2204 Major Theoretical Models

According to Maslow's hierarchy of needs, which client action would be considered most basic? 1. A client discusses the need for order in his or her life and freedom from fear. 2. A client states that he or she feels lonely and is looking for someone to share experiences in his or her life. 3. A client begins to realize his or her full potential. 4. A client is role-playing a situation with a nurse to practice assertiveness skills.

Answer: 1 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 physiological, safety and security, love and belonging, and self-esteem/esteem-of-others needs. 4. Someone discussing the need for assertiveness 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 correctly, the test taker must understand the principle 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, selfesteem/ esteem-of-others, and finally selfactualization.

Which initial information gathered by the nurse is most important when assessing Erikson's stages of development? 1. The chronological age of the individual. 2. The developmental age exhibited through behaviors. 3. The time-frame needed to complete a successful outcome at a previous stage. 4. The implementation of interventions based on developmental age.

Answer: 1 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 individualized, a timeframe would not help assess an individual's stage of development. Erikson placed developmental task conflicts at chronological ages at which successful accomplishment 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 implement 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 developmental stage, chronological age is used to decide which developmental task a client should be accomplishing. After this developmental assessment, the nurse would look at any deficits that may have occurred in previous stages.

Considering the many criteria for good mental health, the nursing student has been instructed to list four of these criteria. The student's list consists of the following: (1) an appropriate perception of reality, (2) the ability to accept oneself, (3) the ability to establish relationships, (4) a need for detachment and the desire for privacy. How would the nurse evaluate the nursing student's list? 1. Excellent. All the student's criteria are correct. 2. Good. Three out of the four criteria are correct. 3. Mediocre. Two out of the four criteria are correct. 4. Poor. All four of the criteria are incorrect.

Answer: 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 comprehensive, but all four criteria listed are correct reflections of good mental health. A mentally healthy individual views reality with a realistic perception based on objective data. Accepting oneself, including strengths and weaknesses, is indicative of good mental health. The ability to establish 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 criteria are correct. 4. All four of the criteria are correct, not incorrect. 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 detachment and a need for privacy are healthy assists the test taker to include these criteria as an indication of good mental health.

Which is an example of appropriate psychosexual development? 1. An 18-month-old relieves anxiety by the use of a pacifier. 2. A 5-year-old boy focuses on relationships with other boys. 3. A 7-year-old girl identifies with her mother. 4. A 12-month-old begins learning about independence and control.

Answer: 1 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 development. 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 relationships 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 development. During this stage, a child is suppressing sexuality and focusing on relationships with same-sex peers. Identifying with the parent of the same sex occurs in the phallic 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 correctly, 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 characteristics developed during these early years bore heavily on one's adaptation patterns and personality traits in adulthood.

According to Maslow's hierarchy of needs, which situation exhibits the highest level of attainment? 1. An individual demonstrates an ability to discuss objectively all points of view and possesses a strong sense of ethics. 2. An individual avoids harm while maintaining comfort, order, and physical safety. 3. An individual establishes meaningful interpersonal relationships and can identify himself or herself within a group. 4. An individual desires prestige from personal accomplishments.

Answer: 1 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 preoccupied, if only temporarily, with the need for physiological integrity. 1. Demonstrating an ability to discuss objectively 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 physiological, safety and security, love and belonging, and self-esteem/esteem-ofothers 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 relationships and identifying oneself within a group relates to Maslow's description of love and belonging needs, the third level of attainment, which occurs after the client has met physiological and safety and security needs. 4. Desiring prestige from personal accomplishments relates to Maslow's description of selfesteem/ 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 correctly, the test taker must understand the hierarchy of needs as described by Maslow and be able to recognize indications of successful completion of the various levels.

Nursing theorists have identified that the nurse-client relationship is central to the practice of nursing. After studying these concepts of nursing theory, the nursing student understands that Peplau is to the phases of the nurse-client relationship as Watson is to: 1. Seven assumptions about the science of caring. 2. Cultural care diversity and universality. 3. Modeling and role modeling. 4. Human energy fields.

Answer: 1 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. 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 integrated 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 interactive skills. 4. A variety of nursing theorists based their theories 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 presented. The nurse-client relationship is the concept underlying Peplau's nursing theory model. Assumptions of caring are underlying concepts of Watson's theoretical model.

