Chapter 3

Which statement alerts the nurse to the use of suppression by a 19-year-old who lost a leg in a car accident? a. "I don't remember anything about what happened to me." b. "I'd rather not talk about it right now." c. "It's all Andy's fault! He was going 90 miles an hour on the freeway." d. "My mother is heartbroken about this."

a. "I don't remember anything about what happened to me."

A client with a history of trauma has told the nurse that he is pursuing psychoanalysis with an independent therapist. What statement by the client would be most consistent with a Freudian approach to psychoanalysis? a. "We're spending quite a bit of time exploring the themes in my dreams." b. "We discuss the tension between my expectations for myself and the expectations of society." c. "I've learned a lot about how I've been conditioned to respond to situations in a certain way." d. "We talk a lot about how I've learned to model my behavior after other people in my life."

a. "We're spending quite a bit of time exploring the themes in my dreams."

Who developed cognitive therapy for persons with depression? a. Aaron Beck b. Albert Ellis c. Sigmund Freud d. Jean Piaget

a. Aaron Beck

Which is the key common element in the various psychotherapeutic approaches? a. An effective client-therapist relationship b. The clients' history of therapeutic success in the past c. The therapist's ability to manage the clients' symptoms d. The underlying origin of the clients' issues

a. An effective client-therapist relationship

Which developmental conflict correlates with the toddler, according to Erikson's eight stages of man? a. Autonomy vs. shame and doubt b. Basic trust vs. mistrust c. Initiative vs. guilt d. Industry vs. inferiority

a. Autonomy vs. shame and doubt

Which defense mechanism is being used when a student decides not to think about a parent's illness but to rather concentrate on studying for an upcoming test? a. Suppression b. Substitution c. Projection d. Introjection

a. Suppression

An instructor is teaching a class about the use of cognitive therapies in psychiatric nursing. Which statement made by a student identifies a need for further instruction? a. "Solution-focused approaches have been effective with hospitalized people experiencing delusions." b. "Lengths of stay for clients in inpatient settings are becoming longer each year." c. "The context of practice has changed considerably over the years for psychiatric nurses." d. "Lengths of stay for clients in inpatient settings are becoming shorter each year."

b. "Lengths of stay for clients in inpatient settings are becoming longer each year."

Which theorist developed the theoretical framework that has as its focus observable behavior? a. Harry Stack Sullivan b. B. F. Skinner c. Sigmund Freud d. Erik Erikson

b. B. F. Skinner

Which psychotherapy pioneer introduced the term parataxis? a. B. F. Skinner b. Harry Stack Sullivan c. Sigmund Freud d. Carl Rogers

b. Harry Stack Sullivan

Aaron T. Beck is associated with ... a. cognitive therapy. b. social learning theory. c. developmental stages. d. family development theory.

c. cognitive therapy Aaron T. Beck is associated with cognitive therapy that he and his colleagues used to treat clients with depression.

While working with an older male client, a nurse begins to think of the client as a grandfather and responds to the client as a grandchild. The nurse is developing what type of emotional reaction? a. empathy b. transference c. countertransference d. modeling

c. countertransference The nurse, upon feeling that the client reminds the nurse of a grandfather, is developing countertransference; that is, the nurse is developing an attachment to the client, treating the client as a grandfather. Empathy refers to the ability to feel what the client is feeling.

Degree of agreement between the leader's norms and the group's norms, ability to deal with members' infractions, and conformity to group norms are characteristics of what kind of groups? a. Formal groups b. Secondary groups c. Primary groups d. All groups

d. All groups A group is three or more people with related goals. The following characteristics vary among different types of groups

The concept that irrational beliefs lead to negative emotions underlies which psychotherapeutic approach? a. Gestalt therapy b. Choice therapy c. Solution-focused therapy d. Rational emotive behavior therapy

d. Rational emotive behavior therapy

Which defense mechanism is being used when a student decides not to think about a parent's illness but to rather concentrate on studying for an upcoming test? a. suppression b. substitution c. projection d. introjection

a. suppression Suppression is the conscious exclusion of unacceptable thoughts and feelings from conscious awareness.

What is the most basic need, according to Maslow's hierarchy of needs? a. Physiological b. Safety and security c. Love and belonging d. Self-actualization

a. Physiological The most basic needs—the physiological needs of food, water, sleep, shelter, asexual expression and freedom from pain—must be met first.

