Chapter 3: Psychosocial Theories and Therapy
A nurse is leading a group. During the session, the nurse observes the members testing each other to see if they can trust each other. The nurse leader also notes that the members are testing the nurse, too. The nurse interprets this behavior as characteristic of which phase? Beginning Termination Intermittent Working
Beginning In the beginning or honeymoon phase, members begin to test whether they can trust one another and the leader. During the working phase, the group realizes its purpose. If the purpose is education, the participants engage in learning new content or skills. The termination phase is the final stage in which members begin to grieve for the loss of the group's closeness and begin to reestablish themselves as individuals. There is no phase called intermittent.
The working stage of group therapy is marked by which characteristic? Therapists' tendency to "back off" to allow the group to work. Members' propensity to leave the group. Group members' concern about confidentiality issues. Conflict and cooperation among group members.
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.
Which action by the group leader demonstrates effective leadership? Encouraging participation by all members Using autocratic leadership strategies Firmly disciplining negative behavior Conducting meetings based on personality attributes
Encouraging participation by all members The key to being a good leader is to integrate group leadership, knowledge, and skills with nursing interventions that fit a selected group. Firmly disciplining negative behavior, using autocratic leadership strategies, and conducting meetings based on personality attributes are not keys to being a good leader.
Which theorist's contribution led nurses to recognize that personality development begins at birth? Sigmund Freud B. F. Skinner Erik Erikson Harry Stack Sullivan
Erik Erikson Erik Erikson's psychosocial developmental theory helped nurses to recognize that personality development begins at birth and continues across the lifespan until death. This was not the theoretical contribution of Harry Stack Sullivan, Sigmund Freud, or B. F. Skinner.
Which theorist's contribution led nurses to recognize that personality development begins at birth? Harry Stack Sullivan B. F. Skinner Erik Erikson Sigmund Freud
Erik Erikson Explanation: Erik Erikson's psychosocial developmental theory helped nurses to recognize that personality development begins at birth and continues across the lifespan until death. This was not the theoretical contribution of Harry Stack Sullivan, Sigmund Freud, or B. F. Skinner.
Which group characteristic is lacking in the following statement: "Our group never talks about really emotional issues. I mean, no one ever cries." Group cohesiveness Imparting of information Competition Countertransference
Group cohesiveness Group cohesiveness is evident when members value each other's contributions and feel free to express opinions and emotions honestly. This statement reflects a group that is lacking cohesiveness. Countertransference occurs when the therapist responds negatively to the client's transference, further complicating communication. Competition refers to a process in group development where group members can develop rivalry but can positively affect the group outcome. In this case, competition is not reflected in the statement. Imparting information is the use of data in a planned, structured manner, such as didactic instruction given in a lecture format.
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 Help her identify reliable, affordable help with her childcare needs Comply with her prescribed therapies including the use of an antidepressant Rely more on her extended family's offer to act as a support system
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.
Interpersonal theorists, such as Harry Stack Sullivan, emphasize which tenet? Alleviating symptoms by utilizing biological tools, such as medicines The existence of the id, ego, and superego The importance of conditioning responses in working with people Interpersonal socialization of humans throughout their developmental stages
Interpersonal socialization of humans throughout their developmental stages Development is somewhat predictable as progression through stages and achieved by means of interactions with others. Freud emphasized the id, ego, and superego. Conditioning stems from the behavioral theory. Alleviating symptoms by utilizing biological tools, such as medications, is related to the biophysiological theory.
Which nursing theory focuses on the nurse-client relationship and development of problem-solving skills? Interpersonal theory Adaptation theory Theory of human becoming Behavioral nursing theory
Interpersonal theory Hildegard Peplau's interpersonal theory focuses primarily on the nurse-client relationship, in which problem-solving skills are developed. The theory incorporates communication and relationship concepts from Harry Stack Sullivan's interpersonal theory. Orem's self-care deficit theory is a behavioral nursing theory. Roy's adaptation theory states that humans are biopsychosocial adaptive systems who use coping mechanisms to adapt to both internal and external stimuli. Parse's theory of human becoming posits that quality of life from each person's own perspective is the goal of nursing practice.
What is the most basic need, according to Maslow's hierarchy of needs? Safety and security Physiological Love and belonging Self-actualization
Physiological The most basic needs—the physiological needs of food, water, sleep, shelter, asexual expression and freedom from pain—must be met first.
