mental 3

What is a group that has structure and authority known as?

A formal group:A formal group has limited interaction, structure, and authority, which usually emanates from above. A faculty meeting is an example. Informal groups provide much of a person's education and contribute greatly to individual values. Members of primary groups have face-to-face contact, boundaries, norms, and explicit and implicit interdependent roles. An example is a family. Secondary groups usually are larger and more impersonal than primary groups. Members do not have emotional ties.

In viewing the stages of the family life cycle, those families in later life undergo which emotional transition?

Accepting the shifting of generational roles:Families in later life experience the emotional transition of accepting the shifting of generational roles. The other options do not usually occur in families in later life, according to the family life cycle.

In which phase of Freud's developmental stage does toilet training occur?

Anal:Toilet training occurs in the anal stage, which occurs between 18 and 36 months of age.

Learned maladaptive behavior is a concept central to which theory of human behavior?

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.

A nurse working on a psychiatric unit is helping clients to understand how individual perceptions determine a person's response or behavior in stressful situations. Which therapeutic approach is the nurse employing?

Cognitive therapy: Cognitive therapy is a psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative and inaccurate thoughts.

The working stage of group therapy is marked by which characteristic?

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.

The nurse has a client who reminds the nurse of the nurse's sister, with whom the nurse has a close and positive relationship. This phenomenon is best characterized by which term?

Countertransference:Countertransference is the phenomenon whereby the nurse transfers feelings that the nurse has about another person onto the client. These feelings are not based on the reality of the client-nurse relationship but a past relationship that is not connected with the client.

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?

Emotional development: Psychological influences on mental health include interactions, intelligence quotient, self-concept, skills, creativity, and emotional developmental level. Neuroanatomy is a biologic influence on mental health. Values, beliefs, and religion are sociocultural influences on mental health.

A client states to the nurse "I am anxious because I feel that I don't belong." The nurse recognizes that, based on the client's history of growing up in foster care, the client would benefit most from which theory use?

Frederick Perl's Gestalt therapy:Frederick Perl's Gestalt therapy focuses on determination of how unmet needs are causing anxiety for the client and explores this through exercises both in a group and individually. While Maslow's hierarchy of needs does include a level for love and belonging, there is no evidence that the prior two levels have been achieved to begin addressing this alone. Pavlov's theory related to provision of an unconditioned response to an unconditioned stimulus and doesn't' relate to the verbal communication provided by the client. King's theory of goal attainment relates to the client and nurse setting goals and the process of attaining these; this doesn't relate to the client's need in this situation to explore the feeling of not belonging.

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?

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).

Several members of a self-help group are making T-shirts for the group to wear in a parade. This is an example of which element of group therapy?

Group cohesiveness:Group cohesiveness is the development of a strong sense of group membership and alliance. Catharsis involves members relating to one another through the verbal expression of positive and negative feelings. Altruism is the process in which clients have the experience of learning to help others, and in the process, they begin to feel better about themselves. Universality can be defined as the sense of realizing that one is not completely alone in any situation.

Which is an advantage of group therapy over individual therapy for a client with a borderline personality disorder?

Group therapy provides the client with relationship opportunities upon which to test behavior modifications:Group therapy differs from individual therapy in that it is more effective for treating problems with interpersonal relationships, such as for the client with a borderline personality disorder. It offers multiple relationships to assist the individual in growth and problem solving and allows psychiatric clients a greater opportunity for reality testing and experiencing mutual concern and support.

When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to help her achieve which goal?

Help regain confidence in her pervious ability to cope with the stress of being a single parent: The psychiatric nurse uses counseling interventions to assist clients in improving or regaining their previous coping abilities since the primary goal of crisis therapy is to regain precrisis levels of function. When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to help her regain confidence in her pervious ability to cope with the stress of being a single parent.

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?

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.

Which concept states that if a certain behavior is rewarded with praise, the behavior will probably be repeated?