According to Maslow's hierarchy of needs, which situation on an in-patient psychiatric unit would require priority intervention? 1. A client is disturbed that family can be seen only during visiting hours. 2. A client exhibits hostile and angry behaviors toward another client. 3. A client states, "I have no one who cares about me." 4. A client states, "I have never met my career goals."

Answer: 2 1. Being disturbed about not being able to see family members relates to Maslow's description of love and belonging needs, which occur after the client has met safety and security and physiological needs. 2. Maintaining a safe environment is a priority 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 hierarchy of needs is to memorize and list the order as a reference to use when answering related test questions.

Which goal represents the cognitive-behavioral model according to Beck and Ellis? 1. Developing satisfactory relationships, maturity, and relative freedom from anxiety. 2. Substituting rational beliefs for irrational beliefs and eliminating self-defeating behaviors. 3. Facing reality and developing standards for behaving responsibly. 4. Reducing bodily tensions and managing stress by biofeedback and relaxation training.

Answer: 2 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.

After studying the concepts of personality development, the nursing student understands that Freud is to psychoanalytic theory as Peplau is to: 1. Psychosocial theory. 2. Nursing theory. 3. Interpersonal theory. 4. Object relations theory.

Answer: 2 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 psychosexual 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 inferiority, 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 symbiotic 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.

A 7-year-old boy is active in sports and has received a most-improved player award at his baseball tournament. Which outcome reflects this child's developmental task assessment as described by Erikson? 1. Autonomy. 2. Identity. 3. Industry. 4. Initiative.

Answer: 3 1. Autonomy is the positive 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 developmental task for early childhood is to gain some selfcontrol and independence within the environment. 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 developmental 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 development, 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 successfully, and receiving recognition from significant 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, initiative 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.

According to Maslow's hierarchy of needs, which client action would be an example of a highly evolved, mature client? 1. A client discusses the need for avoiding harm and maintaining comfort. 2. A client states the need for giving and receiving support from others. 3. A client begins to discuss feelings of self-fulfillment. 4. A client discusses the need to achieve success and recognition in work.

Answer: 3 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 support from others relates to Maslow's description 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 physiological, safety and security, love and belonging, and self-esteem/esteem-ofothers needs. It is an indication of a highly 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/esteemof- 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 prioritize client's needs, moving from stabilizing physiological needs toward self-actualization.

In which client situation is ego development evident? 1. A client calls out in pain to get his or her needs met. 2. A client complains of poor self-esteem because of punishments from his or her past. 3. A client exhibits the ability to assert himself or herself without anger or aggression. 4. A client morally feels guilty about wanting to have sexual relations outside of marriage.

Answer: 3 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 caregivers. 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 principle" 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 oneself 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 considered the "perfection principle." Not only do parents assist in the development of the superego by a reward-and-punishment system, 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.

The statement, "Growth involves resolution of critical tasks through the eight stages of the life cycle," is a concept of which therapeutic model? 1. Interpersonal. 2. Cognitive-behavioral. 3. Intrapersonal. 4. Psychoanalytic.

Answer: 3 1. Interpersonal theories assume that development occurs in stages related to experiencing different types of relationships. 2. Cognitive-behavioral theories assume individuals have the potential for rational and irrational thinking, which alters behaviors. 3. Erikson's developmental theory assumes that intrapersonal growth involves resolution 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.

A 4-year-old child is unable to consider another child's ideas about playing house. This situation is an example of which concept contained in Piaget's theory of cognitive development? 1. Intrinsic curiosity. 2. Secondary circular reactions. 3. Inability egocentrism. 4. Concrete operations.

Answer: 3 1. Intrinsic curiosity occurs from 12 to 18 months of age during the stage of sensorimotor 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 circular 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 discussing his or her personal interests. These "conversations" are called "collective 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.

A 25-year-old client diagnosed with major depressive disorder is admitted to an inpatient psychiatric unit. Since being fired 2 months ago, the client stays inside and avoids others. Which outcome reflects this client's developmental task assessment as described by Erikson? 1. Stagnation. 2. Despair. 3. Isolation. 4. Role confusion.

Answer: 3 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 developmental 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 creative 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 development, 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 correctly, 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 developmental 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.

After studying nursing interventions in the context of nursing theory, the nursing student understands that Neuman is to primary, secondary, or tertiary prevention as Roy is to: 1. Activities needed to meet self-care demands and solve self-care deficits. 2. Assisting the client to examine and understand the meaning of life experiences. 3. Interventions that seek to alter or manage stimuli so that adaptive responses can occur. 4. Interactions with versus for the client to achieve maximum potential.