Calling the client by name and spending time with the client are examples of what? Empathy Acceptance Values Positive regard
Positive regard Positive regard is an unconditional, nonjudgmental attitude. Acceptance occurs when the nurse does not become upset or respond negatively to a client's outbursts, anger, or acting out. Empathy is the ability of the nurse to perceive the meaning and feelings of the client and to communicate that understanding to the client. Values are abstract standards that give a person a sense of right and wrong and establish a code of conduct for living.
A mental health nurse is discussing the potential adverse effects of electroconvulsive therapy (ECT). According to Peplau's interpersonal theory, the nurse is functioning in which nursing role? Resource person Teacher Stranger Leader
Teacher Peplau believed that the nurse serves as a therapist, counselor, socializing agent, manager, technical nurse, mother surrogate, and teacher. In this situation, the nurse is functioning in the teacher mode by helping the client to learn formally or informally.
A therapist is planning care for an adult client with past trauma and neglect. The therapeutic approach will be accessing the client's unconscious conflicts from their past and resolving the issues with the mature adult mind. Which therapy is the therapist utilizing? play therapy object relations psychoanalysis cognitive-behavioral therapy
psychoanalysis Psychoanalysis refers to the therapeutic process of accessing the client's unconscious conflicts that originate in childhood and resolving the issues with a mature adult mind. Psychoanalysis attempts to reconstruct the personality by examining associations and the interpretations of dreams. Play therapy is utilized mostly with children and involves playing with objects to act out and process past traumas or conflicts. Object relations is a term describing the psychological attachment to another person or object and believes the relationship between maternal parent and child affects future relationships for the child as an adult. Cognitive-behavioral therapy targets the client's cognitive distortions to change the client's behaviors.
The nurse leader of a group observes a group member attempting to stimulate the group to action or decision. The nurse interprets this member as fulfilling which role? coordinator energizer recorder orienter
energizer The energizer attempts to stimulate the group to action or decision. The recorder writes suggestions, keeps minutes, and serves as group memory. The orienter defines the position of the group with respect to its goals. The coordinator shows or clarifies the relationships among various ideas and suggestions.
A nurse is performing discharge planning for a client who will be returning home to live with family members. Which concept will be most important for the nurse in considering client needs? transference modeling formal support system family dynamics
family dynamics Family dynamics are most important in determining client needs. This involves patterns of both social and interpersonal interactions and the behavior of one person can influence the others in this open system of a family. Therefore the nurse would want to determine the family dynamics in order to be sure the client's needs would be met in this environment. Family members would be part of the informal, not formal, support system. While transference involves displacement of thought, feelings and behaviors related to significant others, the client would displace these with a therapeutic relationship instead of with significant others such as family members. Modeling involves internalizing behaviors of others but may not be a positive aspect to meet a client's needs based on family members.
In the Freudian model, which is true regarding the id? It is associated with ethics and standards of behavior. It is the sum of certain mental mechanisms such as perception. It is formed by unconscious desires and primitive instincts. It is able to control movement and contact with reality.
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.
Learned maladaptive behavior is a concept central to which theory of human behavior? Behavioral theory Sociocultural theory Psychoanalytic theory Humanistic theory
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.
The client's parents have begun a program of therapy that includes giving the client a token each time the client follows directions. Which theoretical framework provides the background for such a program? Systems theory Psychodynamic theory Token economy theory Behavioral theory
Behavioral theory Reinforcing behaviors with rewards reflects a basic principle of behavioral therapy.
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 Transference Reaction formation Free association
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.
Which is one common mistake that people working in the helping professions do when applying theory to the therapeutic process? Develop an overzealous commitment to one form of therapy, ignoring the benefits that other types of therapies may have for a given individual. Give medications along with psychotherapy. Deny access to care by restricting clients to only one form of therapy. Provide a biological approach to helping with psychiatric disorders by giving several medications at one time.
Develop an overzealous commitment to one form of therapy, ignoring the benefits that other types of therapies may have for a given individual. All theories can contribute beneficial knowledge in various situations. An eclectic approach to care is the most comprehensive and effective.