In operant conditioning, the focus is on the consequences of a behavioral response, not a specific stimulus. If a behavior is reinforced or regarded with success, praise, money, and so on, the behavior will probably be repeated. Modeling is one person trying to be similar to another. Self-efficacy is a person's sense of the individual's ability to deal effectively with the environment. Behaviorism is a learning theory that focuses only on objectively observable behaviors and discounts any independent activities of the mind.

Which statement offers the most likely explanation for the decline in the use of Freudian psychoanalysis?

Insurers will not cover the costs.: Because of their cost, lack of insurance reimbursement, and time commitment from clients, psychoanalysis and psychodynamic psychotherapy are not practical choices in today's era of managed mental health care.

In the Freudian model, which is true regarding the id?

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.

Which is an example of group cohesiveness?

Members wearing T-shirts that they made to a group session: Cohesion is a way in which group members stick together. Using a member as a scapegoat, monopolizing the therapy session, and discussing a client's personal issues in front of other group members are not examples of group cohesiveness.

A new program has been launched with the goal of fostering the development of life skills for community-dwelling clients with mental illness, aiming to teach them how to shop, cook, and manage money more effectively. This program demonstrates what approach to practice?

Needs-oriented approach: Supplementing knowledge and teaching skills to clients are activities that are central to the needs-oriented approach to nursing. Such a program is less likely to prioritize the relationship focus of the interaction-oriented approach or the emphasis on health environments that is associated with the outcome-oriented approach. The eclectic approach is more individualized to the nurse's perspectives, priorities, and skills.

The generalist psychiatric-mental health nurse counsels the client and family about relapse prevention. What is this an example of?

Psychiatric rehabilitation: The focus of psychiatric rehabilitation is strengthening self-care and promoting and improving quality of life through relapse prevention.

According to Maslow, an individual who has developed to the individual's fullest potential has achieved what level of his hierarchy?

Self-actualization:Maslow used the term self-actualization to describe a person who has achieved all the needs of the hierarchy and has developed the individual's fullest potential in life. Few people ever become fully self-actualized.

Which theorist developed the psychoanalytic theory?

Sigmund Freud: Sigmund Freud was responsible for the psychoanalytic theory. Erik Erikson formed developmental theory. Harry Stack Sullivan was responsible for interpersonal theory. B. F. Skinner proposed behavior theory.

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?

Suppression:Suppression is the conscious exclusion of unacceptable thoughts and feelings from conscious awareness. Substitution is replacing the desired gratification with one that is more readily available. Projection is the unconscious blaming of unacceptable inclinations or thoughts on an external object. Introjection is accepting another person's attitudes, beliefs, and values as one's own.

The nurse is caring for a client postoperatively who has recently experienced a family member's death. The nurse is demonstrating empathetic linkage with the client with which action?

Telling the client that it is normal to feel sad when someone has died: When the nurse is demonstrating empathetic linkage, it is the ability to feel the same feelings experienced by the other person as discussed with Peplau's theory. Telling the client it is normal to feel sad empathizes with this feeling for the client. Explaining about medication and offering to pick out menu items are a way to offer support in maintaining activities of daily living. With determining a support system, the nurse is helping to prepare the client for discharge.

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?

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. If the child is in the infant stage (0-language), the child's primary need is to have bodily contact and tenderness and would most likely prefer to sit in the mother's lap. The preadolescent child (8-12 years) tends to move away from family as the primary satisfaction in the relationship and start making friends. In the juvenile stage (5-8 years), the child learns to negotiate individual needs. Expressing views and ideas to the parents begin at this age.

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?

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. Hunger and sexual expression are captured within the first level of Maslow's hierarchy of needs. Feeling unsafe indicates the client is functioning on the second level and is focused on security needs.

The nursing theorist Peplau identified which as the essence of psychiatric-mental health nursing?

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?

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.

The following statements are heard in a group: "You can't say that because you don't really know me." "I wonder if the therapist is going to leave?" and "I'm not sure whether or not I can really talk freely." These best reflect which group theme?

Trust and belonging: The theme expressed in these statements represents the latent lack of trust in the leader or other group members. These statements are not related to guilt and punishment, fear for safety, or loss and abandonment.

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?

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.

