Chap. 41 Theoretical Models of Personality Development

28. Which is a nursing intervention to assist a client to achieve Eriksons developmental task of ego integrity? A. Encourage a life review of triumphs and disappointments. B. Provide opportunities for success experiences. C. Focus on embracing the future. D. Foster the development of creativity.

ANS: A Erikson believed that between the age of 65 years and death, the goal is to review ones life and derive meaning from both positive and negative events, while achieving a positive sense of self.

26. According to Peplau, treatment of client symptoms should involve which nursing action? A. Establishing a therapeutic nurseclient relationship B. Using the technique of desensitization C. Challenging clients negative thoughts D. Uncovering clients past experiences

ANS: A Peplau applied interpersonal theory to nursing practice and, most specifically, to nurseclient relationship development.

23. Which statement describes achievement of Eriksons generativity versus stagnation developmental stage? A. Ive been a girl scout leader for troop 259 for 7 years. B. I feel great that I could pay for my bike with my paper route money. C. My parents are so pleased that John and I are going to be married. D. Ive had a very full life. Im not afraid to leave this world.

ANS: A The major task of generativity versus stagnation is to achieve the life goals established for oneself while also considering the welfare of future generations.

9. Which underlying concept should a nurse associate with interpersonal theory when assessing clients? A. The effects of social processes on personality development B. The effects of unconscious processes and personality structures C. The effects on thoughts and perceptual processes D. The effects of chemical and genetic influences

ANS: A The nurse should associate interpersonal theory with the underlying concept of effects of social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their effect on personality and individual behavior.

17. A female complains that her husband only meets his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husbands actions? A. The id B. The superid C. The ego D. The superego

ANS: A The nurse should identify that the husbands actions are driven by the predominance of the id. According to Freud, the id is the part of the personality that is identified as the pleasure principle. The id is the locus of instinctual drives.

14. A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Eriksons developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: A The nurse should recognize that a 10-year-old child who is successful in school both academically and socially has successfully accomplished the industry versus inferiority developmental stage of Eriksons psychosocial theory. The industry versus inferiority stage of development usually occurs between 6 and 12 years of age, at which time individuals achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from others.

30. Which concepts are included in the definition of personality? Select all that apply. A. Personality is the characteristic way in which a person thinks, feels, and behaves. B. Personality is the ingrained pattern of behavior that evolves as ones style of life. C. Personality is developed in sporadic stages that vary from person to person. D. Personality develops both consciously and unconsciously. E. Personality is inborn and cannot be influenced by developmental progression.

ANS: A, B, D Black and Andreasen (2011) offer a definition of personality that includes each of the concepts in answers A, B, and D. Various theorists have identified stages in the development of personality; none identify personality development as sporadic or variable.

21. A 29-year-old client living with parents has few interpersonal relationships. The client states, I have trouble trusting people. Based on Eriksons developmental theory, which should the nurse recognize as a true statement about this client? A. The client has not progressed beyond the trust versus mistrust developmental stage. B. Developmental deficits in earlier life stages have impaired the clients adult functioning. C. The client cannot move to the next developmental stage until mastering all earlier stages. D. The clients developmental problems began in the intimacy versus isolation stage.

ANS: B Many individuals with mental health problems are still struggling to achieve tasks from a number of developmental stages. Nurses can plan care to assist these individuals to complete these tasks and move on to a higher developmental level.

24. A psychiatric nurse uses Sullivans theories in group and individual therapy. According to Sullivan and other theorists like him, how are client symptoms viewed? A. Client symptoms are viewed as learned behaviors that are maintained because they are reinforced. B. Client symptoms are viewed as responses to anxiety arising from interpersonal relationships. C. Client symptoms are viewed as internal conflicts arising from early childhood trauma. D. Client symptoms are viewed as the misinterpretations of experiences.

ANS: B Sullivan believed that anxiety is the chief disruptive force in interpersonal relations and the main factor in the development of serious difficulty in living.

22. Which statement is most likely to be made by a nurse practitioner who shares the philosophy of an interpersonal theorist? A. Lets discuss your use of defense mechanisms. B. We need to examine how your relationships affect your ability to cope. C. It is important that you take the medications that I have prescribed for you. D. Your genetic background is a factor in your predisposition to mental illness.