A group of nursing students is reviewing information about Freud's personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of what element of personality? Id Ego Unconscious Defense mechanisms
Ego In Freud's personality structure, the ability to form mutually satisfying relationships is a fundamental function of the ego and is formed throughout a child's development. Defense mechanisms are coping styles that protect a person from unwanted anxiety. The unconscious refers to feelings and thoughts outside awareness and not remembered. The id is formed by unconscious desires, primitive instincts, and unstructured drives.
The nurse is explaining the hospital routines and expectations to a newly admitted client. The nurse also asks if the client has any questions surrounding the admission. Which stage is this according to Peplau's concept of the nurse-patient therapeutic relationship? Resolution Exploitation Orientation Identification
Orientation Explaining the hospital routines and asking if the client has any questions are an attempt to engage the client in the treatment process. During this orientation phase of the therapeutic nurse-patient relationship, the nurse will also clarify the client's problems and needs. In the identification stage, the client works interdependently with the nurse, begins to share feelings with the nurse, and starts feeling stronger. In the exploitation phase, the client makes full use of the services offered by the nurse and other health care personnel. The client starts making goals such as going home and working independently. The resolution phase indicates the end of therapeutic nurse-patient relationship. The client no longer needs professional services and gives up dependent behavior.
A psychiatric mental health nurse is applying Erikson's theory of psychosocial development in the care of a young adult client. What outcome should the nurse identify to best address the developmental conflict that this client is experiencing at this age? The client describes a greater appreciation for the value of hard work and prolonged effort The client shows an increased ability to delay gratification The client demonstrates increased autonomy and independence in the client's decision-making The client demonstrates new interpersonal skills to promote the development of intimate relationships
The client demonstrates new interpersonal skills to promote the development of intimate relationships The developmental conflict of young adulthood is intimacy versus isolation. Improved interpersonal skills would promote the development of intimacy. All of the other listed outcomes are beneficial, but none directly address Erikson's developmental conflict of young adulthood.
For a client who has anxiety, the individual psychotherapy process moves into the working phase when which occurs? The psychiatric assessment process has produced client-focused interventions The client expresses a willingness to discuss what the client thinks is the cause of the anxiety The nurse-client relationship is well established The nurse feels that the client has developed sufficient coping skills to now deal with the stress
The client expresses a willingness to discuss what the client thinks is the cause of the anxiety Explanation: The anxious client's individual psychotherapy process moves into the working phase when the client expresses a willingness to discuss what the client thinks is the cause of the anxiety, not when the nurse-client relationship is well established, when the nurse feels the client has developed sufficient coping skills to now deal with the stress, or when the psychiatric assessment process has produced client-focused interventions.
The nurse determines that Pavlov's theory of classical conditioning is demonstrated with which client behavior? The client states "I think my doctor is out in the hallway talking with my family members." The client states "My stomach is growling" with the sound of the food cart in the hallway. The client states "I need my pain medication" when the physical therapist comes for therapy. The client states "I can't stop crying every time I think about the death of my mother."
The client states "My stomach is growling" with the sound of the food cart in the hallway. Classical conditioning involves an unconditioned stimulus with an unconditioned response. In this example, the client would associate food, which is the unconditioned stimulus, with the sound of the food cart, a conditioned stimulus. This would elicit the unconditioned response of the stomach growling. The client who associates the need for pain medication would have a conditioned response based on the awareness that there is pain associated with physical therapy. The client's grief over a mother's death and the sounds of the doctor talking in the hallway are unrelated to this concept.
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 medication adherence, as this is my primary issue." "My activating event must be one that actually occurred." "I am the only one who can exacerbate my irritational thinking." "We will work on changing my irrational beliefs into reasonable thoughts."
We will work on changing my irrational beliefs into reasonable thoughts." 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.
A client is being discharged from the psychiatric unit this afternoon, and a nurse needs to teach the client about discharge medications. The client is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau's views regarding anxiety, the nurse would expect to implement the education plan at which time? When the client's anxiety decreases to a mild level When the client is completely free of anxiety When the client's anxiety escalates to the panic level When the client's anxiety stabilizes at its current level
When the client's anxiety decreases to a mild level Mild anxiety is useful for learning; therefore, it would be appropriate to begin educating the client when his anxiety decreases to a mild level. Severe anxiety interferes with learning. Anxiety should be relieved as much as possible, but it would be unrealistic to expect that the client would become completely free of anxiety.