Calling the client by name and spending time with the client are examples of what? a. Positive regard b. Acceptance c. Empathy d. Values

a. Positive regard

Which therapeutic factor refers to the group members' relationships to the therapist and other group members? a. group cohesion b. catharsis c. altruism d. universality

a. group cohesion Group cohesiveness refers to the group members' relationships to the therapist and other group members.

When describing the influence of Harry Stack Sullivan on psychiatric-mental health nursing, which would an instructor address as a major concept? a. interpersonal relations b. harmony between the individual and society c. collective unconscious d. unconditional positive regard

a. interpersonal relations Harry Stack Sullivan (1892-1949), an American psychiatrist, extended the concept of interpersonal relations to include characteristic interaction patterns.

It is evident that a client has entered Piaget's stage of formal operations when the client ... a. speaks about a recent ballad as being reflective of the client's life story. b. expresses sadness about the loss of the client's dog. c. can sleep through the night without having enuresis. d. talks about humans being homo sapiens.

a. speaks about a recent ballad as being reflective of the client's life story. Comparing a ballad to real-life events reflects the ability to think abstractly.

The nurse explains to the client that extra television time will be awarded based on appropriate behavior during group therapy. Which theorist's concepts is the nurse utilizing? a. B. F. Skinner's operant conditioning b. Erik Erikson's psychosocial development c. Frederick Perl's Gestalt therapy d. Melanie Klein's play therapy

a. B. F. Skinner's operant conditioning

A nurse is leading a group. During the session, the nurse observes the members testing each other to see if they can trust each other. The nurse leader also notes that the members are testing the nurse, too. The nurse interprets this behavior as characteristic of which phase? a. Beginning b. Working c. Termination d. Intermittent

a. Beginning

A nurse demonstrates a sound understanding of the use of ego defense mechanisms by providing which explanation? a. Can be either a therapeutic or a pathological way to manage stress b. Are often symptomatic of moderate to severe mental illness c. Are substitutes for effective coping skills d. Should be used only when faced with severe stressors

a. Can be either a therapeutic or a pathological way to manage stress

Which statement is inconsistent with the concept of milieu therapy, originally developed by Henry Stack Sullivan? a. Clients work independently to solve day-to-day problems. b. The therapy includes the practice of interpersonal relationship skills. c. The therapy incorporates a safe, therapeutic setting. d. The therapy enables clients to give one another feedback about behavior.

a. Clients work independently to solve day-to-day problems.

The working stage of group therapy is marked by which characteristic? a. Conflict and cooperation among group members. b. Members' propensity to leave the group. c. Therapists' tendency to "back off" to allow the group to work. d. Group members' concern about confidentiality issues.

a. Conflict and cooperation among group members. The group accomplishes its real work during the working phase. Conflict and cooperation indicate that trust has been established and group members are taking risks and working together to create behavior changes. In this stage, conflict and cooperation surface during the group's work.

A psychiatric nurse who was sexually assaulted by a tall, blonde man finds herself becoming severely anxious whenever a man with those characteristics is admitted to the unit. Which symptom is the nurse is exhibiting? a. Countertransference b. Transference c. Transference d. Unconscious resistance

a. Countertransference The nurse is exhibiting symptoms of countertransference, not transference, conscious resistance, or unconscious resistance.

Which theorist viewed interpersonal relations as a basis of human development and behavior? a. Harry Stack Sullivan b. B. F. Skinner c. Frederick Perls d. Abraham Maslow

a. Harry Stack Sullivan

Which indicates that the nurse, acting as a leader for a group of recovering clients with alcohol abuse, is addressing the responsibility of maintaining the group's process? a. Keeping the group on task by restating goals b. Deciding how often the group will meet c. Selecting individuals for membership in the group d. Determining that the group's format will be closed

a. Keeping the group on task by restating goals In a therapy group, the nurse-therapist has both task and maintenance role functions. Group task functions are concerned with the practical issues of leading a group, whereas group maintenance functions focus on less-tangible group processes.

One particular member of a medication group always seeks out the nurse for one-on-one conversation before each meeting and during scheduled breaks during meetings. What should be the nurse's initial response? a. Make a point of engaging with other group members before and after meetings and during breaks. b. Confront the member with the fact that this behavior is unfair to other members and inhibits cohesiveness. c. Explain to the member that the nurse is not participating in the group for social purposes. d. Arrive just in time for meetings and leave promptly after they conclude.

a. Make a point of engaging with other group members before and after meetings and during breaks.

