Ch 18 Cognitive Behavior Therapy

17. Which statement does the nurse recognize as exemplifying the level of cognitive function of a client experiencing mild anxiety? 1. "Right now I feel as sharp as a tack." 2. "I'm having a tough time focusing." 3. "Sometimes I feel like I'm having an out-of-body experience." 4. "All I seem to focus on is my anger."

1. This is correct. A client experiencing mild anxiety has enhanced cognitive ability. Mild anxiety prepares the individual for heightened responses to environmental stimuli.

15. A nursing instructor is teaching about dichotomous thinking. Which student statement indicates learning has occurred? 1. "Dichotomous thinking is when an individual views a situation as being good or bad or black or white." 2. "Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances." 3. "Dichotomous thinking is when an individual exaggerates the negative significance of an event." 4. "Dichotomous thinking is when an individual undervalues the positive significance of an event."

1. This is correct. An individual who is using dichotomous thinking views situations in terms of all or nothing, good or bad, or black or white.

10. Beck's original concept for cognitive behavior therapy has been expanded by many theorists, but the foundation remains. Which of the following best describes the historical foundation of cognitive behavior therapy? 1. Rejection of passive listening used in psychoanalysis in favor of active, direct dialogues with clients. 2. Utilization of the psychoanalytic view of seeing depression as "anger turned inward." 3. Recognition that cognitive behavior therapy works for depression but not for other emotional disorders. 4. Cognitive behavior therapy has been the forefront of the Freudian framework of psychoanalysis.

1. This is correct. Beck was trained in the Freudian psychoanalytic view of depression but began to observe a common theme of negative cognitive processing in thoughts and dreams of his depressed clients.

1. Which of the following best defines the basis of cognitive behavior therapy? 1. Cognitive behavior therapy is based on the concept that distorted thoughts are the foundation of many emotional, mental, and behavioral disorders. 2. Cognitive behavior therapy is based on the concept that higher education can prevent emotional, mental, and behavioral disorders. 3. Cognitive behavior therapy is based on the concept that a contingency contract can help a client develop adaptive behaviors. 4. Cognitive behavior therapy is based on a reward system of positive reinforcement of positive self-statements.

1. This is correct. Cognitive behavior therapy is based on the theory that distorted perceptions, or cognition, are the foundation of many emotional, mental, and behavioral disorders

7. An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client's concerns. What is the purpose of this nursing intervention? 1. To identify important areas needing concentration during therapy 2. To increase self-esteem and decrease feelings of helplessness 3. To modify maladaptive behaviors using role-play 4. To divert away from intrusive thoughts and depressive ruminations

1. This is correct. In activity scheduling, the client is asked to keep a daily log of activities and rate them for mastery and pleasure to identify recurring daily patterns that can be addressed in therapy.

3. A successful business executive continually thinks her job accomplishments are not adequate. The nurse recognizes the client's thinking reflects which cognitive error? 1. Minimization 2. Dichotomous thinking 3. Arbitrary inference 4. Personalization

1. This is correct. Minimization is the cognitive error that undervalues positive events and experiences. The client cannot give credit for personal strengths.

24. A nurse practitioner uses cognitive behavior therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts (DRDT). Which of the following are appropriate nursing replies to a client asking about the purpose of this exercise? Select all that apply. 1. "The purpose of this exercise is to identify automatic thoughts." 2. "The purpose of this exercise is to identify rational alternatives." 3. "The purpose of this exercise is to modify cognitive errors." 4. "The purpose of this exercise is to eliminate irrational beliefs."

1. This is correct. The DRDT is a tool commonly used in cognitive behavior therapy to help clients identify automatic thoughts. 2. This is correct. The DRDT is a tool commonly used in cognitive behavior therapy to help clients generate rational alternatives. 3. This is correct. The DRDT is a tool commonly used in cognitive behavior therapy to help clients modify thinking.

11. A high-school basketball player sustains a serious knee injury and states to the school nurse, "I will never get into college if I don't receive a basketball scholarship." Which nursing reply would assist the student to see a broader range of possibilities? 1. "Let's look at the alternatives for funding your college education." 2. "I know you are feeling helpless now, but you are looking at this from only one perspective." 3. "Can your family afford knee surgery?" 4. "You now need to prioritize your academics and not focus on basketball."

1. This is correct. The cognitive technique of generating alternatives will help the student see a broader range of possibilities.