According to Yalom (2005), there are 11 therapeutic factors through which changes occur in group psychotherapy. Which factor correlates with learning to give to others? altruism catharsis universality group cohesiveness
altruism Altruism is learning to give to others. Universality refers to finding out that others have similar problems. Catharsis is the open expression of affect to purge or "cleanse" oneself. Group cohesiveness is the group members' relationship to the therapist and other group members.
The most superficial and accessible levels of cognition and generally the first to be targeted in treatment are ... core beliefs. intermediate beliefs. automatic thoughts. cognitive schema.
automatic thoughts. The most superficial and accessible levels of cognition and generally the first to be targeted in treatment are automatic beliefs.
To provide culturally sensitive care, the nurse should consider which when developing psychiatric interventions? A client's preference for medication That all members of a particular culture have similar beliefs That all members of a particular culture suffer from similar conditions A client's background, beliefs, and concerns
client's background, beliefs, and concerns Because of differences in culturally influenced or determined values, it is imperative for health care providers to consider a client's background, beliefs, and concerns when choosing therapies and interventions.
An adult client diagnosed with depression and social isolation is admitted to the psychiatric-mental health unit. The client states, "I am lonely and don't have any friends because no one cares about me." Which type of therapy would the nurse suggest for the client? play therapy dialectical-behavioral therapy cognitive-behavioral therapy systematic desensitization
cognitive-behavioral therapy Cognitive-behavioral therapy focuses on changing the cognitive distortions that the client has in order to change behavior and the client's moods and emotions. The client's statement of being lonely and not having friends because no one cares about them is a cognitive distortion, which is not reality based, and is causing or promoting the depression and social isolation. Therefore, cognitive-behavioral therapy would be encouraged for the client. Systematic desensitization is an exposure type of therapy that treats phobias and anxiety, which would not be prescribed. Dialectical behavioral therapy is a specific type of cognitive-behavioral therapy focused on teaching mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness. Although this is a type of cognitive-behavioral therapy, the focus issue for the client is a cognitive distortion, which cognitive-behavioral therapy would address. Play therapy is designed for children to expose their unconscious fantasies and anxieties, and thus would not be appropriate for the adult client.
For Freud, the therapist's emotional reactions to the client based on personal unconscious needs and conflicts is termed ... countertransference. situational conflict. transference. interpersonal relations.
countertransference. For Freud, the term countertransference means the therapist's emotional reactions to the client based on personal unconscious needs and conflicts. Countertransference interferes with the therapeutic relationship.
Which statement would indicate that the group is in the working phase of development? "I'm not sure what we are supposed to be talking about." "Let's go around the circle and tell one thing that you enjoy doing." "I don't understand why Mary doesn't see my point of view, and frankly it really irritates me when she does that!" "What have you learned, and how will you take this out into your life?"
"I don't understand why Mary doesn't see my point of view, and frankly it really irritates me when she does that!" In the working phase, members confront each other with constructive feedback and honesty to gain insight into dysfunction. The initial stage of group development occurs when members are becoming acquainted and searching for similarity between themselves and others. The mature stage of the group demonstrates positive characteristics such as empathy, effective communication, and a definite, inclusive group culture. The termination stage encompasses when the group evaluates and explores members' feelings about it and the impending separation.
In which phase of Freud's developmental stage does toilet training occur? Latency Oral Genital Anal
Anal Toilet training occurs in the anal stage, which occurs between 18 and 36 months of age.
A psychiatric-mental health nurse is preparing a review class for a group of colleagues on the various theoretical models used in psychiatric-mental health nursing. When describing cognitive theories, which statement would the nurse practitioner most likely include about what these theories attempt to do? "They link internal thought processes with behavior" "They explain normal human growth and development" "They describe how people learn and act" "They explain development of the mental processes and effects on behavior"
"They link internal thought processes with behavior" Cognitive theories attempt to link internal thought processes with human behavior. Psychodynamic theories attempt to explain mental processes and how they affect behavior. Behavioral theories attempt to describe how people learn and act. Developmental theories attempt to explain normal human growth and development over time.
