PrepU- Ch. 13 Individual Therapies & Nursing Interventions

When a client who has recently committed himself for drug rehab therapy asks what he can expect from individual psychotherapy sessions if he "works really hard at it," the nurse answers the question most effectively when responding a) "Psychotherapy will help you understand why you abuse drugs." b) "Working hard is the key to staying drug free." c) "You'll begin to regain control of your life again." d) "Psychotherapy helps you find different coping mechanisms to replace the drugs."

"You'll begin to regain control of your life again." Explanation: When a client who has recently committed himself for drug rehab therapy asks what he can expect from individual psychotherapy sessions if he "works really hard at it," the nurse answers the question most effectively when responding with the following: "You'll begin to regain control of your life again." The following are not the most appropriate responses: "Working hard is the key to staying drug free", "Psychotherapy will help you understand why you abuse drugs", and "Psychotherapy helps you find different coping mechanisms to replace the drugs".

Which of the following individuals is most likely to benefit from brief cognitive therapy? a) A woman with major depression who is scheduled to begin electroconvulsive therapy b) A female student who has been diagnosed with anorexia nervosa c) A college freshman who is experiencing intense anxiety in the days before his final exams d) A male hospital patient who has a diagnosis of schizophrenia, paranoid type

A college freshman who is experiencing intense anxiety in the days before his final exams Explanation: Candidates for brief cognitive therapy are described as educated, verbal, and psychologically minded. Individuals with severe symptoms or protracted mental health problems are less likely to benefit from this mode of treatment.

Preferential rational emotive behavior therapy includes general rational emotive behavior therapy (REBT) but also emphasizes which of the following? a) Relationships among thoughts, feelings, and behaviors b) Solutions rather than problems c) Thoughts about oneself, the world, and the future d) A profound philosophic change

A profound philosophic change Explanation: Preferential REBT includes general REBT but also emphasizes a profound philosophic change. It teaches clients how to dispute irrational ideas and unhealthy behaviors and to become more creative, scientific, and skeptical thinkers. Solution-focused brief therapy focuses on solutions rather than problems. In cognitive behavioral therapy, the relationships among thoughts, feelings, and behavior are emphasized. The cognitive triad includes thoughts about oneself, the world, and the future.

An "all or nothing at all" thought process is an example of which theme associated with irrational beliefs? a) A demand b) Low frustration tolerance c) Catastrophizing d) Absolute thinking

Absolute thinking Explanation: An "all or nothing at all" thought process is an example of absolute thinking. An irrational belief that everything should be easy is an example of low frustration tolerance. Catastrophizing is exaggerating negative consequences of an event. A demand is an irrational belief that something "must happen."

A cognitive therapist would say that there are three issues that result in the formation and maintenance of common psychological disorders. All but which of the following are in that list? a) Schema or core beliefs b) Cognitive triad c) Cognitive denial d) Cognitive distortion

Cognitive denial Explanation: Cognitive denial is not included as an issue of maintaining common psychological disorders. Cognitive triad refers to the interaction of the client's negative view of self, the world, and the future. Cognitive distortions may distort reality either positively or negatively. Schema or core beliefs are an accumulation of the person's learning and experience within the family, religion, ethnicity, gender, regional subgroups, and broader society.

Which of the following therapies was developed by Linehan for the chronically suicidal client with borderline personality disorder? a) Split-treatment psychotherapy b) Dialectic behavioral therapy (DBT) c) E-therapy d) Brief cognitive therapy

Dialectic behavioral therapy (DBT) Explanation: Linehan developed DBT for suicidal clients with a diagnosis of borderline personality disorder. This therapy blends behavior therapy with treatment strategies that focus on acceptance and validation. E-therapy is online psychotherapy. Brief cognitive therapy encompasses the therapist assuming an active role while working with individuals to solve present-day problems by identifying distorted thinking that causes emotional discomfort, exploring alternate behaviors, and creating change. Split-treatment psychotherapy involves a protocol between a nurse-therapist who provides psychotherapy and a psychiatrist or nurse practitioner who provides pharmacotherapy for the client.

When focusing on the primary goal of crisis therapy, a psychiatric nurse counsels a single mother who is recovering from a suicide attempt to a) Help regain confidence in her pervious ability to cope with the stress of being a single parent b) Comply with her prescribed therapies including the use of an antidepressant. c) Rely more on her extended family's offer to act as a support system d) Help her identify reliable, affordable help with her childcare needs

Help regain confidence in her pervious ability to cope with the stress of being a single parent Explanation: 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.

Which of the following is accurate regarding solution-focused brief therapy (SFBT)? a) Solution-focused approaches emphasize the uniqueness of groups. b) The focus is on problems. c) The approach challenges the existence of problems. d) It emphasizes what is functional and healthful.

It emphasizes what is functional and healthful. Explanation: SFBT, although basically a cognitive approach, differs in philosophy and approach from other cognitive-based approaches. The primary difference is the de-emphasis on the client's problems, or symptoms, and an emphasis on what is functional and healthful.

A nursing student who fails an examination believes that because he earned a low grade, he now must develop a better understanding of the material. This student is exhibiting a belief system that is what? a) Rational b) Irrational c) Grandiose d) Self-defeating

Rational Explanation: Belief systems are shaped by rationality, which is self-constructive, and irrationality, which is self-defeating. In this case the student concludes correctly that he should study to better master content. Rational beliefs accept that human beings are fallible and reject absolutes such as "always" and "never."

An individual's life rules that act as a filter for cognitive distortions are known as what? a) Engagement b) Schema c) Demand d) Activating event

Schema Explanation: Schema is an individual's life rules that act as a sieve or filter. They allow only information compatible with the internal picture of the self and the world to be brought to the person's awareness. The activating event may be either external or internal; it is not necessarily an actual event but may be an emotion, thought, or expectation. Engagement is the first step in CBT. A demand is something that must happen.