What action by the psychiatric mental health nurse best demonstrates the behaviorist theories of B. F. Skinner? a. Offering to take a client for an outside smoke break if the client agrees to eat a nutritious meal at the scheduled meal time b. Dialoguing with a client about the client's perceptions of the negative consequences of the client's behavior c. Having a group of clients independently establish the behavior guidelines on the inpatient unit d. Removing the restrictions from clients' behavior in the belief that they will ultimately choose what is most beneficial

a. Offering to take a client for an outside smoke break if the client agrees to eat a nutritious meal at the scheduled meal time

The nurse is explaining the hospital routines and expectations to a newly admitted client. The nurse also asks if the client has any questions surrounding the admission. Which stage is this according to Peplau's concept of the nurse-patient therapeutic relationship? a. Orientation b. Identification c. Exploitation d. Resolution

a. Orientation Explaining the hospital routines and asking if the client has any questions are an attempt to engage the client in the treatment process. During this orientation phase of the therapeutic nurse-patient relationship, the nurse will also clarify the client's problems and needs.

A nurse has been working with a client who has a personality disorder and the nurse has recognized the potential for countertransference. How can the nurse best prevent this phenomenon? a. Reflecting on the nurse's own thinking to identify times where the nurse may project individual feelings on to the client b. Dialoguing with the client about the client's tendency to direct feelings about the client's father on to the nurse c. Teaching the client basic techniques for enhancing coping skills and managing stress d. Challenging the client when the nurse feels that the client is mimicking the nurse's ideas or demeanor

a. Reflecting on the nurse's own thinking to identify times where the nurse may project individual feelings on to the client Countertransference exists when the nurse projects individual feelings on to the client. The opposite phenomenon constitutes transference.

Based on the theory of transference, if a client's childhood experiences teach the client to mistrust authority figures, the client will do what as an adult? a. Resist advice given by the mental health care professionals b. Develop paranoid tendencies toward all of the unit's staff c. Strive to be a truthful authority figure to the client's family and friends. d. Freely discuss the client's experiences with people with power and authority

a. Resist advice given by the mental health care professionals

A client has lost a job of 20 years. This is an example of which type of crisis? a. Situational b. Maturational c. Developmental d. Adventitious

a. Situational

A client is engaging in conscious resistance to the psychiatric unit's rules when the client does what? a. Stating that, "I don't make my bed at home and I'm not making it here." b. Asking "Why do the lights have to be out by 11 p.m.?" c. Telephoning the client's mother during exercise group session because "that's when I'm sure she's home." d. Stating that "all the food here makes me gag."

a. Stating that, "I don't make my bed at home and I'm not making it here." Resistance is the conscious or unconscious psychological defense against engaging in a behavior that is usually expected or a part of the client's therapy. Conscious resistance requires the client to actively and knowingly resist the behavior.

Which type of group therapy is organized to help members who share a common problem to cope with it? a. Support b. Family c. Education d. Psychotherapy

a. Support

A psychiatric mental health nurse is applying Erikson's theory of psychosocial development in the care of a young adult client. What outcome should the nurse identify to best address the developmental conflict that this client is experiencing at this age? a. The client demonstrates new interpersonal skills to promote the development of intimate relationships b. The client demonstrates increased autonomy and independence in the client's decision-making c. The client describes a greater appreciation for the value of hard work and prolonged effort d. The client shows an increased ability to delay gratification

a. The client demonstrates new interpersonal skills to promote the development of intimate relationships

For a client who has anxiety, the individual psychotherapy process moves into the working phase when which occurs? a. The client expresses a willingness to discuss what the client thinks is the cause of the anxiety b. The nurse-client relationship is well established c. The nurse feels that the client has developed sufficient coping skills to now deal with the stress d. The psychiatric assessment process has produced client-focused interventions

a. The client expresses a willingness to discuss what the client thinks is the cause of the anxiety

A client is undergoing individual psychotherapy. The client is yelling at the therapist because of a fight with the client's spouse about their children several years ago. In this instance, the client is exhibiting which response? a. Transference b. Countertransference c. Resistance d. Parataxis

a. Transference Transference is the client's unconscious assignment of feelings and attitudes originally associated with important figures in the client's early life to the therapist.

