmed. 4lacing the client
in a -uiet room is also indicated, but the
nurse must stay with the client. It is not
possible to teach the client deep
breathing until a the an+iety decreases.
Fncouraging the client to discuss
concerns and feelings would not ta#e
place until the an+iety has increased.
($% Answer A
It is important to provide a consistent daily
routine and a low stimulating environment
when the client is agitated and confused.
Noise levels including a radio and
televisionmay add to the confusion and
disorientation. Doving the client ne+t to
the nurses station is not the initial action.
(&% Answer C
It is important to the nurse to reinforce
reality with the client. .ptions A, 7 and 1
do not reinforce reality but rather the
hallucination that the voices are real.
("% Answer A
ardive dys#inesia is a severe reaction
associated with the long term use of
antipsychotic medication. he clinical
manifestation are abnormal movements
:dys#inesia= and involuntary movements
of the mouth, tongue and face. In its more
severe form, tardive dys#inesia involves
the fingers, arms, trun# and respiratory
muscles. ,hen this occurs, the
medication is discontinued.
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1C. A nurse is caring for a female client who has
recently admitted for anore+ia nervosa. he
nurse enters the clients room and notes that
the client is engaged in rigorous push9ups.
,hich nursing action is most appropriate!
a. Allow the client to complete her e+ercise
program
b. ell the client that she is not allowed to
e+ercise rigorously
c. Interrupt the client and offer to ta#e her for
a wal#
d. Interrupt the client and weigh immediately
&;. A nurse is caring for a client with anore+ia
nervosa. he nurse monitoring the clients
behavior understands that the client with
anore+ia nervosa manages an+iety by!
a. Always reinforcing self approval
b. Aaving the need to always ma#e the right
decision
c. Fngaging in immoral acts
d. .bserving rigid rules and regulations
&1. A nurse is developing a plan of care for the
hospitali3ed client with bulimia nervosa.
,hich of the following would not be included
in the plan of care!
a. Donitoring inta#e and output
b. Donitoring electrolyte levels
c. .bserving for e+cessive e+ercise
d. 8hec#ing for the presence of la+atives
and diuretics in the clients belongings
&&. A nurse is caring for a client who abuses
alcohol for signs of alcohol withdrawal. ,hich
of the following will alert the nurse to the
potential for delirium tremors :1=%
a. Aypertension, changes in the levels of
consciousness, hallucinations
b. Aypotension, ata+ia, vomiting
c. )tupor, agitation, muscular rigidity
d. Aypotension, coarse hand tremor,
agitation
('% Answer C
8lients with anore+ia nervosa are
fre-uently preoccupied with rigorous
e+ercise and push themselves beyond
normal limits to wor# off caloric inta#e.
he nurse must provide for appropriate
e+ercise as well as place limits on
rigorous activities. .ptions A, 7 and 1 are
inappropriate nursing actions.
!% Answer D
8lients with anore+ia nervosa have the
desire to please others. heir need to be
correct of perfect interferes with rational
delusion9ma#ing processes. hese clients
are moralistic. 2ules and rituals help
these clients manage their an+iety.
(% Answer C
F+cessive e+ercise is a characteristic of
anore+ia nervosa, not a characteristic of
client with bulimia. "re-uent vomiting, in
addition to the la+ative and diuretic abuse,
may lead to dehydration and electrolyte
imbalance. Assessing for dehydration and
electrolyte imbalance are important
nursing actions. .ption 8 is the only
option that is not a characteristics of
bulimia.
% Answer A
he symptoms associated with 1s
typically are an+iety, insomia, anore+ia,
hypertension, disorientation, visual or
tactile hallucinations, changes in the level
of consciousness, agitation, fever and
delusions.
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&*. A spouse of a client admitted for alcohol
withdrawal says to the nurse I should get
out of this bad situation he most helpful
response by the nurse would be!
a. I agree with you. $ou should get out of
this situation
b. ,hat do you find difficult about this
situation
c. ,hy dont you tell your husband about
this
d. his is not the best time to ma#e the
decision.
&/. A nurse is caring for a client who is
suspected to be dependent on drugs. ,hich
of the following -uestions would be most
appropriate for the nurse to as# when
collecting data from the client regarding the
drug abuse%
a. ,hy did you get started on these drugs%
b. Aow long did you thin# you could ta#e
these drugs without someone finding it
c. Aow much do you use and what effect
does it have on to you
d. he nurse does not as# any -uestions in
fear that the client is in denial and will
throw the nurse out of the room
&5. he nurse is assigned to care for a client at
ris# for alcohol withdrawal. he nurse
monitors the client #nowing that the early
signs of withdrawal will develop within how
much time after the cessation or reduction of
alcohol inta#e%
a. ,ithin a few hours c. In 1 wee#
b. After several hours d. In & to * wee#s
&?. A nurse is collecting data from the client with
a diagnosis of bulimia nervosa. he nurse
understands that which of the following is not
a characteristic finding in this disorder%
a. Fnlarged parotid glands
b. 1ental erosions
c. Flectrolyte imbalance
d. 7ody weight well below the ideal range
&>. A nurse is reviewing the health care record of
a client admitted to the psychiatric unit. he
nurse notes that the admission nurse has
documented that the client is e+periencing
an+iety as a result of a situational crisis. he
nurse would determine that this type of crisis
could be caused by!
a. A fire that destroy the clients home
b. A recent rape episode e+perienced by the
client
c. he death of a loved one
d. ,itnessing a murder
+% Answer #
he most helpful response is the one that
encourages the client to problem solve.
'iving advice implies that the nurse
#nows what is best and can also foster
dependency. he nurse should not agree
with the client, nor should the nurse
re-uest that the client provide
e+planations.
)% Answer C
,henever the nurse performs an
assessment for a client who is dependent
on drugs, it is best for the nurse to
attempt to ellicit information by being non
0udgmental and direct. .ption A is
incorrect because it is 0udgmental, off
focus, and reflects the nurses bias.
.ption 7 is incorrect because it is
0udgmental, insensitive and aggressive,
which is non therapeutic. .ption 1 is
incorrect because it indicated passivity on
the part of the nurse and uses
rationali3ation to avoid the therapeutic
nursing intervention.
*% Answer A
Farly signs of alcohol withdrawal develop
within a few hours after the cessation or
reduction of alcohol and pea#s after &/ to
/< hours.
$% Answer D
8lients with bulimia nervosa may not
initially appears to be physically and
emotionally ill. hey are ofetn or slightly
below ideal body weight. .n further
inspection, the client demonstrates
enlargement of the parotid glands with
dental erosion and caries if the client is
inducing vomiting. Flectrolyte imbalances
are present.
