1.

When interacting with patients, it is important for the nurse to recognize that defense

mechanisms:
a.

keep id impulses from gaining control.

b.

protect the ego from excessive anxiety.

c.

access unconscious feelings and

memories.

d.

prevent conflict among the id, ego, and

superego.

ANS: B

Theorists widely accept the Freudian concept that ego defense mechanisms operate
unconsciously to lower anxiety. The function of defense mechanisms is limited to anxiety
control, so the other options are incorrect.

3.A patient asks, Why is it important to uncover memories and conflicts hidden in the

unconscious? A Freudian therapist would explain that bringing unconscious information

to consciousness will:
a.

resolve developmental issues, fears, and

crises.

b.

allow an individual control over the id and

superego.

c.

suppress painful feelings and increase

rational thinking.

d.

provide insight into behavior and allow

meaningful change to occur.

ANS: D

Freud believed that uncovering unconscious material generates an understanding of

behavior that enables individuals to make choices about behavior and thus improve
mental health. It will not, however, automatically resolve issues, give the patient control
over id and superego strivings, or result in rational thinking.

4.A patient uses defense mechanisms excessively. The nurse should expect to find evidence that:
a.

the patient has difficulty with problem

solving.

b.

the patient has an increased risk for

psychosis.

c.

emotions are experienced with great

intensity.
d.

reality is denied.

ANS: A

Excessive use of defense mechanisms results in the distortion of reality. When reality is
not perceived accurately, problem solving is impaired. The other options might or might
not be experienced by the patient.

5.A patient experiences severe panic attacks and uses denial, repression, and displacement.

Nursing interventions should be directed toward:

a.

teaching more effective coping strategies.

b.

setting limits on use of the defense

mechanisms.

c.

assisting the patient to change values and

beliefs.

d.

helping the patient uncover unconscious

conflicts.

ANS: A

A desired outcome would be that the patient will use more effective coping strategies.
Nursing intervention would focus on helping the patient identify and use more adaptive
coping strategies. Setting limits on the use of defense mechanisms is impossible. Values
clarification might be unnecessary. Uncovering conflicts is not a focus of nursing
intervention.

7.When the nurse conducts a developmental assessment with a new patient, the assessment can

be expected to yield information regarding what?

a.

The use of defense mechanisms

b.

The degree of mastery of critical tasks

c.

Strategies to help the patient make rational

decisions

d.

The mobilization of defenses against the

patient's stressors

ANS: B

According to Eriksons developmental theory, a developmental assessment is conducted

for the purpose of determining the extent to which an individual has successfully
mastered the critical task of each stage of development up to his or her chronologic age.
Lack of mastery or partial mastery will yield clues about issues to be addressed in

working with the patient. Because of its focus, the developmental assessment might yield
only minimal information about defense mechanism use and defenses used to cope with
stress. Rational decision making is not expected to be fostered as a result of
developmental assessment.

8.A patient diagnosed with lung cancer continues to smoke and says, I think my cancer is more

the result of a bad gene than of smoking. The patient shows the use of which defense
mechanism?
a.

Denial

b.

Compensation

c.

Intellectualization

d.

Reaction formation

ANS: A

Denial is the unconscious refusal to admit an unacceptable idea or behavior, as shown in

this example. Compensation refers to covering a weakness by overemphasizing a
desirable trait. Intellectualization involves using a logical explanation without expressing
emotion or affect. Reaction formation is a conscious behavior that is the opposite of an
unconscious feeling.

9.A patient tells the nurse, The reason I use drugs is because everybody nags me to do things

that dont interest me. The patient shows use of which defense mechanism?
a.

Sublimation

b.

Introjection

c.

Identification

d.

Rationalization

ANS: D

Rationalization is an attempt to prove that ones behaviors or feelings are justifiable and
involves making justifications of feelings or behaviors. Sublimation channels instinctual
drives into acceptable channels. The patient is not modeling after another person or
incorporating anothers values.

10.A patient is mute, curled in a fetal position, and incontinent of urine. The patient eats small

amounts only if spoon-fed. The nurse assesses this behavior as most indicative of:
a.

displacement.

b.

compensation.

c.

conversion.

d.

regression.

ANS: D

Regression is defined as the return to an earlier, more comfortable developmental state

in this case, infancy. Displacement involves discharging feelings to an object that is less
threatening. Compensation refers to covering a weakness by overemphasizing a desirable
trait. Conversion refers to the unconscious expression of conflict symbolically through
physical symptoms.

