Mental Health Exam 2 Chapter 13

Which statement made by the client identifies a misconception of the goal of cognitive behavioral therapy (CBT) that the nurse should address initially?

"Concentrating on past mistakes will help me make better decisions in the future." Explanation: In CBT, goals are developed in partnership and supply a forward-looking focus for what "can be" in the future as opposed to "what happened" in the past. All the remaining options either focus on the future or express an desire to change past perceptions.

Which question asked by the nurse demonstrates an attempt to implement cognitive behavioral therapy (CBT) with a client who has stated, "I'm worthless"?

Explanation: The goal of CBT is to restructure how a person perceives events in his or her life to facilitate behavioral and emotional change. By asking the client to identify an admirable quality, the nurse is attempting to help the client substitute a negative perception of self with a positive one. While the other options are possibly appropriate questions, they are not associated with the goals of CBT.

A nurse working in a psychiatric facility identifies the goal of cognitive therapy (CT) to be what?

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

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

In which of the following environments did cognitive interventions have their beginning?

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.

Dysfunctional consequences follow which type of belief?

Rigid Explanation: Whereas dysfunctional consequences of the interaction between A (activating event) and B (belief system) follow from absolute, rigid, irrational beliefs, functional consequences follow from flexible, rational beliefs.

Beck's cognitive triad refers to the client's views about what three areas?

Self, the world, and the future Explanation: Beck developed the cognitive triad to help understand the interaction of the client's negative view of self, the world, and the future. All issues and problems can be subsumed under one or a combination of these three areas.

Considering that cognitive behavioral therapy (CBT) requires a clear understanding of one's own belief system, which client is not a candidate for effective CBT?

The client diagnosed with schizophrenia 2 years ago. Explanation: Chief among the limitations identified associated with CBT is the concern that success is dependent on the client developing a clear understanding of their belief system and the origin of that system; thus, CBT is not effective with persons who have thought disorders and other issues that interfere with the ability to do so. Schizophrenia is a thought disorder while the other options are all mood disorders, such as depression and anxiety.

Evaluating one's automatic thoughts invokes identifying cognitive distortions that are defined as ...

Twisted thinking Explanation: Cognitive distortions, also referred to as thinking errors, problematic thinking styles, and "twisted thinking" are the characteristic and habitual ways in which people make errors in thinking about themselves or others.

A nurse is reading a journal article about cognitive processes and how they influence the development of mental disorders. The nurse demonstrates understanding of the information by identifying which concept as reflecting basic beliefs not articulated in explicit words, but rather accepted as absolute truth?

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.

The education provided to a client receiving cognitive behavioral therapy provides the client with information on the nature and course of the disorder and ...

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.

Which technique reinforces the client's successes and the strengths needed to achieve those successes?

giving compliments Explanation: Compliments are affirmations of the client; they reinforce the client's successes and the strengths needed to achieve those successes.

Which response by a client involved in solution focused brief therapy demonstrates an understanding of the fundamental principles of this form of therapy?

"Finding ways to manage my anger will allow my relationships to be so much more fulfilling." 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. While accurate statements, none of the other options focus on the guidelines principles of solution-focused brief therapy.

Which statement demonstrates a client's cognitive distortion about success in a course the client is enrolled in?

"I didn't make an A on that test; I'm never going to pass this course." Explanation: Cognitive distortions are generated by organizing distorted information and/or inaccurate interpretation of a situation. Cognitive distortions or "twisted thinking" occur in the statement about the effects of the grade on the future.

Which statement made by a client engaged in solution-focused behavior therapy (SFBT) demonstrates an understanding of a fundamental assumption of this form of therapy?

"I'm trying to find ways to change how I function when I'm faced with a frustrating situation." Explanation: SFBT assumes that change is most likely to occur when the focus is on what is changeable. None of the other statements are expressing the need to focus on change in order to manage the problem. Triggers are associated with rational emotive behavior therapy.

