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Ch02 Test bank for Varcarolis' Foudations of Psychiatric-Mental Health Nursing
Mental Health Concepts (h372)
Indiana University
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Chapter 02: Relevant Theories and Therapies for Nursing Practice
MULTIPLE CHOICE
- A parent says, “My 2-year-old child refuses toilet training and shouts ‘No!’ when given directions. What do you think is wrong?” Select the nurse’s best reply. a. “Your child needs firmer control. It is important to set limits now.” b. “This is normal for your child’s age. The child is striving for independence.” c. “There may be developmental problems. Most children are toilet trained by age 2.” d. “Some undesirable attitudes are developing. A child psychologist can help you develop a plan.”
ANS: B This behavior is typical of a child around the age of 2 years, whose developmental task is to develop autonomy. The distracters indicate the child’s behavior is abnormal.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 22-23 (Table 2-2) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
- A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!” Which stage of psychosexual development is evident? a. Oral c. Phallic b. Anal d. Genital
ANS: B The anal stage occurs from age 1 to 3 years and has as its focus toilet training and learning to delay immediate gratification. The oral stage occurs between birth and 1 year. The phallic stage occurs between 3 and 5 years, and the genital stage occurs between age 13 and 20 years.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 21-22 (Table 2-1) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
- A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!” Which psychosocial crisis is evident? a. Trust versus mistrust
c. Industry versus inferiority b. Initiative versus guilt
d. Autonomy versus shame and doubt
ANS: D The crisis of autonomy versus shame and doubt relates to the developmental task of
gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early- school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 22-23 (Table 2-2) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
- A 4-year-old grabs toys from siblings and says, “I want that now!” The siblings cry, and the child’s parent becomes upset with the behavior. According to Freudian theory, this behavior is a product of impulses originating in which system of the personality? a. Id c. Superego b. Ego d. Preconscious
ANS: A The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother’s wrath. The superego would oppose the impulsive behavior as “not nice.” The preconscious is a level of awareness. This item relates to an audience response question.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 20-21 TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
- The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. The nurse supports this use of praise related to these behaviors. These qualities are likely to be internalized and become part of which system of the personality? a. Id c. Superego b. Ego d. Preconscious
ANS: C The superego contains the “thou shalts,” or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem- solving and reality-testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort. This item relates to an audience response question.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 20-21 TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance
- A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness and helpfulness in adulthood, which feeling will
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 22-23 (Table 2-2) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
- A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate? a. Oral c. Phallic b. Anal d. Genital
ANS: A The behaviors in the stem develop as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the opposites of these traits.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 21-22 (Table 2-1) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
- A patient expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of psychosexual development is most relevant to the patient’s needs? a. Latency c. Anal b. Phallic d. Oral
ANS: D Fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an audience response question.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 21-22 (Table 2-1) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
- A nurse listens to a group of recent retirees. One says, “I volunteer with Meals on Wheels, coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy taking care of myself to volunteer to help others.” Which developmental task do these statements contrast? a. Trust and mistrust c. Industry and inferiority b. Intimacy and isolation
d. Generativity and self-absorption
ANS: D Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption. One exemplifies generativity; the other embodies self-absorption. This developmental crisis would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviors that would be contrasted would be emotional isolation and the ability to love and commit oneself.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 22-23 (Table 2-2) TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
- Although ego defense mechanisms and security operations are mainly unconscious and designed to relieve anxiety, the major difference is that: a. defense mechanisms are intrapsychic and not observable. b. defense mechanisms cause arrested personal development. c. security operations are masterminded by the id and superego. d. security operations address interpersonal relationship activities.
ANS: D Sullivan’s theory explains that security operations are interpersonal relationship activities designed to relieve anxiety. Because they are interpersonal, they are observable. Defense mechanisms are unconscious and automatic. Repression is entirely intrapsychic, but other mechanisms result in observable behaviors. Frequent, continued use of many defense mechanisms often results in reality distortion and interference with healthy adjustment and emotional development. Occasional use of defense mechanisms is normal and does not markedly interfere with development. Security operations are ego-centered. This item relates to an audience response question.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 33-34 (Table 2-6) TOP: Nursing Process: Analysis MSC: Client Needs: Health Promotion and Maintenance
- A student nurse says, “I don’t need to interact with my patients. I learn what I need to know by observation.” An instructor can best interpret the nursing implications of Sullivan’s theory to this student by responding: a. “Interactions are required in order to help you develop therapeutic communication skills.”
ANS: A The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 31-32 (Figure 2-5) TOP: Nursing Process: Planning/Outcomes Identification MSC: Client Needs: Safe, Effective Care Environment
- Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? a. Encourage the child to observe others talking. b. Include the child in small group activities. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques.
ANS: C Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and reinforce speech through positive reinforcement.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 27 (Fig 2-3) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
- The parent of a child diagnosed with schizophrenia tearfully asks the nurse, “What could I have done differently to prevent this illness?” Select the nurse’s best response. a. “Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance.” b. “Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child’s illness.” c. “There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment.” d. “Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.”
ANS: B The parent’s comment suggests feelings of guilt or inadequacy. The nurse’s response should address these feelings as well as provide information. Patients and families need reassurance that the major mental disorders are biological in origin and are not the “fault” of parents. One distracter places the burden of having faulty genes on the shoulders of the
parents. The other distracters are neither wholly accurate nor reassuring.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 33 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
- A nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on: a. rewarding desired behaviors. b. use of assertive communication. c. changing the patient’s self-concept. d. administering medications to relieve anxiety.