A client with a history of trauma has told the nurse that he is pursuing psychoanalysis with an independent therapist. What statement by the client would be most consistent with a Freudian approach to psychoanalysis? "We're spending quite a bit of time exploring the themes in my dreams." "I've learned a lot about how I've been conditioned to respond to situations in a certain way." "We talk a lot about how I've learned to model my behavior after other people in my life." "We discuss the tension between my expectations for myself and the expectations of society."
"We're spending quite a bit of time exploring the themes in my dreams." Explanation: Freud prioritized the importance of dreams. Conditioning is central to behaviorist theories. Modeling is a focus of cognitive theories. Psychoanalysis does not focus specifically on societal expectations.
Which should be considered the fundamental principle of family therapy? A family is composed of individuals who care about each other. Parental involvement is the key to family health. A family is a system of interrelated dependent relationships. Children are pivotal to family function.
A family is a system of interrelated dependent relationships. The fundamental principle of family therapy is that a family is a system of interrelated dependent relationships. The other statements are not reflective of the fundamental principle of family therapy.
Which cognitive theorist conceptualized distorted cognitions as a basis for depression? Edward Tolman Aaron Beck Ivan Pavlov Kurt Lewin
Aaron Beck Aaron Beck conceptualized distorted cognitions as a basis for depression. Kurt Lewin developed field theory, a system for understanding learning, motivation, personality, and social behavior. Edward Tolman introduced the concept of cognitions; he believed that human beings act on beliefs and attitudes and strive toward goals. Ivan Pavlov was a behavioral theorist most noted for classical conditioning.
Degree of agreement between the leader's norms and the group's norms, ability to deal with members' infractions, and conformity to group norms are characteristics of what kind of groups? Primary groups Secondary groups Formal groups All groups
All groups Explanation: A group is three or more people with related goals. The following characteristics vary among different types of groups: size, homogeneity or heterogeneity of members, stability, degree of cohesiveness among members, climate, conformity to group norms, degree of agreement with the leader's and the group's norms, ability to deal with members' infractions, and goal-directedness and task orientation of the group's work.
Cognitive techniques focus on the client's patterns of which type of thinking? Delusional Magical Delayed Automatic
Automatic 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.
The nurse has been asked to sit in and observe a support group for individuals who were once addicted to drugs. The nurse notices that one group member disagrees with statements made by all other group members. What role is this individual playing in the group? Blocker Dominator Follower Gatekeeper
Blocker The blocker resists progress by arguing or disagreeing beyond reason. The dominator asserts authority and superiority by manipulating the group or certain members. The follower goes along with the ideas of others, assuming an audience role. The gatekeeper facilitates and encourages the contributions of others, thereby keeping communication open.
The nurse explains to the client that extra television time will be awarded based on appropriate behavior during group therapy. Which theorist's concepts is the nurse utilizing? Erik Erikson's psychosocial development Frederick Perl's Gestalt therapy B. F. Skinner's operant conditioning Melanie Klein's play therapy
B. F. Skinner's operant conditioning The theory of behaviorism that corresponds most closely to this is B. F. Skinner's operant conditioning. The client will receive a reward based on appropriate behavior- in this case, getting to watch television longer based on having appropriate behavior in group therapy. Gestalt therapy relates to expression of unmet needs in order to decrease anxiety levels. With Melanie Klein's theory, play therapy is used with children to help reveal infantile fantasies and anxieties. Erik Erikson's psychosocial development defines stages and developmental conflicts that individuals work through in order to achieve essential strength and virtues.
A nurse demonstrates a sound understanding of the use of ego defense mechanisms by providing which explanation? Can be either a therapeutic or a pathological way to manage stress Should be used only when faced with severe stressors Are substitutes for effective coping skills Are often symptomatic of moderate to severe mental illness
Can be either a therapeutic or a pathological way to manage stress Depending upon their use, ego defense mechanisms can be therapeutic or pathologic, because all defense mechanisms include a distortion of reality, some degree of self-deception, and what appears to be irrational behavior. Ego defense mechanisms are considered healthy protective barriers when appropriately used to manage instinct and affect in stressful situations. Ego defense mechanisms when appropriately used are coping skills used to resolve a mental conflict, to reduce anxiety or fear, to protect one's self-esteem, or to protect one's sense of security.
