Ch 17 Behavior Therapy

12. A mother states, "You are old enough to clean your own bedroom." Upon later inspection, the mother finds the floor is clear and everything is stacked in a chair. The mother praises the child for clearing the floor. This is consistent with which technique of behavior modification? 1. Shaping 2. Extinction 3. Stimulus generalization 4. Reciprocal inhibition

1. This is correct. The mother is using shaping, which involves molding behavior in a desired direction by reinforcing (praise for clearing the floor) each small step toward the desired behavior (child cleaning own bedroom).

18. A nurse recognizes which intervention within a behavioral therapy program is best? 1. A child is given a Popsicle for staying dry and clean. 2. A child is put in time-out after soiling his or her undergarments. 3. A child is allowed to remain in soiled undergarments. 4. A child is taught the advantages of staying dry and clean.

1. This is correct. This is an example of positive reinforcement. A stimulus that follows a behavior or response is called a reinforcing stimulus or reinforcer. The Popsicle is a reinforcer, or stimulus, for the child to stay dry and clean. This is an example of operant conditioning, a form of behavioral therapy.

3. A third-grader feigns illness to avoid doing homework. The teacher recommends an educational program that uses token economy. Which of the following statements by the school nurse best explains token economy? 1. "Your child will receive green tokens for completing homework that can be cashed in for desired rewards." 2. "Your child will receive red tokens when homework is incomplete, and this will result in school suspension." 3. "Without any tokens, your child will receive a time-out for each homework assignment not completed. 4. "You will use tokens or stars to help your child envision receiving rewards when homework is completed."

1. This is correct. Token economy is a type of contingency contracting in which tokens immediately reinforce appropriate behavior (completed homework) and are later exchanged for a desired reward

9. The spouse of an alcoholic comes to the clinic and asks for some medication to help the client stop drinking. The spouse states that there is a drug given to help stop drinking by making them sick after ingesting alcohol. Which of the following is the most appropriate response to this request? 1. "This may work, as it has been a form of eliminating behavior with a more-adaptive behavior." 2. "This would be a discussion with the individual who wishes to stop drinking by replacing the euphoric feeling with a severe punishment." 3. "I am sure that the therapist can prescribe this and you can add it to your spouse's food." 4. "Have you tried to use a written contract with your spouse first? The side effects of the medication are dangerous."

2. This is correct This is a form of overt sensitization, or aversion therapy, that produces unpleasant consequences. This disulfiram (Antabuse) is given to individuals who wish to stop drinking. Further discussion is necessary, as the client must agree to this treatment.

14. A nursing instructor is teaching about the behavior technique of modeling. When asked to give an example of this behavioral intervention, which student statement indicates learning has occurred? 1. "A child is first rewarded for using a spoon to eat and then rewarded for using a fork, and finally rewarded for cutting food with a knife." 2. "An adolescent imitates their parents by using and caring for household appliances appropriately." 3. "A client and therapist agree to conditions of therapy, stating explicitly in writing the behavior change that is desired." 4. "A mother tells her child that television can be watched only after homework is completed."

2. This is correct. Modeling is the learning of new behaviors by imitating the behaviors in others.

2. An adolescent comes from a family where physical and verbal abuse prevails. The adolescent bullies and fights with classmates at school. Which of the following is the probable source of this behavior? 1. Shaping 2. Modeling 3. Premack principle 4. Reciprocal inhibition

2. This is correct. Modeling is the learning of new behaviors by imitating the behaviors seen in others. The adolescent is imitating physical and verbal abuse behavior patterns witnessed at home.

4. A client is diagnosed with an anxiety disorder. The nurse counselor recommends the behavioral technique of reciprocal inhibition. The client asks, "What's that?" Which is the best nursing reply? 1. "At the beginning of this intervention, a contract will be drawn up explicitly stating the behavior change agreed upon." 2. "By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate.

2. This is correct. Reciprocal inhibition decreases or eliminates an undesired behavior by introducing a more adaptive behavior that is incompatible with the undesired behavior.

19. An adolescent client was recently admitted to the psychiatric unit because of impulsivity and acting-out behavior at school. Which nursing action should the nurse implement first? 1. Redirect the client to activities to decrease stress. 2. Explain the unit rules and consequences of breaking the rules. 3. Place the client on close observation to ensure a trusting relationship. 4. Administer an antianxiety medication.

2. This is correct. The first nursing action is to explain the unit rules and the consequences of breaking the rules to influence the adolescent's behavior. Operant conditioning theory asserts that stimuli (environmental events) interact with and influence an individual's behavior.

20. Per behavioral theory, the treatment of phobic symptoms involves which action? 1. Decrease the environmental stimuli in the room. 2. Progressive exposure of the phobia to the actual experience. 3. Request the family participate in the care planning. 4. Discovery of previous noxious experiences via hypnosis.

2. This is correct. This is an example of systematic desensitization, which is used to assist an individual overcome fear of a phobic stimulus. It is systematic in that there is a hierarchy of anxiety-producing events through which the individual progresses during therapy

10. A client is in therapy with a nurse practitioner for the treatment of arachnophobia. The nurse practitioner decides to use the technique of flooding. Which intervention best exemplifies flooding? 1. Giving rewards for demonstrating a decrease in fear of spiders 2. Encouraging the client to sit through the movie Spider-Man 3. Accompanying the client to a 1-hour visit to the local zoo's spider room 4. Offering a computer program that progressively presents anxiety-producing spider scenarios

3. This is correct. Flooding is used to desensitize individuals to phobic stimuli. The individual is flooded with a continuous presentation (visiting the spider room) of the phobic stimulus until it no longer elicits anxiety.