An instructor is teaching a class about the use of cognitive therapies in psychiatric nursing. Which statement made by a student identifies a need for further instruction?

"Lengths of stay for clients in inpatient settings are becoming longer each year." Explanation: The lengths of stay for clients in inpatient settings are becoming shorter each year, not longer. All the other statements are true and thus do not indicate a need for further instruction.

A psychiatric-mental health nurse is teaching a client about cognitive behavioral therapy. Which client statement demonstrates an understanding of the fundamental framework of this therapy?

"My distorted beliefs about how I look are responsible for my distorted thoughts." Explanation: It is important to realize that the thoughts a person has about a problem are not beliefs. CBT helps the patient identify the underlying belief, and then they then go on to explore the evidence that supports or refutes the belief about the event; identify alternative explanations for the event; and examine the real implications if the belief is true. It is believed that one's schema or rule of life are formed in early childhood and fixed by middle childhood. The focus of CBT is not "what happened" but rather what "can be." It is rational emotive behavior therapy that is based on the assumptions that people are born with the potential to be rational (self-constructive) and irrational (self-defeating).

A psychiatric-mental health nurse is interviewing a client who has come to the community mental health center for an evaluation of anger issues. Which client statement would the nurse interpret as an irrational belief?

"Nobody understands the enormous stress I'm under, so what's the use." Explanation: Irrational beliefs promote dysfunctional negative emotions that in turn lead to psychic pain and discomfort. Behaviors directed at relief of this pain tend to be self-defeating: "I can't fight the system; I will never succeed." The statement that nobody understands reflects this type of belief. Rational beliefs are flexible and lead to reasonable evaluations of negative activating events. Rational beliefs accept that human beings are fallible and reject absolutes such as always and never. The statements about needing to work on controlling my temper, not liking but being willing to try to learn, and needing to get help reflect rational beliefs.

A psychiatric-mental health nurse is working with a client. Which statement made by the client involved in solution-focused behavior therapy demonstrates effective use of a scaling question?

"Now that I understand what triggers my fear of flying, it feels more like a 7 than a 5." Explanation: Scaling questions are useful in making the patient's problem or issue more specific, in quantifying the exceptions noted in intensity, and in tracking change over time. A client is asked to rate the 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. Any change on the scale toward 10 is discussed, and the client is asked to talk about what was done to make that happen. The other options do not rate the severity of the client's issue on a scale of 1 to 10.

The nurse provides care for a client who is participating in rational emotive behavioral therapy (REBT). Which client response indicates an accurate understanding of the primary emphasis of REBT?

"We will work on changing my irrational beliefs into reasonable thoughts." Explanation: Rational emotive behavior therapy (REBT) is a psychotherapeutic approach that proposes that unrealistic and irrational beliefs cause many emotional problems. Medication adherence is not the primary focus for REBT. Irrational thinking is exacerbated by cultural groups and family. An activating event may be perceived and not be an actual event.

Cognitive interventions are based on the concept of cognition. Who developed cognitive behavioral therapy?

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

Who developed cognitive therapy for persons with depression?

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

A psychiatric-mental health nurse is working with a client who is receiving rational emotive behavior therapy. While reviewing the client's history, the nurse identifies statements that reflect common themes associated with irrational beliefs. Which theme would the nurse most identify in these beliefs?

Absolute thinking Explanation: There are five themes common in irrational beliefs: a demand, such that "This must happen"; absolute thinking, for example, "All or nothing at all"; catastrophizing, that is, exaggerating negative consequences of an event; low frustration tolerance (i.e., everything should be easy); and global evaluations of human worth, such that "People can be rated and some are better than others."

Rational beliefs accept that human beings are fallible and reject absolutes such as what? Select all that apply.

Always Never Explanation: Rational beliefs accept that human beings are fallible and reject absolutes such as "always" and "never." Rationale emotive therapy is based on this premise. This form of therapy also includes the belief that people use identified specific beliefs called irrational beliefs to make themselves unhappy.