12.A young adult reports overwhelming guilt about minor social errors, feels self-pity, and says,

I stay on the sidelines of life so I can avoid the embarrassment of being noticed. The
nurse can assess deficits in mastery of critical tasks associated with which developmental
stage?
a.

Trust versus mistrust

b.

Industry versus inferiority

c.

Autonomy versus shame and doubt

d.

Generativity versus self-absorption

ANS: B

Adult behaviors reflecting developmental problems associated with the stage of industry
versus inferiority include excessive guilt and embarrassment, passivity, apathy,
rumination and self-pity, assumption of the victim role, and underachievement of
potential. The behaviors given in the scenario reflect the critical tasks of industry versus
inferiority. Tasks of the other stages are entirely different.

13.An older retired executive reports, I am unable to say no when asked to help with

community causes. These projects overtax my strength, but if I dont do them, who will?
The nurse can assess that this person is having difficulty with critical tasks related to
which developmental stage?
a.

Trust versus mistrust

b.

Integrity versus despair

c.

Identity versus role diffusion

d.

Autonomy versus shame and doubt

ANS: B

Adult behaviors reflecting problems associated with the developmental stage of integrity
versus despair include inability to reduce activities, overtaxing strength, and feeling
indispensable, or the opposite: feeling helpless, useless, or lonely; focusing on past

mistakes; and inability to occupy oneself with satisfying activities. Tasks of the other
stages are not described in the scenario.

14.The nurse who uses the interpersonal model as a basis for practice will focus assessment on

identifying:
a.

intrapsychic conflicts.

b.

relationship problems.

c.

how the environment affects behavior.

d.

the patients achievement of development

tasks.

ANS: B

Interpersonal therapists assess for current difficulties in the patients relationships with
others. Learning new, more effective interpersonal skills becomes a goal of therapy.
Psychoanalytic therapists focus on intrapsychic conflicts. The other options are not the
focus of the model.

16.A 26-month-old child displays negative behaviors. The parent says, My child refuses toilet

training and shouts No! when given direction. What do you think is wrong? Select the
nurses best reply.
a.

This is normal for your childs age. The

child is striving for independence.

b.

The child needs firmer control. Punish

the child for defiance and saying no.

c.

There may be developmental problems.

Most children are toilet trained by age 2.

d.

Some undesirable attitudes are

developing. A child psychologist can help
you develop a remedial plan.

ANS: A

The distracters indicate that the childs behavior is abnormal when, in fact, this behavior
is typical of a child around the age of 2 years whose developmental task is to develop
autonomy.

17.A nurse clinician uses rational-emotive therapy with a patient who is chronically depressed.

The initial step in this process is to help the patient:

a.

identify developmental tasks and progress.

b.

manage environmental stressors more

effectively.

c.

explore childhood influences on the

patients emotional state.

d.

recognize how irrational beliefs are related

to painful feelings.

ANS: D

Cognitive therapists believe that irrational beliefs or automatic thoughts cause selfdefeating behaviors to be maintained. Individuals can challenge their self-defeating
behaviors once they identify irrational beliefs and see their connection to painful feelings.
The other options reflect interventions that might occur later.

19.During an interdisciplinary team meeting, a nurse says, The patients psychological distress

seems to result from automatic thoughts that cause self-defeating behaviors. The nurse is
conceptualizing the patients problem from the viewpoint of which model?
a.

Interpersonal

b.

Psychoanalytic

c.

Stress-adaptation

d.

Cognitive-behavioral

ANS: D

The cognitive-behavioral model recognizes the role of automatic thoughts (irrational

beliefs) in promulgating self-defeating behaviors. The information given in the scenario
does not reflect conceptualization using any of the other models.

20.Which statement by an adult would lead a nurse to suspect deficits in mastery of the

developmental task of infancy?

a.

I have many warm and close

friendships.

b.

I am afraid to let anyone really get to

know me.

c.

I am always right. Keep your opinion to

yourself.

d.

I am ashamed I did that wrong. Please

forgive me.

ANS: B

According to Erikson, the developmental task of infancy is the development of trust. The
the only statement clearly showing the lack of ability to trust others mentions being
"afraid to let anyone really get to know me".. The distracters suggest that the
developmental task of infancy was successfully completed: rigidity rather than mistrust,
and failure to resolve the crisis of initiative versus guilt.

