Foundations of Psychiatric Nursing Practice Exam/Test (Questions 21-29)

Situation: F., age 18, returns home from school to discover that her mother has been in a serious automobile accident.

21. F. initially responds to the news by yelling, "No, I don't believe it. It can't be true." F. is using which defense mechanism?

a) introjection
b) suppression
c) denial
d) repression

22. F. excuses herself from the hospital to go home by saying to her father, "I have to go home. I can't stay awake anymore, and I've been here most of the day." Which defense mechanism is F. using?

a) reaction formation
b) rationalization
c) denial
d) regression

23. On arriving home, F. encounters neighbors who ask about her mother's condition. F. tells them all the details unemotionally and without feeling upset. This behavior illustrates her use of:

a) displacement
b) introjection
c) intellectualization
d) conversion

Situation: W., a 27 year old secretary, is brought to the hospital in an agitated state. She is admitted to the psychiatric unit for observation and treatment.

24. The nurse enters W.'s room for the first time and says, "W., I'm E., the nurse. I'll help you get settled." W. responds, "I want another nurse. I don't like you. You're mean." The nurse recognizes that W.'s response in an example of:

a) identification
b) regression
c) countertransference
d) transference

25. Before responding to W.'s initial outburst, the nurse should:

a) make sure she is a safe distance from the patient
b) move closer to the patient to show that she is not afraid
c) assess her own feelings and responses to the patient's behavior
d) recognize that it takes time for relationships to develop and not feel hurt

26. What would be the most therapeutic initial response by the nurse?

a) say nothing, accept what the patient has said, and remain nearby
b) say, "W., we've just met. Why do you think I'm mean?"
c) say, "I'm only trying to be helpful. Let me help you put your things away."
d) say, "I'll be back in half an hour," then leave the patient's room

27. as W. puts her things away, she talks rapidly and folds and unfolds her clothes several times. She cannot seem to settle down. Which nursing diagnostic category is most applicable initially?

a) self-care deficit
b) anxiety
c) impaired verbal communication
d) powerlessness

28. The nurse needs to complete W.'s admission interview. In light of the patient's initial behavior, which nursing approach is best?

a) allow W. as much time as she needs to arrange her clothes and belongings
b) recognize that W. is upset, but stress that the admission interview must be completed
c) tell W. that her repetitious behavior is interfering with the interview and that she must stop and cooperate
d) suggest that W. finish arranging her belongings later, and mention that she needs to complete her admission interview

29. The best way to continue W.'s mental status interview is to ask:

a) why are you here W.?
b) what events led to your coming to the hospital?
c) what do you want us to do for you while you are here
d) tell me about your family. W . . .



ANSWERS AND RATIONALE

21) C
- denial is the avoidance of reality by ignoring or refusing to acknowledge unpleasant incidents. This defense mechanism is used to allay anxiety immediately following a stressful event. Introjection is an intense form of identification in which a person incorporates the values or qualities of another person or group into his own ego structure. Suppression is the conscious analog of repression. A person uses suppression intentionally and consciously excludes material from awareness. Repression is the unconscious exclusion of painful episodes from awareness

22) B
- Rationalization is the offering of a socially acceptable or logical reason for doing, feeling, or behaving in a way that might not be otherwise acceptable. Reaction formation is the development of attitudes or behaviors that are opposite of what one actually feels or wants to do. Denial is avoiding reality by ignoring unpleasant events. Regression is a return to behaviors that reflect an earlier developmental level

23) C
- intellectualization is the splitting off the emotional part of an idea, impulse, or act. The emotional aspect then is repressed, either temporarily or over the long term. Displacement is discharging feelings in an indirect way perceived as safe. Introjection is an intense identification in which an individual incorporates another person's or group's values or qualities into his own ego structure. Conversion is the transfer of a mental conflict into a physical symptom.

24) D
- when a patient's response to the nurse is extremely negative or extremely positive with no apparent basis, transference of feelings from another relationship is probably occurring. If the nurse has similar unwarranted responses to the patient, countertransference is taking place. Identification is a defense mechanism in which the patient adopts the characteristics of the nurse. Regression is a retreat to behaviors manifested during an earlier developmental level

25) C
- the nurse must first identify her feelings toward the patient and use them as a guide to determine an appropriate response. An accurate assessment of the distance needed between the nurse patient is possibly only if the nurse assesses her own response first. The nurse's recognition hat trust takes time to develop may be useful in planning an appropriate response; however, the nurse should identify her feelings about the patient before formulating a response.

26) A
- displaying an accepting attitude of the patient's negative response helps foster trust. It also demonstrates the nurse's interest in and concern for the patient without challenging the patient, denying the patient's feelings, or leaving the patient alone. The patient probably cannot verbalize why she feels the way she does; challenging her will only increase her anxiety and make her feel more vulnerable. By emphasizing that she is only being helpful, the nurse implies that the patient's feelings are erroneous. Leaving the room serves no purpose and may exacerbate the patient's anxiety by increasing her feelings of aloneness and introducing a feeling of desertion.

27) B
- anxiety is an appropriate nursing diagnostic category initially because the patient's behavior mimics some of the objective signs of anxiety, which include restlessness, irritability, rapid speech, inability to complete to complete tasks, and verbal expressions of tension. The other diagnostic categories -- self-care deficit, impaired verbal communication, and powerlessness --- are premature because the nurse has not had an opportunity to complete a thorough nursing assessment.

28) D
- establishing priorities and communicating them to the patient in a clear, nonjudgmental way is important. Suggesting that the patient can continue her activities. Later demonstrates acceptance of the patient's behavior yet helps the nurse complete the admission interview in a timely manner. Emphasizing the nurse's need to complete the interview shifts the focus from the patient to the nurse.

29) B
- obtaining the patient's perspective of the events lading to her admission is an excellent source of assessment data. "Why" questions should be avoided because they require analysis of the problem and often produce anxiety. Finding out about the patient's family and her goals for treatment are important but should be discussed later.


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Related Topics:

• Online Nursing Practice Test about Foundation of Psychiatric Nursing (30-39)
• Go back to Online Nursing Practice Test about Foundation of Psychiatric Nursing (1-10) to start the test from the beginning.