The correct answer number and rationale for why it is the correct answer are given in boldface blue
type.
Rationales for why the other possible answer options are incorrect also are given, but they are not in boldface type.
Major Theoretical Models
1. 1. Excellent. All the student’s criteria are
correct. There are numerous descriptors
depicting the concept of good mental
health. The student’s list is not compre-
hensive, but all four criteria listed are cor-
rect reflections of good mental health. A
mentally healthy individual views reality
with a realistic perception based on objec-
tive data. Accepting oneself, including
strengths and weaknesses, is indicative of
good mental health. The ability to estab-
lish relationships by use of communication
skills is essential for good mental health.
Mentally healthy individuals seek time to
be alone and appreciate periods of
privacy.
2. Four out of four, not three out of the four
criteria are correct.
3. Four out of four, not two out of the four cri-
4. teria are correct. are correct, not incor-
All four of the criteria
rect.
TEST-TAKING HINT: To answer this question
correctly, the test taker should review criteria for
good mental health as they relate to the concept
of self, relationships with others, and interactions
with the environment. Recognizing that detach-
ment and a need for privacy are healthy assists
the test taker to include these criteria as an
indication of good mental health.
2. 1. The amount of creativity a patient exhibits is
not reflective of mental health or illness.
Some individuals are innately more creative
than others.
2. The inability to face a problem is not specific
to mental illness. Many individuals not diag-
nosed with a mental illness have difficulty
facing problems, such as a diabetic refusing
to adhere to an American Diabetes
Association diet.
3. Intensity of emotional reactions is not indica-
tive of mental illness. Grief, an expected
response to a perceived loss, can vary in
intensity from person to person and be
affected by cultural norms.
4. It is important when assessing for mental
illness that social and cultural norms be
evaluated. The context of cultural norms
determines if behaviors are considered
acceptable or aberrant. Belief in reincarna-
tion can be acceptable in one culture and
considered “delusional” in another.
TEST-TAKING HINT: To answer this question cor-
rectly the test taker must understand that cul-
ture is a particular society’s entire way of living,
encompassing shared patterns of belief, feelings,
and knowledge that guide people’s conduct and
are passed down from generation to generation.
3. 1. Intrapersonal theory deals with conflicts
within the individual. Assisting clients to
note defense mechanisms used would be an
example of interventions that reflect the use
of intrapersonal theory.
2. Discussing acting-out behaviors and why
they occur is an intervention reflective of
behavioral theory. A major concept of this
theory is that all behavior has meaning.
3. Discussion of thoughts is an intervention
reflective of cognitive theory. Cognitive the-
ory is based on the principle that thoughts
affect feelings and behaviors.
4. Interpersonal theory states that individual
behavior and personality development are
the direct result of interpersonal relation-
ships. The identification of a positive
relationship is an intervention that
reflects interpersonal theory.
TEST-TAKING HINT: Understanding the basic con-
cepts of interpersonal theory assists the test taker
to answer this question correctly. Remember
interpersonal theory by thinking “inter” and
“personal,” or “between people.” It often gets
confused with intrapersonal theory. Think “intra”
and “personal,” meaning “within oneself.”
4. 1. From birth to 18 months of age, a child is
in the oral stage of Freud’s psychosexual
development. During this stage, an infant
would attempt to decrease anxiety by
finding relief using oral gratification.
2. From the age of 3 to 6 years, a child is in the
phallic stage of Freud’s psychosexual develop-
ment. During this stage, a child is looking to
identify with the parent of the same sex and
developing his or her own sexual identity by
focusing on genital organs. Focusing on rela-
tionships with same-sex peers occurs during
the latency stage, which occurs from 6 to
12 years of age.
 3. From 6 to 12 years of age, a child is in the
latency stage of Freud’s psychosexual devel-
opment. During this stage, a child is sup-
pressing sexuality and focusing on relation-
ships with same-sex peers. Identifying with
the parent of the same sex occurs in the phal-
lic stage, which occurs from 3 to 6 years of
age.
4. Learning about independence and control
occurs in Freud’s anal phase of psychosexual
development, which occurs from 18 months
to 3 years of age.