According to Yalom (2005), there are 11 therapeutic factors through which changes occur in group psychotherapy. Which factor correlates with learning to give to others? a. altruism b. universality c. catharsis d. group cohesiveness

a. altruism

A nurse regularly volunteers to work double shifts in order to impress the nursing supervisor. This is an example of which defense mechanism? a. compensation b. displacement c. regression d. fixation

a. compensation Compensation is over achievement in one area to offset real or perceived deficiencies in another area.

For Freud, the therapist's emotional reactions to the client based on personal unconscious needs and conflicts is termed ... a. countertransference. b. transference. c. situational conflict. d. interpersonal relations.

a. countertransference.

Many families take years to understand that a member is mentally ill and identify the warning signs of relapse. During this period, they try to normalize puzzling behaviors. This is called ... a. denial. b. avoidance. c. ignorance. d. reaction formation.

a. denial.

Which concept(s) can the nurse utilize in development of a positive nurse-client relationship? Select all that apply. a. empathic linkage b. unconditional positive regard c. transference d. caritas processes e. cognitions

a. empathic linkage b. unconditional positive regard d. caritas processes The nurse can utilize unconditional positive regard, which is a nonjudgmental caring for the client, in developing a nurse-client relationship as well as caritas processes, which are core principles of caring for others.

The nurse is working with a client who is grieving over the death of a parent. Which concept is the nurse demonstrating when stating to the client, "I know how sad I was when I lost my parent"? a. empathy b. transference c. object relations d. operant behavior

a. empathy The nurse is demonstrating empathy with discussion of the same experience so that the nurse can relate to the client's grief.

The nurse leader of a group observes a group member attempting to stimulate the group to action or decision. The nurse interprets this member as fulfilling which role? a. energizer b. recorder c. orienter d. coordinator

a. energizer

A nurse is performing discharge planning for a client who will be returning home to live with family members. Which concept will be most important for the nurse in considering client needs? a. family dynamics b. formal support system c. transference d. modeling

a. family dynamics

During a care conference, the nurse therapist receives feedback from a colleague who says that the therapist seems "blind" to a client's manipulative behavior. The nurse therapist's "blind spot" is an example of which processes? a. Distorted cognition b. Countertransference c. Respondent conditioning d. Transference

b. Countertransference

While a nurse is performing an admission assessment for a client in an inpatient mental health setting, the client states, "All of my problems are caused by my parents." The client statement reflects which factor that influences mental health? a. Neuroanatomy b. Emotional development c. Values and beliefs d. Religion

b. Emotional development

In group, Client 1 talks about how stressful and important Client 1's job is. Client 2 comments that Client 1 seems to think Client 1 is "better than the rest of us." Client 3 supports Client 1's comment and says Client 3 doesn't understand why everyone wants Client 1 to "break down and cry." This dynamic illustrates what? a. Content communication b. Group process c. Transference d. Countertransference

b. Group process

From the standpoint of cognitive therapy, the term cognition refers to what? a. Faulty thought patterns that result in abnormal behavior b. How clients think about themselves and their world c. An idea d. Dysfunctional ways of responding to situations

b. How clients think about themselves and their world Cognitive therapy focuses on how clients think about themselves and their world.

In the Freudian model, which is true regarding the id? a. It is the sum of certain mental mechanisms such as perception. b. It is formed by unconscious desires and primitive instincts. c. It is associated with ethics and standards of behavior. d. It is able to control movement and contact with reality.

b. It is formed by unconscious desires and primitive instincts. In the Freudian model, the id is formed by unconscious desires and primitive instincts. The libido, or sexual instinct, resides in the id.

Two staff nurses in a psychiatric emergency department are being considered for a promotion that will be announced via memo on a unit bulletin board. They work in a collaborative team environment, have been colleagues for 15 years, and socialize outside of work. Nurse A hears from a third colleague that Nurse B was promoted. Nurse A leaves the room in tears. This behavior is an example of which ego defense mechanism? a. Conversion b. Regression c. Introjection d. Rationalization

b. Regression Regressive behavior occurs when the ego returns to an earlier, comforting, and less mature stage in the face of disappointment. Crying is an example of a regressive behavior

A nurse working in a psychiatric facility identifies the goal of cognitive therapy (CT) to be what? a. Change events in a person's life. b. Restructure how a person perceives events. c. Help the person maintain all thoughts and behaviors. d. Redirect all events in a person's life.

b. Restructure how a person perceives events.