Which type of cognitive intervention identifies the possible solutions before addressing the problem? a) Rational emotive behavior therapy b) Psychotherapy c) Cognitive behavioral therapy d) Solution-focused behavior therapy

Solution-focused behavior therapy Explanation: Solution-focused behavior therapy identifies the possible solutions before addressing the problem. In SFBT, the therapist takes a position of curiosity in learning about the client as opposed to an expert to whom the person has come to be helped.

Which type of cognitive intervention identifies the possible solutions before addressing the problem? a) Solution-focused behavior therapy b) Rational emotive behavior therapy c) Psychotherapy d) Cognitive behavioral therapy

Solution-focused behavior therapy Explanation: Solution-focused behavior therapy identifies the possible solutions before addressing the problem. In SFBT, the therapist takes a position of curiosity in learning about the client as opposed to an expert to whom the person has come to be helped.

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

Transference Explanation: Transference is the client's unconscious assignment of feelings and attitudes originally associated with important figures in his or her early life to the therapist. Countertransference is the emotional reaction to the client based on the therapist's unconscious needs and conflicts. Resistance is defined as the conscious or unconscious psychological defense against bringing repressed thoughts into conscious awareness. Parataxis is the presence of distorted perception or judgment exhibited by the client during therapy.

Basic beliefs are often not articulated in explicit words, but rather are accepted as absolute truth. This describes ... a) cognitive schema. b) intermediate beliefs. c) automatic thoughts. d) emotional reasoning.

cognitive schema. Explanation: Basic beliefs are often not articulated in explicit words but rather are accepted as absolute truth. This describes cognitive schema or core beliefs.

Patients starting therapy can be afraid uncertain and unsure it it will be helpful therefore the therapist must provide a a) therapeutic alliance. b) limited and brief interaction. c) Socratic questions. d) structure and direction.

therapeutic alliance. Explanation: Patients starting therapy can be afraid uncertain and unsure it will be helpful therefore the therapist must provide a therapeutic alliance.

Patients starting therapy can be afraid uncertain and unsure it will be helpful therefore the therapist must provide a a) limited and brief interaction. b) therapeutic alliance. c) structure and direction. d) Socratic questions

therapeutic alliance. Explanation: Patients starting therapy can be afraid uncertain and unsure it will be helpful therefore the therapist must provide a therapeutic alliance.

Changing negative thought patterns as means to improve mood and behavior is the basis of ... a) Cognitive behavior therapy b) Anxiety disorders c) Diagnostic evaluation d) Psychotherapy

• A demand • Catastrophizing • Low frustration tolerance • Global evaluation of human worth Explanation: Common themes in irrational beliefs include a demand, absolute thinking, catastrophizing, low frustration tolerance, and global evaluations of human worth.

Which of the following is a theme common in irrational beliefs? Select all that apply. a) Concrete thinking b) A demand c) Low frustration tolerance d) Catastrophizing e) Global evaluation of human worth

• A demand • Catastrophizing • Low frustration tolerance • Global evaluation of human worth Explanation: Common themes in irrational beliefs include a demand, absolute thinking, catastrophizing, low frustration tolerance, and global evaluations of human worth.

Three cognitive processes are involved in the development of common mental disorders. These include which of the following? Select all that apply. a) Environment b) Cognitive distortion c) Cognitive triad d) Schema e) Family systems

• Cognitive distortion • Cognitive triad • Schema Explanation: Three cognitive processes are involved in the development of common mental disorders such as depression. These processes include the cognitive triad, cognitive distortions, and schema. The environment and family system are not cognitive processes.

Schema are the individual's life rules that act as a sieve or filter. Which of the following influence schema development? Select all that apply. a) Gender b) Religious affiliation c) Environment d) Culture e) Ethnicity

• Ethnicity • Culture • Gender • Religious affiliation Explanation: Ethnicity, culture, gender, and religious affiliation influence schema development.

Which of the following components is part of the cognitive triad? Select all that apply. a) Demand b) Future c) Tolerance d) World e) Oneself

• Future • World • Oneself Explanation: The cognitive triad includes thoughts about oneself, the world, and the future. Demand and tolerance are not part of the cognitive triad.

An outline of the developmental issues that contribute to and continue to reinforce the problem refers to a) Cognitive-behavioral formulation b) Cognitive schema c) Behavioral treatment technique d) Intermediate beliefs

Cognitive-behavioral formulation Explanation: A cognitive-behavioral formulation also outlines the developmental issues that contributed to and continue to reinforce the current problem.

An outline of the developmental issues that contribute to and continue to reinforce the problem refers to a) Cognitive-behavioral formulation b) Cognitive schema c) Intermediate beliefs d) Behavioral treatment technique

Cognitive-behavioral formulation Explanation: A cognitive-behavioral formulation also outlines the developmental issues that contributed to and continue to reinforce the current problem.

Which of the following is accurate about schema? a) They develop late in childhood. b) They are expressly the accumulation of learning. c) They become fixed in adulthood. d) They are the individual's life rules.

They are the individual's life rules. Explanation: Schema are the individual's life rules that act as a sieve or filter. Schema develop in early childhood and become relatively fixed by middle childhood. They are the accumulation of both learning and experience from the individual's genetic makeup, family and school environments, peer relationships, and society as a whole.

Cognitive behavioral therapy (CBT) is not effective with which client population? a) Depression b) Thought disorders c) Anxiety d) Eating disorders

Thought disorders Explanation: CBT is not effective with people who have thought disorders and other issues that interfere with cognitive abilities.