TEST-TAKING HINT: To answer this question cor-
rectly, the test taker must be familiar with the
basic concepts of psychosexual development
according to Freud. Freud placed much emphasis
on the first 5 years of life and believed that char-
acteristics developed during these early years
bore heavily on one’s adaptation patterns and
personality traits in adulthood.
5. 1. Instinctual drives are considered examples of
the id, which is based on the “pleasure
principle.” The id is present at birth and
assists individuals to decrease immediately
the anxiety based on primal needs. Calling
out in pain is an example of a primal
response.
2. Between 3 and 6 years of age, a child begins
to develop his or her own superego by being
rewarded or punished for “good” and “bad”
behavior. The superego internalizes values
and morals set forth by the primary care-
givers. This is considered the “perfection
principle.” The superego is important in
that it assists the ego in controlling the
impulses of the id. When the superego
becomes penalizing, self-esteem issues
can arise.
3. The ego is considered the “reality prin-
ciple” and is developed between 4 and 6
months of age. The ego experiences the
outside world and then adapts and
responds to it. The ego’s main goal is to
maintain harmony between the id and
the superego. The ability to assert one-
self without anger or aggression is an
example of a healthy ego.
4. As children grow and are rewarded for
“good” and “bad” behavior, they begin to
develop their own superego. This is consid-
ered the “perfection principle.” Not only do
parents assist in the development of the
superego by a reward-and-punishment sys-
tem, but also societal norms play a role in
superego development.
TEST-TAKING HINT: To answer this question
correctly, the test taker must understand
that Freud organized the structure of the
personality into three major components: the
id, ego, and superego. They are distinguished
by their unique functions and different
characteristics.
6. Freud, known as the father of psychiatry,
developed and organized the structure of the
personality into three components: the id, ego,
and superego. He also described the formation
of personality through five stages of psycho-
sexual development: oral, anal, phallic, latency,
and genital.
1. Erikson developed psychosocial theory as a
further expansion of Freud’s psychoanalytic
theory. Erikson’s theory is based on the
eight stages of personality development
throughout the life cycle: trust versus
mistrust, autonomy versus shame and doubt,
initiative versus guilt, industry versus inferi-
ority, identity versus role confusion,
intimacy versus isolation, generativity
versus stagnation, and ego integrity versus
despair.
2. Peplau developed the nursing theory that
promotes the nurse-client relationship by
applying interpersonal theory to nursing
practice. Key concepts include the nurse
as a resource person, a counselor, a
teacher, a leader, a technical expert, and a
surrogate.
3. Sullivan developed interpersonal theory based
on the belief that individual behavior and
personality development are the direct
results of interpersonal relationships.
According to Sullivan, there are six stages of
development: infancy, childhood, juvenile,
preadolescence, early adolescence, and late
adolescence.
4. Mahler developed the object relations theory
(birth to 36 months), which describes the
separation-individuation process of the infant
from the maternal figure. Using three phases,
Mahler described the autistic phase, the sym-
biotic phase, and the separation-individuation
phase. Mahler’s theory of object relations aids
the nurse in assessing the client’s level of
individuation from primary caregivers.
TEST-TAKING HINT: The test taker must have
a basic knowledge of human personality
development and be able to distinguish
among the various theorists who authored
these theories to answer this question
correctly.
 7. Peplau developed the nursing theory that pro-
motes the nurse-client relationship by applying
interpersonal theory to nursing practice. Key
concepts include the nurse as a resource person,
a counselor, a teacher, a leader, a technical
expert, and a surrogate.
1. Watson believed that curing disease is the
domain of medicine, whereas caring is the
domain of nursing. She developed seven
assumptions about the science of caring,
which allows the nurse to deliver integrat-
ed holistic care.
2. Leininger based her theory of cultural care
diversity and universality on the belief that
across cultures there are health-care practices
and beliefs that are diverse and similar. The
nurse must understand the client’s culture to
provide care.
3. Erickson, Tomlin, and Swain developed their
theory of modeling and role modeling to
emphasize the nurse’s interpersonal and inter-
active skills.