21.A student nurse says, I dont need to interact with my patients. I learn by observing them.

The instructor can best interpret the nursing implications of Sullivans theory to this
student by responding:
a.

Nurses cannot be isolated. We must

interact to provide patients with
opportunities to practice interpersonal
skills.

b.

Observing patient interactions can help

you formulate priority nursing diagnoses
and appropriate interventions.

c.

I wonder how accurate your assessment

of the patients needs can be if you do not
interact with the patient.

d.

It is important to note patient behavioral

changes because these signify changes in
personality.

ANS: A

Sullivan believed that the nurses role includes educating patients and assisting them in
developing effective interpersonal relationships. Mutuality, respect for the patient,
unconditional acceptance, and empathy are cornerstones of Sullivans theory. These
cornerstones cannot be demonstrated by the nurse who does not interact with the patient.
Observations provide only objective data. Priority nursing diagnoses usually cannot be
accurately established without subjective data from the patient. The other distracters
relate to Maslows theory and behavioral theory.

23.After an episode of self-mutilation, a patient diagnosed with borderline personality disorder

will begin individual therapy and group skills training. The goals are to decrease use of
dissociation, increase distress tolerance, and regulate affect. Which type of therapy is
evident?
a.

Rational-emotive behavioral

b.

Motivational enhancement

c.

Dialectical behavioral

d.

Interpersonal

ANS: C

Each of the components described in the scenario is a component of dialectical

behavioral therapy. The scenario information is not consistent with the components of
any of the other types of therapy given as options.

2.When observing and interpreting a patients nonverbal communication, which nursing

consideration is important?
a.

Patients are usually aware of their

nonverbal cues.

b.

Verbal responses are more important than

nonverbal cues.

c.

Nonverbal cues have obvious meaning

and are easily interpreted.

d.

Nonverbal cues provide significant

information but must be validated.

ANS: D

Body language has meaning, but meaning cannot be globally ascribed. Validation with
the individual is necessary to accurate interpretation. The other options are incorrect.

3.A patient diagnosed with schizophrenia, paranoid type, frequently gets up and walks away

during interactions with a nurse. The nurse can best increase the patients comfort level
by:
a.

arranging the chairs side by side, about 2

feet apart.

b.

sitting at eye level across the table from

the patient.

c.

standing a few feet away from where the

patient sits.

d.

talking in the patients room with the door

closed.

ANS: B

Suspicious patients require increased personal space. Sitting across the table provides that
space. Being at the same eye level fosters communication. Side-by-side placement of
chairs might not give the suspicious patient the ability to watch the nurse closely enough
for comfort. Being in a closed room might be threatening to the patient.

5.Effective use of the nursing process is dependent on communication that:

a.

is structured and goal-directed.

b.

meets the needs of both patient and nurse.

c.

is spontaneous and affords mutual selfdisclosure.

d.

fosters emotional distance between patient

and nurse.

ANS: A

Therapeutic communication occurs with the purpose of helping patients. It is patientcentered, structured, and goal-directed. It is not expected to meet the needs of the nurse or
to include mutual self-disclosure. These are characteristics of social communication. The
nurse maintains objectivity, rather than emotional distance.

7.When assessing a patients social skills, which remark would serve the nurse best?
a.

It sounds as if you need to develop some

assertiveness skills.

b.

Describe an example of a time when you

felt uncomfortable in a social situation.

c.

It is not easy to be assertive. We can roleplay some situations to give you practice.

d.

What do you plan to do the next time you

find yourself in an uncomfortable social
situation?

ANS: B

The nurse is seeking clarification, a therapeutic technique that is a useful assessment tool.
Mention of assertiveness skill development indicates that the assessment has been made.
Asking for the patients plan would occur during problem solving rather than assessment.

9.A patient has difficulty expressing anger appropriately. The nurse encourages the patient to set

realistic goals by stating:

a.

You seem to have problems expressing

anger in a nonaggressive way.

b.

I thought you sounded angry when I told

you it was time for group.

c.

What do you think needs to change about

how you express anger?

d.

What bothers you about your actions

when you get angry?

ANS: C

Goal-setting is most directly related to the technique of asking patients to decide on the
type of change needed. The distracters demonstrate making observations and exploring.

