Fortinash & Holoday Worret: Psychiatric Mental Health Nursing, 3rd

Edition
Chapter 1: Foundations of Psychiatric Mental Health Nursing
MULTIPLE CHOICE
1. Which of the following characteristics would the nurse evaluate as indicative of healthy
boundaries?
a. Giving as much as you can for the sake of giving
b. Believing others can anticipate your needs
c. Letting others define you
d. Taking responsibility to meet ones own needs
ANS: D
Healthy boundaries are characterized by behaviors that are adaptive. Only d is an
example of an adaptive behavior.
2. The student nurse is planning to initiate a therapeutic relationship with a client. Which
intervention should she plan to incorporate in their interactions?
a. Becoming subjectively involved
b. Mutually sharing ideas and experiences
c. Giving and receiving friendship equally
d. Encouraging the client to choose a topic for discussion
ANS: D
Encouraging the client to choose the topic for discussion maintains a client-centered
focus. This is desirable and in keeping with accepted principles for therapeutic nurseclient relationships. The other responses are components of a social rather than a
therapeutic relationship.
3. A client frequently diverts the focus from himself by changing the topic or commenting
on the nurses appearance. The nurse should recognize this as an example of:
a. transference.
b. resistance.
c. countertransference.
d. therapeutic alliance.
ANS: B
Resistance is seen as client behavior that permits change of focus from the client and his
or her problems to a less emotionally charged topic. a. Transference refers to positive or
negative feelings the client has for a significant figure that he or she attributes to the
nurse. c. Countertransference refers to feelings the nurse has for a significant figure that
he or she attributes to the client. d. A therapeutic alliance is another name for the
therapeutic nurse-client relationship.
Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

4. An expected outcome of the nurses attempts to maintain objectivity in a therapeutic

relationship with a client is:
a. personally identifying with the client.
b. processing information based on facts.
c. subjectively determining the clients needs.
d. using intellectualization to remain separate from the client.
ANS: B
Expected outcomes of maintaining objectivity would be positive. Only b is a positive
outcome. a, c, and d are negative outcomes.
5. The result of a nurse becoming subjectively involved in a therapeutic relationship is
likely to be that the client will:
a. explore issues.
b. expand on topics.
c. feel accepted and understood.
d. stop sharing information.
ANS: D
The outcome of subjective involvement with a client will be negative. Only d is a
negative outcome. a, b, and c are desirable outcomes.
6. An expected outcome of the preorientation phase of the therapeutic relationship is that
the nurse will:
a. initiate a trusting relationship with the client.
b. complete the required assessment process.
c. examine his or her own feelings and perceptions about the client.
d. recognize his or her own need for therapy.
ANS: C
During the preorientation phase the nurse engages in autodiagnosis regarding the client
and attempts to uncover biases or stereotypes that could influence the contact in a
nontherapeutic way. Options a and b take place in other phases of the nurse-client
relationship. Option d is not an expected outcome.
7. A client displays isolation, bizarre behaviors, self-mutilation, and poor hygiene. Which of
the following will be the highest priority in the nursing care plan?
a. Safety
b. Hygiene
c. Isolation
d. Bizarre behaviors
ANS: A

Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

The safety needs associated with self-mutilation are of highest priority. Poor hygiene,
isolation, and bizarre behaviors are not as likely to be life threatening.
8. The nurse and client have met for six predetermined sessions. The agreed-on goal has
been attained. Which nursing intervention would be appropriate for the termination
phase?
a. Exploring the clients past in depth
b. Confronting changes not completed
c. Helping client summarize accomplishments
d. Identifying new problem areas
ANS: C
Termination is a time for bringing closure. A helpful technique to use is having the client
identify changes he or she has made toward growth and sharing nurse perceptions of the
clients progress. Options a, b, and d do not foster the goal of bringing closure. Instead,
they open new topics.
9. When assessing a client, the nurse incorporates an understanding of definitions of mental
health and would describe an individual as healthy:
a. if the clients beliefs are consistent with the nurses beliefs.
b. when behavior conforms to DSM-IV-TR criteria.
c. if precise physiologic signs are absent.
d. as measured by psychiatric and psychologic standards.
ANS: D
An individual would be considered healthy based on established standards. a. The nurses
beliefs are not the benchmark. b. DSM-IV-TR criteria define mental disorders. c. Few
mental disorders have easily measured physiologic signs.
10. The student nurse is learning how to reduce the stigma associated with mental illness.
Which of the following statements by the student nurse would reflect that learning has
taken place?
a. A 34-year-old is being admitted for suicidal threats as a result of cocaine use.
b. Were admitting a cocaine addict who threatened to kill herself.
c. Were admitting an out-of-control, manic client.
d. Theyve added another psychotic to my caseload.
ANS: A
This statement reflects the nurses view that the client is not the disorder but is a person
with and illness. b labels the client as an addict. c and d label the client as the disorder.
11. Which of the following would be included in a plan designed to teach a client to use a
conscious technique to manage anxiety?
a. Rationalizing problems
Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

b. Exercising
c. Reaction formation
d. Introjection
ANS: B
Exercising is the only conscious technique listed. Options a, c, and d are unconscious
defense mechanisms.
12. The nurse is assigned to care for a suspicious client who uses projection. Which of the
following behaviors would the nurse expect to observe?
a. Engaging in lofty discourse of painful situations with little emotionality
b. Viewing others as hostile
c. Making excuses for shortcomings
d. Attempting to atone for wrongdoings
ANS: B
Projection involves unconsciously attributing ones own unacceptable feelings to another.
Projecting hostility is a commonly observed behavior among clients who demonstrate
high levels of suspicion. a describes intellectualization. c is defined as rationalization. d
describes undoing.
13. A client on a medical unit is stable after treatment for pleurisy but repeatedly whines and
asks the nurse to do things that she is very capable of performing for herself. The nurse
interprets this as:
a. regression.
b. sublimation.
c. suppression.
d. introjection.
ANS: A
An individual who demonstrates regression used behaviors that would be appropriate
during an earlier stage of development. Dependent behaviors are displayed by young
children. b refers to modification of an instinctual, but socially unacceptable, impulse. c
refers to conscious inhibition of an impulse. d refers to treating something outside the self
as if actually inside the self.
14. If a client was not included in a celebration but then spent her time imagining herself
dressing and attending this event, the nurse would analyze this as an example of:
a. omnipotence.
b. isolation of affect.
c. fantasy.
d. acting out.
ANS: C

Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

Fantasy involves the gratification of frustrated desires by substituting daydreams and

imagery for the desires. a involves feeling or acting as if the person is superior to others.
b separates feelings from thoughts and ideas originally associated with them. d refers to
the use of actions to deal with stress.
15. Which of the following would the nurse anticipate observing in a client whose use of
protective mechanisms is adaptive?
a. Internal stressors that are greater than the capacity to defend against them
b. The perception that one cannot overcome stress
c. The exclusive use of one defense
d. Maintenance of reality orientation
ANS: D
Healthy individuals use defenses that help to maintain reality orientation. a, b, and c
suggest problems with the use of defense mechanisms.
16. The community health nurse plans to implement primary prevention in her role. Which of
the following activities should be incorporated in the plan?
a. Teaching parenting skills
b. Treating acutely ill clients
c. Referring clients to mental health providers
d. Providing family support to deal with a childs addiction
ANS: A
Teaching basic skills that will prevent problems is an example of primary prevention. b
and c are secondary prevention. d is tertiary prevention.
17. A new psychiatric technician asks the nurse, Arent you bored? All psychiatric nursing
requires is the skill of being vigilant. The only thing nurses do is watch the client. The
reply that is most educative is:
a. Nurses must implement knowledge of the science of nursing to provide safe,
effective care.
b. Clients are people and need both protection and kindness, as well as close
monitoring.
c. Psychiatric nurses must also have the ability to follow professional guidelines.
d. Your statement seems to be an attempt to define me.
ANS: A
Psychiatric nurses are prepared to use the nursing process to care for clients with
psychiatric disorders. Skilled clinical practice is based on knowledge, research, and
interventions that use evidence-based techniques to provide safe, effective care.

Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

18. A client who is experiencing depression following loss of his job tells the nurse, Its
hopeless! Ill never be able to find another job. Which of the following is the best
interpretation of these data?
a. The client is displaying isolation of affect by separating feelings from ideas.
b. The client has experienced stress that exceeds his capacity to adapt.
c. Passive aggressive anger is at the root of this statement.
d. It is a natural response to and insult to self-esteem.
ANS: B
This formulation uses the stress diathesis model, focusing on the outcome of the
convergence of vulnerability and stressors. The information available gives no evidence
to support any of the other statements.
19. At a neighborhood meeting where a half-way house is being proposed for the
neighborhood, a member of the community states, We dont want the facility. We dont
want violent people living near us. The response by the nurse that best addresses the
need to reduce stigma would be:
a. In truth, most individuals with psychiatric disorder are passive and withdrawn.
b. We can give neighbors training in how to defend yourselves so you will be more
comfortable.
c. Clients with psychiatric disorder are so well-medicated that they do not display
violent behaviors.
d. After a few weeks, the folks in the neighborhood will develop tolerance to
ambiguity.
ANS: A
A major reason for the existence of the stigma placed on persons with mental illness is
lack of knowledge. The main fear is of client violence, although only a small percentage
of clients with mental illness display this behavior. Providing the public with accurate
information can help reduce stigma.
20. A client who displayed withdrawn, suspicious behavior at admission believed the CIA
wished to kill him. After 5 days of hospitalization with psychotropic medication, the
client is interacting appropriately with other clients and staff and states he formerly felt
afraid and thought the CIA had targeted him. Now he states, I know that thinking was
pretty sick. The evaluation the nurse can make is:
a. The client is telling staff what they wish to hear to gain discharge.
b. The client is experiencing continuing negative responses to stress.
c. Recent behavior and statements are signs of returning mental health.
d. Signs of mental disorder are increasing in frequency and intensity.
ANS: C
The ability to think logically and reach insightful conclusions is a component of mental
health. There are no data to support the other responses.

Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

21. A client makes an appointment to see the psychiatric mental health nurse about family
problems. The nurse will assume that the principal focus of the nurse-client relationship
will be determined by:
a. client needs.
b. nurse expertise.
c. social interaction.
d. epidemiology and research.
ANS: A
An operative principle for developing and maintaining a therapeutic nurse-client
relationship states that client needs and problems are the focus of the therapeutic nurseclient relationship. b. Nurse expertise never dictates the focus; it is always clientcentered. c. Social interaction does not determined focus; needs are assessed during
therapeutic interactions. d. Epidemiology and research are not the primary focus of the
relationship.

22. Near the end of her orientation to a unit, a new nurse tells her mentor, Ive become
aware of my need to influence vulnerable clients so I can feel more in control. It can be
determined that the new nurse has engaged in the process of:
a. labeling.
b. stereotyping.
c. subjectivity.
d. autodiagnosis.
ANS: D
Autodiagnosis is the examination of ones own thoughts, feelings, perceptions, attitudes,
and motives about a situation. The need for control or power motivates some nurses to
enter the profession. It is important to become aware of this motivation so that one may
replace it with a healthier motivation.
23. When a client tells the nurse, Its so wonderful how youve helped me; I think Ive
fallen in love with you, it suggests that:
a. the client is goal directed.
b. confrontation is occurring.
c. the client is demonstrating unhealthy boundaries.
d. the nurse is motivated by the desire to contribute to society.
ANS: C
Falling in love with someone who reaches out suggests the presence of unhealthy
boundaries. a. The situation does not reveal information about client goal direction. b.
This is not an example for confrontation, a process of pointing out a discrepancy. d. The
situation does not reveal information about nurse motivation.

Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

24. The client is withdrawn and passive and evidences feelings of hopelessness and
helplessness. A desired outcome of nurse use of helping behaviors that can be identified
is that the client will:
a. allow the nurse to do for him.
b. accept responsibility for helping self.
c. displace deeply felt, pent-up feelings.
d. request help, then reject the advice.
ANS: B
Helping is a process that aims to assist another person toward healthy behaviors. In the
scenario described, b is the only truly healthy behavior.
25. The nurse has begun to treat the client as a mutual friend, focusing on topics of social
interest and seeking support from the client. The result that can be anticipated is most
likely to be:
a. blurred boundaries and role confusion.
b. establishment and maintenance of trust.
c. client experiencing freedom to grow.
d. collaboration to determine client needs.
ANS: A
Becoming the clients friend is a negative event, shifting the focus from client needs,
changing the purpose of the relationship, and resulting in boundary blurring and role
confusion. The other choices are positive in nature.
26. A client states I cant stand my mother. Shes always interfering. The nurse responds,
I know what you mean. My mother is very controlling, too. What assessment can the
nurse mentor who overhears the interchange make?
a. The client has unhealthy boundaries.
b. The nurses response was subjective.
c. The nurse client relationship is in the working phase.
d. The nurse is establishing the client-centered goals.
ANS: B
b. Subjective responses emphasize the nurses feelings, attitudes, and opinions. There are
insufficient data to make this assessment. c. There are insufficient data to make this
assessment. d. The nurse is no longer objective and client-centered.
27. Which of the following client behaviors should suggest to the nurse that a client needs
intervention and treatment? The individual who:
a. Shoplifts and is arrested and jailed
b. Loses a clerical position, then volunteers in a social agency to maintain skills
c. Loses his wife in an accident and resumes his usual activities within a week
d. Is depressed and unable to work or assume family responsibilities

Copyright 2004 Mosby, Inc. All Rights Reserved

Chapter 1: Foundations of Psychiatric Mental Health Nursing

ANS: D
Mental health implies absence of signs and symptoms of mental disorder and freedom
from excessive mental and emotional disability and pain. Depression and inability to
work or assume family responsibilities suggests emotional pain and disability. a is
criminal behavior rather than mental illness. b is adaptive behavior. c is within the range
of normal behavior associated with grief work.
28. A layperson states, With all the new information about psychiatric disorders, the need
for psychiatric nurses will be drastically reduced. The response by the nurse that shows
the best understanding of current patterns of psychiatric disease burden is:
a. You make an excellent point about needing fewer psychiatric nurses.
b. My understanding indicates that the need for psychiatric nurses will remain
stable.
c. Disability from mental illness has been seriously overestimated in the past few
years.
d. The number of psychiatric nurses is projected to be insufficient to meet future
needs.
ANS: D
The Global Burden of Disease and Injury Study reports the burden of psychiatric diseases
has been seriously underestimated in the past. Present numbers of psychiatric nurses are
insufficient, and the projections of need for year 2020 suggest an even greater shortage.
29. Which statement best describes the effects of terrorism on the U.S. population after
September 11, 2001? The effects can be evaluated as:
a. primarily negative related to disruption of safety and security needs of an entire
nation.
b. entirely negative based on reports of increased incidence of mental disorders within
the first six months following the incident.
c. mixed based on reports of both increased stress-related symptoms and increased
affiliation within the population.
d. primarily positive associated with increased awareness of need for primary
prevention measures focusing on safety and security.
ANS: C
The effects are seen as mixed, with numerous reports of increased mental disorders in
both adults and children on the negative side and reports of increased affiliation among
both families and strangers who worked together and valued each others contributions.

Copyright 2004 Mosby, Inc. All Rights Reserved