&% Answer C
A situational crisis arises from e+ternal
rather than internal sources. F+ternal
situations that could precipitate crisis
include loss of or change of a 0ob, the
death of a loved one, abortion, a change
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in financial status, divirce, the addition of
a new family members, pregnancy and
severe illness. .ptions A,7 and 1 identify
adventitious crisis. An adventitious crisis
is not part of everyday life, is unplanned
and accidental.
&<. A nurse is gathering a data from a crisis.
,hen determining the clients perception of
the precipitating event that led on the crisis,
the most appropriate -uestion to as# is!
a. ,hat leads you to see# help now%
b. ,ho is available to help you%
c. ,hat do you usually do to feel better%
d. ,ith whom do you live%
&C. A nurse is assisting in developing a plan of
care for the client in crisis state. ,hen
developing plan, the nurse will consider
which of the following%
a. 4resenting symptoms in a crisis situation
are similar for all individuals e+periencing
a crisis
b. A crisis states indicates that the individual
is suffering from emotional illness
c. A crisis state indicates that the individual
is suffering from a mental illness
d. A clients response to a crisis for one
person may not constitute a crisis for
another person
*;. A nurse observes that the client with a
potential for violence is agitated, pacing up
and down the hallway, and is ma#ing
aggressive belligerent gestures at the other
clients. ,hich of the following statements
would be the most appropriate to ma#e to
this client%
a. ,hat is causing you to become
agitated%
b. $ou need to stop that behavior now@
c. $ou will need to be restrained if you
dont change your behavior
d. $ou will need to place in seclusion
*1. A nurse is planning care for a client who is
being hospitali3ed because the client has
been displaying violent behavio and is at ris#
for potential harm to others. ,hich of the
following would not be a component of the
plan of care%
a. Eeep the door to the clients room open
when with the client
b. Assign the client to a room at the end of
the hall
c. "ace the client when providing care
d. Fnsure that the security officer is within
the immediate area
"% Answer A
A nurses initial tas# when gathering data
from a client in crisis is to assess the
individual or family and the problem. he
more clearly the problem can be defined,
the better the chance a solution can be
found. .ption A will assist in determining
data related to the precipitating event that
led on the crisis. .ption 7 and 1 identify
situational supports. .ption 8 identifies
personal coping s#ills.
'% Answer D
Although each crisis response can be
described in similar terms as far as
presenting symptoms are concerned,
what constitutes a crisis from one person
may not constitute a crisis for another
person because each is a uni-ue
individual. 7eing in crisis state does not
mean that the client is suffering from an
emotional or mental illness.
+!% Answer A
he best statement is to as# the client
what is causing the agitation. his will
assist the client to become aware of the
behavior and will assist the nurse in
planning appropriate interventions for the
client. .ption 7 is demanding behavior,
which could cause increased agitation to
the client. .ptions 8 and 1 are threats to
the client and are inappropriate.
+(% Answer #
he client should be placed in a room
near the nurses station and not at the end
of a long, relatively unprotected corridor.
he nurse should not isolate self with a
potentially violent client. he door to the
clients room should be #ept open, and
the nurse should never turn away from
the client. A security officer or male aide
should be within immediate call if there is
a suspicion that an act of violence is
imminent.
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*&. ,hich behaviors observed by the nurse
might lead to the suspicion that a depressed
female adolescent client may be suicidal%
a. he client becomes angry while spea#ing
on the telephone and slams the receiver
down on the hoo#
b. he client runs out of the therapy group
swearing at the group leader and runs to
her room
c. he clients gets angry with her roommate
when the room mate borrows the clients
clothes without as#ing
d. he client gives away a pri3ed 81 and a
cherished autograph picture of the
performer
**. he police arrive at the emergency room with
a client who has seriously lacerated both
wrists. he initial nursing action is to!
a. F+amine and treat the wound site
b. )ecure and record a detailed history
c. Fncourage and assist the client to
ventilate feelings
d. Administer an antian+iety agent
*/. A nurse receives a telephone call from a
male client who states that he wants to #ill
himself and has a bottle of sleeping pills in
front of him. he best nursing action is to!
a. Insist that the client give you his name
and address so that you can get the
police there immediately
b. Eeep the client tal#ing and allow the client
to ventilate feelings
c. Gse therapeutic communications,
especially the reflection of feeling
d. Eeep the client tal#ing, signal to another
staff member to trace the call so that
appropriate help can be sent
*5. he activity that would be the least
therapeutic for severely depressed clients
would be!
a. )pecific, simple instructions to be allowed
b. )imple, easily completed, short term
pro0ects
c. Donotonous, repetitive pro0ects and
activities
d. Allowing the clients to plan their own
activities
+% Answer D
A depressed suicidal client often gives
away that which is of value as a way of
saying goodbye and wanting to be
remembered. .ptions A, 7 and 8 identify
acting out behaviors.
++% Answer A
he initial nursing action is to e+amine
and treat the self inflicted in0uries. In0uries
from the lacerated wrist can lead to a life
threatening situation. .ther interventions
may follow after the client has been
treated medically.
+)% Answer D
In a crisis, the nurse must ta#e an
authoitative,active role to promote the
clients safety. A bottle of sleeping pills in
front of the client who verbali3es he wants
to #ill himself is a crisis. he client safety
is of prime concern. Eeeping the client on
the phone and getting help to the client is
the best intervention. he word insist
may anger the client anf he may hang up.
.ption 7 lac#s the authoritative action
stance of securing the clients safety.
Gsingtherapeutic communication is
important, but overuse of reflection may
sound uncaring or superficial and is
lac#ing directionIsolutions to the
immediate problem of the clients safety.
+*% Answer D
)everely depressed clients are not
motivated to ta#e action or to plan ahead.
hey are unable to direct their energy on
the environment.
A. his would be helpful to a severely
depressed client, whose attention
span is limited.
7. his would be helpful to a severely
depressed client because it re-uires
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little thought and provides gratification
and satisfaction.
8. his would be helpful for a person with
depression as well as for the
cognitively impaired.
*?. ,hen caring for the e+tremely depressed
client, the staff should set specific goals
directed toward helping the client!
a. )et realistic life goals
b. 1evelop trust in others
c. F+press hostile feelings
d. 'et involved in activities
*>. ,hen developing a nursing care plan for a
depressed client, the approach that would be
most therapeutic would be!
a. Allowing time for the clients slowness
when planning activities
b. Aelping the client focus on family
strengths and support systems
c. Fncouraging the client to perform menial
tas#s to meet the need for punishment
d. 2epeating again and again that the staff
views the client as worthwhile and
important
*<. he activity that would be most appropriate
for a depressed client during the early part of
hospitali3ation would be a!
a. 'ame of trivial pursuit
b. 4ro0ect involving drawing
c. )mall dance9therapy group
d. 8ard game with three other clients
*C. A withdrawn client refuses to go out of bed
and becomes upset. It would be most
therapeutic for the nurse to!
a. 2e-uire the client to get out of bed at
once
b. )tay with the client until the client calms
down
c. 'ive the client the 42N neuroleptic that is
ordered
d. Allow the client to stay in bed for the
present without company
/;. A client is place on suicide precautions. he
most therapeutic way to provide these
precautions would be to!
a. 2emove all sharp and cutting ob0ects
b. Not allow the client to leave hisIher room
c. 'ive the client the opportunity to ventilate
feelings
d. Assign a staff member to be with the
client at all times
*?. Answer C 1epressed clients find it
difficult to e+press anger and hostility
because they have internali3ed these
feelings and turned them on themselves.