4. A variety of nursing theorists based their theo-
ries on the concept of a human energy field.
These theories share a common view of the
individual as an irreducible whole, comprising
a physical body surrounded by an aura.
TEST-TAKING HINT: The focus of this question is
the basic concept of the theoretical models pre-
sented. The nurse-client relationship is the con-
cept underlying Peplau’s nursing theory model.
Assumptions of caring are underlying concepts of
Watson’s theoretical model.
8. Neuman’s systems model is based on concepts
related to stress and reaction to stress. Nursing
interventions are classified as primary prevention
(occurs before stressors invade the normal line of
defense), secondary prevention (occurs after the
system has reacted to the invasion of a stressor),
and tertiary prevention (occurs after secondary
prevention has begun to be successful and focuses
on rehabilitation).
1. Orem developed a general self-care deficit
theory of nursing composed of three interre-
lated concepts: self-care, self-care deficit, and
nursing systems. Nursing interventions
described in this theory consist of activities
needed to meet self-care demands and solve
self-care deficits.
2. Rizzo Parse developed her theory of “human
becoming” from existential theory. Parse
believes that people create reality for them-
selves through the choices they make at many
levels, and nurses intervene by assisting the
client to examine and understand the mean-
ing of life experiences.
3. Roy developed the “Roy Adaptation
Model,” which consists of four essential
elements: humans as adaptive systems,
environment, health, and the goal of nurs-
ing. Roy describes nursing actions as
interventions that seek to alter or manage
stimuli so that adaptive responses can
occur.
4. Rogers believed the science of nursing is the
“science of unitary human beings.” Rogers
believed humans are in constant interaction
with the environment and described interac-
tions with versus for the client to achieve
maximum potential.
TEST-TAKING HINT: The test taker must note that
the focus of this question relates to the nursing
interventions that are included in the theoretical
models presented. Primary, secondary, or terti-
ary prevention is Neuman’s language to describe
nursing interventions. Interventions that seek to
alter or manage stimuli so that adaptive responses
can occur are Roy’s language to describe nursing
interventions.
9. 1. Developing satisfactory relationships,
maturity, and relative freedom from anxiety is
a goal of interpersonal theory subscribed to
by Sullivan and Peplau.
2. Substituting rational beliefs for irrational
beliefs and eliminating self-defeating
behaviors is a goal of cognitive-behavioral
theory subscribed to by Beck and Ellis.
3. Facing reality and developing standards for
behaving responsibly is a goal of reality
theory subscribed to by Glasser.
4. Reducing bodily tensions and managing stress
by biofeedback and relaxation training is a
goal of stress theory subscribed to by Selye
and Lazarus.
TEST-TAKING HINT: To answer this question
correctly, the test taker must note that the focus
of this question is the goals that are established
in the theoretical model presented.
10. 1. Behavioral therapy includes advocating for
relaxation training as an intervention to deal
with stressors.
2. Intrapersonal therapy includes understanding
how situations during developmental stages
affect current emotions.
3. Interpersonal therapy deals with faulty pat-
terns of relating to others and encourages
interactions with others to develop the self-
system.
4. Reality therapy, based on cognitive theory,
is a type of therapy in which the client is
taught to control thought distortions that
 are considered to be a factor in the devel-
opment and maintenance of emotional
disorders. The response described focuses
the client on the reality of the impact of
behaviors on the consequences of actions.
TEST-TAKING HINT: Sometimes it is helpful for the
test taker to determine which theoretical model
each answer represents. Note the theory next to
the dialogue presented and choose the answer
that reflects reality theory.
11. 1. Intrinsic curiosity occurs from 12 to 18
months of age during the stage of sensorimo-
tor intelligence (0 to 2 years of age). Intrinsic
curiosity allows the child to explore the world
without adult teaching.
2. Secondary circular reactions occur from 4 to 10
months of age during the stage of sensorimotor
intelligence (0 to 2 years of age). Secondary cir-
cular reactions involve repeating an event that
occurs outside the infant’s body.
3. Inability egocentrism occurs during the
stage of preoperational thought (2 to
7 years of age). A child may appear to be
having a conversation, yet actually is dis-
cussing his or her personal interests.