Cognitive behavioral therapy (CBT) is not effective with which client population? a) Depression b) Thought disorders c) Eating disorders d) Anxiety

Thought disorders Explanation: CBT is not effective with people who have thought disorders and other issues that interfere with cognitive abilities.

A nurse using cognitive-behavioral therapy (CBT) understands that this therapy operates on the premise that a person is disturbed by which of the following? a) Both the event and perception of the event b) Perception of an event c) An event d) Nothing

Perception of an event Explanation: Proponents of CBT posit that people are disturbed not by an event but by the perception of that event.

A nurse using cognitive-behavioral therapy (CBT) understands that this therapy operates on the premise that a person is disturbed by which of the following? a) Perception of an event b) Nothing c) An event d) Both the event and perception of the event

Perception of an event Explanation: Proponents of CBT posit that people are disturbed not by an event but by the perception of that event.

The cognitive model is described as the interconnection between behaviors, emotions and a) thoughts. b) perceptions. c) feelings. d) understandings.

thoughts. Explanation: The cognitive model is described as the interconnection between behaviors, emotions and thoughts.

Rational beliefs accept that human beings are fallible and reject absolutes such as which of the following? Select all that apply. a) "Once in a while" b) "Never" c) "Sometimes" d) "Maybe" e) "Always"

• "Never" • "Always" Explanation: Rational beliefs accept that human beings are fallible and reject absolutes such as "always" and "never."

The tendency to see things in black and white categories with no shades of grey describes ... a) All-or-nothing thinking b) Overgeneralization c) Mental filter d) Labeling

All-or-nothing thinking Explanation: The tendency to see things in black and white categories with no shades of grey describes all-or-nothing thinking

The tendency to see things in black and white categories with no shades of grey describes ... a) Overgeneralization b) Labeling c) Mental filter d) All-or-nothing thinking

All-or-nothing thinking Explanation: The tendency to see things in black and white categories with no shades of grey describes all-or-nothing thinking.

Of the following, which treatment modalities have the greatest empirical support? a) Behavioral therapy and choice therapy b) Cognitive therapy and behavioral therapy c) Motivational therapy and classic psychoanalysis d) Classic psychoanalysis and behavioral therapy

Cognitive therapy and behavioral therapy Explanation: Both treatment modalities identify discrete behaviors as units of analysis and outcome.

Who developed cognitive behavioral therapy (CBT)? a) Jean Piaget b) Aaron Beck c) Sigmund Freud d) Albert Ellis

Aaron Beck Explanation: Beginning, in the 1960s, other cognitively based theories and therapeutic approaches were developed, the most prominent being cognitive behavioral therapy (CBT) by Aaron Beck. It was not developed by Albert Ellis, Sigmund Freud, or Jean Piaget.

Cognitive interventions are based on the concept of cognition. Who developed cognitive behavioral therapy (CBT)? a) Aaron Beck b) Steven DeShazer c) Insoo Kim Berg d) Albert Ellis

Aaron Beck Explanation: Beginning in the 1960s, more cognitive-based theories and therapeutic approaches were developed, the most prominent being CBT by Aaron Beck.

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

An effective client-therapist relationship Explanation: The key common element in the various psychotherapeutic approaches is an effective client-therapist relationship.

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

An effective client-therapist relationship Explanation: The key common element in the various psychotherapeutic approaches is an effective client-therapist relationship.

How would Ellis describe a rational belief? a) The belief that humans can change their thinking no matter what the circumstances b) A belief that is grounded in the individual's past experience with the family of origin c) A belief that makes sense to most of the normal population d) An evaluative cognition that is expressed as a wish, like, or dislike that may or may not be attained

An evaluative cognition that is expressed as a wish, like, or dislike that may or may not be attained Explanation: Rational beliefs are cognitive interpretations indicating a person's wants, preferences, or aversions. They are evaluative, preferential (not demanding), and nonabsolute cognitions

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

Automatic Explanation: 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. Cognitive techniques do not focus on delayed, delusional, or magical thinking.

Which of the following is an assumption of solution-focused behavior therapy? a) It is necessary to know a lot about the complaint and its origins or functions in order to resolve it. b) Change is most likely to occur when the focus is on what is changeable. c) There is only a right way to see things. d) Usually, long-standing issues cannot be resolved in short periods of time.

Change is most likely to occur when the focus is on what is changeable. Explanation: According to solution-focused behavior therapy, change is most likely to occur when the focus is on what is changeable. It isn't necessary to know a lot about the complaint and its origin or functions in order to resolve it. Even long-standing issues can be resolved in a relatively short period of time. There is not a right or wrong way to see things.

Which of the following is an assumption of solution-focused behavior therapy? a) Usually, long-standing issues cannot be resolved in short periods of time. b) It is necessary to know a lot about the complaint and its origins or functions in order to resolve it. c) Change is most likely to occur when the focus is on what is changeable. d) There is only a right way to see things.

Change is most likely to occur when the focus is on what is changeable. Explanation: According to solution-focused behavior therapy, change is most likely to occur when the focus is on what is changeable. It isn't necessary to know a lot about the complaint and its origin or functions in order to resolve it. Even long-standing issues can be resolved in a relatively short period of time. There is not a right or wrong way to see things.

Which of the following is an assumption of solution-focused behavior therapy? a) There is only a right way to see things. b) It is necessary to know a lot about the complaint and its origins or functions in order to resolve it. c) Change is most likely to occur when the focus is on what is changeable. d) Usually, long-standing issues cannot be resolved in short periods of time.