A. here is nothing to indicate that the
client has unrealistic goals.
7. his would develop in timeJ it is not
really a goal of therapy.
1. his would be part of the intervention,
not a goal.
*>. Answer A 2outines should be #ept
simple and no demands should be made
that the client cannot meet. he client is
depressed and all actions are slow.
4utting pressure on the client will only
increase an+iety and feelings of
worthlessness.
7. he client will have to focus on
personbal strenghts, not on family
strenghts.
8. his would feed into the clients
feelings of unwothiness and
frustrations.
1. "eelings of worth must come from
within the individualJ the nurse must
reassure the client through actions,
not words.
*<. Answer # An art9type pro0ect that could
be wor#ed on successfully at ones own
pace would be important.
A. his would re-uire too much
concentration and increase the clients
feelings of despair.
8. his is used mostly for severely
regressed clients, and at this point it
may not be appropriate for this client.
1. )ame as Answer A
*C. Answer # his provides support and
security without re0ecting the client or
placing value 0udgments on behavior.
A. 6imits will have to be set in giving care
but staying with the client and showing
acceptance are immediate nursing
actions.
8. his would only calm the client downJ
it does not try to deal with the problem
1. his would be ignoring the problemJ
isolation would imply punishment.
/;. Answer D Fmotional support and close
surveillance can demonstrate the staffs
caring and their attempt to preventing
acting out of suicidal ideation.
A. his would be routinely doneJ by itself
it is not necessarily therapeutic
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& C
7. his would be a punishment for the
client who may still find a way to carry
out a suicide attempt in a room.
8. his is not a suicide precaution.
/1. An elderly client, depressed client fre-uently
paces the halls, becoming physically tired
from the activity. o help the client reduce
this activity, the nurse should!
a. )upply the client with simple monotonous
tas#s
b. 2e-uest a sedative order from the clients
physician
c. 2estrain the client in a chair, reducing the
opportunity to pace
d. 4lace the client in a single room, thus
limiting pacing on a smaller area
/&. A long term therapy goal for a female client
hospitali3ed for a ma0or depressive episode
should be that the client will be!
a. Able to tal# about her depressed feelings
b. Able to develop new defense
mechanisms
c. Dore realistic in accepting herself and
others
d. Aware of the unconscious source of her
anger
/*. he action by the nurse that would be most
therapeutic when a depressed client states,
I am no good. Im better off dead. ,ould be!
a. )tating, I thin# youre goodJ you should
thin# of living
b. )tating, I will always stay with you until
you are less depressed.
c. Alerting the staff to provide &/ hour
observation of the client
d. Gnobtrusively removing those articles that
could be used in suicide attempts
//. A positive nursing action when caring for a
middle9aged, depressed client is to!
a. 4lay a game of chess with the client
b. Allow the client to ma#e personal
decisions
c. )it down ne+t to the client as often as
possible
d. 4rovide the client with fre-uent periods of
thin#ing time
)(% Answer A
hese clinets can be usually fairly easily
distracted by planned involvement in
repetitious simple tas#s.
7. his should be employed only if the
clients restlessness cannot be
controlled with other measures and
physical e+haustion creates a danger
for the client.
8. his would be abusive treatment for
the client with a need to pace and
would reinforce the clients belief that
punishment was re-uired for
redemption.
1. he client may perceive this isolation
as a punishment, and it would not
allow observation for the staff.
)% Answer C
A ma0or part of depression involves an
inability to accept the self as it is, which
leads to ma#ing demands on others to
meet unrealistic needs.
A. A short term goal would be to tal#
about the clients depressed feelingsJ
a long term goal would be to loo# at
what is causing those feelings.
7. 1eveloping new defense mechanisms
would not the the priority because they
tend to help the client avoid reality.
1. his is not important or crucial to the
clients recovery.
)+% Answer C
his is the most therapeutic approach.
he staff member also provides special
attention to help the client meets
dependency needs and reduce a self
defeating attitude.
A. his response negates clients feelings
and cuts off further communication.
7. his is unrealistic because the nurse
cannot be with the client constantly
until the depression lifts.
1. he priority &/ hour observation of the
clientJ removing articles that could
provide a means for suicide would
also be done.
))% Answer C
his gives the client the nonverbal
message that someone cares and views
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1;
the client as being worthy of attention and
concern.
A. he concentration re-uired for chess
is too much for the client at thisn time.
7. he client is incapable of ma#ing
decisions at this time.
1. 1epressed clients often too much
thin#ing time.
/5. A client is admitted to the hospital following a
wee# long period of complete inability to
function and aimless activity. 1uring the
assessment, the nurse notes the client is
pacing the floor, weeping and wringing the
hands. he nurse would e+pect the physician
to order an!
a. Antimanic medication
b. Antian+iety medication
c. Antipsychotic medication
d. Antidepressive medication
/?. .n the second day after admission, a suicidal
client as#s the nurse, ,hy am I being
observed around the cloc# and why is my
freedom to move around the unit restricted%
the nurse most appropriate reply would be!
a. ,hy do you thin# we are observing you%
b. ,hat ma#es you thin# that we are
observing you%
c. ,e are concerned that you might try to
harm yourself
d. $our doctor has ordered it and is the one
you should as# about it.
/>. .ne day, while shaving, a male client with a
diagnosis of bipolar disorder states to the
nurse, I have hidden a ra3or blade and
tonight I am going to #ill myself. he nurses
best reply would be to!
a. $oure going to #ill yourself%
b. hings can really be that bad
c. HIm sure you dont really mean that.
d. $oud better finish shavingJ its time for
lunch.
/<. he treatment plan for a client admitted with
a severe, persistent, intractable depression
and suicidal ideation would probably include!
a. Flectroconvulsive therapy
b. )hort term psychoanalysis
c. Nondirective psychotherapy
d. Aigh doses of an+iolytic drugs
)*% Answer D
hese behaviors are signs of clinical
depression and need to be treated with
antidepressives such as ))2Is, tricyclic
antidepressants, and DA.Is which
stimulates purposeful activity.