Answer: 3 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 interrelated 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 themselves through the choices they make at many levels, and nurses intervene by assisting the client to examine and understand the meaning 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 nursing. 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 interactions 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 tertiary 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.

Which scenario describes an individual in Erikson's developmental stage of "old age" exhibiting a negative outcome of despair? 1. A 60-year-old woman having difficulty taking care of her aged mother. 2. A 50-year-old man reviewing the positive and negative aspects of his life. 3. A 65-year-old man openly discusses his life's accomplishments and failures. 4. A 70-year-old woman angry about where her life has ended up.

Answer: 4 1. A 60-year-old would be in Erikson's developmental stage of "adulthood" (30 to 65 years old), generativity versus stagnation. The example given presents someone exhibiting behaviors reflective of stagnation. 2. A 50-year-old would be in Erikson's developmental 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 developmental 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 worthlessness and helplessness. Anger, depression, and loneliness are evident. The age of the client presented in the question should alert the test taker to the developmental task conflict experienced.

Which interaction is an example of dialogue that would be used in the context of reality therapy? 1. Client: "I'm so anxious I can't sleep." Nurse: "I have a relaxation exercise I can show you." 2. Client: "I was punished frequently by my mother, and can't do anything right." Nurse: "Tell me about your feelings of anger." 3. Client: "I can't sit still, I'm too anxious." Nurse: "Let's take a walk for a while." 4. Client: "The stupid doctor revoked my pass for tomorrow." Nurse: "What did you do that showed that you were not ready for a pass?"

Answer: 4 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 patterns of relating to others and encourages interactions with others to develop the selfsystem. 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 development 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.

Which is an example of an individual successfully completing Erikson's "school age" stage of development? 1. A 14-year-old girl verbalizes that she resisted peer pressure to drink alcohol at a party. 2. A 5-year-old boy is able to ask others in his class to play hide-and-seek with him. 3. A 3-year-old preschool boy is able to play by himself while other family members play games. 4. An 11-year-old girl is trying out for cheerleading.

Answer: 4 1. Erikson's developmental stage for a 14-yearold is "adolescence," identity versus role confusion. 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 development. 2. Erikson's developmental stage for a 5-yearold is "late childhood," initiative versus guilt. The major developmental task for this stage is to develop a sense of purpose and the ability 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-yearold 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 versus 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 reflecting 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 developmental task conflict experienced

Which is an example of an interpersonal intervention for a client on an in-patient psychiatric unit? 1. Assist the client to note common defense mechanisms used. 2. Discuss "acting out" behaviors, and assist the client in understanding why they occur. 3. Ask the client to use a journal to record thoughts he or she is having before actingout behaviors occur. 4. Ask the client to acknowledge one positive person in his or her life to assist the client after discharge.

Answer: 4 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 theory 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 relationships. The identification of a positive relationship is an intervention that reflects interpersonal theory TEST-TAKING HINT: Understanding the basic concepts 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."

A mother brings her 2-year-old child to a well-baby clinic for a physical. The child does not attempt to do things independently and continually looks to the mother for meeting all needs. Which outcome reflects this child's developmental task assessment as described by Erikson? 1. Mistrust. 2. Guilt. 3. Inferiority. 4. Shame and doubt.

Answer: 4 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, initiative 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 developmental task for school age is to achieve a sense of self-confidence by learning, competing, 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 developmental 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 behaviors 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.

Which assessment is most important when evaluating signs and symptoms of mental illness? 1. The decreased amount of creativity a client exhibits. 2. The inability to face problems within one's life. 3. The intensity of an emotional reaction. 4. The client's social and cultural norms.

Answer: 4 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 diagnosed 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 indicative 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 reincarnation can be acceptable in one culture and considered "delusional" in another. TEST-TAKING HINT: To answer this question correctly the test taker must understand that culture 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.

Rank the following statements using Maslow's hierarchy of needs, starting with the basic level of attainment and progressing toward self-actualization. ___ "I am glad I can now be assertive in controversial situations." ___ "My wife and I are planning a second honeymoon for our 20th anniversary." ___ "Using my CPAP machine consistently has eliminated my sleep apnea." ___ "I change my smoke alarm batteries every year on New Year's Day." ___ "Getting my graduate degree was a wonderful 50th birthday present to myself."

Answer: In order of attainment: 4, 3, 1, 2, 5. (1) Sleeping is one of many basic physiological 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-fulfillment 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.