Change is most likely to occur when the focus is on what is changeable. Explanation: According to solution-focused behavior therapy, change is most likely to occur when the focus is on what is changeable. It isn't necessary to know a lot about the complaint and its origin or functions in order to resolve it. Even long-standing issues can be resolved in a relatively short period of time. There is not a right or wrong way to see things.

Changing negative thought patterns as means to improve mood and behavior is the basis of ... a) Anxiety disorders b) Psychotherapy c) Cognitive behavior therapy d) Diagnostic evaluation

Cognitive behavior therapy Explanation: Cognitive behavioral therapy is based on changing negative thought patterns as a means to improve mood and behavior.

A nurse working on a psychiatric unit is helping clients to alter distorted beliefs and problem behaviors by identifying and replacing negative thoughts and changing the rewards for behaviors. What method is the nurse employing? a) Humanistic therapy b) Psychoanalytic therapy c) Cognitive behavioral therapy d) Group therapy

Cognitive behavioral therapy Explanation: Cognitive behavioral therapy is a highly structured psychotherapeutic method used to alter distorted beliefs and problem behaviors by identifying and replacing negative and inaccurate thoughts, and changing the rewards for behaviors.

A nursing student does not prepare for a test on the respiratory system because she believes that the material on the test will be too difficult and that she will fail regardless. What cognitive process is the student exhibiting? a) Cognitive triad b) Cognitive distortions c) Schema d) All of the above

Cognitive distortion Explanation: The student who believed that he or she would fail the test no matter what is using "twisted thinking" or cognitive distortion. Cognitive distortions are generated by organizing distorted information or inaccurate interpretations of a situation.

A nursing student has heard that material on the next test is difficult to master and many students have failed this particular test over the last few years. The student chooses to go skiing for the weekend instead of studying for the test and ultimately fails. The student then blames the test, not the lack of attention to study. This is an example of which cognitive process? a) Cognitive triad b) Cognitive distortion c) Schema d) All of the above

Cognitive distortion Explanation: The student who believed that he or she would fail the test no matter what is using "twisted thinking" or cognitive distortion. Cognitive distortions are generated by organizing distorted information or inaccurate interpretations of a situation.

A nursing student does not prepare for a test on the respiratory system because she believes that the material on the test will be too difficult and that she will fail regardless. What cognitive process is the student exhibiting? a) Cognitive triad b) Cognitive distortions c) Schema d) All of the above

Cognitive distortions Explanation: The student's belief is not supported by empirical evidence but is generated automatically in response to a given situation. These automatic thoughts are called cognitive distortions.

A nursing student does not prepare for a test on the respiratory system because she believes that the material on the test will be too difficult and that she will fail regardless. What cognitive process is the student exhibiting? a) Cognitive triad b) Cognitive distortions c) Schema d) All of the above

Cognitive distortions Explanation: The student's belief is not supported by empirical evidence but is generated automatically in response to a given situation. These automatic thoughts are called cognitive distortions.

Of the following, which treatment modalities have the greatest empirical support? a) Cognitive therapy and behavioral therapy b) Behavioral therapy and choice therapy c) Motivational therapy and classic psychoanalysis d) Classic psychoanalysis and behavioral therapy

Cognitive therapy and behavioral therapy Explanation: Both treatment modalities identify discrete behaviors as units of analysis and outcome

Which of the following types of questions reinforces the client's successes and the strengths needed to achieve those successes? a) Scaling b) Exception c) Compliments d) Relationship

Compliments Explanation: Compliments are affirmations of the client; they reinforce the client's success and the strengths needed to achieve those successes. Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. Scaling questions ask the client to rate the issue or problem on a scale of 1 to 10, with 1 being the worst, or greatest intensity, and 10 being the complete absence of the issue. Relationship questions ask clients to consider the points of view of significant others in their lives. Exception questions are rooted in the belief that nothing is constantly present at the same level of intensity, that there are fluctuations on how the client experiences "the problem."

Which of the following types of questions reinforces the client's successes and the strengths needed to achieve those successes? a) Relationship b) Scaling c) Exception d) Compliments

Compliments Explanation: Compliments are affirmations of the client; they reinforce the client's success and the strengths needed to achieve those successes. Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. Scaling questions ask the client to rate the issue or problem on a scale of 1 to 10, with 1 being the worst, or greatest intensity, and 10 being the complete absence of the issue. Relationship questions ask clients to consider the points of view of significant others in their lives. Exception questions are rooted in the belief that nothing is constantly present at the same level of intensity, that there are fluctuations on how the client experiences "the problem."

Which of the following reinforce the client's successes and strengths? a) Compliments b) Scaling questions c) Relationship questions d) Miracle questions

Compliments Explanation: Compliments are affirmations of the client. They reinforce the client's successes and the strengths needed to achieve those successes. Scaling questions are useful in making the client's problem or issue more specific, in quantifying exceptions noted in intensity, and in tracking change over time. In miracle questions, the therapist structures a scenario that the patient is asked to think about carefully and to use his or her imagination in crafting the response, again to very specific questions. Relationship questions are used to amplify and reinforce positive responses to the other questions.

Jodie is an RN whose client reminds her of her sister, with whom she has a close and positive relationship. This phenomenon is best characterized by which term? a) Free association b) Transference c) Reaction formation d) Countertransference

Countertransference Explanation Explanation:Countertransference is the phenomenon whereby the nurse transfers feelings that he or she 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.

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. The nurse is exhibiting symptoms of a) Unconscious resistance b) Countertransference c) Conscious resistance d) Transference

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

Jodie is an RN whose client reminds her of her sister, with whom she has a close and positive relationship. This phenomenon is best characterized by which term? a) Reaction formation b) Transference c) Free association d) Countertransference

Countertransference Explanation: Countertransference is the phenomenon whereby the nurse transfers feelings that he or she 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.