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships.

29. From an interpersonal theory perspective, which intervention would a nurse use to assist a client diagnosed with major depressive disorder? A. Encourage discussion of feelings B. Offer family therapy sessions C. Discuss childhood events D. Teach alternate coping skills

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. Family therapy would assist the client to deal with relationships within the family system.

19. A nurse is caring for a hospitalized client who is quarrelsome and opinionated and has little regard for others. According to Sullivans interpersonal theory, the nurse should associate the clients behaviors with a previous deficit in which stage of development? A. Infancy B. Childhood C. Early adolescence D. Late adolescence

ANS: B The nurse should associate the clients behavior with a deficit in the childhood stage of Sullivans interpersonal theory. The childhood stage in Sullivans interpersonal theory typically occurs from the ages of 18 months to 6 years of age, during which the child learns to experience a delay in personal gratification without undue anxiety.

16. According to Freud, which statement should a nurse associate with predominance of the superego? A. No one is looking, so I will take three cigarettes from Moms pack. B. I dont ever cheat on tests; it is wrong. C. If I skip school I will get in trouble and fail my test. D. Dad wont miss this little bit of vodka.

ANS: B The nurse should associate the statement I dont ever cheat on tests; it is wrong as indicative of the predominance of the superego. Freud described the superego as the part of the personality that internalizes the values and morals set forth by primary caregivers. The superego can be referred to as the perfection principle.

11. A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infants history, in which phase of development according to Mahlers theory should a nurse expect to see a potential deficit? A. The symbiotic phase B. The autistic phase C. The consolidation phase D. The rapprochement phase

ANS: B The nurse should expect that a 1-month-old infant who is left alone, has little physical stimulation, and is malnourished would not meet the autistic phase of development. The autistic phase of development usually occurs from birth to 1 month, at which time the infants focus is on basic needs and comfort.

3. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse recognize that this child has completed? A. Learning to count on others B. Learning to delay satisfaction C. Identifying oneself D. Developing skills in participation

ANS: B The nurse should recognize that this client has completed the Learning to delay satisfaction stage of development according to Peplaus interpersonal theory. This stage typically occurs in toddlerhood when one learns the satisfaction of pleasing others.

8. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? A. A possible genetic basis for the client problems B. The structure and dynamics of the personality C. Behavioral responses to stressors D. Maladaptive cognitions

ANS: B The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, ego, and superego.

15. A client has flashbacks of sexual abuse by her uncle. She had not been aware of these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivans concept of the self-system? A. The good me B. The bad me C. The not me D. The bad you

ANS: C The nurse should identify a client remembering sexual abuse when becoming sexually active with her boyfriend as experiencing the not me part of the personality. According to Sullivan, the not me part of the personality develops in response to situations that produced intense anxiety in childhood.

18. A father of a 5-year-old demeans and curses at his child for disobedience. In turn, when upset, the child uses swear words in kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development according to Peplau? A. Learning to count on others B. Learning to delay satisfaction C. Identifying oneself D. Developing skills in participation

ANS: C The nurse should identify that the child using swear words in kindergarten has not successfully completed the identifying oneself stage according to Peplaus interpersonal theory. During this stage of early childhood, a child learns to structure self-concept by observing how others interact with him or her.

12. A 6-year-old boy uses his fathers flashlight to explore his 3-year-old sisters genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal? A. Oral B. Anal C. Phallic D. Latency

ANS: C The nurse should identify this behavior as normal because the 6-year-old client who focuses on genital organs is in the phallic stage of Freuds stages of psychosexual stages of development. Children in the phallic stage of development focus on genital organs and develop a sense of sexual identity. Identification with the same-sex parent also occurs at this stage.

13. A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Eriksons developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: C The nurse should recognize that a 26-year-old client who is married and has a child has successfully accomplished the intimacy versus isolation stage of Eriksons developmental theory. The intimacy versus isolation stage of young adulthood involves forming lasting relationships. Achievement of this task results in the capacity for mutual love and respect.

2. A jilted college student is admitted to a hospital following a suicide attempt and states, No one will ever love a loser like me. According to Eriksons theory of personality development, a nurse should recognize a deficit in which developmental stage? A. Trust versus mistrust B. Initiative versus guilt C. Intimacy versus isolation D. Ego integrity versus despair

ANS: C The nurse should recognize that the client who states, No one will ever love a loser like me has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort.