Cognitive techniques focus on the client's patterns of which type of thinking?

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.

A therapist using cognitive-behavioral therapy (CBT) with a client has introduced a tool to help change self-perception. This tool uses books that offer alternative thoughts and responses. Additionally, the therapist encourages the client to keep a diary focused on emotional responses. These approaches are known as which of the following?

Bibliotherapy Explanation: Bibliotherapy is the use of books that offer alternative thoughts and responses, journaling, and keeping a diary focused on emotional and behavioral responses to upsetting situations.

Which is an assumption of solution-focused behavior therapy?

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 report 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.

According to Albert Ellis, cognitive therapy integrates which of the following? Select all that apply.

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

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?

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.

Which of the following reinforce the client's successes and strengths?

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.

Which type of cognitive intervention identifies the possible solutions before addressing the problem?

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 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 ...

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 client is using cognitive therapy as an adjunct treatment for bipolar disorder. Which would be an overall goal for this client related to the use of cognitive therapy for this condition?

The client will engage in self-care independent of professional assistance. Explanation: Cognitive therapy assumes that individuals have an innate ability to solve their own problems; thus, the overarching treatment goal is for the patient to engage in self-care independent of professional assistance.

A psychiatric- mental health advanced practice nurse is conducting rational emotive behavior therapy (REBT) with a client. When explaining the concept of consequences, which information would the nurse most likely include about dysfunctional consequences?

They are the result of irrational beliefs Explanation: Dysfunctional consequences follow from absolute, rigid, and irrational beliefs whereas functional consequences follow from flexible and rational beliefs. Although consequences are the end result of an action, may be the reasons people engage in certain behaviors, and give meaning to one's actions, these explanations do not address this concept as it is used in REBT.

Cognitive behavioral therapy is not effective with which client population?

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

A client states that she is anxious about separating from her emotionally abusive husband because she hasn't worked in many years. Using Beck's cognitive triad, the nurse understands that the client is concerned primarily about what?

Threats about her future Explanation: All issues and problems can be subsumed under one or a combination of Beck's cognitive triad. One client may be more concerned about self ("Can I do this?"). This client is concerned about the future ("Will there be a job for me?").

A client reports anxiety over "sounding stupid" when talking to strangers. As a part of cognitive behavioral therapy, the client is expected to speak to a stranger on the bus ride home and to journal about the experience. What information will be evaluated to determine the effect the activity has on the client's irrational belief about "sounding stupid"?

What actually happened compared to what the client feared would happen Explanation: The information concerning what really happened during the conversation compared to what the client feared would happen will be evaluated to determine the refuting of the irrational belief at the root of the client's fears. None of the other options are focused on the belief but rather the client's response to, preparation for, and memory of the conversation.

Which is developed during the engagement and assessment phase of cognitive behavioral therapy (CBT)? Select all that apply.

nurse-client rapport definition of the problem contract with the number of sessions Explanation: The first step in CBT is engagement and assessment. In this phase, the therapist establishes rapport with the client and develops the theme that problems are manageable. The client's definition of the problem that brought them into treatment is explored through a series of open-ended questions. Additionally, a contract is developed for several sessions (frequently 10 to 12). Examination of "self-talk" and the evaluation of the accuracy of automatic thoughts are addressed in the intervention framework step of CBT.

A psychiatric-mental health nurse is assessing a client and evaluating a client's beliefs. The nurse determines that the client's beliefs are rational because the belief:

reflects flexibility. Explanation: Rational beliefs are flexible and lead to reasonable evaluations of negative activating events. Rational beliefs accept that human beings are fallible and reject absolutes such as always and never.

When clients are asked to consider the points of view of significant others in their lives, the nurse is asking which type of question?

relationship Explanation: When relationship questions are used, clients are asked to consider the points of view of significant others in their lives. Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. 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." Compliments are affirmations of the client; they reinforce the client's success and the strengths needed to achieve those successes.