12.A nurse realizes that the comment just made to a patient was inconsiderate. Select the nurses

most therapeutic statement in this situation.

a.

How do you feel about what I just said?

b.

See, even nurses say stupid things

sometimes.

c.

Sorry about that. Lets continue where

we left off.

d.

That was an insensitive remark. Im sorry

if it hurt you.

ANS: D

Acknowledging insensitivity and apologizing for it will usually repair damage. Patients
usually evaluate the nurse on overall caring rather than on one single comment. None of
the other options includes both acknowledgment and apology.

14.A patient says to the nurse, My family was mean to me when they visited today. They have

no right to treat me like that. Select the nurses best initial response.
a.

Why do you think they were mean?

b.

Perhaps you overreacted to what they

said.

c.

How do you feel about your family

treating you that way?

d.

Describe what happened when your

family visited you today.

ANS: D

Before proceeding, the nurse needs to have a better understanding of what happened in
the interaction between the patient and family. The correct option seeks that clarification,
whereas none of the other options takes that approach.

17.A patient at the crisis intervention clinic states, When I got up this morning, I realized I

could not go on any longer. Select the nurses best response to facilitate analyzing the
problem and making a nursing diagnosis.
a.

How long have you been feeling this

way?

b.

What is different about your feelings

today?

c.

We are here to help you. Im glad you

decided to come to the center.

d.

You said you felt like you could not go

on. Tell me more about that.

ANS: B

Encouraging comparison is a useful technique when the nurse wishes to analyze the
problem and draw conclusions to facilitate establishing a nursing diagnosis. None of the
other options would be as effective in encouraging the patient to analyze feelings.

18.A newly admitted patient asks the nurse, Can you hear those people laughing at me? They

are making fun of me. Select the nurses best response.

a.

You are mistaken. No one is laughing at

you.

b.

I know the sound of laughter is real to

you, but I dont hear it.

c.

Your mind is playing tricks on you,

making you think you hear laughter.

d.

When people are mentally ill, they often

experience things that others cannot relate
to.

ANS: B

This reply acknowledges the patients perceptions and gently casts doubt on the reality of
the patients conclusions through the use of an I statement. It is not argumentative or
accusative.

19.Select the best description of therapeutic use of self to provide to a new psychiatric nurse.
a.

Most nurses have caring personalities

that equip them to be helpful to patients.

b.

Its mostly about using good verbal and

nonverbal communication, objectivity,
genuineness, and empathy.

c.

It means that you keep yourself at a

distance so you are not affected by
patients problems and emotions.

d.

The most important aspect of practice is

when and how much to touch, as well as
when to listen and give advice.

ANS: B

The correct answer lists several of the components of therapeutic use of self. The other
options provide less information for the new nurse to use to continue to develop skills.

22.A patient says to the nurse, I dreamed I could not breathe and was being attacked. When I

woke up, I felt emotionally drained, as though I hadnt rested well. Which comment
would be appropriate if the nurse seeks to interpret?
a.

It sounds as though you were

uncomfortable with the content of your
dream.

b.

So you are saying that you were not able

to breathe and felt in danger?

c.

I understand. Thank you for telling me

about your bad dream.

d.

So, you feel as though you had a poor

nights sleep?

ANS: A

The technique of interpreting is therapeutic and helps the nurse examine meaning and
importance of the experience. The distracters use other techniques.

3.A patient diagnosed with schizophrenia says to the nurse, I feel really close to you. Youre

the only true friend I have. Select the nurses most therapeutic response.
a.

We are not friends. Our relationship is a

professional one.

b.

I feel sure there are other friends in your

life. Can you name some?

c.

I am glad you trust me. Trust is important

for the work we are doing together.

d.

Our relationship is professional, but lets

explore ways to strengthen friendships.

ANS: D

The patients remarks call for the nurse to remind the patient of the parameters of their
relationship and take the opportunity to discuss the issue of friends. Only this option
incorporates both desired elements.

7.A patient has identified the need for better anger management and tells the nurse, Im afraid

that someday I might explode. The best strategy for reducing this patients fear of losing
control is to:
a.

talk about these feelings openly and

directly.

b.

discuss feelings in general without

reference to the patient.

c.

avoid talking about the feelings until the

patient feels comfortable.

d.

reassure the patient that expressing

feelings is the first step to resolving them.