4. When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycare caregiver. The nurse should recognize that according to Mahlers developmental theory, this childs development is at which phase? A. The autistic phase B. The symbiotic phase C. The differentiation subphase of the separationindividuation phase D. The rapprochement subphase of the separationindividuation phase

ANS: C The nurse should understand that this client is in the differentiation subphase of the separationindividuation phase. This subphase begins with the childs initial physical movements away from the mothering figure. A primary recognition of separateness commences.

6. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role? A. The role of technical expert B. The role of resource person C. The role of surrogate D. The role of leader

ANS: C The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate according to Peplau's interpersonal theory. A surrogate serves as a substitute for another person in this case, the child's parent.

27. The nurse practitioner plans to use a psychoanalytical framework when treating a client diagnosed with an anxiety disorder. Which would be the focus of this nursing intervention? A. Correcting inappropriate learning patterns B. Changing a dysfunctional social environment C. Exploring the here and now with the client and family D. Exploring behaviors and defense mechanisms associated with the superego.

ANS: D Freud identified the superego as the component of the personality that strives for perfection. Violation of the superegos standards generates guilt and anxiety in a person with a strong superego and understanding of these defense mechanisms is identified as important to assisting the client in achieving desired changes or accepting themselves as unique individuals.

20. According to psychoanalytic theory, treatment of symptoms should involve which nursing action? A. Modifying client behaviors by manipulating the environment B. Expressing empathy and presenting reality C. Encouraging the client to note cause and effects of actions D. Recognizing and discussing the clients use of ego defense mechanisms

ANS: D From a psychoanalytic perspective, understanding the use of ego defense mechanisms is important in making determinations about maladaptive behaviors, in planning care for clients to assist in creating change, or in helping clients accept themselves as unique individuals.

25. A nursing instructor is teaching about the application of Peplaus theory to nursing care. Which student statement indicates that learning has occurred? A. The nurse assumes the role of a parenting figure, instructing the client in good health practices. B. The nurse is concerned more about psychosocial functioning than physiological functioning. C. The nurse bases the client care plan on standardized nursing approaches and physician orders. D. The nurse applies principles of human relations to the problems that arise at all levels of experience.

ANS: D Peplau applied interpersonal theory to nursing practice and, most specifically, to nurseclient relationship development.

10. A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Eriksons theory, which developmental task should a nurse assist the client to accomplish? A. Establishing the ability to control emotional reactions B. Establishing a strong sense of ethics and character structure C. Establishing and maintaining self-esteem D. Establishing a career, personal relationships, and societal connections

ANS: D The nurse should assist the client in establishing a career, personal relationships, and societal connections. According to Erikson, nonachievement in the generativity versus stagnation stage results in self-absorption, including withdrawal from others and having no capacity for giving of the self to others.

1. According to Eriksons developmental theory, when planning care for a 47-year-old client, which developmental task should a nurse identify as appropriate for this client? A. To develop a basic trust in others B. To achieve a sense of self-confidence and recognition from others C. To reflect back on life events to derive pleasure and meaning D. To achieve established life goals and consider the welfare of future generations

ANS: D The nurse should identify that an appropriate developmental task for a 47-year-old client would be to achieve established life goals and consider the welfare of future generations. According to Erikson, the client would be in the generativity versus stagnation stage of development.

5. A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller-skating, or loses when playing games. According to Peplau's interpersonal theory, in which stage of development should the nurse identify a need for improvement? A. Learning to count on others B. Learning to delay satisfaction C. Identifying oneself D. Developing skills in participation

ANS: D The nurse should identify that this client needs to improve in the Developing skills in participation stage of Peplaus interpersonal theory. Older children in this phase learn the skills of compromise, competition, and cooperation with others.

7. A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplaus framework for psychodynamic nursing, what therapeutic role is this nurse assuming? A. The role of technical expert B. The role of resource person C. The role of teacher D. The role of leader

ANS: D The nurse who directs client interaction and plans for interventions is assuming the role of leader. According to Peplau, a leader directs the nurseclient interaction and ensures that actions are taken to achieve goals.