A basic function of psychiatric nurses is to implement a group that focuses on helping individuals coping with their illness. This refers to ...

a supportive therapy group:Supportive therapy groups are usually less intense than psychotherapy groups and focus on helping individuals cope with their illnesses and problems as well as build interpersonal connections. Implementing supportive therapy groups is one of the basic functions of the psychiatric nurse.

In Erik Erikson's developmental theory, there are several ages of man identified. Place the ages in order based on youngest to oldest age. All options must be used.

basic trust versus mistrust autonomy versus shame and doubt initiative versus guilt industry versus inferiority intimacy versus isolation ego integrity versus despair:The ages of man, according to Erikson are as follows: Basic trust versus mistrust, which usually involves the infant; autonomy versus shame and doubt, which is in the toddler age; the preschool aged child experiences initiative versus guilt; the school aged child will experience industry versus inferiority; intimacy versus isolation involves the young adult; and the mature individual will experience ego integrity versus despair.

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?

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. 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.

A nursing student is preparing to take an exam and is experiencing anxiety as a heightened sense of awareness. Which level of anxiety would this correspond with?

mild:The nursing student is experiencing a heightened sense of awareness or mild anxiety which can be useful for learning. Having moderate levels of anxiety involves a narrowing of awareness and, with severe anxiety, a student would have an even more focused and narrowed awareness. The student having panic would be unable to function.

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 ...

new members can join the group at any time:One advantage of an open group system is that new members can join the group at any time and stay in the group as long as needed.

An adult client states "I always imitated my parent and now I have grown up to be just like my parent." According to Sigmund Freud, which concept does this represent?

object relations: This concept of object relations involves imitation and modelling due to a psychological attachment to another person. This is typical in childhood with a child who develops family relationships. Self-efficacy involves self-confidence and belief in a person's own abilities. Countertransference is defined as the direction of a therapist's feelings and attitudes toward a client. Cognitions are a concept by Aaron Beck and are verbal or pictorial events in the stream of consciousness.

The primary purpose for generalist nurses to develop skills with psychosocial interventions is:

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. Psychosocial interventions are included on the licensing exam, but that is not the primary reason for developing proficiency. Any health care personnel will care for psychiatric patients in acute care settings. Current trends reflect a decline in mental health services and employment opportunities.

The nurse is demonstrating countertransference with a client with which behavior?

relating to the client because the client resembles a favorite cousin:Countertransference is a concept identified by Sigmund Freud and involves the mental health care worker's feelings toward a client. It is problematic when the nurse assigns these based on an interpersonal experience, such as with the client resembling a cousin. The nurse may be hampered in treatment of the client based on these feelings. The nurse discussing the client's behavior or maintaining a professional demeanor do not represent use of interpersonal experiences by the nurse. The client may feel attachment as part of transference based on his/her own interpersonal experience.

The nurse is discussing discharge plans with a client. The client states "I am ready to go home and begin taking care of my household again." Which concept is the client demonstrating with this statement?

self-efficacy:Self-efficacy is a concept identified by Albert Bandura and means that a person has a sense of his or her ability to deal effectively with the environment. The client is demonstrating this through being ready to return home and take charge of the household environment. Disconnections represent a person's lack of mutually responsive and enhancing relationships and there is no evidence of this with the client. Formal support is offered within a formal system such as a hospital or nursing home and this statement may mean the client is no longer in need of this support but doesn't represent the concept of this with being discharged. Empathic linkage relates to the ability to feel in oneself the feelings experienced by another person and there is no evidence of this in the interaction with the nurse and client.

When a therapist is interviewing a client diagnosed with depression, the client's feelings toward the client's parents as a child are being directed at the therapist. This is an example of:

transference:Transference is the displacement of thoughts, feelings, and behaviors originally associated with significant others from childhood onto a person in a current therapeutic relationship. Countertransference is defined as the direction of all of the therapist's feelings and attitudes toward the client. Psychoanalysis is the therapeutic process of accessing the unconscious conflicts that originate in childhood and then resolving the issues with a mature adult mind. Object relations is the psychological attachment to another person or object.