A group of psychiatric-mental health nurses are reviewing information about different theorists who have played a role in shaping pyschiatric-mental health nursing practice. The group demonstrates understanding of the information when they identify which theorist as proposing that adult sexuality is an end product of a complex process of development that begins in early childhood and involves a variety of body functions or areas that correspond to stages of relationships, especially with parents? a. B. F. Skinner b. Sigmund Freud c. Erik Erikson d. Harry Stack Sullivan

b. Sigmund Freud

A student nurse does not want to think about the upcoming final exam. The student nurse will start studying for the exam tomorrow. The student nurse is exhibiting which type of defense mechanism? a. Denial b. Suppression c. Regression d. Conversion

b. Suppression

A client is using cognitive therapy as an adjunct treatment for bipolar disorder. Which would be an overall goal for this client related to the use of cognitive therapy for this condition? a. The client will no longer have to take medication. b. The client will engage in self-care independent of professional assistance. c. The client will relinquish all control. d. The client will continue to have sessions with the therapist once a week for life.

b. The client will engage in self-care independent of professional assistance. Cognitive therapy assumes that individuals have an innate ability to solve their own problems; thus, the overarching treatment goal is for the patient to engage in self-care independent of professional assistance.

Why are the developmental theories important to nursing practice? a. They describe how parts work together as a system. b. They outline the process of human growth and development. c. They define human adaptation to others and to the environment. d. They explain the importance of legal and ethical care.

b. They outline the process of human growth and development. Developmental theories outline the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death.

The most superficial and accessible levels of cognition and generally the first to be targeted in treatment are ... a. core beliefs. b. automatic thoughts. c. intermediate beliefs. d. cognitive schema.

b. automatic thoughts.

What best describes the use of psychotherapy as a mental health intervention? a. a type of psychoanalysis b. bringing about a change in feelings, attitudes, thinking, and behavior c. a form of behavior therapy that includes behavior modification d. used for clients with Axis I disorders

b. bringing about a change in feelings, attitudes, thinking, and behavior Psychotherapy is a process by which a trained person applies principles for establishing a professional relationship sought by people who need help with psychological problems through which learning or human development occurs.

A nurse is watching a video that depicts a client and therapist interacting. The client is asked to say whatever comes to the client's mind. The nurse identifies this as: a. dream work. b. free association. c. gestalt therapy. d. classical conditioning.

b. free association. The video is depicting free association, as described by Freud, in which a person verbalizes spontaneous, uncensored words of whatever comes to mind. Dream work refers to the interpretation of dreams as part of psychoanalysis.

The nurse is assessing a pediatric client who states "I want to be just like my Dad." The nurse determines this is an example of which concept? a. transference b. modeling c. self-efficacy d. countertransference

b. modeling Modeling is a concept in Albert Bandura's Social Cognitive Theory and involves pervasive imitation or one person trying to be like another, in this case the pediatric client's Dad. Self-efficacy is a person's ability to deal effectively with the environment.

The primary purpose for generalist nurses to develop skills with psychosocial interventions is: a. psychosocial interventions are included on the nursing licensure examinations. b. psychosocial interventions are needed in all nursing practice settings. c. nurses will be consulted to assist in the care of psychiatric clients in acute care settings. d. there are a growing number of nursing practice opportunities in mental health settings.

b. psychosocial interventions are needed in all nursing practice settings. Nurses often use psychosocial interventions to help meet clients' needs and achieve outcomes in all practice settings, not just mental health.

Which statement would indicate that the group is in the working phase of development? a. "Let's go around the circle and tell one thing that you enjoy doing." b. "What have you learned, and how will you take this out into your life?" c. "I don't understand why Mary doesn't see my point of view, and frankly it really irritates me when she does that!" d. "I'm not sure what we are supposed to be talking about."

c. "I don't understand why Mary doesn't see my point of view, and frankly it really irritates me when she does that!"

A psychiatric-mental health nurse is preparing a review class for a group of colleagues on the various theoretical models used in psychiatric-mental health nursing. When describing cognitive theories, which statement would the nurse practitioner most likely include about what these theories attempt to do? a. "Explain development of the mental processes and effects on behavior." b. "Describe how people learn and act." c. "Link internal thought processes with behavior." d. "Explain normal human growth and development."

c. "Link internal thought processes with behavior." Cognitive theories attempt to link internal thought processes with human behavior. Psychodynamic theories attempt to explain mental processes and how they affect behavior.