Of the following, which is a type of individual therapy? a) Psychoanalysis b) Deconstruction c) Behavioral d) Cognitive

Deconstruction Explanation: Psychoanalysis, behavior therapy, and cognitive therapy are all used in psychiatric nursing. Deconstruction is not a type of therapy.

Which of the following therapies was developed by Linehan for the chronically suicidal client with borderline personality disorder? a) E-therapy b) Brief cognitive therapy c) Dialectic behavioral therapy (DBT) d) Split-treatment psychotherapy

Dialectic behavioral therapy (DBT) Explanation: Linehan developed DBT for suicidal clients with a diagnosis of borderline personality disorder. This therapy blends behavior therapy with treatment strategies that focus on acceptance and validation. E-therapy is online psychotherapy. Brief cognitive therapy encompasses the therapist assuming an active role while working with individuals to solve present-day problems by identifying distorted thinking that causes emotional discomfort, exploring alternate behaviors, and creating change. Split-treatment psychotherapy involves a protocol between a nurse-therapist who provides psychotherapy and a psychiatrist or nurse practitioner who provides pharmacotherapy for the client.

What is the focus of cognitive behavioral therapy (CBT)? a) Dysfunctional thinking through the examination of the cognitive triad b) Identification of possible solutions before addressing the problem c) Changing irrational beliefs that cause emotional distress into thoughts that are more reasonable and rational d) Identification of irrational beliefs that lead to negative consequences

Dysfunctional thinking through the examination of the cognitive triad Explanation: CBT focuses on dysfunctional thinking through the examination of the cognitive triad, cognitive distortions, and schema. Rational emotive behavior therapy focuses on identifying and changing irrational beliefs that lead to negative consequences. Solution-focused therapy identifies the possible solution before addressing the problem.

A nurse is applying principles of cognitive behavioral therapy (CBT) in the treatment of a client with depression. Which of the following interventions is an example of CBT? a) Encouraging the client to review the past and focus on strengths and accomplishments b) Rewarding the client with five tokens for attending group therapy c) Encouraging the client to identify destructive thoughts and practice mindfulness d) Fostering hope by encouraging a focus on abilities rather than problems

Encouraging the client to identify destructive thoughts and practice mindfulness Explanation: Encouraging the client to identify destructive thoughts and practice mindfulness is correct, because the purpose of CBT is to focus on automatic thoughts and schemas. Rewarding the client with five tokens for attending group therapy is an example of conditioning/reinforcement behavior modification. Fostering hope by encouraging a focus on abilities rather than problems is used in motivating and raising self-esteem, but does not encourage a restructuring of negative thought patterns. Encouraging the client to review the past and focus on strengths and accomplishments is also used in raising self-esteem and self-understanding, but does not encourage a restructuring of negative thought patterns.

A mental health therapist is providing psychotherapy, while a psychiatrist is providing the pharmacotherapy for a client with a mood disorder. This type of therapy is categorized as which of the following therapies? a) Solution-focused brief therapy b) Cognitive-behavioral therapy c) Split-treatment psychotherapy d) Brief interpersonal psychotherapy

Explanation: Cognitive-behavioral therapy combines the individual goals of cognitive therapy and behavioral therapy. Brief interpersonal therapy involves a semistructured, psychodynamically time-limited model of psychotherapy. Split-treatment psychotherapy involves a protocol between a nurse-therapist who provides psychotherapy and a psychiatrist or nurse practitioner who provides pharmacotherapy for the client. Solution-focused therapy focuses on helping clients construct solutions rather than solve problems, noting that change occurs all the time and individuals are capable of adapting and effecting change.

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

Facilitating the nurse's understanding of how these beliefs affect the client's perception of her disorder Explanation: When the psychiatric nurse is aware of the cultural beliefs of a client diagnosed with bipolar disorder, the therapeutic process is most enhanced by facilitating the nurse's understanding of how these beliefs affect the client's perception of her disorder. The therapeutic process is not most enhanced by strengthening the therapeutic nature of the nurse-client relationship through mutual respect, facilitating the nurse's ability to effectively empathize with the client, or showing the client that the nurse is truly interested in the client as a person.

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

Facilitating the nurse's understanding of how these beliefs affect the client's perception of her disorder Explanation: When the psychiatric nurse is aware of the cultural beliefs of a client diagnosed with bipolar disorder, the therapeutic process is most enhanced by facilitating the nurse's understanding of how these beliefs affect the client's perception of her disorder. The therapeutic process is not most enhanced by strengthening the therapeutic nature of the nurse-client relationship through mutual respect, facilitating the nurse's ability to effectively empathize with the client, or showing the client that the nurse is truly interested in the client as a person.

The nurse is aware of the changing demographics and growth of ethnic subcultures of the community and is trying to ensure that residents' needs for psychotherapy are effectively met. How should the nurse best work toward this goal? a) Ensure that therapists and clients always share the same ethnic background. b) Perform teaching for clients about the different cultures represented in the United States. c) Foster cultural competency among those caregivers who perform psychotherapy and counseling. d) Enlist the assistance of counselors in clients' home countries using e-therapy.

Foster cultural competency among those caregivers who perform psychotherapy and counseling. Explanation: While e-therapy and client education may have some utility, the primary factor needed in order to provide transcultural care is cultural competence on the part of practitioners. It is not always feasible to match care providers and clients based on ethnicity.

The nurse is aware of the changing demographics and growth of ethnic subcultures of the community and is trying to ensure that residents' needs for psychotherapy are effectively met. How should the nurse best work toward this goal? a) Ensure that therapists and clients always share the same ethnic background. b) Enlist the assistance of counselors in clients' home countries using e-therapy. c) Foster cultural competency among those caregivers who perform psychotherapy and counseling. d) Perform teaching for clients about the different cultures represented in the United States.