These “conversations” are called “collec-
tive monologues.”
4. Concrete operations occur around age 11 and
continue through adulthood. The individual
is able to think systematically and logically as
long as the thought is related to tangible
objects.
TEST-TAKING HINT: Developmental theories are
based on chronological age. In the question, the
test taker must note the client’s age to be able to
choose the correct answer.
12. 1. Interpersonal theories assume that develop-
ment occurs in stages related to experiencing
different types of relationships.
2. Cognitive-behavioral theories assume individ-
uals have the potential for rational and irra-
tional thinking, which alters behaviors.
3. Erikson’s developmental theory assumes
that intrapersonal growth involves resolu-
tion of critical tasks throughout eight
stages of the life cycle. Erikson’s
theory is classified as an intrapersonal
theory.
4. Psychoanalytic theories assume individuals
are motivated by unconscious desires and
conflicts.
TEST-TAKING HINT: The test taker first must
determine which theory is being addressed in the
question. When a determination has been made
that the statement reflects Erikson’s theory, the
test taker must recognize that this theory is
classified as intrapersonal in nature. Erikson
described the eight stages of man as a further
development of Freud’s intrapersonal theory.
13. 1. Stagnation is the negative outcome of
Erikson’s “adulthood” stage of development,
generativity versus stagnation. Adulthood’s
stage ranges from 30 to 65 years of age. The
major developmental task for the adulthood
stage is to achieve the life goals established
for oneself, while considering the welfare of
future generations. The client described does
not fall within the age range of the adulthood
stage.
2. Despair is the negative outcome of Erikson’s
“old age” stage of development, ego integrity
versus despair. This stage ranges from
65 years until death. The major developmen-
tal task for this stage is to review one’s life and
derive meaning from positive and negative
events. Through this process, one needs to
achieve a positive sense of self-worth. The
client described does not fall within the age
range of the old age stage.
3. Isolation is the negative outcome of
Erikson’s “young adulthood” stage of
development, intimacy versus isolation.
This stage ranges from 20 to 30 years of
age. The major developmental task for
young adulthood is to form an intense,
lasting relationship or a commitment to
another person, cause, institution, or cre-
ative effort. The 25-year-old client falls
within the age range for young adulthood
and is exhibiting behaviors associated with
isolation.
4. Role confusion is the negative outcome of
Erikson’s “adolescence” stage of develop-
ment, identity versus role confusion. This
stage ranges from 12 to 20 years of age. The
major developmental task for this stage is to
integrate the tasks mastered in the previous
stages into a secure sense of self. The client
described does not fall within the age range
of adolescence.
TEST-TAKING HINT: To answer this question cor-
rectly, the test taker must understand that Erikson
described the eight stages of the life cycle during
which individuals struggle with developmental
challenges. Being able to recognize these develop-
mental conflicts assists the test taker to recognize
isolation as a negative outcome. The test taker
always must remember that Erikson developed his
psychosocial theory to be based on chronological
age, which is significant information needed to
answer this question correctly.
14. 1. Mistrust is the negative outcome of Erikson’s
“infancy” stage of development, trust versus
mistrust. This stage ranges from birth to 18
months of age. The major developmental task
for infancy is to develop a basic trust in the
parenting figure and be able to generalize
it to others. The client described does not
fall within the age range of the infancy
stage.
2. Guilt is the negative outcome of Erikson’s
“late childhood” stage of development, initia-
tive versus guilt. This stage ranges from 3 to
6 years of age. The major developmental task
for late childhood is to develop a sense of
purpose and the ability to initiate and direct
one’s own activities. The client described
does not fall within the age range of the late
childhood stage.
3. Inferiority is the negative outcome of
Erikson’s “school age” stage of development,
industry versus inferiority. This stage ranges
from 6 to 12 years of age. The major devel-
opmental task for school age is to achieve a
sense of self-confidence by learning, compet-
ing, performing successfully, and receiving
recognition from significant others, peers,
and acquaintances. The client described does
not fall within the age range of the school age
stage.