ANS: A

Talking openly about feelings conveys the message that feelings are natural and can be
handled. Once feelings can be discussed, the focus can shift to learning to cope more
effectively with them. The other options are either avoidant or nontherapeutic.

10.A patient with a history of self-mutilation says to the nurse, I want to stop hurting myself.

What is the initial step of the problem-solving process to be taken toward resolution of a
patients identified problem?
a.

Deciding on a plan of action

b.

Determining necessary changes

c.

Considering alternative behaviors

d.

Describing the problem or situation

ANS: D

The nurse learns how well the patient understands the problem by asking for a detailed,
in-depth description of situations, thoughts, feelings, and behaviors relevant to the
identified problem. This step must be completed before moving through the problemsolving process. The other actions are premature.
14.A novice nurse says, I have more important things to do than play games with patients.
These activities are not a worthwhile use of my time. Select the nurse managers best

response.
a.

Games are part of the therapeutic

milieu.

b.

Patients need a break from intensive

individual therapy.

c.

Informal activities help patients develop

social skills and take risks.

d.

Please review material on the

psychotherapeutic management model.

ANS: C

Nurses who engage in therapeutic activities with patients recognize that each encounter
with patients is part of an overall therapeutic picture. Patients discuss real problems and
solutions and practice skills needed in real-life situations. These encounters offer
opportunities for assessment, for patients to process feelings, and for validation and
feedback, as well as for tension relief. The correct answer is the most global response.
The distracters do not educate the new nurse about the purpose of informal activities.

17.A patient shouts at a nurse who just entered the room, Youre an incompetent fool. Leave

me alone. The nurses response should be based on which rationale?

a.

The anger was created by a situation or

significant person, not the nurse.

b.

The reaction probably results from

transference and countertransference.

c.

The patient is probably reacting to fear of

loss of emotional control.

d.

The patient has a right to openly express

negative feelings.

ANS: A

Anger toward the nurse is often displaced anger that has arisen from some situation or
significant person in the patients life. Nurses feel the brunt of the anger because they are
handy and might be considered by the patient to be a safe object for the displacement.
Knowing that the nurse is not the true object of the anger allows the nurse to plan a
therapeutic strategy for helping the individual manage the emotion. None of the other
options provides an accurate basis for planning intervention.

21.A nurse says, What step would you like to take next to resolve this issue? The patient

stands up and shouts, You are so controlling! You want me to do everything your way.
What is the likely basis of the patients behavior?

a.

Projection

b.

Dissociation

c.

Transference

d.

Emotional catharsis

ANS: C

Transference involves a patients emotional reaction to the nurse that is actually based on
an earlier relationship or experience. In this case, the transference is negative and might
be related to an earlier experience with an authority figure. Although projection is a
possibility, it is less obvious. Dissociation and emotional catharsis do not apply.

22.A nurse considers interventions for a diabetic patient who needs to change eating habits and

lose weight. The nurse will base strategies on which principle?

a.

The nurses primary responsibility is to

encourage the change.

b.

Patient-initiated change is more successful

than imposed change.

c.

For successful change, both the benefit

and the risk to the patient must be high.

d.

Patients value advice from nurses because

of the trusting dimensions of the
relationship.

ANS: B

The answer indicates that the patient is invested in the change process. Nurses have
multiple responsibilities in the change process, including education and reinforcement.
Nurses should avoid giving advice.

25.Assessment findings by the multidisciplinary team after a patient-intake interview are used

primarily to:
a.

confirm ongoing discharge planning.

b.

expand and confirm the initial assessment.

c.

verify the appropriateness of nursing

diagnoses.

d.

analyze the patients feelings about

hospitalization.

ANS: B

As members of the multidisciplinary team interact with the patient, their impressions
might support or differ slightly from the initial assessment. The findings are synthesized
and used in planning ongoing treatment. The other options have less relevance or are not
applicable.
27.As the nurse plans care for a newly admitted patient, identification of dysfunctional

behaviors will provide the focus for:

a.

evaluation.

b.

nursing diagnosis.

c.

nursing interventions.

d.

outcome identification.

ANS: C

The nurse recognizes that dysfunctional behaviors are behaviors that would benefit the
patient to change. These dysfunctional behaviors are written as defining characteristics in
the nursing diagnosis. Nursing interventions are formulated that address changing
dysfunctional behaviors to more adaptive behaviors. The focus of evaluation is patient
progress; the focus of nursing diagnosis is patient problems; the focus of outcome
identification is adaptive behaviors.