19. Using a cognitive approach, which intervention would the nurse choose to assist clients in managing anger without the use of violence? 1. Assist the client in identifying thoughts that trigger anger and substitute reality-based thinking. 2. Provide consequences, such as removal from group therapy, in response to angry outbursts. 3. Administer antipsychotic medications and use limit setting, such as a room restriction. 4. Administer antianxiety medication, and encourage participation in a group on medication actions.

1. This is correct. The nurse can help the client to alter dysfunctional beliefs that predispose the client to distort experiences by assisting the client in identifying thoughts that trigger anger and encourage the substitution of reality-based thinking

9. A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of examining the evidence. Which response by the nursing instructor exemplifies this technique? 1. "Let's look at the potential reasons why your partner has not participated." 2. "How do you define irresponsibility?" 3. "Has it occurred to you that your partner may be working on the project at home?" 4. "Are you telling me that you feel totally responsible for this project?"

1. This is correct. The nursing instructor uses the technique of examining evidence to help review data that supports or contradicts the accuracy of the student beliefs

14. The director of nursing (DON) sets up a meeting with the newly appointed nurse manager who has been doing an excellent job. The DON anticipates that the nurse manager plans to resign. Which is the best description of the DON's cognitive error? 1. Thinking from an all-or-nothing perspective 2. Always thinking the worst will occur without considering positive outcomes 3. Viewing only selected negative evidence while editing out positive aspects 4. Undervaluing the positive significance of an event

2. This is correct. Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of positive outcomes. The DON quickly jumped to the conclusion that the new nurse manager plans to resign

23. A nursing instructor is lecturing about cognitive behavior therapy. Which of the following are objectives of implementation of this therapy? Select all that apply. 1. To modify automatic thoughts to promote minimization of negative cognitions 2. To apply a variety of methods to create change in an individual's thinking 3. To apply cognitive principles to change an individual's basic schema 4. To modify belief systems to bring about emotional change 5. To modify belief systems to bring about behavioral change

2. This is correct. The objective of cognitive behavior therapy involves using a variety of methods to create change in a client's thinking. 4. This is correct. The objective of cognitive behavior therapy is to create change in a client's belief system to bring about lasting emotional changes. 5. This is correct. The objective of cognitive behavior therapy is to create change in a client's belief system to bring about lasting behavioral changes.

18. Which statement demonstrates that the nurse is using a cognitive approach when teaching a client about panic disorder? 1. "You might want to stay in the house when you notice the symptoms beginning." 2. "Medications such as lorazepam (Ativan) should be taken when symptoms start." 3. "Remind yourself that symptoms of a panic attack are time limited and will end." 4. "Keep a journal to note feelings surrounding the panic attacks."

3. This is correct. By teaching the client that symptoms of a panic attack are time limited and will end, the nurse is using the cognitive approach of presenting rational thinking

8. The student comes in to the instructor's office and reports that they wish to drop out of nursing school due to the overwhelming work. The instructor advises the student to write assignments and due dates on a calendar to help break down what needs to be done and when. What technique is the instructor using? 1. Activity scheduling 2. Distraction 3. Graded task assignments 4. Behavioral rehearsal

3. This is correct. Graded task assignments are used to break down the task into subtasks that the client can complete one step at a time. Using a calendar with the assignments and due dates may help the student/client increase self-esteem and decrease feeling of helplessness.

12. A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-lb baby. Which statement by the mother indicates to the nurse the use of the cognitive error of selective abstraction? 1. "My baby is refusing to nurse, and I know it's because she already hates me." 2. "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me." 3. "My baby is wonderful, but I'm depressed because I had my heart set on having twins." 4. "My baby has an elevated bilirubin; I know it will get worse, and she will die."

3. This is correct. In selective abstraction, the individual focuses attention on evidence that is viewed as a failure (not having twins) rather than any successes (a healthy baby) that have occurred.

4. A nursing student states, "The instructor gave me a failing grade on my research paper. I know it's because the instructor doesn't like me." Which cognitive error does the nurse recognize in this student's statement? 1. Dichotomous thinking 2. Catastrophic thinking 3. Magnification 4. Overgeneralization

3. This is correct. Magnification is exaggerating the negative significance of an event

22. A client diagnosed with borderline personality disorder states, "Get out of here. No one cares about me or my situation!" Which nursing reply is an example of a cognitive intervention? 1. "You have an antianxiety medication ordered. It may make you feel better." 2. "It sounds like you are feeling really frustrated." 3. "Can you explain further your thinking about your situation?" 4. "No one cares about you?"