Cognitive techniques focus on the client's patterns of which type of thinking? a. Delayed b. Delusional c. Automatic d. Magical

c. Automatic Cognitive techniques focus on the client's patterns of automatic thinking, first identifying what he or she is examining of recurrent patterns in everyday life and then testing the validity of these automatic thoughts.

The nurse is working with a family that has indicated a desire to learn better communication skills. The nurse role-plays assertive communication techniques with each family member. The role-play is an example of which type of family intervention? a. Cognitive b. Affective c. Behavioral d. Advocacy

c. Behavioral

The client's parents have begun a program of therapy that includes giving the client a token each time the client follows directions. Which theoretical framework provides the background for such a program? a. Psychodynamic theory b. Systems theory c. Behavioral theory d. Token economy theory

c. Behavioral theory

The nurse is working with a client seeking treatment for bulimia and determines that cognitive restructuring will help build the client's self-esteem. Which best describes the goals of cognitive restructuring? a. Avoid negative self-talk b. Find a sounding board for identifying and discussing feelings c. Change distorted thinking and the subsequent behaviors d. Use adaptive defense mechanisms

c. Change distorted thinking and the subsequent behaviors

When the psychiatric nurse is aware of the cultural beliefs of a client diagnosed with bipolar disorder, the therapeutic process is most enhanced by what? a. Facilitating the nurse's understanding of how these beliefs affect the client's perception of the disorder b. Strengthening the therapeutic nature of the nurse-client relationship through mutual respect c. Facilitating the nurse's ability to effectively empathize with the client d. Showing the client that the nurse is truly interested in the client as a person

c. Facilitating the nurse's ability to effectively empathize with the client

A nursing instructor is integrating Piaget's theory of cognitive development into the discussion of learning and mental health issues affecting adolescents. The instructor would identify this age group as in what stage? a. concrete operations b. preoperational c. formal operations d. sensorimotor

c. formal operations Adolescents are in the formal operations stage of development. School-age children are in the concrete operations stage.

In recent years, the client has been experiencing increasing levels of anxiety when in large crowds. The client has recently begun behavioral therapy, which will emphasize which component? a. Hypnotherapy b. Identifying seminal childhood moments that may have contributed to the problem c. Identifying and promoting adaptive behaviors to reduce anxiety d. Uncovering trauma that may be the unconscious source of anxiety

c. Identifying and promoting adaptive behaviors to reduce anxiety Behavior therapy focuses on modifying overt symptoms without regard to the client's private experience or inner conflicts. Consequently, hypnotherapy would not normally be used, and past life events would not be the focus.

A nurse is planning an educational program for families with a mentally ill relative. Which goal is consistent with the current objectives of family education? a. Fewer hospital admissions b. Improved medication compliance c. Improved family quality of life d. Increased independence with activities of daily living

c. Improved family quality of life

One of the most valuable applications of group therapy is to allow group members to gain an understanding concerning what personal aspect? a. Decreasing the cost of their acute mental health services b. Helping others learn how to solve their problems c. Interacting with others and receiving feedback on how others perceive and react to the client d. Allowing other group members to realize that they often distort their own problems out of proportion.

c. Interacting with others and receiving feedback on how others perceive and react to the client

A 55-year-old client is being treated for narcissistic personality disorder. The therapist shows caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory? a. Shaping b. Discrimination c. Modeling d. Conditioning

c. Modeling

Freud thought that the main defense mechanism in paranoia (delusional disorder) was what? a. Denial b. Rationalization c. Projection d. Suppression

c. Projection

The nurse is caring for a 4-year-old child during a well-child visit. According to the Sullivan's stages of development, which behavior would the nurse expect to find in this child? a. The child may prefer to be in the mother's lap. b. The child spends more time with friends than family. c. The child performs actions to earn praise from parents. d. The child expresses individual views and ideas to the child's parents.

c. The child performs actions to earn praise from parents. According to Sullivan's life stages, this child is in the childhood stage. During this stage, children look at their parents as sources of praise and appreciation.

