Chapter 5
A nurse is applying King's model to a nurseñclient interaction by identifying the outcome as which of the following? A) Transaction B) Adaptation C) Transpersonal caring D) Self-system
Ans: A Feedback: According to King's theory, the outcome of the interaction within a nurseñclient relationship is a transaction, defined as the transfer of value between two or more people. Adaptation is associated with Roy's model. Transpersonal caring is associated with Watson. Self-system is associated with Peplau.
A nurse is developing a plan of care integrating Maslow's hierarchy of needs. Which of the following would the nurse identify as the priority? A) Activity level B) Predictable social environment C) Acceptance from family D) Positive self-image
Ans: A Feedback: According to Maslow's hierarchy, physiologic and survival needs such as activity are the priorities. These are followed by safety and security needs (predictable social environment), love and belonging needs (acceptance from family), and esteem needs (positive self-image).
A nursing student is to provide a class presentation about interpersonal and psychoanalytic theories. As part of this presentation, the student is planning to address the major way these two categories differ. Which of the following would the student include as key to interpersonal theories? A) Human relationships B) Instincts C) Drives D) Potential for goodness
Ans: A Feedback: Although there are similarities between psychoanalytic and interpersonal theories, the major difference is that interpersonal theories acknowledge the importance of individual relationships in personality development. Instincts and drives are less important. The potential for goodness forms the basis of humanistic theories.
A group of nursing students is reviewing information about psychodynamic theories. The students demonstrate a need for additional study when they identify which of the following as a humanistic theorist? A) Carl Jung B) Carl Rogers C) Abraham Maslow D) Frederick Perls
Ans: A Feedback: Carl Jung is considered a neo-Freudian theorist. Rogers, Maslow, and Perls are considered humanistic theorists.
When describing the influence of Harry Stack Sullivan on psychiatricñmental health nursing, which of the following 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
Ans: A Feedback: Harry Stack Sullivan (1892ñ1949), an American psychiatrist, extended the concept of interpersonal relations to include characteristic interaction patterns. Carl Rogers addressed the concept of unconditional positive regard. Fromm addressed the need for harmony and understanding between an individual and society. Jung addressed the collective unconscious such that individuals had both extroverted and introverted tendencies.
A psychiatricñmental health nurse is working on an inpatient unit that uses a privilege system. The nurse understands that this intervention integrates which group of theories? A) Behavioral B) Developmental C) Humanistic D) Cognitive
Ans: A Feedback: Interventions such as privilege systems and token economies are interventions based on behavioral theories. Understanding childhood and adolescent experiences, and their manifestations as adult problems, reflects developmental theories. Exploring personal capabilities to develop self-worth reflects humanistic theories. Focusing on thought processes and how they relate to behavior reflects cognitive theories.
A group of nursing students is reviewing information about the various nursing theorists and their application to psychiatricñmental health nursing. The students demonstrate understanding when they identify which theorist as responsible for developing the theory of cultural care diversity and universality? A) Madeleine Leininger B) Sister Calista Roy C) Hildegard Peplau D) Dorothea Orem
Ans: A Feedback: The nurseñanthropologist who developed the theory of cultural care diversity and universality is Madeleine Leininger. Calista Roy developed an adaptation model. Hildegard Peplau focused on the nurseñclient relationship and emphasized the power of empathy. Dorothea Orem developed the self-care deficit nursing theory.
A nurse is assessing a client with anxiety and observes the client yelling and screaming. The nurse, integrating Peplau's theory, interprets this behavior as which of the following? A) Panic behaviors B) Relief behaviors C) Empathetic linkage D) Social distance
Ans: B Feedback: According to Peplau, behavioral cues related to the levels of anxiety are "relief behaviors." Panic is the most severe form of anxiety manifested by an inability to function. Empathetic linkage is the ability to feel in oneself the feelings experienced by another person. Social distance is a concept associated with formal and informal support systems. It is the degree to which the values of the formal support organization and primary group members differ.
A nurse is integrating Peplau's model when providing care to a client with a mental illness. Which of the following would the nurse identify as a key component? A) Suffering B) Anxiety C) Self-care D) Nonverbal behaviors
Ans: B Feedback: Anxiety is a key concept of Peplau's model. According to her, anxiety is the energy that arises when expectations that are present are not met. If anxiety is not recognized, it continues to rise and escalates toward panic. Orem focused on self-care.
A nurse is demonstrating behaviors that the treatment team is attempting to get the client to develop. The nurse is integrating which theory? A) Erikson's model of psychosocial development B) Albert Bandura's social cognitive theory C) Skinner's operant conditioning D) Freud's psychoanalytic model
Ans: B Feedback: Bandura developed his ideas after being concerned about violence on television contributing to aggression in children. He believes that important behaviors are learned by internalizing the behaviors of others. His initial contribution was identifying the process of modeling: pervasive imitation, or one person trying to be similar to another. Erickson identified eight stages of psychosocial development. Skinner proposed that if a behavior is reinforced or rewarded, the behavior will probably be repeated. Freud's psychoanalytic model identified the human mind as composed of conscious and unconscious mental processes.