A. hese behaviors indicates agitated
depression, not mania.
7. heses behaviors are signs of agitated
depression, not an+iety.
8. Antipsychotic medications such as the
phenothia3ine group, haloperidol, and
clo3apine are used to treat the manic
phase of bipolar disorder, not for any
depression.
)$% Answer C
his statement helps the client reali3e that
staff members care and feel that the client
is worthy of care.
A. his is a response that places the
client on the defensive
7. his is inppropriate response to a
rather obvious situation.
1. his is an evasive tactic by the nurse
)&% Answer A
he clients is as#ing for help to prevent
suicide. his response focuses on
feelings and does not challenge or deny
them.
7. his response negates the clients
feelings and interprets the situation for
the client.
8. his response denies the clients
feelings and does not follow through
on what the client is saying.
1. his response ignores the clients cry
for help and that does not follow
through on what the client is
e+pressing.
/<. Answer A Flectoconvulsive therapy,
which interrupts established patterns of
behavior, helps relieves symptoms and
limits possible suicide attempts in clients
with severe, intractable depressions that
do not reapond to antidepressant
medications.
7. he clients depressed mood would
greatly limit participation in
psychotherapyJ feelings precipitated
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 11
by therapy may lead to suicidal acting
out.
8. 4sychotherapy is directed toward
helping the person learn new coping
mechanisms and better ways of
dealing with problems, the depressed
client needs direction to accomplish
this.
1. hese are antian+iety medications that
would not ordinarily be used for the
clients with depression.
/C. A severely depressed client is to have an
electroconvulsive therapy :F8=. ,hen
discussing this therapy, the nurse should tell
the client that!
a. )leep will be induced and treatment will
not cause pain
b. ,ith new methods of administration,
treatment is totally safe
c. It is better not to tal# about it, but you can
as# any -uestion you li#e
d. here may be some permanent memory
loss as a result of the treatment
5;. A side effect of electroconvulsive therapy
that a client may e+perience is!
a. 6oss of appetite
b. 4ostural hypotension
c. 8onfusion for a time after treatment
d. 8omplete loss of memory for a time
51. A /? year old male client has 0ust awa#ened
from his first scheduled F8 treatment. he
most appropriate nursing intervention would
be to!
a. Arrange for the dietary staff to bring the
client a lunch tray
b. .rient the client to the time and place and
tell him that he has 0ust had a treatment
c. 'et the client up and out of bed as soon
as possible and bac# into the units
routine
d. a#e the blood pressure and pulse every
15 minutes until the client is fully awa#e
5&. 1uring the orientation tour for three new staff
members, a young, hyperactive, manic client
greets them by saying, ,elcome to the
funny farm. Im Ko9Ko, the head yo9yo. his
comment might mean that the client is!
a. rying to fill the life9of9the9party role
b. 6oo#ing for attention from the new staff
c. Gnable to distinguish fantasy from reality
d. An+ious over the arrival of the new staff
members
)'% Answer A
8lients fear this therapy because of the
e+pected pain. If they will be reassured
that they will be asleep and have no pain,
ther will be less an+iety and more
cooperation.
7. No treatment re-uiring anesthesia is
totally safe.
8. 8lients may not reali3e their own fears
and not #now what -uestions to as#J
this statement cuts off future
communication.
1. emporary, not permanent, loss
occurs.
*!% Answer C
he electrical energy passing through the
cerebral corte+ during F8 results in
temporary state of confusion after
treatment.
A. his is not a usual or e+pected side
effect
7. )ame as Answer A
1. )ame as Answer A
*(% Answer #
8lients are confused whewn they are
awa#en after F8. hey have a loss of
recent memory, so it is imporatnt to orient
them to time, place and situation.
A. his would be a later action, if the
client as#ed for food.
8. his would not be appropriate for a
client who has 0ust awa#ened after a
treatment.
1. his is not necessary.
*% Answer D
he clients behavior demonstrates
increased an+iety. )ince it was directed
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1&
toward the new staff, it was probably
precipitated by their arrival.
A. he client is not filling the life9of9the9
party roleJ the client is rsulting to
previous coping behavior in the face of
e+treme stress.
7. his is possible, but the remar# is
more indicative of increased an+iety.
8. he client is aware of what is going on
and who everyone is at this time.
5*. ,hen the language of a client in the manic
phase of a bipolar disorder becomes vulgar
and profane, the nurse should!
a. )tate, ,e do not li#e that #ing of tal#
around here.
b. Ignore it, since the client is using it only to
get attention
c. 2ecogni3e the language as part of the
illness, but set limits on it
d. )tate, ,hen you can tal# in an
acceptable way, we will tal# to you.
5/. he nurse is assigned to care for a *C9year9
old, hyperactive, manic client who e+hibits
flight of ideas. he client is not eating. he
nurse recogni3es this may be because the
client!
a. "eels undeserving of the food
b. Is too busy to ta#e the time to eat
c. ,ishes to avoid the clients in the dining
room
d. 7elieves that at this time there is no need
for food
55. he nurse recogni3es that an e+cellent
indicator of improvement in a client with the
diagnosis of generali3ed an+iety disorder is
when the client!
a. 6earns to avoid an+iety
b. 4articipates in activities
c. a#es medications as prescribed
d. Identifies when an+iety is developing
5?. ,hen caring for a client with generali3ed
an+iety disorder, the nurse should be aware
that one of the best indicators of the clients
present condition is the clients!
a. Demory c. Kudgment
b. 7ehavior d. 2esponsiveness
5>. An obviously distraught client arrives at the
mental health clinic. he client is disheveled,
is agitated and demands that someonedo
something to end this feeling. he nurse
recogni3es that the client has!
a. "eelings of panic
b. )uicidal tendencies
c. Narcissistic behavior
d. A demanding personality
5*. Answer C 2ecogni3ing the language as
part of the illness ma#es it easier to
tolearte, but limits must be set for the
benefit of the staff and other clients.
)etting limits also shows the client that
the nucrse care enough to stop the
behavior.
A. his statement shows little
understanding or tolerance of the
illness.
7. Ignoring the behavior is a form of
re0ectionJ the client is not using the
behavior for attention.
1. his statement demonstrate a
re0ection of the client and little
understanding of the illness.
5/. Answer # Ayperactive cleints fre-uuently
will not ta#e the time to eat because they
are overinvolved in everything that is
going on.
A. his is indicative of depressive
episode
8. he client is unable to sit long enough
with the other clients to eat a mealJ
this is not conscious avoidance.
1. he client probably gives no thought to
food because of overinvolvement of
activities in the enviroment.
55. Answer D 2ecognition of an+iety or
symptoms of increasing an+iety are an
indication that the client is improving.
A. Avoidance of an+iety is not a good
indication of improvement, the is no
guarantee that the an+iety can always
be avoided.