ANS: B The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. Helping the patient learn to use assertive communication will improve the patient’s interpersonal relationships. The distracters apply to theories of cognitive, behavioral, and biological therapy.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 21-22 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
- A patient had psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method. a. Rational-emotive behavior therapy
c. Cognitive- behavioral therapy b. Psychodynamic psychotherapy
d. Operant conditioning
ANS: B The techniques are aspects of psychodynamic psychotherapy. The distracters use other techniques.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 20-21 | Page 34 (Table 2-6) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
- Consider this comment from a therapist: “The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation.” Which perspective is evident in the speaker? a. Theory of interpersonal relationships
c. Psychosexual theory
exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the patient understand what is going on in his life.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 24-25 | Page 34 (Table 2-6) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
- Which technique is most applicable to aversion therapy? a. Punishment c. Role modeling b. Desensitization d. Positive reinforcement
ANS: A Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a noxious stimulus, punishment, and avoidance training.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 28 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
- A patient says to the nurse, “My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child.” Which term applies to the patient’s comment? a. Superego c. Reality testing b. Transference d. Counter- transference
ANS: B Transference refers to feelings a patient has toward the health care workers that were originally held toward significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker has toward the patient. The superego represents the moral component of personality; it seeks perfection.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 21-22 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
- A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this patient? a. Psychoanalysis c. Systematic desensitization b. Milieu therapy d. Short-term dynamic therapy
ANS: C Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Milieu therapy involves environmental factors.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 27-28 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
- A patient would benefit from therapy in which peers as well as staff have a voice in determining patients’ privileges and psychoeducational topics. Which approach would be best? a. Milieu therapy c. Short-term dynamic therapy b. Cognitive therapy d. Systematic desensitization
ANS: A Milieu therapy is based on the idea that all members of the environment contribute to the planning and functioning of the setting. The distracters are individual therapies that do not fit the description.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 33 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
- A patient repeatedly stated, “I’m stupid.” Which statement by that patient would show progress resulting from cognitive behavioral therapy? a. “Sometimes I do stupid things.” b. “Things always go wrong for me.” c. “I always fail when I try new things.” d. “I’m disappointed in my lack of ability.”
ANS: A “I’m stupid” is a cognitive distortion. A more rational thought is “Sometimes I do stupid things.” The latter thinking promotes emotional self-control. The distracters reflect irrational or distorted thinking. This item relates to an audience response question.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 29-31 (Table 2-5) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
- A patient says, “All my life I’ve been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent.” This patient is experiencing a: a. self-esteem deficit. c. deficit in motivation. b. cognitive distortion. d. deficit in love and belonging.
ANS: B Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. See related audience response question.
d. “My favorite leisure is walking on the beach, hearing soft sounds of rolling waves.”
ANS: D The self-actualized personality is associated with high productivity and enjoyment of life. Self-actualized persons experience pleasure in being alone and an ability to reflect on events.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 31-32 (Box 2-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
- A nurse and patient discuss a problem the patient has kept secret for many years. Afterward the patient says, “I feel so relieved that I finally told somebody.” Which term best describes the patient’s feeling? a. Catharsis c. Cognitive distortion b. Superego d. Counter- transference
ANS: A Freud initially used talk therapy, known as the cathartic method. Today we refer to catharsis as “getting things off our chests.” The superego represents the moral component of personality.
PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 20 TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity
- Which patient is the best candidate for brief psychodynamic therapy? a. An accountant with a loving family and successful career who was involved in a short extramarital affair b. An adult with a long history of major depression who was charged with driving under the influence (DUI) c. A woman with a history of borderline personality disorder who recently cut both wrists d. An adult male recently diagnosed with anorexia nervosa
ANS: A The best candidates for psychodynamic therapy are relatively healthy and well- functioning individuals, sometimes referred to as the “worried well,” who have a clearly circumscribed area of difficulty and are intelligent, psychologically minded, and well- motivated for change. Patients with psychosis, severe depression, borderline personality disorders, and severe character disorders are not appropriate candidates for this type of
treatment.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 21-22 TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity
MULTIPLE RESPONSE
- A patient states, “I’m starting cognitive-behavioral therapy. What can I expect from the sessions?” Which responses by the nurse would be appropriate? Select all that apply. a. “The therapist will be active and questioning.” b. “You will be given some homework assignments.” c. “The therapist will ask you to describe your dreams.” d. “The therapist will help you look at your ideas and beliefs about yourself.” e. “The goal is to increase subjectivity about thoughts that govern your behavior.”
ANS: A, B, D Cognitive therapists are active rather than passive during therapy sessions because they help patients reality-test their thinking. Homework assignments are given and completed outside the therapy sessions. Homework is usually discussed at the next therapy session. The goal of cognitive therapy is to assist the patient in identifying inaccurate cognitions and in reality- testing and formulating new, accurate cognitions. One distracter applies to psychoanalysis. Increasing subjectivity is not desirable.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 29-31 | Page 34 (Table 2-6) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
- Which comments by an elderly person best indicate successful completion of the developmental task? Select all that apply. a. “I am proud of my children’s successes in life.” b. “I should have given to community charities more often.” c. “My relationship with my father made life more difficult for me.” d. “My experiences in the war helped me appreciate the meaning of life.”
Peplau described the science and art of professional nursing practice. The art component of nursing consists of the care, compassion, and advocacy nurses provide to enhance patient comfort and well-being. The science component of nursing involves the application of knowledge to understand a broad range of human problems and psychosocial phenomena, intervening to relieve patients’ suffering and promote growth. See related audience response question.
PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 24-25 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
Ch02 Test bank for Varcarolis' Foudations of Psychiatric-Mental Health Nursing
Course: Mental Health Concepts (h372)
University: Indiana University
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