A client is being discharged from the psychiatric unit this afternoon, and a nurse needs to teach the client about discharge medications. The client is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau's views regarding anxiety, the nurse would expect to implement the education plan at which time? A) When his anxiety stabilizes at its current level B) When his anxiety decreases to a mild level C) When he is completely free of anxiety D) When his anxiety escalates to the panic level
Ans: B Feedback: Mild anxiety is useful for learning; therefore, it would be appropriate to begin educating the client when his anxiety decreases to a mild level. Severe anxiety interferes with learning. Anxiety should be relieved as much as possible, but it would be unrealistic to expect that the client would become completely free of anxiety.
A nurse is watching a video that depicts a client and therapist interacting. The client is asked to say whatever comes to his mind. The nurse identifies this as which of the following? A) Dream work B) Free association C) Gestalt therapy D) Classical conditioning
Ans: B Feedback: 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. Gestalt therapy involves individual and group exercises to bring unmet needs into awareness. Classical conditioning refers to behavior that occurs in response to a stimulus.
A group of nursing students is reviewing the various theories that form the basis for psychiatricñmental health nursing. The students demonstrate understanding of these theories when they identify which theorist as addressing female development? Select all that apply. A) Maslow B) Gilligan C) Bandura D) Miller E) Thorndike
Ans: B, D Feedback: Both Gilligan and Miller addressed female development, identifying that females develop differently from males. Maslow focused on a hierarchy of needs, Bandura focused on learning through the internalization of behaviors of others, and Thorndike focused on reinforcement of positive behavior as important for learning.
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 which stage? A) Concrete operations B) Preoperational C) Formal operations D) Sensorimotor
Ans: C Feedback: Adolescents are in the formal operations stage of development. School-age children are in the concrete operations stage. Children between the ages of 2 and 7 years are in the preoperational stage of cognitive development. Infants and toddlers to age 2 years are in the sensorimotor stage.
An instructor is preparing a class discussion on the various theoretical models used in psychiatricñmental health nursing. When describing cognitive theories, which statement would the instructor include? The theories attempt to: 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."
Ans: C Feedback: Cognitive theories attempt to link internal thought processes with human behavior. Psychodynamic theories attempt to explain mental processes and how they affect behavior. Behavioral theories attempt to describe how people learn and act. Developmental theories attempt to explain normal human growth and development over time.
A nurse is assessing a young adult and determines that the individual has achieved successful resolution of the previous stage of growth and development, evidenced by demonstrating which of the following? A) Drive and hope B) Direction and purpose C) Devotion and fidelity D) Production and care
Ans: C Feedback: In the stage before young adulthoodóadolescenceóthe young adult would have successfully developed identity, achieving the outcome of devotion and fidelity. A young adult is experiencing a current developmental conflict of intimacy versus isolation, with the ultimate long-term outcome of achieving affiliation and love. Drive and hope are the long-term outcomes of infancy. Direction and purpose are the long-term outcomes of the preschool stage. Production and care are the long-term outcomes of adulthood, which the young adult has yet to reach.
While working with an older male client, a nurse begins to think that the client reminds her of her grandfather, and responds as if she was the granddaughter. The nurse is developing which of the following? A) Empathy B) Transference C) Countertransference D) Modeling
Ans: C Feedback: The nurse, upon feeling that the patient reminds her of her grandfather, is developing countertransference; that is, the nurse is developing an attachment to the client, treating the client as her grandfather. Empathy refers to the ability to feel what the client is feeling. Transference is the displacement of the thoughts, feelings, and behaviors originally associated with a significant other from childhood onto a person in a current therapeutic relationship. Modeling is pervasive imitation, or one person trying to be similar to another.
When describing the major concepts of Jean Watson's theory to a group of nursing students, which of the following would a nurse expect to include? Select all that apply. A) Freedom B) Paradox C) Caritas Process D) Rhythmicity E) Caritas field F) Mystery
Ans: C, E Feedback: Jean Watson's theory contains three foundational concepts: transpersonal caring, clinical caritas process (original 10 caritas processes), and caritas field. Freedom, paradox, rhythmicity, and mystery are associated with Parse's theory of human becoming.
A psychiatricñmental health nurse is integrating Carl Rogers's theory into the plan of care for a client with a mental illness. The nurse incorporates understanding of this theory by acknowledging that the therapist accomplishes which of the following? A) Provides validation of the terminology used during the session B) Focuses on the client's instinctual drives C) Recognizes an understanding of the client's basic needs D) Develops unconditional positive regard for the client
Ans: D Feedback: Carl Rogers advocated that the therapist develop unconditional positive regard for the client (i.e., a nonjudgmental caring for the client). Genuineness of the therapist was also an important factor. Rogers did not address validation, instinctual drives, and basic needs.
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 which of the following? A) Defense mechanisms B) Unconscious C) Id D) Ego
Ans: D Feedback: In Freud's personality structure, the ability to form mutually satisfying relationships is a fundamental function of the ego and is formed throughout a child's development. Defense mechanisms are coping styles that protect a person from unwanted anxiety. The "unconscious" refers to feelings and thoughts outside awareness and not remembered. The "id" is formed by unconscious desires, primitive instincts, and unstructured drives.
When integrating the Neuman systems model while caring for a client with a mood disorder, a nurse would focus on which of the following about the client? A) Behaviors B) Relationships C) Self-care activities D) Stressors
Ans: D Feedback: The Neuman systems model focuses on the client system interacting with the environment. Neuman was one of the first psychiatric nurses to include the concept of stressors in understanding nursing care. Behaviors, relationships, and self-care activities would not be addressed.