7. his does not indicate improvement or
recognition of feelingsJ the client may
0ust be doing what others e+pect.
8. )ame as Answer 7
5?. Answer # he client current behavior is
the best indicator of the clients current
level of functioningJ all behavior has
meaning.
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1*
A. his is important and should be
assesed, but it is not the best indicator
of the current level of functioning.
8. )ame as Answer A
1. )ame as Answer A
5>. Answer A he client can no longer
control or tolerate feelings and attempts to
disregard reality as a means of avoiding
it.
7. he client has not indicated plans for
self harmJthe client is as#ing others to
do something to help relieve the
feeling.
8. he client is e+periencing panic and is
crying for helpJ this behavior is not
typical of a narcissistic personality.
1. he client is in a state of panic and is
crying for helpJ this behavior does not
indicate a demanding personality.
5<. he nurse is aware that as an+iety increases,
ones concept of reality alters. herefore
when caring for a client with generali3ed
an+iety disorder, the nurses first intervention
would be to!
a. Aave the client verbali3e feelings of
an+iety
b. Administer the 42N medication ordered
by the physician
c. 2emove as many stimuli from the clients
environment as possible
d. Aave the client list the relief behaviors
that are used to reduce an+iety
5C. A phobic reaction will rarely occur unless the
person!
a. hin#s about the feared ob0ect
b. Absolves the guilt of the feared ob0ect
c. Intro0ects the feared ob0ect into the body
d. 8omes into contact with the feared ob0ect
?;. he nurse, when e+ploring the modalities
available for the treatment of phobias, should
inform the client that the treatment having the
biggest success rate of people with phobias
is!
a. )ystematic desensiti3ation using
rela+ation techni-ues
b. Insight therapy to determine the origin of
the an+iety and fear
c. 4sychotherapy aimed at rearranging
maladaptive thought processes
d. 4sychoanalytic e+ploration of repressed
conflicts of an earlier developmental
phase
?1. ,hen spea#ing with the client who has 0ust
e+perienced a panic attac#, the nurse can
address the clients concerns most
therapeutically by stating!
a. $ou must have been really upset
b. $ou are concern that this might happen
again
c. Fpisodes li#e this can be upsetting, but
they do end.
d. $our family was concerned that you were
having heart attac#.
*"% Answer C
2emoving as many e+ternal stimuli as
possible helps reduce the clients an+iety
by limiting the factorsthat must be dealt
withJ decreasing stimuli usually decreases
an+iety.
A. his may not decrease an+iety and
may in fact increase it.
7. his may or may not be necessaryJ
not the first intervention until an
assessment is completed.
1. he an+iety level must be decreased
before this intervention can be
implemented.
*'% Answer D
In phobias the individual transfers an+iety
to a rather safe inanimate ob0ect.
herefore the an+iety and resulting
feelings will inly be precipitated when in
direct contact with the ob0ect.
A. It is not thin#ing about the feared
ob0ect that causes an+ietyJ it is the
possibility of having to come into
contact with it.
7. It is the guilt or the fear within the
person, not the ob0ect, that nust be
dealt with.
8. It is not possible to intro0ect the feared
ob0ect into the body.
$!% Answer A
he most successful therapy for clients
with phobias involves behavior
modification techni-ues using
desensiti3ation.
7. Insight into the origin of the phobia will
not necessarily help the client
overcome the problem.
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1/
8. Day increase understanding of the
phobia but may not help the client to
deal with the fearJ there is no
maladaptive thought processes
associated with phobia.
1. 4sychoanalysis may increase the
understanding of the phobia , but may
not help the client deal successfully
with the unreasonable fear.
$(% Answer #
2ecurrence of attac#s is a common
concern.
A. his is not therapeutic
8. Although this response initially focuses
on feelings it then cuts off
communication.
1. he client will be focused on won
needs, not what the family says.
?&. Gnsatisfied needs create an+iety that
motivates an individual to action. his action
is brought about mainly to!
a. 2educe tension
b. 1eny the situation
c. 2emove the problem
d. 2elieve physical discomfort
?*. he most appropriate way to decrease a
clients an+iety is by!
a. Avoiding unpleasant ob0ects and events
b. 4rolonged e+posure to fearful situations
c. Ac-uiring s#ills with which to face
stressful events
d. Introducing an element of pleasure into
fearful situations
?/. A young client is admitted with a severe
an+iety disorder. he client is crying, wringing
the hands and pacing. he first nursing
intervention should be to!
a. )tay physically close to the client
b. 'ently as# what is bothering the client
c. ell the client to sit down and try to rela+
d. 'et the client involve in nonthreatening
activity
?5. he nurse could most appropriately begin to
help an e+tremely an+ious client with a sleep
problem, who has been assigned to a four9
bed room since admission, by saying!
a. $ou seem unable to sleep at night.
b. Im going to move you on a private
room.
c. 1ont worry, youll sleep when you are
tired.
d. Ill give you the sedative your doctor
ordered
??. o give effective nursing care to a client who
is using ritualistic behavior, the nurse must
first recogni3e that the client!
a. )hould be prevented from performing the
rituals
b. Need to reali3e that the rituals has no
purpose
c. Dust immediately be diverted when
performing the ritual
d. 1oes not want to repeat the ritual, but
feels compelled to do so
$% Answer A
,hen tension is reduced, an+iety
diminishes and the person feels more
comfortable, safe and secure.
7. her would be less an+iety if the
person were able to deny the situation.
8. ,hen an+iety is high the client is
unable to focus on the problem.
1. his action would have an effect on
psychologic rather than physical
discomfort.
$+% Answer C
6earning a variety of coping mechanisms
help rduce an+iety in stressful situations.
A. A person must learn to cope with
unpleasant ob0ects and events.
7. 4rolonged e+posure will increase
an+iety to possibly uncontrollable
levels.
1. "earful situations can never be viewed
as pleasurable.
$)% Answer A
7y staying physically close, the nurse
conveys to the client the message that
someone cares enough to be there and
that the client is a person worth caring for.
7. he client is incapable of telling
anyone what the problem is
8. )itting still will increase the tension the
client is e+periencing
1. his would not be an initial nursing
intervention.
$*% Answer #
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 15
he client is too an+ious to sleep in four
bedroom and should be simply be moved
to a private room.
A. Kust tal#ing about the problem will not
improve itJ -uietly moving the client to
a private room would be better
intervention at this time.
8. his is false reassurance
1. his probably would not help since it
would not relieve the clients an+iety.
$$% Answer D
he repeated thought or act defends the
client against even higher, more severe
levels of an+iety.
A. o deny the client the ritual may
precipitate panic levels of an+iety.
7. he client already recogni3es that the
ritual serves little purpose.