6. A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to the child's demands. During family therapy, which is the best nursing statement when counseling the parents? 1. "You are shaping your child's behavior." 2. "Your child has modeled your behavior." 3. "You are positively reinforcing your child's behavior." 4. "You are negatively reinforcing your child's behavior."

3. This is correct. Positive reinforcement refers to a stimulus (giving in) that increases the probability a behavior (child's demands) will recur

5. A client reports, "My friend panicked at the sight of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious." Which technique was the friend's therapist using? 1. Extinction 2. Covert sensitization 3. Systematic desensitization 4. Reciprocal inhibition

3. This is correct. Systematic desensitization is a treatment for phobias in which a phobic individual is gradually exposed to increasing amounts of the phobic stimulus while practicing relaxation techniques. Eventually, the phobic stimulus causes little or no anxiety

15. A mother tells her teenager that for college tuition to be paid, the teenager must quit smoking. They develop a written agreement stipulating time frames and consequences. This is an example of which technique of behavior modification? 1. Shaping 2. Modeling 3. Contracting 4. Premack principle

3. This is correct. The mother is using contingency contracting, which is the process of creating a contract specifying a specific behavior change (smoking cessation) and the reinforcers to be given (paid college tuition) for performing the desired behaviors.

13. During hospitalization, an attention-seeking client has repeatedly cut herself. After threatening to cut herself again, the nurse states, "Here are some Band-Aids so you won't bleed on the sheets." Which is the underlying reason for this nurse's response? 1. The nurse is using an aversive stimulus in response to the client's manipulative cutting behavior. 2. The nurse is using negative reinforcement in response to the client's behavior. 3. The nurse is working to extinguish the client's manipulative behavior. 4. The nurse lacks empathy for the client's recurring self-injurious behavior.

3. This is correct. The nurse's goal is extinction of the client's manipulative, attentionseeking behavior. Extinction is the gradual decrease in frequency or disappearance of a response when a positive reinforcement is withheld.

11. During a smoking cessation group, the community health nurse explains that in their effort to quit smoking, a reciprocal inhibition approach will be used. The nurse should give the group which example of this technique? 1. "Before you can smoke, you must first take a half-hour walk." 2. "When you have the urge to smoke, imagine being short of breath." 3. "You'll receive $1 for each cigarette not smoked and forfeit $2 for each cigarette smoked." 4. "When you have the urge to smoke, hold your breath and then rhythmically breathe."

4. This is correct. Breathing exercises are an example of reciprocal inhibition. Reciprocal inhibition is a technique that decreases or eliminates an unacceptable behavior (smoking) by introducing a more-adaptive behavior (smoking cessation) that is incompatible with the unacceptable behavior.

7. When seeking special privileges, a child always chooses to ask the mother rather than the father. The father is more apt to disagree with the child's requests, whereas the mother usually consents. Which component of operant conditioning explains the child's choice? 1. Conditioned stimuli 2. Unconditioned stimuli 3. Aversive stimuli 4. Discriminative stimuli

4. This is correct. Discriminative stimuli are under an individual's control. The child can discriminate between stimuli and can predict with assurance that asking the mother (not the father) will result in a desired response.

1. A kindergarten rule states that if unacceptable behavior occurs, a child's personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse identifies this intervention is based on which principle of behavior therapy? 1. Classical conditioning 2. Conditioned response 3. Positive reinforcement 4. Negative reinforcement

4. This is correct. Negative reinforcement increases the probability that a behavior (appropriate classroom behavior) will recur by the removal of an undesirable reinforcing stimulus (personalized fish in sea grass).

17. Which assumption is most reflective of a behavioral theory model? 1. Mental illness is characterized by biochemical alterations. 2. Cognitive reasoning influences behaviors. 3. Personality development is dependent upon social context. 4. There is a fundamental relationship between stimulus and response.

4. This is correct. Pavlov's behavioral theory introduced the assumption that there is a basic relationship between a stimulus and a response. The connection between a stimulus and a response is strengthened or weakened by the consequences of the response.

8. Parents decide to try the nurse practitioner's suggestion of time-out when their child misbehaves. Which is the nurse practitioner's best statement when teaching the parents? 1. "Correct your child's behavior by spanking for a specified time period." 2. "Ignore the child's negative behavior." 3. "Add positive reinforcement for acceptable behavior." 4. "Temporarily move your child to an area where behavior is not being reinforced."

4. This is correct. Removing the child from the environment where the unacceptable behavior is occurring (a time-out) is an aversive stimulus or punishment. There is no reinforcing attention during the time the child is isolated, which discourages a reoccurrence of the undesired behavior.

16. The parents of a 10-year-old child come to the office to discuss the issues raised during the most recent parent-teacher conference. One parent states that the child is able to act age appropriately unless given a task to complete, such as making their bed. In this case, the child crawls on the floor and begins to speak "baby talk" until the other parent relents and does the task for the child. What is the most appropriate reason for this maladaptive behavior? 1. This is an example of extinction technique. 2. This is an example of overt sensitization. 3. This is an example of systematic desensitization. 4. This is an example of classical conditioning.

4. This is correct. The father has been conditioned by the child to perform the tasks forthe child's maladaptive behavior.