28.A patient tells the nurse, I was raped a month ago. Since then Ive felt anxious and have

been unable to talk normally to my husband. Ive had frequent thoughts about cutting my
wrists. What is the priority nursing concern regarding this patient?
a.

The risk for self-directed violence

b.

The development of rape traumatic

syndrome

c.

The damage that could result in poor selfesteem

d.

The demonstration of signs and symptoms

of acute anxiety

ANS: A

The risk for self-injury is of highest priority, because patient safety is involved.

30.A realistic outcome for a patient with situational low self-esteem who will have a short

inpatient stay would be for the patient to:

a.

write a list of strengths, abilities, and

talents.

b.

role-play with others to improve social

skills.
c.

replace a negative self-image with a

positive one.

d.

respond with positive self-esteem in all

encounters.

ANS: A

A short-term goal is one that can be attained in 4 to 6 days. Identification of strengths,

abilities, and talents is attainable within this time frame. The other options are long-term
goals.

31.Realistic short-term goals for a patient who is newly admitted to the hospital should be

achievable in:
a.

1 to 2 days.

b.

4 to 6 days.

c.

1 to 2 weeks.

d.

2 to 4 weeks.

ANS: B

Short-term goals are those achievable in 4 to 6 days for hospitalized patients and
somewhat longer for patients in other settings. A period of 1 to 2 days allows too little
time. The other options suggest longer times than necessary.

32.A patient with suicidal ideation is hospitalized. What is the priority intervention?
a.

Negotiating a no-harm contract

b.

Facilitating attendance at groups

c.

Administering a psychotropic drug

d.

Determining the precipitating situation

ANS: A

Preservation of patient safety is of higher priority than any of the other interventions.

33.A patient hospitalized for 6 days has made little progress toward outcomes written at the time

of admission. The nurse decides that the lack of progress toward goals indicates that:
a.

needs for reassessment exist.

b.

discharge should be delayed.

c.

nursing diagnoses were incorrect.

d.

nursing interventions were inadequate.

ANS: A

When the evaluation is made that goals are not being attained, reassessment should take
place. Nursing diagnoses might need to be reformulated, more realistic outcomes
identified, or nursing interventions changed, but none of these measures can be
determined to be appropriate until the reassessment has been completed.

38.The nurse performing a mental status examination wants to assess for hallucinations. The

nurse should ask:

a.

Can you tell me where you are now?

b.

Do you hear or see things when others

dont?

c.

Do your moods shift more than those of

other people?

d.

What would you do if you found a

stamped, addressed letter on the floor?

ANS: B

Hallucinations are false sensory perceptions. The correct answer directly inquires about
possible hallucinations. The other options seek information about other aspects of the
MSE.

39.During an MSE a patient says, I am a special messenger sent to provide the world a cure for

cancer. The patients statement indicates the presence of:

a.

a phobia.

b.

a delusion.

c.

hypervigilance.

d.

loose associations.

ANS: B

Delusions are false beliefs. Grandiose delusions are beliefs that one possesses greatness
or special powers. A phobia is an excessive fear. Hypervigilance refers to being
hyperalert and suspicious. Loose associations refer to a thought disorder in which ideas
are only loosely connected.

2.A patient in a support group says, Im tired of being sick. Everyone always helps me, but Ill

be glad when I can help someone else. This statement reflects:

a.

altruism.

b.

universality.

c.

cohesiveness.

d.

corrective recapitulation.

ANS: A

Altruism refers to the experience of being helpful or useful to others, a condition that the
patient anticipates will happen. The other options are also therapeutic factors identified
by Yalom.

8.A patient admitted to an inpatient unit after a suicide attempt says, I feel so overwhelmed.

There are so many issues I have to deal with. The nurse should schedule the patient to
attend which type of group?
a.

Social skills

b.

Psychodrama

c.

Problem-solving

d.

Medication information

ANS: C

Problem-solving groups teach the skills necessary to solve problems. A patient with
multiple problems will benefit from learning the process for problem solving, because the
multiple problems to which he or she refers probably will not be resolved during a short
inpatient stay. The scenario does not pose problems with social skills or medication.
Psychodrama is rarely offered in an inpatient setting.
11.A talkative member of a support group for patients diagnosed with bipolar disorder has

monopolized the group discussion for 15 minutes. The nurse leading the group would
best intervene by:
a.

maintaining silence. It is important for

group members to give feedback to each
other.

b.

encouraging the patient to continue.