8. )ame as Answer A
?>. he nursing diagnosis that would be most
appropriate for a &&9year9old client who uses
ritualistic behavior would be!
a. Ineffective coping
b. Impaired 0udgment
c. 4ersonal identity disturbance
d. )ensoryIperceptual alterations
?<. he priority discharge criteria for a female
client who has been using ritualistic
behaviors would have to include that the
client should be able to!
a. Lerbali3e positive aspects about herself
b. "ollow the rules and regulations of the
milieu
c. 2ecogni3e that her hallucinations occur at
times of e+treme an+iety and can be
controlled
d. Lerbali3e signs and symptoms of
increasing an+iety and intervene to
maintain it at a manageable level
?C. he nurse allows the client to use ritualistic
behavior ample time for the performance of
the ritual because!
a. ,ithout consistency of limit setting,
change will not occur
b. o deny the client this activity may
precipitate panic levels of an+iety
c. his behavior is viewed as a result of
anger turned inward on the self
d. )uccessful performance of independent
activities enhances self esteem
>;. .ne day a male client with the diagnoses of
borderline personality disorder describes a
situation that happened at wor# when his
immediate supervisor reprimanded him for
not completing an assignment. Ae e+plains
that it was not his fault and states, 4eople
get angry and ta#e it out on me. he nurse
recogni3es that the client is using the
defense mechanism called!
a. 1enial c. 1isplacement
b. 4ro0ection d. Intellectuali3ation
$&% Answer A
Ineffective coping is the impairment of the
persons adaptive behaviors and problem
sloving abilities in mmeting lifes
demandsJ ritualistic behavior fits under
this category as a definign charateristics.
7. Not enough information is available to
use this nursing diagnosis in this
situation
8. )ame as Answer A
1. )ame as Answer A
$"% Answer D
his outcome would result from teaching
the client to recogni3e situations that
provo#e ritualistic behavior and the
clients learning how to interrupt the
pattern.
A. Not a priorityJ the client probably had
littlt difficulty in this area.
7. )ame as Answer A
8. No evidence is presented to indicate
the client was hallucinating.
$'% Answer #
he repeated thought or act defends the
client against severe an+ietyJ the client
doies not want to perform the ritual but
feels compelled to do so to #eep an+iety
at a controllable level.
A. No limits are being set by the nurses
action
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1?
8. his causes depression and is
unrelated to ritualistic behavior
1. 2ituals are not activities that enhances
self9esteemJ they control an+iety.
&!% Answer #
Attributing unacceptable feelings or
attributes to others is the mechanism
#nown as pro0ectionJthe data demonstrate
use of this defense mechanism.
A. 1enial is the unconscious refusal to
recogni3e the reality of an an+iety
producing situationJ the data do not
demonstrate use of this defense
mechanism.
8. 1isplacement is the shifting of feelings
from an emotionally charged situation
to a substitute person or ob0ectJ the
date do not demonstrate the use of
this defense mechanism.
1. Intellectuali3ation is the use of
reasoning to avoid confronting an
ob0ectionable impulseJ the data do no
demonstrate the use of these defense
mechanism
>1. ,hen wor#ing with the nurse during the
orientation phase of the relationship, a client
with a borderline personality disorder would
probably have the most difficulty in!
a. 8ontrolling an+iety
b. erminating the session on time
c. Accepting the psychiatric diagnosis
d. )etting mutual goals for the relationship
>&. he main personality problem for clients who
need props to blur reality is usually!
a. Distrust c.1ependency
b. Fgo ideal d. 2ole blurring
>*. Dany people control an+iety by ritualistic
behavior. ,hen ta#ing care of these
individuals it is important for the nurse to!
a. Avoid mentioning the ritual
b. F+plain the meaning of the ritual
c. Allow them time to carry out the ritual
d. 4revent them from carrying out the ritual
>/. A person who habitually e+presses an+iety
through physical symptoms is using!
a. 4ro0ection c. 8onversion
b. 2egression d. Aypochondriasis
>5. he client with an antisocial personality
disorderJ
a. )uffers from great deal of an+iety
b. Is generally unable to postpone
gratification
c. 2apidly learns by e+perience and
punishment
d. Aas a great sense of responsibility toward
others
>1. Answer D 8lients with borderline
personality disorders fre-uently
demonstrate a patter or unstable
interpersonal relationships,
impulsiveness, affective instability, and
frasntic efforts to avoid abandonmentJ
these beahviors create great difficulty in
establishing mutual goals.
A. he client with a borderline personality
disorder usually would not have
difficulty in this area.
7. )ame as Answer A c. )ame as
Answer A
>&. Answer C ,hen props are needed to blur
reality, the individual is not able to rely on
the self to test out situations, and
therefore dependence on others or props
increases.
A. he person who mistrusts, has not
learned to trust the environmentJ
however, the person does not
necessarily needs props.
7. he person with an ego ideal would
not need props to blur reality.
1. 2ole blurring is not a problem
re-uiring prop.
>*. Answer C 8lients prevented from using
ritualistic behavior to control an+iety will
be deprived of a defense and have no
way of relieving tension.
A. he clients behavior should never be
ignoredJ it is important to accept and
support these clients during this time.
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1>
7. his would not decrease the ritualistic
behavior
1. 4reventing ritualistic behavior will only
increase an+iety.
>/. Answer C he development of physical symptoms
without a physical cause is an an+iety reducing
mechanism #nown as conversion.
A. 7laming others for the environment for failure
and mista#es is not converting an+iety into
physical symptoms.
7. 'oing bac# to an earlier state when one felt
safer and more secure is not converting
an+iety into physical symptoms
1. his is a continued concern about health
characteri3ed by an+iety and an unrealistic
interpretation of real or imaginary symptoms
as indication of serious illness.
>5. Answer # Individuals with personality
disorder tend to be self centered and
impulsive. hey lac# 0udgment and self
control and do not profit from their
mista#es.
A. 'enerally, 0ust the opposite is true
8. hese people never learn from their
mista#es, e+periences and
punishment.
1. hese people are too self centered to
have a sense of responsibilty to
anyone.
>?. A person with an antisocial personality
disorder has difficulty relating to others
because of never having learned to!
a. 8ount on others
b. Fmpathi3e with others
c. 7e dependent on others
d. 8ommunicate with others socially
>>. A person who deliberately pretends an illness
is usually thought to be!
a. Neurotic
b. Dalingering
c. .ut of contact with reality
d. Gsing conversion defenses
><. he basic difference between
psychophysiologic disorders and somatoform
disorders is that in psychophysiologic
disorders there is!
a. A feeling of illness
b. An emotional cause
c. A restriction of activities
d. An actual tissue change
>C. A fre-uent finding in clients with
paraphiliac se+ual disorders is that they
have!
a. .ther covert or overt emotional disorders
b. 'onadal and pituitary hormone
deficiencies
c. An inade-uate physical development of
the se+ual organs
d. A poor ad0ustment due to association of
the societys fringe groups
<;. "ollowing an automobile accident involving a
fatality and a subse-uent arrest for speeding,
a client has amnesia for the events
surrounding the accident. his is an e+ample
of the defense mechanism #nown as!
a. 4ro0ection c. 1issociation
b. 2epression d. )uppression
&$% Answer #
he lac# of superego control allows the
ego and the id to control the behavior.