4. Shame and doubt is the negative outcome
of Erikson’s “early childhood” stage of
development, autonomy versus shame and
doubt. This stage ranges from 18 months
through 3 years of age. The major devel-
opmental task for early childhood is to
gain some self-control and independence
within the environment. The 2-year-old
child described falls within the age range
of early childhood and is exhibiting behav-
iors reflective of a negative outcome of
shame and doubt.
TEST-TAKING HINT: When assessing for signs of
shame and doubt, the test taker must look for
lack of self-confidence, lack of pride, a sense of
being controlled by others, and potential rage
against self. The age of the client presented in
the question should alert the test taker to the
developmental task conflict experienced.
15. 1. Autonomy is the positive outcome of
Erikson’s “early childhood” stage of develop-
ment, autonomy versus shame and doubt.
This stage ranges from 18 months through 3
years of age. The major developmental task
for early childhood is to gain some self-
control and independence within the envi-
ronment. The client described does not fall
within the age range of early childhood.
2. Identity is the positive outcome of Erikson’s
“adolescence” stage of development, identity
versus role confusion. This stage ranges from
12 to 20 years of age. The major develop-
mental task for adolescence is to develop a
sense of confidence, emotional stability, and a
view of oneself as a unique individual. The
client described does not fall within the age
range of adolescence.
3. Industry is the positive outcome of
Erikson’s “school age” stage of develop-
ment, industry versus inferiority. This stage
ranges from 6 to 12 years of age. The
major developmental task for school age is
to achieve a sense of self-confidence by
learning, competing, performing success-
fully, and receiving recognition from signifi-
cant others, peers, and acquaintances. The 7-
year-old boy described falls within the age
range of school age and is exhibiting
behaviors reflective of a positive outcome of
industry.
4. Initiative is the positive outcome of Erikson’s
“late childhood” stage of development, initia-
tive versus guilt. This stage ranges from 3 to
6 years of age. The major developmental task
for late childhood is to develop a sense of
purpose and the ability to initiate and direct
one’s own activities. The client described
does not fall within the age range of late
childhood.
TEST-TAKING HINT: When assessing for industry,
the test taker must look for the development of
social, physical, and school skills that generate
competence and pride in achievements. The age
of the client presented in the question should
alert the test taker to the developmental task
conflict experienced.
16. 1. A 60-year-old would be in Erikson’s develop-
mental stage of “adulthood” (30 to 65 years
old), generativity versus stagnation. The
example given presents someone exhibiting
2. behaviors reflective of stagnation. s develop-
A 50-year-old would be in Erikson’
mental stage of “adulthood” (30 to 65 years
old), generativity versus stagnation. The
example is of someone exhibiting behaviors
reflective of stagnation.
3. A 65-year-old would be in Erikson’s develop-
mental stage of “old age” (65 years old to
death), ego integrity versus despair. The
example reflects someone who is exhibiting
the desire to discuss all aspects of life events
 and is experiencing a positive outcome of ego
integrity.
4. A 70-year-old would be in Erikson’s
developmental stage of “old age” (65
years old to death), ego integrity versus
despair. The major developmental task in
old age is for an individual to review one’s
life and derive meaning from positive
and negative events. The 70-year-old
woman presented is exhibiting behaviors
reflecting the negative outcome of
despair.
TEST-TAKING HINT: When assessing for despair,
the test taker must look for feelings of worth-
lessness and helplessness. Anger, depression, and
loneliness are evident. The age of the client pre-
sented in the question should alert the test taker
to the developmental task conflict experienced.
17. 1. Erikson’s developmental stage for a 14-year-
old is “adolescence,” identity versus role con-
fusion. The major developmental task for this
stage is to develop a sense of confidence,
emotional stability, and a view of oneself as a
unique individual. The situation presented is
not reflective of the school age stage of devel-
opment.
2. Erikson’s developmental stage for a 5-year-
old is “late childhood,” initiative versus guilt.
The major developmental task for this stage
is to develop a sense of purpose and the abili-
ty to initiate and direct one’s own activities.
The situation presented is not reflective of
the school age stage of development.