Patients learn from each other in group
sessions.

c.

saying, You must allow some of the other

members of the group to talk. You cannot
monopolize the conversation.

d.

addressing the patient by name and

saying, Im glad you shared your
thoughts with us. Lets hear what others
think.

ANS: D

This intervention provides support for the dominant patient but opens the floor for
contributions from others. Doing nothing or encouraging the patient to continue would be
ineffective strategies, because they fail to recognize the needs of others in the group.

13.The nurse asks members of a group for recovering alcoholics how they handle the urge to

drink. Which communication technique is the nurse using?

a.

Summarizing

b.

Presenting reality

c.

Encouraging comparison

d.

Seeking consensual validation

ANS: C

Distinguishing among the techniques listed shows that the nurse is encouraging
comparisons. Asking members to compare and contrast their experiences promotes group
sharing.

14.After a patients first group session, the nurse asks, How was the experience of participating

in group for you? Which communication technique is the nurse using?

a.

Summarizing

b.

Seeking clarification

c.

Making observations

d.

Encouraging evaluation

ANS: D

Distinguishing among the techniques listed shows that the nurse is encouraging
evaluation when asking a patient to make a judgment about the experience. This opens
the door to further exploration of thoughts and feelings.

19.A leader begins the discussion at the first meeting of a new group. Which comment would be

most appropriate?
a.

Lets start by establishing some rules for

our group.

b.

Lets begin with each person here

defining his or her problem.

c.

I want each person to explain why he or

she is attending this group.

d.

Talking to family about our group will

help us achieve our goals.

ANS: A

The leader must set ground rules for the group before members can effectively
participate. Bringing family members would jeopardize confidentiality. Members share
feelings after the group develops an identity and cohesiveness.

2.Which documentation of family assessment indicates a healthy and functional family?

a.

Members provide mutual support.

b.

Power is distributed equally among all

members.

c.

Members believe that there are specific

causes for events.

d.

Under stress, members turn inward and

become enmeshed.

ANS: A

Healthy families nurture and support their members, buffer against stress, and provide
stability and cohesion. The distracters are unrelated or incorrect.

3.A 15-year-old patient is hospitalized after a suicide attempt. The adolescent lives with his

mother, stepfather, and several siblings. When performing a family assessment, the nurse
must first determine:
a.

how the family expresses and manages

emotion.

b.

the names and relationships of the

patients family members.

c.

the communication patterns between the

patient and parents.

d.

the meaning the patients suicide attempt

has for family members.

ANS: B

The names and relationships of the patients family members constitute the most
fundamental information and should be obtained first. Without this, the nurse cannot fully
process the other responses.

4.Which information is the nurse most likely to find when assessing the family of a patient with

a serious and persistent mental illness?

a.

The family exhibits many characteristics

of dysfunctional families.

b.

Several family members have serious

problems with their physical health.

c.

Power in the family is maintained in the

parental dyad and rarely delegated.

d.

The stress of living with a mentally ill

individual has negatively affected family
function.

ANS: D

The information almost universally obtained is that the family is under stress associated
with having a mentally ill member. This stress lowers the familys level of functioning in
at least one significant way. Stress does not necessarily mean the family has become
dysfunctional.

6.An adult diagnosed with paranoid schizophrenia lives with older adult parents. The patient

was recently hospitalized with acute psychosis. One parent is very anxious, and the other
is ill from all the stress. Select the most applicable nursing diagnosis.
a.

Ineffective family coping related to

parental role conflict

b.

Caregiver role strain, related to the stress

of chronic illness

c.

Impaired parenting, related to patients

repeated hospitalizations

d.

Interrupted family processes, related to

relapse of acute psychosis

ANS: B

Caregiver role strain refers to a caregivers felt or exhibited difficulty in performing a

family caregiver role. In this case one parent exhibits stress-related illness, and the other
exhibits increased anxiety. The other nursing diagnoses are not substantiated by the
information given and are incorrectly formatted (one nursing diagnosis should not be the
etiology for another).

9.A parent is admitted to a chemical dependency treatment unit. The patients spouse and

adolescent children attend a family session. What is the priority assessment question to
ask family members?
a.