3. This is correct. The nurse is using a cognitive approach to assessment by asking for an explanation about the client's thinking. The focus of cognitive interventions is on the modification of distorted cognitions and maladaptive behaviors.

25. Which of the following statements regarding role-playing is correct? Select all that apply. 1. Role-playing is a type of distractor from negative thinking. 2. The client assumes the role of the antagonist that produces the maladaptive response. 3. The situation is played out to help the client recognize their automatic thinking. 4. Role-play is limited to strong relationships between client and therapist. . Role-play teaching increases awareness of controlled breathing.

3. This is correct. The situation is played out to elicit recognition of automatic thinking on the part of the client. 4. This is correct. Role-play is a technique that should be used only when the relationship between client and therapist is strong and there is little likelihood of maladaptive transference.

20. A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? 1. "I can't give up alcohol right now because I just gave up smoking." 2. "I just read that red wine has health benefits." 3. "I may have a minor problem, but I can handle it." 4. "I don't drink as much as my spouse, and nobody thinks she has a problem."

3. This is correct. This statement is an example of the cognitive distortion of minimization, where an individual undervalues the positive significance of an event.

2. A psychiatric-mental health nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. Which assessment data will the nurse document? 1. "Thought patterns are triggered by specific stressful stimuli." 2. "Thought patterns contain the client's fundamental beliefs and assumptions." 3. "Thought patterns are flexible and based on personal experience." 4. "Thought patterns include a predominance of automatic thoughts."

4. This is correct. Automatic thoughts consist of rapid responses to a situation without rational analysis. These thoughts are often negative and based on erroneous logic.

5. An advanced practice nurse recommends that a client participate in cognitive behavior therapy. The client asks, "What's cognitive behavior therapy, and how can it help me?" Which is the nurse's best reply? 1. "It is a system of techniques in which you use positive thinking to improve your mood." 2. "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences." 3. "It is an interpersonal treatment approach that specifically targets magical thinking." 4. "It is a focused treatment for the modification of distorted thinking and maladaptive behaviors.

4. This is correct. Cognitive behavior therapy is a time-limited intervention in which the therapist works in collaboration with the client to modify thinking to eliminate cognitive errors that reinforce emotional disturbances.

16. A client states, "I keep having horrible nightmares about the car accident that killed my child. I shouldn't have taken her with me to the store." Using a cognitive approach, which nursing reply is most therapeutic? 1. "Are other issues from your past affecting your ability to move on?" 2. "Describe your current feelings about your loss." 3. "Let's talk about something that will help you move on." 4. "Can anyone predict when a car accident will happen?"

4. This is correct. Reframing thoughts is the most therapeutic cognitive approach. Cognitive behavior therapy facilitates problem-solving skills to guide clients' thinking.

6. A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. Which is the best technique for the employee health nurse to use to help the employee request the promotion? 1. Socratic questioning 2. Activity scheduling 3. Distraction 4. Cognitive rehearsal

4. This is correct. The employee health nurse can utilize cognitive rehearsal before the employee requests the promotion. Cognitive rehearsal helps an individual identify and modify any dysfunctional thoughts.

21. A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of the following? 1. "Try singing 'Happy Birthday' until the voices are gone." 2. "Document what the voices are saying to note cause and effect." 3. "Try listening to music using headphones for distraction." 4. "Remind yourself that the voices are symptoms of your disease."

4. This is correct. The focus of cognitive behavior therapy is on the modification of distorted cognitions and maladaptive behaviors.

13. A client admitted to a Veterans Administration hospital with a diagnosis of major depressive disorder tells the nurse, "I failed my battalion by giving the wrong order. Fortunately, no one was injured." Which nursing diagnosis will the nurse assign this client? 1. Chronic low self-esteem 2. Risk for self-directed violence 3. Powerlessness 4. Situational low self-esteem

4. This is correct. The nursing diagnosis of situational low self-esteem is used with individuals who have a negative perception of self-worth in response to a current situation. This client's low self-esteem is related to the emotional response, which led to the client's cognitive appraisal of the situation. The psychiatric diagnosis of major depressive disorder is based on the client's depressive symptoms (emotional response).