3. Erikson’s developmental stage for a 3-year-
old is “early childhood,” autonomy versus
shame and doubt. The major developmental
task for this stage is to gain some self-control
and independence within the environment.
The situation presented is not reflective of
the school age stage of development.
4. Erikson’s developmental stage for an
11-year-old is “school age,” industry ver-
sus inferiority. The major developmental
task for this stage is to achieve a sense of
self-confidence by learning, competing,
performing successfully, and receiving
recognition from significant others, peers,
and acquaintances. The 11-year-old girl
presented is exhibiting behaviors reflect-
ing a positive outcome of industry.
TEST-TAKING HINT: Achievement of the task of
industry results in a sense of satisfaction and
pleasure in the interaction and involvement with
others. The age of the client presented in the
question should alert the test taker to the devel-
opmental task conflict experienced.
18. 1. Erikson based his psychosocial theory
on an individual’s chronological age.
Although individuals may have some
unresolved issues from previous stages,
the individual is assessed in a stage based
on chronological age.
2. Individuals may have unresolved issues from
past stages that affect their developmental
age; however, they are assessed in Erikson’s
psychosocial stages based initially on their
chronological age.
3. A timeframe of successful completion of any
developmental stage is not needed to assess
an individual’s stage of development. Because
progression through any stage is individual-
ized, a timeframe would not help assess an
individual’s stage of development. Erikson
placed developmental task conflicts at
chronological ages at which successful accom-
plishment would be anticipated. Failure at a
previous stage does not preclude, but may
impair progression to successful future task
completion.
4. Although it is crucial for the nurse to imple-
ment interventions to assist clients to meet
their developmental tasks, the question asks
for assessment versus implementation data.
TEST-TAKING HINT: Note the word “initial” in the
question. When assessing a client’s developmen-
tal stage, chronological age is used to decide
which developmental task a client should be
accomplishing. After this developmental assess-
ment, the nurse would look at any deficits that
may have occurred in previous stages.
19. 1. Discussing order in one’s life and freedom
from fear relates to Maslow’s description
of safety and security, which is the second
most basic need after the client has met
physiological needs.
2. Looking for someone to share experiences
relates to Maslow’s description of love and
belonging, which occurs after the client has
met safety and security and physiological
needs.
3. When someone begins to realize his or her
full potential, he or she is in Maslow’s
description of self-actualization. This need
occurs last, after the client has met physiolog-
ical, safety and security, love and belonging,
and self-esteem/esteem-of-others needs.
4. Someone discussing the need for assertive-
ness skills is an example of Maslow’s
 description of self-esteem/esteem-of-others
needs. These needs occur after the client has
met physiological, safety and security, and
love and belonging needs.
TEST-TAKING HINT: To answer this question cor-
rectly, the test taker must understand the princi-
ple of Maslow’s theory to prioritize client needs
correctly. According to Maslow, the order of
individual’s needs is prioritized from most basic
to highest attainment. The hierarchy begins
with physiological needs and moves toward safety
and security, love and belonging, self-
esteem/esteem-of-others, and finally self-
actualization.
20. 1. Discussing the need for avoiding harm and
maintaining comfort relates to Maslow’s
description of safety and security, which
occurs after the client has met physiological
needs.
2. Stating the need for giving and receiving sup-
port from others relates to Maslow’s descrip-
tion of love and belonging, which occurs after
the client has met physiological and safety
and security needs.
3. When someone begins to realize his or
her full potential, he or she is in Maslow’s
description of self-actualization. This
occurs last, after the client has met physi-
ological, safety and security, love and
belonging, and self-esteem/esteem-of-
others needs. It is an indication of a high-
ly evolved and mature client.
4. Someone discussing the need for achieving
success and recognition in work is an example
of Maslow’s description of self-esteem/esteem-
of-others needs. These occur after the client
has met physiological, safety and security, and
love and belonging needs.
TEST-TAKING HINT: Understanding of Maslow’s
hierarchy of needs assists the test taker to priori-
tize client’s needs, moving from stabilizing physi-
ological needs toward self-actualization.
21. 1. Being disturbed about not being able to see
family members relates to Maslow’s descrip-
tion of love and belonging needs, which
occur after the client has met safety and secu-
rity and physiological needs.