Foster cultural competency among those caregivers who perform psychotherapy and counseling. Explanation: While e-therapy and client education may have some utility, the primary factor needed in order to provide transcultural care is cultural competence on the part of practitioners. It is not always feasible to match care providers and clients based on ethnicity.

Which of the following is a difference between counseling and psychotherapy? a) Transference and countertransference are significant obstacles in psychotherapy that can be avoided in a counseling mode. b) Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. c) Counseling may be used in the care of acutely psychotic clients, but psychotherapy is contraindicated. d) Psychotherapy is reserved for clients who have a documented history of failing to respond to counseling.

Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. Explanation: The psychiatric nurse uses counseling interventions, but psychotherapy requires advanced certification according to the American Nurses Association. Psychotherapy is not reserved solely for those who have not responded to counseling. Transference and countertransference are significant obstacles in both modes, and neither intervention is appropriate during acute psychotic episodes.

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

Identifying and promoting adaptive behaviors to reduce anxiety Explanation: 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.

When counseling an acutely depressed client who is experiencing severe financial problems, the psychiatric nurse initially a) Identifies community resources that may be able to help him manage the financial issues b) Suggests that the prescribed medication will help him deal with the financial issues c) Introduces the client to a problem-solving approach to dealing with his financial issues d) Discusses the connection between depression and stressful situations such as the financial issues

Introduces the client to a problem-solving approach to dealing with his financial issues Explanation: When counseling an acutely depressed client who is experiencing severe financial problems, the psychiatric nurse initially introduces the client to a problem-solving approach to dealing with his financial issues. Initially, the nurse would not discuss the connection between depression and stressful situation, identify community resources, or suggest the medication will help with financial issues.

Which of the following is accurate regarding solution-focused brief therapy (SFBT)? a) The approach challenges the existence of problems. b) The focus is on problems. c) Solution-focused approaches emphasize the uniqueness of groups. d) It emphasizes what is functional and healthful.

It emphasizes what is functional and healthful. Explanation: SFBT, although basically a cognitive approach, differs in philosophy and approach from other cognitive-based approaches. The primary difference is the de-emphasis on the client's problems, or symptoms, and an emphasis on what is functional and healthful.

All of the following are cognitive therapy techniques except ... a) Reviewing the session prior to ending b) Reviewing homework assignments c) Listing an agenda for each session d) Listing primary defenses used in life

Listing primary defenses used in life Explanation: Listing of the primary defenses used in life would be a psychoanalytic technique, not a cognitive technique

All except which of the following are cognitive therapy techniques? a) Listing an agenda for each session b) Listing primary defenses used in life c) Reviewing homework assignments d) Reviewing the session prior to ending

Listing primary defenses used in life Explanation: Raising awareness of the use of defenses is not a component of cognitive therapy. Defense mechanisms reflect a psychoanalytic approach to therapy.

In which of the following environments did cognitive interventions have their beginning? a) Community health clinics b) Long-term inpatient settings c) Emergency care centers d) Skilled care

Long-term inpatient settings Explanation: Cognitive interventions had their beginnings in the long-term inpatient environment, but today they are a mainstay of psychiatric care in all settings and are used by all disciplines, at all levels of practice.

In which of the following environments did cognitive interventions have their beginning? a) Skilled care b) Emergency care centers c) Community health clinics d) Long-term inpatient settings

Long-term inpatient settings Explanation: Cognitive interventions had their beginnings in the long-term inpatient environment, but today they are a mainstay of psychiatric care in all settings and are used by all disciplines, at all levels of practice.

A therapist believes that a client is suffering from self-defeating behaviors and wants to change the irrational beliefs that are causing the client emotional distress. Which of the following would this therapist most likely use when working with this client? a) Rational emotive behavior therapy b) Bibliotherapy c) Psychoanalytic therapy d) Cognitive-behavioral therapy

Rational emotive behavior therapy (REBT) Explanation: Rational emotive behavior therapy (REBT) is based on the assumption that people are born with the potential to be rational (self-constructive) and irrational (self-defeating). REBT primarily emphasizes changing irrational beliefs that cause emotional distress into reasonable and rational thoughts.

All but which of the following are areas of focus within psychiatric rehabilitation? a) Emphasis on recovery of hope and of function b) Stronger collaborative relationships with treatment services c) Reduction in acute symptoms of psychosis d) Consumer empowerment

Reduction in acute symptoms of psychosis Explanation: Psychiatric rehabilitation is tertiary care that focuses on improving the client's level of functioning and self-governance for long-term self-care. Personal empowerment, hope, and collaboration achieve self-management. Reducing acute symptoms is a goal for the secondary level of care.

All but which of the following are areas of focus within psychiatric rehabilitation? a) Reduction in acute symptoms of psychosis b) Emphasis on recovery of hope and of function c) Consumer empowerment d) Stronger collaborative relationships with treatment services

Reduction in acute symptoms of psychosis Explanation: Psychiatric rehabilitation is tertiary care that focuses on improving the client's level of functioning and self-governance for long-term self-care. Personal empowerment, hope, and collaboration achieve self-management. Reducing acute symptoms is a goal for the secondary level of care.

Based on the theory of transference, if a client's childhood experiences teach him to mistrust authority figures, as an adult he will 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 his family and friends. d) Freely discusses his experiences with people with power and authority

Resist advice given by the mental health care professionals Explanation: It is believed that our relationships with other people are patterned by early infant and childhood relationships with significant people in our environment. These patterns of relationships are repeated later in our lives and may interfere with client-therapist relationships because of transference, or the client's unconscious assignment to the therapist of feelings and attitudes originally associated with important figures in his or her early life. Based on these ideas, if a client's childhood experiences teach him to mistrust authority figures, as an adult he will resist advice given by the mental health care professionals.