While assessing a client, the nurse notes the client is functioning at the fourth level according to Maslow's hierarchy of needs. Which observation of the client led the nurse to conclude this? a. The client is extremely hungry. b. The client feels unsafe in the new city. c. The client longs to have validation for success and accomplishments. d. The client wants to be able to disclose the client's sexuality openly.

c. The client longs to have validation for success and accomplishments. According to Maslow's hierarchy of needs, the fourth level involves the need related to esteem needs, which includes the need for self-esteem and respect from others.

The client has a longstanding history of depression. A psychoanalytic theorist might say what about the client? a. The client has seen the client's mother being depressed and has learned that this is one way to receive attention. b. When the client exhibits depressive symptoms, the client has always been taken care of by a spouse until the client is less depressed. c. The client's depression is a result of a poor family upbringing, living in a hostile environment growing up, and frequently seeing violent fighting in the client's neighborhood. d. The client may be unconsciously repressing feelings of anger that arise due to early childhood abuse experiences, and these feelings emerge as depression.

c. The client may be unconsciously repressing feelings of anger that arise due to early childhood abuse experiences, and these feelings emerge as depression. Psychoanalytic theory explores a person's past to explain current behaviors. In addition, the explanations of levels of conscious and defense mechanisms are derived from psychoanalytic theory.

The nursing theorist Peplau identified which as the essence of psychiatric-mental health nursing? a. Nursing care independent of physicians b. The nurse's use of self c. The nurse-client relationship d. A neurobiologic approach

c. The nurse-client relationship Peplau was known for first highlighting the importance of the relationship between the nurse and the client as the basis for the therapeutic relationship. She believed that this relationship was the essence of psychiatric-mental health nursing.

A client asks the nurse to help the client understand what a psychologist meant when the psychologist said that the client displaced anger. Which is the best definition for displacement the nurse can provide? a. Replacing consciously unacceptable emotions, drives, attitudes, or needs by those that are more acceptable b. Making up for a real or imagined inability or deficiency by engaging in a specific behavior to maintain self-respect or self-esteem c. Transferring feelings—such as frustration, hostility, or anxiety—from an idea, person, or object to one that is less threatening d. Negating a previous unconsciously tolerable action or experience to reduce or alleviate feelings of guilt

c. Transferring feelings—such as frustration, hostility, or anxiety—from an idea, person, or object to one that is less threatening Displacement refers to the transfer of feelings from one object to another. It involves neither replacement or making up for feelings nor negating them.

Learned maladaptive behavior is a concept central to which theory of human behavior? a. Humanistic theory b. Sociocultural theory c. Behavioral theory d. Psychoanalytic theory

c. behavioral theory Behavior theory maintains that all human behavior is learned. Its major focus is on how environmental conditions result in the acquisition, modification, maintenance, and elimination of adaptive and maladaptive behaviors.

In a group therapy session, group members confront a 35-year-old client about the client's abuse of prescription pain medications. The client states, "The doctor prescribed me these pills, that doesn't make me a drug addict." The nurse identifies this as an example of which defense mechanism? a. Regression b. Projection c. Denial d. Sublimation

c. denial Denial is refusing to recognize a reality that might be troublesome or traumatic. Regression refers to going back to an earlier and happier time of development. Projection is when a person refuses to recognize behavior in oneself and instead "projects" it or sees it in someone else.

A newly admitted client has joined an anger management group as part of treatment in the hospital. Which type of group would be appropriate for this client? a. Cohesion b. closed c. open d. dyad

c. open In an open group, new members may join, and older members may leave the group at different sessions. Cohesion is the ability of a group to stick together. In a closed group, members begin the group at one time, and no new members are admitted. A dyad is a group of two people.

A nurse is meeting with a therapy group for the first time. The nurse notes that members are silent and fidgety. Which statement by the nurse would be best in this situation? a. "I feel uncomfortable with this silence. How do all of you feel about it?" b. "We have 1 hour. It's OK if we spend the hour in silence." c. "I notice everyone is quiet. Bob, would you like to tell us what's on your mind today?" d. "I notice there is a lot of silence and some discomfort. This is pretty common in new groups and is perfectly OK. Who would like to share how they feel right now?"

d. "I notice there is a lot of silence and some discomfort. This is pretty common in new groups and is perfectly OK. Who would like to share how they feel right now?"