The nurse is working with a client seeking treatment for bulimia and determines that cognitive restructuring will help build the client's self-esteem. Which best describes the goals of cognitive restructuring? Avoid negative self-talk Find a sounding board for identifying and discussing feelings Change distorted thinking and the subsequent behaviors Use adaptive defense mechanisms
Change distorted thinking and the subsequent behaviors Change distorted thinking and the subsequent behaviors The goals of cognitive restructuring are for clients to monitor their maladaptive thoughts and beliefs, look for evidence supporting their beliefs, dispute their maladaptive self-statements, substitute adaptive thoughts, and thus change their patterns of distorted thinking and, consequently, their behavior. Avoiding negative self talk is not a goal of cognitive restructuring; the aim is to identify it so the client can change it. Finding a sounding board for identifying and discussing feelings is one of the goals of crisis intervention. Using adaptive defense mechanisms is not part of cognitive restructuring; rather it is a component of behavioral therapy.
While working with an older client, a nurse begins to think of the client as a grandparent and responds to the client as a grandchild. The nurse is developing what type of emotional reaction? Empathy Countertransference Transference Modeling
Countertransference The nurse, upon feeling that the client reminds the nurse of a grandparent, is developing countertransference. The nurse is developing an attachment to the client, thus treating the client as a grandparent. 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.
In a group therapy session, group members confront a 35-year-old client about the client's abuse of prescription pain medications. The client states, "The doctor prescribed me these pills, that doesn't make me a drug addict." The nurse identifies this as an example of which defense mechanism? Sublimation Regression Denial Projection
Denial Denial is refusing to recognize a reality that might be troublesome or traumatic. Regression refers to going back to an earlier and happier time of development. Projection is when a person refuses to recognize behavior in oneself and instead "projects" it or sees it in someone else. Sublimation means taking repressed feelings and transforming them into positive and constructive pursuits.
A client in a psychiatric clinic has a history of two distinct personality states. The client is also unable to remember important personal information. What is the client likely to be suffering from? Dissociative identity disorder Acute stress disorder Dissociative amnesia Derealization disorder
Dissociative identity disorder is one of the dissociative disorders characterized by disruption of the integrated functions of consciousness, memory, identity, or environmental perception. In dissociative identity disorder, the client may assume two or more distinct identities that recurrently take control of the client's behavior. The client may also be unable to remember important personal information that is of a stressful nature. Dissociative amnesia is characterized by a fugue experience in which the client moves to a new geographical location, with no memory of past events. Derealization disorder is characterized by a feeling of being detached from one's mental processes or body. Acute stress response occurs in response to a stressful event and is ch
A nurse is applying principles of cognitive behavioral therapy (CBT) in the treatment of a client with depression. Which intervention is an example of CBT? Encouraging the client to review the past and focus on strengths and accomplishments Fostering hope by encouraging a focus on abilities rather than problems Encouraging the client to identify destructive thoughts and practice mindfulness Rewarding the client with five tokens for attending group therapy
Encouraging the client to identify destructive thoughts and practice mindfulness 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.
Which group role is best reflected by the client who consistently validates members' contributions, tries to be the "mediator" between members, and interprets the group's procedures? Group cohesion Group building and maintenance Task Individual
Group building and maintenance Group building and maintenance roles are oriented toward overall group functioning. They alter or maintain the way of working to strengthen, regulate, and perpetuate the group. Individually oriented behavior, which often stems from anxiety, distracts from and temporarily stymies the group and its progress. Task roles promote growth and productivity. Group cohesion relates to bonding and solidarity, the feeling of "we" instead of "I."
Which nursing theorist was opposed to the idea that the client passively receives treatment? Madeleine Leininger Hildegard Peplau Dorothea Orem Sister Callista Roy
Hildegard Peplau Hildegard Peplau was opposed to the idea that the client passively receives treatment and the nurse passively acts out doctor's orders. Peplau believed that the nurse serves as a stranger, resource person, teacher, leader, surrogate, and counselor.
A nurse is planning an educational program for families with a mentally ill relative. Which goal is consistent with the current objectives of family education? Increased independence with activities of daily living Improved family quality of life Improved medication compliance Fewer hospital admissions
Improved family quality of life Explanation: The successful outcome measures for family education are reduced family burden and improvement in the family's quality of life. Client improvement often accompanies this outcome but is not a primary goal.