2. Maintaining a safe environment is a prior-
ity intervention because, according to
Maslow, safety and security needs must be
met before any other needs, with the
exception of physiological ones. When a
client exhibits hostile and angry behaviors
toward another client, interventions must
be focused on safety.
3. Expressing that “no one cares” relates to
Maslow’s description of love and belonging
needs, which occur after the client has met
safety and security and physiological needs.
4. Concern about not meeting life goals relates
to Maslow’s description of self-actualization.
This occurs last, after the client has met
physiological, safety and security, love and
belonging, and self-esteem/esteem-of-others
needs.
TEST-TAKING HINT: A practical approach in
remembering the prioritization of Maslow’s hier-
archy of needs is to memorize and list the order
as a reference to use when answering related test
questions.
22. An individual’s position in the hierarchy may
change based on life circumstances. An acutely
ill client who has been working on tasks to
achieve self-actualization may become preoccu-
pied, if only temporarily, with the need for phys-
iological integrity.
1. Demonstrating an ability to discuss objec-
tively all points of view and possessing a
strong sense of ethics relate to Maslow’s
description of self-actualization. This is
the fifth and highest level of attainment.
It occurs after the client has met physio-
logical, safety and security, love and
belonging, and self-esteem/esteem-of-
others needs.
2. Avoiding harm while maintaining comfort,
order, and physical safety relates to Maslow’s
description of safety and security needs, which
are the second level of attainment after the
client has met physiological needs.
3. Establishing meaningful interpersonal rela-
tionships and identifying oneself within a
group relates to Maslow’s description of love
and belonging needs, the third level of attain-
ment, which occurs after the client has met
physiological and safety and security needs.
4. Desiring prestige from personal accomplish-
ments relates to Maslow’s description of self-
esteem/esteem-of-others needs. These occur
after the client has met physiological, safety
and security, and love and belonging needs.
TEST-TAKING HINT: To answer this question cor-
rectly, the test taker must understand the hierar-
chy of needs as described by Maslow and be able
to recognize indications of successful completion
of the various levels.
23. In order of attainment: 4, 3, 1, 2, 5.
(1) Sleeping is one of many basic physiologi-
cal needs, which should be attained first
under Maslow’s hierarchy of needs.
 (2) Smoke alarms are an assistive device to
maintain safety and security, which should be
attained second under Maslow’s hierarchy of
needs. (3) An intimate relationship shows
attainment of love and belonging, which
should be attained third under Maslow’s
hierarchy of needs. (4) To assert oneself is a
behavior that exemplifies self-esteem, which
should be attained fourth under Maslow’s
hierarchy of needs. (5) A sense of self-fulfill-
ment and accomplishment is an example of
self-actualization, which should be attained
fifth under Maslow’s hierarchy of needs.
TEST-TAKING HINT: On a paper-and-pencil test, or
on the paper provided during the NCLEX, it
might be helpful, when examples are given, to
note the need that is reflected in the example.
This should assist the test taker to distinguish
the correct order of need assessment.
Diagnostic and Statistical
Manual of Mental Disorders
IV-TR (DSM-IV-TR)
24. Axis III is used for the reporting of current gen-
eral medical conditions that are relevant to the
understanding or management of the client’s
mental disorder.
1. Borderline personality disorder and all other
personality disorders, along with mental
retardation, are reported on Axis II, not Axis
III.
2. Borderline personality disorder should be
reported on Axis II. Axis III is used for
reporting current general medical condi-
tions. The classification presented in the
question is incorrect.
3. The GAF score is reported on Axis V, not
Axis III. The GAF reports overall functioning
and is useful in tracking clinical progress with
a single measure.
4. Major psychiatric disorders are reported on
Axis I, not Axis III.
TEST-TAKING HINT: To answer this question
correctly, the test taker must understand that in
the DSM-IV-TR multiaxial system every client is
evaluated on five axes, each dealing with a
different class of information about the client.
25. The DSM-IV-TR is a multiaxial system that
embraces and facilitates assessment in five areas
of functioning. This format provides clinical
information that may aid the clinician in plan-
ning treatments and predicting outcomes. Axis II
includes mental retardation and personality dis-
orders, which are determined by specific testing.