What changes are most important to

you?

b.

How are feelings expressed in your

family?

c.

What types of family education would

benefit your family?

d.

Can you identify a long-term goal for

improved functioning?

ANS: B

It is important to understand family characteristics in both the family of origin and the
present family. The other questions are related more to outcome identification and
planning intervention, neither of which should be attempted until assessment is complete.

11.Two divorced people plan to marry. The man has a teenager, and the woman has a toddler.

This family will benefit most from:

a.

guidance about parenting at two

developmental levels.

b.

role-playing opportunities for conflict

resolution.

c.

formal teaching about problem-solving

skills.

d.

referral to a family therapist.

ANS: A

The newly formed family will be coping with tasks associated with the stages of rearing
preschool children and dealing with teenagers. These stages require different knowledge
and skills. There is no evidence of a problem, so the distracters are not indicated.

14.A family expresses helplessness related to dealing with a mentally ill members odd

behaviors, mood swings, and argumentativeness. An appropriate nursing intervention for

the family would be to:
a.

express sympathy.

b.

involve local social services.

c.

explain symptoms of relapse.

d.

role-play problem situations.

ANS: D

Helping a family learn to set limits and deal with difficult behaviors can often be
accomplished by using role-playing situations, which give family members the
opportunity to try new, more effective approaches. The other options would not provide
learning opportunities.

15.Parents of a mentally ill teenager say, Weve never known anyone who was mentally ill. We

have no one to talk to because none of our friends understand the problems. The nurses
most helpful intervention would be to:
a.

refer the parents to a support group.

b.

build their self-esteem as coping parents.

c.

teach techniques of therapeutic

communication.

d.

facilitate achievement of normal

developmental tasks.

ANS: A

The need for support can be clearly identified. Referrals are made when working with
families whose needs are unmet. A support group such as the National Alliance for the
Mentally Ill (NAMI) will provide these parents with the support of others who have had
similar experiences and with whom they can share feelings and experiences. The
distracters are less relevant.

19.A parent says, My son and I argue constantly since he started using drugs. When I talk to

him about not using drugs, he tells me to stay out of his business. What is the nurses
most appropriate action?
a.

Educate the parent about the stages of

family development.

b.

Report the son to law enforcement

authorities.

c.

Refer the son for substance abuse

treatment.

d.

Make a referral for family therapy.

ANS: D

Family therapy is indicated, and the nurse should provide a referral. Reporting the child
to law enforcement would undermine trust and violate confidentiality. The other
distracters may occur later.

20.Which option describes a healthy family?

a.

One parent takes care of the children. The

other parent earns income and maintains
the home.

b.

A family has strict boundaries that require

members to address problems inside the
family.

c.

A couple requires their adolescent children

to attend church services three times a
week.

d.

A couple renews their marital relationship

after their children become adults.

ANS: D

Revamping the marital relationship after children move out of the family of origin
indicates that the family is moving through its stages of development. Strict family
boundaries or roles interfere with flexibility and the use of outside resources. Adolescents
should have some input into deciding their activities.

BONUS:
2.After being informed of a diagnosis of lung cancer, a patient says in a cheerful voice, I feel

fine. I will do some reading online about it. Right now, I want to take a nap. The nurse
assesses the use of which defense mechanisms? Select all that apply.
a.

Repression

b.

Undoing

c.

Introjection

d.

Reaction formation

e.

Intellectualization

f.

Suppression

ANS: D, E, F

The cheerful voice is probably the result of reaction formation. The wish to read more
about the diagnosis reflects intellectualization. Taking a nap is suppression and allows the
patient to avoid having to think about the problem. Repression results in unconscious
forgetting. Undoing involves doing something to make up for an unacceptable act.
Introjection is incorporating values and attitudes of others as if they were ones own.

1.A psychiatric aide asks, Can you give me some examples of how we provide structure for

patients? The nurse should offer which suggestions? Select all that apply.
a.

Set limits on destructive behavior.

b.

Direct a patient to go to a quiet place.

c.

Sit with a withdrawn, isolated patient.

d.

Distract a patient who is hallucinating.

e.

Help a patient contemplate needed

change.

ANS: A, B, C, D

Providing structure means that staff members meet patient needs for organizing elements
in the environment to produce specific outcomes. Contemplating change is the only
option that would not be considered an example of structuring.