Which phase of individual psychotherapy involves establishing mutual boundaries of the relationship between the client and the mental health nurse? Resolution Termination Working Introductory
Introductory During the introductory phase, the therapist and the client establish boundaries of the relationship. Resolution occurs in the working phase. The working phase occurs when the therapist and the client focus on the client's problems and reach an understanding of why the problems have occurred. The termination phase occurs when the client has achieved the maximum benefit of therapy.
A newly admitted client has joined an anger management group as part of treatment in the hospital. Which type of group would be appropriate for this client? Open Dyad Closed Cohesion
Open In an open group, new members may join, and older members may leave the group at different sessions. Cohesion is the ability of a group to stick together. In a closed group, members begin the group at one time, and no new members are admitted. A dyad is a group of two people.
A nurse is part of a treatment team using cognitive behavior therapy (CBT). The nurse understands that this therapy operates on the premise that a person is disturbed by what? Nothing An event Perception of an event Both the event and perception of the event
Perception of an event Proponents of CBT posit that people are disturbed not by an event but by the perception of that event. The goal of this type of therapy is to bring the client's attention to how an altered perception is responsible for a maladaptive reaction to various anxiety provoking situations.
The concept that irrational beliefs lead to negative emotions underlies which psychotherapeutic approach? Gestalt therapy Rational emotive behavior therapy Solution-focused therapy Choice therapy
Rational emotive behavior therapy Irrational beliefs tend to be dogmatic and are expressed in the form of rigid "musts," "shoulds," "oughts," or "have-tos." They lead to negative emotions (e.g., depression, anxiety, guilt, anger) that interfere with goal pursuit and attainmen
A nurse has been working with a client who has a personality disorder and the nurse has recognized the potential for countertransference. How can the nurse best prevent this phenomenon? Reflecting on the nurse's own thinking to identify times where the nurse may project individual feelings on to the client Dialoguing with the client about the client's tendency to direct feelings about the client's father on to the nurse Challenging the client when the nurse feels that the client is mimicking the nurse's ideas or demeanor Teaching the client basic techniques for enhancing coping skills and managing stress
Reflecting on the nurse's own thinking to identify times where the nurse may project individual feelings on to the client Countertransference exists when the nurse projects individual feelings on to the client. The opposite phenomenon constitutes transference. Mimicking by a client is not an aspect of countertransference. Fostering coping skills in the client does not affect the nurse's risk of experiencing countertransference.
Which action reflects group development in the initial stage? Seeking similarities Engaging in conflicts Evaluating the group experience Focusing on group accomplishments
Seeking similarities The initial stage of group development is characterized by a group that works on getting acquainted, depends on the leader for direction, searches for purpose of the group, restricts content, searches for similarity, and gives advice.
Which theorist developed the psychoanalytic theory? Harry Stack Sullivan Erik Erikson B. F. Skinner Sigmund Freud
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.
A student nurse does not want to think about the upcoming final exam. The student nurse will start studying for the exam tomorrow. The student nurse is exhibiting which type of defense mechanism? Regression Denial Conversion Suppression
Suppression Suppression is the voluntary rejection of unacceptable thoughts or feelings from conscious awareness. Denial is unconscious refusal to face thoughts, feelings, wishes, needs, or reality factors that are intolerable. Regression is the retreat to past developmental states to meet basic needs. Conversion is the unconscious expression of a mental conflict as a physical symptom to relieve tension or anxiety.
In terms of Maslow's hierarchy of need, families living in poverty may be focused more on which type of needs rather than self-actualization? Security Esteem Safety Survival
Survival In terms of Maslow's need hierarchy, families living in poverty may be more focused on survival needs than self-actualization needs.
When assessing a client from a Freudian developmental perspective, the nurse determines that the client is functioning in the latency stage based on which behavior? The client is beginning to develop inner control over aggressive impulses. The client frequently bites the other children at preschool. The client has developed the capacity for object relations. The client has not yet developed adequate bowel control.
The client is beginning to develop inner control over aggressive impulses. The latency stage, according to Freud, is the stage in which the child is beginning to develop internal control over aggressive impulses.
The nursing theorist Peplau identified which as the essence of psychiatric-mental health nursing? Nursing care independent of physicians The nurse-client relationship The nurse's use of self A neurobiologic approach
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.
Why are the developmental theories important to nursing practice? They define human adaptation to others and to the environment. They outline the process of human growth and development. They describe how parts work together as a system. They explain the importance of legal and ethical care.