)elf motivation and self satisfaction are of
paramount concern.
A. hey count on others to e+tricate them
from the problems they find
themselves faced with.
8. hese people are e+tremely
dependent on others
1. hese people are usually charming on
the surface and can easily con
people into doing what they want.
&&% Answer #
,hen the individual consciously pretends
an illness with no physical basis, it is
called malingering.
A. 4eople using neurotic defense really
believe they are sic#.
8. A person out of contact with reality is
unable to pretend an illness
1. he use of conversion defenses is not
a conscious act.
&"% Answer D
he psychophysiologic responses
:hyperfunction or hypofunction=creates
actual tissue change. )omatoform
disorders are unrelated to organic
changes.
A. here is a feeling of illness in both
instances
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1<
7. here is an emotional component in
both instances
8. here may be a restriction of activities
in both instances.
&'% Answer A
8lients with these se+ual disorders
usually have many other emotional
problems that may be overt or covert in
nature.
7. here is no proof of deficiency of
these hormones
8. here is normal development of
se+ual oragns in individuals with
paraphiliac se+ual disorders.
1. his has no basis in fact.
"!% Answer C
1issociation is defined as handling
emotional conflicts, or internal or e+ternal
stressors by a temporary alteration of
consciousness or identity.
A. 4ro0ection is attributing ones own
unacceptable feelings and thoughts to
others.
7. 2epression is unconsciously #eeping
unaaceptable feelings out of
awareness.
1. )uppression is consciously #eeping
unacceptable feelings and thoughts
out of awareness
<1. he nurse is aware that the approach to be
used during crisis intervention should be!
a. 4assive and reflective
b. Active and goal directed
c. Interpretative and analytical
d. "uture oriented and passive
<&. he outcome that is unrelated to a crisis state
is!
a. 6earning more constructive coping s#ills
b. 1ecompensation to a lower level of
functioning
c. Adaptation an a return to a prior level of
functioning
d. A high level of an+iety continuing for more
than * months.
<*. he most important assessment data for the
nurse to gather from the client in crisis would
be!
a. he clients wor# habits
b. Any significant physical health data
c. A history of any emotional problems in the
family
d. he specific circumstances surrounding
the percieved crisis situation
</. he best e+ample of the nurses use of crisis
interention would be!
a. ell me what you have done to help
yourself
b. 8an you ell me about what is bothering
you%.
c. I understand in the past you have had
problems.
d. I will be here for you to help you figure
things out.
<5. A client, admitted 5 days ago for chronic
abuse of drugs and alcohol, appears to have
e+treme difficulty in participating in an art
therapy group pro0ect. he priority
assessment the nurse needs to ma#e after
the group therapy is to determine if the client
is e+periencing a peiod of!
a. 8risis c. 8onfabulation
b. 1isorientation d.
Aallucinations
"(% Answer #
1uring crisis intervention the nurse should
be goal directive and active in assessing
the current situation and handle the
interview with authority.
A. hese are not appropriateJ the client
cannot move without direction.
8. his approach might be more
appropriate for long term therapy.
1. hese are not appropriate to crisis
intervention.
"% Answer D
his is not an accepted outcome of a
crisis because by definition a crisis would
be resolved in ? wee#s.
A. his is a desirable outcome of a crisis
situation
7. Although this is not the most ideal
outcome for a crisis situation, it is a
possible outcome.
8. his is a desirable outcome of a crisis
situation.
"+% Answer D
his assessment assists the nurse in
determining what the situation means to
the client.
A. his is not as important but should be
inclided in a later assessment.
7. )ame as Answer A
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& 1C
8. )ame as Answer A
")% Answer D
8lients in crisis need assistance with
copingJ the nurse must be involve with
problem solving.
A. Although a positive interview
statement, it does not focus on the
nurses involvement with problem
solving.
7. )ame as Answer A
8. )ame as Answer A
"*% Answer A
he clients behavior indicates that the
peoblem is occuring in response to the
therapy group. he nurse should assess
whether participating in the group is
creating a crisis for the client.
7. here is no data to suggest the client
is disoriented
8. here is no data to suggest the client
is using confabulation
1. here is not data to suggest the client
is hallucinating
<?. ,hen applying mental health principles to the
care of any person with children, the nurse
should be aware that!
a. It is easier to ad0ust to the first child than
to later ones
b. It is pathologic to feel anger and
resentment towards a child
c. Fvery parent has inborn feelings of love
and acceptance for children
d. Dany parents e+perience feelings of
resentment towards their children
<>. )trict toilet training before a child is ready will
cause problems in personality development
because at this age a child is learning to!
a. )atisfy own needs
b. Identify own needs
c. )atisfy parents needs
d. 6ive up to societys e+pectations
<<. A child in the first grade is murdered and
counseling is planned for the children in the
school. o understand a childs response to a
crisis, the nurse must initially identify the!
a. 8hilds developmental level
b. "amily communication patterns
c. Muality of the childs peer relationships
d. 8hilds perception of the crisis situation
<C. An infant in an newborn nursery is
suspected of having cerebral palsy. ,hen
the parents are told, the mother cries, ,hat
did we do to deserve this% he nurses most
therapeutic response would be!
a. 6ets sit down and have a cup of coffee.
b. ,hy do you feel you are being
punished%
c. I #now you must be upset, but its too
early to tell
d. $ou didnt do anythingJ let me tell you
about this disorder
C;. A young single woman delivers a chiuld with
a severe cleft palate. he nurse recogni3es
the fairly typical response to a baby with a
visible birth defect when the woman states!
a. Im unhappy. I guess Im being punished
b. No, you must have brought me the wrong
baby
c. ,hat will my parents say% ,hat could
have happened%
d. I shouldnt have had this baby. Now my
boyfriend will never marry me
"$% Answer D
"eelings of resentment toward children by
parents is a normal response. o relieve
feelings of guilt and shame, it is vital to
help parents reali3e this.
A. he first child causes the greatest
amount of ad0ustment in ones life
7. hese are normal findings
8. his is an untrue generali3ation.
"&% Answer #
oddlers struggle to identify their own
needs. oo early and too strict toilet
training results in ambivalence because
toddlers needs and physical abilities are
in conflict with parental demands.
oddlers are faced with giving up these
needs or ris#ing parental disapproval.