Individual psychotherapy consists of three phases. Which statement by the group therapist would reflect that the group is in the working phase of therapy? a. "We will be meeting once each week for 90 minutes here at this office." b. "Each of you has shared ideas and thoughts about your personal development. This has been a difficult process, and you have all grown tremendously." c. "Shane has asked the group if it is acceptable that he be 5 minutes late to each group session because of his job." d. "James, when Shane speaks, it seems you become angry and tend to withdraw."

d. "James, when Shane speaks, it seems you become angry and tend to withdraw."

A client has entered treatment for substance abuse and psychotherapy. The client asks about what to expect from individual psychotherapy sessions if the client "works really hard at it." The nurse can answer the question most effectively with which response? a. "You'll never return to substance use again." b. "Working hard is the key to staying drug free." c. "Psychotherapy will help you understand your growth and development stage." d. "Psychotherapy will help you adapt healthy coping mechanisms."

d. "Psychotherapy will help you adapt healthy coping mechanisms."

The nurse observes an elderly client teaching an adolescent how to crochet a pot holder. The nurse evaluates this behavior as evidence of resolution of Erickson's developmental stage of what? a. Trust vs. mistrust b. Initiative vs. guilt c. Industry vs. inferiority d. Generativity vs. stagnation

d. Generativity vs. stagnation The ability to teach and help others reveals progression through the developmental stage of generativity (in which individuals are industrious and offer themselves to society) vs. stagnation (characterized by introversion and lack of outward connection with others).

A client has recently joined a group and presented a scenario in which the client ran out of funds to pay the rent this month. The therapist states, "Has anyone else in the group had this experience? Can you share any ideas about how you resolved this situation when it happened to you?" The therapist's intervention utilizes which theory to intervene? a. Psychoanalysis group b. Reeducational group c. Personality reconstruction group d. Problem-solving group

d. Problem-solving group The intervention attempts to engage the entire group in a problem-solving approach to the client's current problem.

Which action reflects group development in the initial stage? a. Evaluating the group experience b. Focusing on group accomplishments c. Engaging in conflicts d. Seeking similarities

d. Seeking similarities The initial stage of group development is characterized by a group that works on getting acquainted, depends on the leader for direction, searches for purpose of the group, restricts content, searches for similarity, and gives advice.

In terms of Maslow's hierarchy of need, families living in poverty may be focused more on which type of needs rather than self-actualization? a. Security b. Safety c. Esteem d. Survival

d. Survival In terms of Maslow's need hierarchy, families living in poverty may be more focused on survival needs than self-actualization needs.

Which explains why theories are important to psychiatric-mental health nursing? a. Theories directly lead to improved client outcomes. b. Theories are confirmed by relevant data. c. Theories simplify treatment decisions for most clients. d. Theories lead to the expansion of knowledge.

d. Theories lead to the expansion of knowledge. Theories lead to the collection of relevant empirical (factual) data or relations not yet observed, leading to the expansion of knowledge in a field. Theories also incorporate known empirical findings within a logically consistent and reasonably simple framework.

A group is trying to handle issues related to dominance, control, and power within the group. In what stage of group development is this group? a. Mature b. Initial c. Termination d. Working

d. Working During the working stage of group development, the group solves selected problems of working together; handles conflicts between members or between members and the leader; and works on issues of dominance, control, and power within the group.

Two staff nurses in a psychiatric emergency department are being considered for a promotion that will be announced via memo on a unit bulletin board. They work in a collaborative team environment, have been colleagues for 15 years, and socialize outside work. Nurse A hears from a third colleague that Nurse B was promoted. Nurse A goes into the staff coffee room and slams several cupboard doors. A custodian enters and remarks, "You seem pretty upset." Nurse A replies, "I am not at all upset." In this instance, Nurse A is probably using: a. reaction formation. b. repression. c. compensation. d. denial.

d. denial

A group of nursing students is reviewing information about Freud's personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of: a. defense mechanisms. b. unconscious. c. id. d. ego.

d. ego

Within a group, facilitating verbal and nonverbal communication to meet treatment goals individually and with the entire group refers to the ... a. individual role. b. maintenance role. c. gatekeeper. d. group leader.

d. group leader.

The nurse is beginning a group counseling session with an open group system. The nurse should explain to the group members that one advantage of an open group system is that ... a. it can offer the best treatment outcomes. b. the topics for the group can be controlled. c. relationships are more easily established in the group. d. new members can join the group at any time.

d. new members can join the group at any time.