They outline the process of human growth and development. Developmental theories outline the process of growth and development of humans as orderly and predictable, beginning with conception and ending with death. Nurses apply this knowledge to develop interventions for people across the lifespan. Systems theory, adaptation theories, and legal/ethical care are also important to nursing, but these do not explain the importance of human growth and development in nursing care.
A client is undergoing individual psychotherapy. The client is yelling at the therapist because of a fight with the client's spouse about their children several years ago. In this instance, the client is exhibiting which response? Resistance Countertransference Transference Parataxis
Transference Transference Transference is the client's unconscious assignment of feelings and attitudes originally associated with important figures in the client's 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.
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? Fear for safety Trust and belonging Guilt and punishment Loss and abandonment
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? Initial Working Termination Mature
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.
What best describes the use of psychotherapy as a mental health intervention? used for clients with Axis I disorders bringing about a change in feelings, attitudes, thinking, and behavior a type of psychoanalysis a form of behavior therapy that includes behavior modification
bringing about a change in feelings, attitudes, thinking, and behavior Psychotherapy is a process by which a trained person applies principles for establishing a professional relationship sought by people who need help with psychological problems through which learning or human development occurs. Psychotherapy, by definition, is a method of bringing about change in a person by exploring their feelings, attitudes, thinking, and behavior.
The nurse is working with a client who is grieving over the death of a parent. Which concept is the nurse demonstrating when stating to the client, "I know how sad I was when I lost my parent"? object relations empathy operant behavior transference
empathy The nurse is demonstrating empathy with discussion of the same experience so that the nurse can relate to the client's grief. Transference is the displacement of thoughts, feelings, and behaviors originally associated with significant others from childhood onto a person in a current therapeutic relationship and would represent the client's and not the nurse's statement. Object relations involves the psychological attachment to another person and while the nurse may demonstrate this with a parent, this doesn't relate to the client's need. Operant behavior involves conditioning such as with Pavlov's theory.
The nurse is assessing a pediatric client who states "I want to be just like my Dad." The nurse determines this is an example of which concept? transference modeling self-efficacy countertransference
modeling Modeling is a concept in Albert Bandura's Social Cognitive Theory and involves pervasive imitation or one person trying to be like another, in this case the pediatric client's Dad. Self-efficacy is a person's ability to deal effectively with the environment. Countertransference is a concept identified by Sigmund Freud and involves the mental health care worker's feelings toward a client. The client may feel attachment as part of transference based on his/her own interpersonal experience.
Two staff nurses in a psychiatric emergency department are being considered for a promotion that will be announced via memo on a unit bulletin board. They work in a collaborative team environment, have been colleagues for 15 years, and socialize outside work. Nurse A hears from a third colleague that Nurse B was promoted. Nurse A responds, "I knew I'd never get the job. The nurse manager hates me." Nurse A is most likely demonstrating: reaction formation. compensation. projection. denial.
projection. Unconsciously adopting blaming behavior is called projection, and it allows people to attribute unacceptable feelings to other people. A nurse who is unconsciously attempting to emphasize a strong point in an attempt to make up for a perceived weakness is engaging in compensation. Unconsciously adopting behavior that is the opposite of actual feelings is called reaction formation. Unconsciously ignoring the existence of an unpleasant reality is called denial.
It is evident that a client has entered Piaget's stage of formal operations when the client ... speaks about a recent ballad as being reflective of the client's life story. can sleep through the night without having enuresis. expresses sadness about the loss of the client's dog. talks about humans being homo sapiens.
speaks about a recent ballad as being reflective of the client's life story. Comparing a ballad to real-life events reflects the ability to think abstractly.
The nurse is caring for a group of clients and recognizes which client is acting from the id portion of personality according to Sigmund Freud? the client who is remorseful over theft of money the client who is critical of own performance the client who is concerned over friendships the client who is sexually promiscuous
the client who is sexually promiscuous The client who is sexually promiscuous is acting from the id portion of personality which is concerned with unconscious desires and sexual tendencies. The client remorseful over theft of money or critical of own performance is acting from the superego part of the personality which is concerned with ethics, standards, and self-criticism. The client concerned over friendships is operating from the ego part of the personality which involves the capacity to form mutually satisfying relationships.