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

Restructure how a person perceives events. Explanation: The goal of CBT is to restructure how a person perceives events in his or her life to facilitate behavioral and emotional change.

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

Restructure how a person perceives events. Explanation: The goal of CBT is to restructure how a person perceives events in his or her life to facilitate behavioral and emotional change.

An individual's life rules that act as a filter for cognitive distortions are known as what? a) Engagement b) Schema c) Demand d) Activating event

Schema Explanation: Schema is an individual's life rules that act as a sieve or filter. They allow only information compatible with the internal picture of the self and the world to be brought to the person's awareness. The activating event may be either external or internal; it is not necessarily an actual event but may be an emotion, thought, or expectation. Engagement is the first step in CBT. A demand is something that must happen.

Solution-focused approaches have been effective with hospitalized clients who experience symptoms of which mental illness? a) Eating disorder b) Mania c) Schizophrenia d) Depression

Schizophrenia Explanation: Solution-focused approaches have been effective with hospitalized people who were experiencing delusions, hallucinations, or loosening of associations.

A therapist who applies a positive approach and views the client as an individual with a collection of strengths and successes as opposed to a diagnosis and collection of symptoms is using which approach? a) Cognitive-behavioral theory b) Solution focused theory c) Rational emotive behavior theory d) Psychoanalytic theory

Solution focused theory Explanation: Solution-focused theory views the patient as an individual with a collection of strengths and successes as opposed to a diagnosis and collection of symptoms. This approach emphasizes the uniqueness of the individual.

A therapist who applies a positive approach and views the client as an individual with a collection of strengths and successes as opposed to a diagnosis and collection of symptoms is using which approach? a) Psychoanalytic theory b) Solution focused theory c) Rational emotive behavior theory d) Cognitive-behavioral theory

Solution focused theory Explanation: Solution-focused theory views the patient as an individual with a collection of strengths and successes as opposed to a diagnosis and collection of symptoms. This approach emphasizes the uniqueness of the individual.

A therapist meeting with a client for the first time plans to use a type of therapy that focuses more on solutions than problems and that asks the client to explore his or her life. This type of therapy is referred to as ... a) Emotive behavior therapy b) Cognitive-behavioral therapy c) Psychoanalytic therapy d) Solution-focused brief therapy

Solution-focused brief therapy Explanation: Solution-focused brief therapy focuses on solutions rather than problems. This approach does not challenge the existence of problems but proposes that problems are best understood in relation to their solutions. Solution-focused brief therapy assists the client to explore life without the problem

A psychiatric nurse knows that with solution-focused behavior therapy (SFBT), it is important for the interventions used to focus on which of the following types of goals? a) Designed by the therapist b) Specific and achievable c) Broad d) Ambitious

Specific and achievable Explanation: Interventions in SFBT focus on specific, concrete, and achievable goals developed in collaboration by the therapist and patient.

The therapeutic relationship between the psychiatric nurse and the child client is particularly important since a) A child's ability to express themselves is limited by their stage of development b) The nurse is subject to developing countertransference issues with the child c) The child client needs to relate to the nurse as a surrogate parent d) The child's ability to actively engage in the therapy is dependent on feeling safe with the nurse

The child's ability to actively engage in the therapy is dependent on feeling safe with the nurse Explanation: The relationship that develops between the therapist and client is very important. Most pediatric or adolescent clients do not voluntarily seek treatment; they are referred to treatment because of a disturbance noted by a family member, teacher, or pediatrician. If the client feels comfortable, safe, and understood, it is much easier to express his or her thoughts and feelings

The therapeutic relationship between the psychiatric nurse and the child client is particularly important since a) The child client needs to relate to the nurse as a surrogate parent b) The child's ability to actively engage in the therapy is dependent on feeling safe with the nurse c) A child's ability to express themselves is limited by their stage of development d) The nurse is subject to developing countertransference issues with the child

The child's ability to actively engage in the therapy is dependent on feeling safe with the nurse Explanation: The relationship that develops between the therapist and client is very important. Most pediatric or adolescent clients do not voluntarily seek treatment; they are referred to treatment because of a disturbance noted by a family member, teacher, or pediatrician. If the client feels comfortable, safe, and understood, it is much easier to express his or her thoughts and feelings.

Some behavioral therapists believe that seclusion and restraint are forms of punishment. It may be assumed that these therapists view seclusion and restraint as a) an unavoidable consequence of aberrant behaviors. b) a treatment administered only when all others have failed. c) continuous negative reinforcement for a response. d) an unpleasant stimulus that happens after a certain unwanted behavior.

an unpleasant stimulus that happens after a certain unwanted behavior. Explanation: Punishment is viewed as a consequence in response to behavior for the intention of changing the undesired behavior.

The education provided to a client receiving cognitive behavioral therapy provides the client with information on the nature and course of the disorder and ... a) examines the pros and cons of receiving cognitive behavior therapy. b) identifies client weaknesses. c) promotes the relationship with therapist for indefinite period of time. d) empowers clients to engage in a collaborative approach to their care.

empowers clients to engage in a collaborative approach to their care. Explanation: Providing clients information on the nature and course of their disorder not only helps them to understand their current struggles, but also empowers clients to engage in a collaborative approach to their care.

