Test bank for psychiatric mental health nursing 3rd edition by fortinash

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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 one’s 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 nurse-client 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
nurse’s 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.

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Full file at />4. An expected outcome of the nurse’s 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 client’s 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
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.

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Full file at />
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 client’s 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 client’s 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 client’s beliefs are consistent with the nurse’s 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 nurse’s 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. “We’re admitting a cocaine addict who threatened to kill herself.”
c. “We’re admitting an out-of-control, manic client.”
d. “They’ve added another psychotic to my caseload.”
ANS: A
This statement reflects the nurse’s 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
b. Exercising
c. Reaction formation
d. Introjection
ANS: B

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Full file at />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 one’s 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
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
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Full file at />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 child’s 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, “Aren’t 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.
18. A client who is experiencing depression following loss of his job tells the nurse, “It’s hopeless!
I’ll 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

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Full file at />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 don’t want the facility. We don’t 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.
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
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Full file at />An operative principle for developing and maintaining a therapeutic nurse-client relationship
states that client needs and problems are the focus of the therapeutic nurse-client relationship. b.
Nurse expertise never dictates the focus; it is always client-centered. 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, “I’ve 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 one’s 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, “It’s so wonderful how you’ve helped me; I think I’ve 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.
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.

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Full file at />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 client’s 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 can’t stand my mother. She’s 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 nurse’s 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 nurse’s 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
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
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Full file at />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.

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