1. Axis I records all psychiatric disorders or
conditions, such as schizophrenia.
2. Axis III records current general medical con-
ditions.
3. Axis IV records psychosocial and environ-
mental problems.
4. Axis V records the Global Assessment of
Functioning (GAF), which assesses the indi-
vidual’s overall level of functioning.
TEST-TAKING HINT: When answering an analogy
question, it is important to recognize the rela-
tionships of subject matter within the question.
In this question, mental retardation is recorded
on Axis II, and schizophrenia on Axis I.
26. COPD, a general medical condition, is recorded
on Axis III.
1. Axis I records all psychiatric disorders or con-
ditions experienced by the client.
2. Axis II records personality disorders and
mental retardation.
3. Axis IV records psychosocial and environ-
mental stressors.
4. Axis V records the GAF, which assesses
the individual’s overall level of
functioning.
TEST-TAKING HINT: When answering an analogy
question, it is important for the test taker to rec-
ognize the relationships of subject matter within
the question. In this question, COPD is reported
on Axis III, and the GAF is reported on Axis V.
27. 1. The GAF on discharge is not based on the
client’s “full” potential. Progress will continue
after discharge with follow-up therapy and
medication management from an out-patient
treatment facility. Also, the GAF is not limit-
ed to the assessment of activities of daily liv-
ing. The GAF assesses the individual’s overall
level of functioning.
2. The client’s past GAF does not assess current
functioning, but does assess functioning on
previous discharge.
3. The client’s discharge needs are assessed by
gathering data from the time of past dis-
charge to current hospitalization and are not
based solely on the past GAF.
4. The current GAF would be compared
with the previous discharge GAF to
understand the client’s potential for
growth during this current hospital-
ization.
TEST-TAKING HINT: To answer this question cor-
rectly it is helpful to see an example: A client’s
GAF on previous discharge was 55 and is noted
to be 20 on current admission. The nurse would
expect to see a GAF closer to 55 when the client
is ready for discharge from this admission.
28. 1. Mild anxiety with occasional arguments with
family members is indicative of a GAF score
range of 81 to 90.
2. Failure to maintain minimal hygiene is
indicative of a GAF score range of 11
to 20.
3. Depressed mood and mild insomnia are
indicative of a GAF score range of 61 to 70.
4. Inability to hold down a job with limited
social contacts is indicative of a GAF score
range of 41 to 50.
TEST-TAKING HINT: To answer this question cor-
rectly, the test taker must understand that the
GAF score ranges from 1 to 100, with 100 being
the highest level of functioning. A client does not
have to experience all of the symptoms described
in the numerical scale. There are many examples
of functioning that may or may not apply to a
client.
29. 1. A psychiatrist would perform the history
and physical examination, and document
client information on Axes I to V.
5. A nurse practitioner would perform the
history and physical examination, and
document client information on Axes
I to V.
TEST-TAKING HINT: To answer this question cor-
rectly, the test taker must understand the scope
of practice for the various members of the
health-care team in an in-patient psychiatric set-
ting. The physician, physicians in training, or the
nurse practitioner can perform and document a
multiaxial assessment.
30. 1. The DSM-IV-TR is a convenient format
for organizing and communicating clinical
data. Use of the system facilitates compre-
hensive and systematic evaluation.
2. The DSM-IV-TR is a means for consider-
ing the complexity of clinical situations. It
addresses behavioral and physical symp-
toms, long-term problems, stressors, and
functioning.
3. The DSM-IV-TR describes the commonali-
ties versus uniqueness of individuals present-
ing with the same diagnosis.
4. The DSM-IV-TR is a format for evaluat ing
clients from a holistic approach. It promotes
the application of the biopsy- chosocial model.
The DSM-IV-TR is not used to understand
better the etiology of different psychiatric
disorders because it does not address etiology.
TEST-TAKING HINT: The test taker must
under- stand that the DSM-IV-TR multiaxial
system evaluates clients on five axes, each
dealing with a different class of information
about the client.