One of the biggest differences between psychiatric nursing and medical-surgical nursing is that a) generalist-level medical-surgical nurses are educated in the biological aspects of body functioning, whereas generalists in psychiatric-mental health nursing are educated more in the psychological aspects. b) medical-surgical nurses often avoid dealing with the client's emotional difficulties, focusing rather on the task at hand, whereas psychiatric nurses rarely focus on tasks. c) psychiatric nurses focus only on the psychological aspects, whereas medical-surgical nurses focus on the physiological. d) psychiatric nurses facilitate clients' identification of resources and use of personal resources to get what they need, and medical-surgical nurses do many more things for clients.

psychiatric nurses facilitate clients' identification of resources and use of personal resources to get what they need, and medical-surgical nurses do many more things for clients. Explanation: Psychiatric nursing involves helping the patient develop the long-term resources to become more self-sufficient and personally satisfied. Medical-surgical nursing often provides needs for patients when they are acutely unable to do so for themselves.

Which of the following is a theme common in irrational beliefs? Select all that apply. a) Catastrophizing b) Global evaluation of human worth c) A demand d) Low frustration tolerance e) Concrete thinking

• A demand • Catastrophizing • Low frustration tolerance • Global evaluation of human worth Explanation: Common themes in irrational beliefs include a demand, absolute thinking, catastrophizing, low frustration tolerance, and global evaluations of human worth.

Which of the following techniques may be used as a part of behavioral therapy in mentally ill clients? (Select all that apply.) a) Role-playing b) Desensitization c) Self-management training d) Assertiveness training e) Pharmacotherapy

• Assertiveness training • Desensitization • Self-management training • Role-playing Explanation: Behavior therapy encompasses assertiveness training, desensitization, role-playing, and self-management training. Pharmacotherapy would not be included as part of behavior therapy in itself.

All psychotherapeutic approaches share the common goal to help the client (Select all that apply.) a) Identify and understand the importance of their true feelings b) Manage or be relieved of the symptomology of their personality disorder c) Manage the disorder through the use of psychotropic drugs d) Gain an understanding of the internal conflicts associated with the disorder e) Become a mature, independent individual

• Become a mature, independent individual • Manage or be relieved of the symptomology of their personality disorder • Gain an understanding of the internal conflicts associated with the disorder • Identify and understand the importance of their true feelings Explanation: Psychotherapy has been referred to as the treatment of emotional and personality problems and disorders by psychological means. Various psychotherapeutic approaches (also referred to as psychodynamic therapies) are used to help the client become a mature, satisfied, and independent person. Further, all psychotherapeutic approaches share the common goal to help the client become a mature, independent individual; manage or be relieved of the symptomology of their personality disorder; gain an understanding of the internal conflicts associated with the disorder; and identify and understand the importance of their true feelings.

All psychotherapeutic approaches share the common goal to help the client (Select all that apply.) a) Gain an understanding of the internal conflicts associated with the disorder b) Manage or be relieved of the symptomology of their personality disorder c) Become a mature, independent individual d) Manage the disorder through the use of psychotropic drugs e) Identify and understand the importance of their true feelings

• Become a mature, independent individual • Manage or be relieved of the symptomology of their personality disorder • Gain an understanding of the internal conflicts associated with the disorder • Identify and understand the importance of their true feelings Explanation: Psychotherapy has been referred to as the treatment of emotional and personality problems and disorders by psychological means. Various psychotherapeutic approaches (also referred to as psychodynamic therapies) are used to help the client become a mature, satisfied, and independent person. Further, all psychotherapeutic approaches share the common goal to help the client become a mature, independent individual; manage or be relieved of the symptomology of their personality disorder; gain an understanding of the internal conflicts associated with the disorder; and identify and understand the importance of their true feelings.

According to Albert Ellis, cognitive therapy integrates which of the following? Select all that apply. a) Social support b) Behavior c) Emotions d) Cognition e) Environment

• Behavior • Emotions • Cognition Correct Explanation: According to Ellis, cognition, emotions, and behavior are integrated and holistic in cognitive therapy.

According to Albert Ellis, cognitive therapy integrates which of the following? Select all that apply. a) Environment b) Social support c) Cognition d) Behavior e) Emotions

• Cognition • Emotions • Behavior Explanation: According to Ellis, cognition, emotions, and behavior are integrated and holistic in cognitive therapy.

Rational emotive behavior therapy (REBT) uses which of the following techniques? Select all that apply. a) Humor b) Operant conditioning c) Classical conditioning d) Role-playing e) Suggestion

• Humor • Role-playing • Suggestion • Operant conditioning Explanation: REBT uses role-playing, assertion training, desensitization, humor, operant conditioning, suggestion, support, and other interventions.

During a session that includes a depressed teenage client and his family, the psychiatric nurse engages in the primary counseling role when (Select all that apply.) a) Explaining that hormonal surges during the teen years can affect mood changes b) Reassuring everyone that with medication and counseling the depression will subside c) Educating the family regarding the signs that their teen may be suicidal d) Reassuring the client that being depressed does not make him a weak person e) Encouraging the client to take the prescribed antidepressant medication as ordered

• Reassuring the client that being depressed does not make him a weak person • Explaining that hormonal surges during the teen years can affect mood changes • Encouraging the client to take the prescribed antidepressant medication as ordered • Educating the family regarding the signs that their teen may be suicidal Explanation: During a session that includes a depressed teenage client and his family, the psychiatric nurse engages in the primary counseling role when she reassures the client that being depressed does not make him a weak person; when she explains that hormonal surges during the teen years can affect mood; when she encourages the client to take his prescribed mediation; and when she educates the family regarding signs the teen may be suicidal.

A client with depression goes through three processes. The first is the cognitive triad, which includes thoughts about which of the following? Select all that apply. a) Health and wellness b) The future c) Spirituality d) Self e) The world

• The world • Self • The future Explanation: The cognitive triad includes thoughts about oneself, the world, and the future.