Theories & Therapies for Nursing Practice - Halter Chapter 2

The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to: A. Establish trust. B. Gain autonomy. C. Achieve identity. D. Develop a sense of industry.

C. Achieve identity. Rationale: According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood.

A cognitive therapist would help a client restructure the thought "I am stupid!" to: A. "What I did was stupid." B. "I am not as smart as others." C. "Things usually go wrong for me." D. "Things like this should not happen to anyone."

A. "What I did was stupid." Rationale: Cognitive therapists help clients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.

The premise underlying behavioral therapy is: A. Behavior is learned and can be modified. B. Behavior is a product of unconscious drives. C. Motives must change before behavior changes. D. Behavior is determined by cognitions; change in cognitions produces new behavior.

A. Behavior is learned and can be modified. Rationale: The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause.

The nurse is working with a client experiencing both post-partum depression and very low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially the nurse's priority is to: A. Establish trust with the client. B. Teach the client effective mothering skills. C. Identify positive traits the client possesses. D. Focus on preparing for a speedy discharge.

A. Establish trust with the client. Rationale: Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his attention to higher-level needs.

Maslow's theory of humanistic psychology has provided nursing with a framework for: A. Holistic assessment. B. Determining moral development. C. Identifying the potential for success in therapy. D. Conducting nurse-client interpersonal interactions.

A. Holistic assessment. Rationale: Central to Maslow's theory is the assumption that human beings are active rather than passive participants in life, striving for self-actualization. Maslow (1968) focuses on human need fulfillment, which he describes in six incremental stages, beginning with physiological survival needs and culminating in self-transcendent needs (see Figure 2-5 in the text). Although these needs are present in all human beings, the behaviors that emanate from them differ according to a person's individual biological makeup and environmental factors. This picture is broader and more holistic. Maslow does not address moral development, the potential for success, or interactions directed toward interpersonal relationships.

Which statement best clarifies the difference between the art and the science of nursing? A. The art is the care, compassion, and advocacy component, and the science is the applied knowledge base. B. The art is the way in which knowledge is applied, and the science is the technological aspects of caregiving. C. The art is the applied technology of practice, and the science is the problem-solving and teaching aspects of caregiving. D. The art is the assessing and planning phases of the nursing process, and the science lies in implementing and evaluating.

A. The art is the care, compassion, and advocacy component, and the science is the applied knowledge base. Rationale: This statement reflects the larger thinking of the profession.

One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand: A. The root causes of client suffering. B. The client's immature behavior. C. The client's interpersonal interactions. D. The client's psychological ability to reason.

A. The root causes of client suffering. Rationale: Freud's theory of the unconscious is particularly valuable as a baseline for considering the complexity of human behavior. By considering conscious and unconscious influences, a nurse can develop and begin to think about the root causes of client suffering.

Using the total environment, including the people, setting, and emotional climate, as therapy is called _____________ therapy.

Answer: Milieu Rationale: Milieu therapy uses the environment, including people, setting, emotional climate, and structure, for healing.

Using Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be: A. Assessing the client's success at fulfilling her appropriate developmental level tasks. B. Assessing the client for her strengths upon which a nurse-client relationship can be based. C. Planning one-on-one time with the client to assist in identifying the fears behind her anxiety. D. Evaluating the client's ability to learn and retain essential information regarding her condition.

B. Assessing the client for her strengths upon which a nurse-client relationship can be based. Rationale: The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship.

Freud believed that individuals cope with anxiety by using: A. The superego. B. Defense mechanisms. C. Security operations. D. Suppression.

B. Defense mechanisms. Rationale: The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings.

Role-playing is associated with which type of therapy? A. Psychoanalysis B. Modeling C. Operant conditioning D. Systematic desensitization

B. Modeling Rationale: In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role-playing in the consulting room for modeling therapy.

Sullivan's term security operations and Freud's term of defense mechanisms both reflect actions that serve to: A. Increase self-esteem. B. Reduce anxiety. C. Increase self-awareness. D. Reduce cognitive distortions.

B. Reduce anxiety. Rationale: Both Sullivan and Freud coined terms to mean actions that individuals do that are an attempt to reduce anxiety. The terms to do not refer to activities that increase self-esteem. Security operations and defense mechanisms are not conscious and therefore do not increase self-awareness. These terms do not refer to reducing cognitive distortions.

Lucas states, "I will always be alone because nobody could love me." This is most likely an example of: A. Emotional consequence. B. Schema. C. Actualization. D. Aversion.

B. Schema. Rationale: Schemas are unique assumptions about ourselves, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of negative thinking process, as described by Ellis. Actualization is a level of Maslow's Hierarchy of Needs. Aversion is a therapy characterized by punishment.

Which of the following is considered a primary behavioral theorist? A. Freud B. Skinner C. Sullivan D. Peplau

B. Skinner Rationale: B. F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.

When asked, the nurse explains that a client's id is: A. The control over the emotional frustration he feels over the loss of his job. B. The source of his instincts to save himself from hurting himself. C. Not in place since he was abused after the age of 5 months. D. Able to differentiate his believed experiences and reality.