A. 8hildren are involved from birth in
satisfying their own needs.
8. 8hildren are involved from birth in
satisfying their parents needs, but
toilet training is really the first time a
conflict develops.
1. A child has no interests in societys
e+pectations.
""% Answer A
1evelopmental level is essential to
understanding a childs response to a
crisis situation.
7. his is not an initial assessment
8. )ame as Answer 7
1. his is important to assess after the
developmental level as been
ascertained.
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& &;
"'% Answer A
)itting down shows the client that the
nurse cares enough to spend time. It also
opens up channels of communication.
7. he nurse sets dimensions on the
mothers feelingsJ this does not
promote free e+pression of feelings
8. his statement provides false hopeJ
the possibility of the diagnosis has
been introduced.
1. his statement ignores the mothers
need to e+press feelingsJ it ta#es a
cognitive approach to the problem.
'!% Answer #
1enial or disbeleif and shoc# are
considered initial responses of greiving.
here is a feeling of guilt and inade-uacy
when a child is born with a defect or
abnormality
A. It would be unusual for a client initially
to verbali3e feelings of punishment or
guilt so directly.
8. A sense of shame and guilt is voiced
laterJ afetr denial, disbelief and shoc#.
1. It would be unusual for the client to
use rationali3ation and voice it so
obviously.
C1. According to psychose+ual theory, the
primary emergence of the personality is
demonstrated around the age of!
a. ? months c. &/ months
b. C months d. /< months
C&. 4ersonality is uni-ue in every individual
because it is the result of the persons!
a. Intellectual capacity, race and
socioeconomic status
b. 'enetic bac#ground, placement in the
family, and autoimmunity
c. 7iologic constitution, psychologic
development and cultural setting
d. 8hildhood e+periences, intellectual
capacity and socioeconomic status
C*. he basic emotional tas# for the toddler is!
a. rust c. Identification
b. Industry d.Independence
C/. he stage of growth and development
basically concerned with role identification is
the!
a. .ral stage c..edipal stage
b. 'enital staged.6atency stage
C5. 4lay for the preschool age child is necessary
for the emotional development of!
a. 4ro0ection c. 8ompetition
b. Intro0ection d.Independence
'(% Answer C
7efore this age the infant has been
developed before ego strength to have an
identity or personality.
A. his is too earlyJ the child has not
developed enough ego strength to
have a personality.
7. )elf concept is none+istent
1. he primary emergence of the
personality has already occurred.
'% Answer C
he parameters set by birth, physiologic
e+periences and the environment ma#e
each individual uni-ue. Although other
factors impinge to a slight degree, these
factors form the personality.
A. hese are not inclusive, they are
limited to only some aspects of
personality dvelopmentJ race plays no
part.
7. Autoimmunity plays no part in
personality development.
1. hese are not inclusiveJ they are
limited to only some aspects of
personality development.
'+% Answer D
esting the self both physically and
psychologically occurs during the toddler
stage after trust has been achieved.
A. as# is the tas# of infancy
7. his tas# is accomplished between the
ages of ? to 1&.
8. 7etween the ages of * and ?, a child
starts to identify with the parent of the
same se+.
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& &1
')% Answer C
he child resolves oedipal conflicts by
learning to identify with the parent of the
opposite se+ and becomes 0ealous of the
parent of the same se+. hese thoughts
results in feelings of guilt, an+iety, fear
and hate toward the parent of the same
se+ which are repressed.
A. Ambivalence does not occur in the
oedipal stage of development
7. he child loves the parent of the
opposite se+ and hates the parent of
the same se+.
1. )ame as Answer 7
'*% Answer #
Lalues and beliefs from parents and
society are e+pressed through the childs
play world. hese values becomes part of
the childs system through the process of
internali3ation.
A. If this happened, children would learn
to blame others for their own faults.
8. his would occur at a later stage.
1. he environment and others in it,
rather than play, influence
independence.
C?. 2esolution of the oedipal comple+ ta#es
place when the child!
a. 2e0ects the parent of the same se+
b. Intro0ects behavior of both parents
c. Identifies with the parent of the same se+
d. Identifies with the parent of the opposite
se+
C>. Fvidence of the e+istence of the
unconsciousis best demonstrated by!
a. he ease of recall c. 1N0O vu
e+periences
b. )lips of the tongue d. "ree floating
an+iety
C<. he level of an+iety that best enhances an
individuals power of perception is!
a. Dild c. )evere
b. 4anic d. Doderate
CC. A persons seeing a design on the wallpaper
perceives it is an animal. his is an e+ample
of!
a. An illusion c. A hallucination
b. A delusion d. An idea of reference
1;;. Autism can be usually diagnosed when
the child is about!
a. & years of age c. ? months of
age
b. ? years of age d. 1 to * months
of age

'$% Answer C
he child reali3es that the parent of the
same se+ cannot be tested in a struggle
for the affection of the parent of the
opposite se+. he role and behavior of the
same se+ parent are therefore assumed
by the child to attract the parent of the
opposite se+.
A. his would be a conflict,J not a
resolution.
7. 1oing this would give rise to greater
conflict and leave a fragmented self.
1. his would be in conflict with
heterose+ual drives.
'&% Answer #
)lips of the tongue, also called freudian
slips are material from the unconsciousP
that slips out in unguarded moments.
A. Daterial in the unconscious cannot
deliberately be brought bac# to
awareness.
8. here is no evidence lin#ing these
e+periences to the unconscious.
1. "ree floating an+iety is lin#ed to the
unconscious, but the best evidence of
the unconscious is slips of the tongue.
'"% Answer A
Dild an+iety motivates one to action, such
as learning emotional changes. Aigher
levels of an+iety tend to blur the
)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& &&
individuals peceptions and interfere with
functioning.
7. Attention is severely reduced by panic.
8. he perceptual field is greatly reduced
with severe an+iety.
1. he perceptual field is narrowed with
moderate an+iety.
''% Answer A
An illusion is an misinterpretation or
misperception of the actual e+ternal
stimuli.
7. his is a false belief that cannot be
changed even by evidenceJ it is a
fi+edfalse belief.
8. his would deal with imaginary, not
real stimuli.
1. A belief that others are tal#ing about
the person is not a visual distortionJ
but rather an idea of reference.
(!!% Answer A
7y & years of age, the child should
demonstrate an interest in others,
communicate verbally, and possess the
ability to learn from the environment.
7efore these s#ills develop, autism is
difficult to diagnose.
7. Autism can be diagnosed long before
this age.
8. Infantile autism can occur at this age
but difficult to diagnose.
1. )ame as Answer 8.

)t. 6ouis 2eview 8enter, Inc91avao el. no. :;<&= &&/9&515 or &&&9<>*& &*