B. The source of his instincts to save himself from hurting himself. Rationale: At birth we are all id. The id is the source of all drives, instincts, reflexes, needs, genetic inheritance, and capacity to respond as well as all the wishes that motivate us.

A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention with sarcasm. When asking for advice, the nurse manager's most helpful response is: A. "You are dealing with a very difficult and resistant client; just keep with your plan." B. "If you haven't been able to establish client trust by now, ask for a change of assignment." C. "Remember that sarcasm represents the oral-stage fixation of development." D. "You are attempting to work with a client who likes to keep others off-balance."

C. "Remember that sarcasm represents the oral-stage fixation of development." Rationale: According to Freud's psychosexual stages of development, this client is exhibiting the oral (0-1 year) personality traits: fixation at the oral stage is associated with passivity, gullibility, and dependence; the use of sarcasm; and the development of orally focused habits (e.g., smoking, nail biting).

According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind will have problems with: A. Only recent memory. B. Both recent and long-term memory. C. All material that the person is aware of at any one time. D. Only material that should be easily retrieved.

C. All material that the person is aware of at any one time. Rationale: Freud described the conscious part of the mind as the tip of the iceberg. It contains all of the material that the person is aware of at any one time.

Sullivan viewed anxiety as: A. Emotional experience felt after the age of 5 years. B. A sign of guilt in adults. C. Any painful feeling or emotion arising from social insecurity. D. Adults trying to go beyond experiences of guilt and pain.

C. Any painful feeling or emotion arising from social insecurity. Rationale: According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied.

An important difference between the developmental theories of Freud and Erikson is A. Freud considers the entire life span from birth to old age. B. Freud focuses to a greater extent on cognitive development. C. Erikson viewed individual growth in terms of social setting. D. Erikson focuses on the development of individual moral thinking.

C. Erikson viewed individual growth in terms of social setting. Rationale: Erikson placed greater emphasis on the role of the ego. He also stressed that an individual's development is influenced by more than the restricted mother-child-father triangle and that culture and society exert significant influence on personality. Sigmund Freud advanced the first theory of personality development and articulated levels of awareness (unconscious, preconscious, conscious) and demonstrated the influence of our unconscious behavior on everyday life, as evidenced by the use of defense mechanisms. Freud identified three psychological processes of personality (id, ego, superego) and described how they operate and develop and articulated one of the first modern developmental theories of personality, based on five psychosexual stages.

You are caring for Alyssa, a 28-year-old patient with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, which of the following symptoms needs to be the first priority in caring for this patient? A. Rapid, pressured speech B. Grandiose thoughts C. Lack of sleep D. Hyperactive behavior

C. Lack of sleep Rationale: Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priority and must be taken care of first. The other options are symptoms of mania but not as critical as lack of sleep.

As a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with: A. Security operations. B. Psychoanalysis. C. Analysis of behavior patterns. D. A psychotherapeutic environment.

D. A psychotherapeutic environment. Rationale: Sullivan demonstrated that a psychotherapeutic environment, revolving around an accepting atmosphere that provides numerous opportunities for practicing interpersonal skills and developing relationships, is an invaluable treatment tool. This method is used today in virtually all residential and day hospital settings.

Which client problem would be most suited to the use of interpersonal therapy? A. Disturbed sensory perception B. Impaired social interaction C. Medication noncompliance D. Dysfunctional grieving

D. Dysfunctional grieving Rationale: Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.

The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by: A. Giving the child what he is asking for. B. Scolding the child when he displays tantrum behaviors. C. Spanking the child at the onset of the tantrum behaviors. D. Ignoring the tantrum and giving attention when the child acts appropriately.

D. Ignoring the tantrum and giving attention when the child acts appropriately. Rationale: Ignoring the tantrum provides no reinforcement of the undesirable behavior. Instead, approval and reinforcement are given when the child is behaving in the desired way. This is an example of absence of reinforcement, or extinction.

You and Jack are two of the nurses working on the psychiatric unit. Jack mentions to you that the biological model for mental illness is the one he embraces, and states "it's the only one I really believe." Which of the following statements is true regarding believing in only the biological model? A. The biological model is the oldest and most reliable model for explaining mental illness. B. The biological model does not explain every symptom of mental illness. C. The biological model is the most popular theory among leading psychiatrists and therefore the one that should be fully embraced. D. In believing only the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

D. In believing only the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account. Rationale: In believing only in the biological model to the exclusion of other theories and perspectives, influences such as educational, social, spiritual, cultural, environmental, and economic are not considered, and these have also been proven to play a part in mental health and mental illness. The other options are untrue.

A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy? A. Psychodynamic B. Cognitive C. Behavioral D. Interpersonal.

D. Interpersonal. Rationale: Interpersonal psychotherapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.