Essentials of Psychiatric Mental Health Nursing ,2nd Edition by Elizabeth M. Varcarolis Test Bank
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Chapter 3: Theories and Therapies
MULTIPLE CHOICE
1. A
26-month-old child displays negative behaviors. The parent says, “My child
refuses toilet training and shouts, ‘No!’ when given direction. What do you
think is wrong?” Select
the nurse’s best reply.
|
a. |
“This is normal for your
child’s age. The child is striving for independence.” |
|
b. |
“The child needs firmer
control. Punish the child for disobedience and say, ‘No.’” |
|
c. |
“There may be developmental
problems. Most children are toilet trained by age 2 years.” |
|
d. |
“Some undesirable attitudes
are developing. A child psychologist can help you develop a remedial plan.” |
ANS: A
These negative behaviors are typical of a child around the age
of 2 years whose developmental task is to develop autonomy. The remaining
options indicate the child’s behavior is abnormal.
DIF: Cognitive Level:
Application
REF: Pages: 28-30
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
2. A
26-month-old child displays negative behavior, refuses toilet training, and
often shouts, “No!” when given directions. Using Freud’s stages of psychosexual
development, a nurse would assess the child’s behavior is based on which stage?
|
a. |
Oral |
|
b. |
Anal |
|
c. |
Phallic |
|
d. |
Genital |
ANS: B
In Freud’s stages of psychosexual development, 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 13 and 20 years.
DIF: Cognitive Level:
Comprehension REF: Pages: 28-30
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
3. A
26-month-old child displays negative behavior, refuses toilet training, and
often shouts, “No!” when given direction. The nurse’s counseling with the
parent should be based on the premise that the child is engaged in which of
Erikson’s psychosocial crises?
|
a. |
Trust versus Mistrust |
|
b. |
Initiative versus Guilt |
|
c. |
Industry versus Inferiority |
|
d. |
Autonomy versus Shame and Doubt |
ANS: D
The crisis of Autonomy versus Shame and Doubt is related 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, and Industry
versus Inferiority is the crisis of the 6- to 12-year-old child.
DIF: Cognitive Level:
Comprehension REF: Pages: 28-30
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
4. A
4-year-old child grabs toys from siblings, saying, “I want that toy now!” The
siblings cry, and the child’s parent becomes upset with the behavior. Using the
Freudian theory, a nurse can interpret the child’s behavior as a product of
impulses originating in the:
|
a. |
id. |
|
b. |
ego. |
|
c. |
superego. |
|
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
parent’s wrath. The superego would oppose the impulsive behavior as “not nice.”
The preconscious is a level of awareness.
DIF: Cognitive Level:
Application
REF: Pages: 28-30
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
5. The
parent of a 4-year-old rewards and praises the child for helping a younger
sibling, being polite, and using good manners. A nurse supports the use of
praise because according to the Freudian theory, these qualities will likely be
internalized and become part of the child’s:
|
a. |
id. |
|
b. |
ego. |
|
c. |
superego. |
|
d. |
preconscious. |
ANS: C
In the Freudian theory, 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 easily retrieved with conscious effort.
DIF: Cognitive Level:
Comprehension REF: Pages: 26-30
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
6. A
nurse supports parental praise of a child who is behaving in a helpful way.
When the individual behaves with politeness and helpfulness in adulthood, which
feeling will most likely result?
|
a. |
Guilt |
|
b. |
Anxiety |
|
c. |
Loneliness |
|
d. |
Self-esteem |
ANS: D
The individual will be living up to the ego ideal, which will result
in positive feelings about self. The other options are incorrect; each
represents a negative feeling.
DIF: Cognitive Level:
Comprehension REF: Pages: 26-30
TOP: Nursing Process: Implementation
MSC: NCLEX: Health Promotion and Maintenance
7. A
patient comments, “I never know the right answer” and “My opinion is not
important.” Using Erikson’s theory, which psychosocial crisis did the patient
have difficulty resolving?
|
a. |
Initiative versus Guilt |
|
b. |
Trust versus Mistrust |
|
c. |
Autonomy versus Shame and
Doubt |
|
d. |
Generativity versus
Self-Absorption |
ANS: C
These statements show severe self-doubt, indicating that the
crisis of gaining control over the environment is not being successfully met.
Unsuccessful resolution of the crisis of Initiative versus Guilt results in
feelings of guilt. Unsuccessful resolution of the crisis of Trust versus
Mistrust results in poor interpersonal relationships and suspicion of others.
Unsuccessful resolution of the crisis of Generativity versus Self-Absorption
results in self-absorption that limits the ability to grow as a person.
DIF: Cognitive Level:
Application
REF: Pages: 28-30
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
8. Which
patient statement would lead a nurse to suspect that the developmental task of
infancy was not successfully
completed?
|
a. |
“I have very warm and close
friendships.” |
|
b. |
“I’m afraid to let anyone
really get to know me.” |
|
c. |
“I am always right, so
don’t bother saying more.” |
|
d. |
“I’m ashamed that I didn’t
do it correctly in the first place.” |
ANS: B
According to Erikson, the developmental task of infancy is the
development of trust. The patient’s statement that he or she is afraid of
becoming acquainted with others clearly shows a lack of ability to trust other
people. Having warm and close friendships suggests the developmental task of
infancy was successfully completed. The third option suggests rigidity rather
than mistrust. The fourth option suggests failure to resolve the crisis of
Initiative versus Guilt.
DIF: Cognitive Level:
Analysis
REF: Pages: 28-30|Page: 35
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
9. A
nurse assesses that a patient is suspicious and frequently manipulates others.
Using the Freudian theory, these traits are related to which psychosexual
stage?
|
a. |
Oral |
|
b. |
Anal |
|
c. |
Phallic |
|
d. |
Genital |
ANS: A
According to Freud, each of the behaviors mentioned develops 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, and a strong sense of personal identity.
DIF: Cognitive Level:
Application
REF: Pages: 27-30
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
10. An
adult expresses the wish to be taken care of and often behaves in a helpless
fashion. This adult has needs related to which of Freud’s stages of
psychosexual development?
|
a. |
Latency |
|
b. |
Phallic |
|
c. |
Anal |
|
d. |
Oral |
ANS: D
According to Freud, fixation at the oral stage sometimes
produces dependent infantile behaviors in adults. Latency fixations often
result in a 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.
DIF: Cognitive Level:
Application
REF: Pages: 27-30
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
11. 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. I don’t have time to
help others.” These comments contrast which developmental tasks?
|
a. |
Trust versus Mistrust |
|
b. |
Industry versus Inferiority |
|
c. |
Intimacy versus Isolation |
|
d. |
Generativity versus
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. The developmental crisis of
Trust versus Mistrust would show a contrast between relating to others in a
trusting fashion and being suspicious and lacking trust. Failure to negotiate
the developmental crisis of Industry versus Inferiority 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 in the crisis of Intimacy
versus Isolation would be emotional isolation and the ability to love and
commit to oneself.
DIF: Cognitive Level:
Application
REF: Pages: 28-30
TOP: Nursing Process:
Assessment MSC:
NCLEX: Health Promotion and Maintenance
12. Cognitive
therapy was provided for a patient who frequently said, “I’m stupid.” Which
statement by the patient indicates the therapy was effective?
|
a. |
“I’m disappointed in my
lack of ability.” |
|
b. |
“I always fail when I try
new things.” |
|
c. |
“Things always go wrong for
me.” |
|
d. |
“Sometimes I do stupid
things.” |
ANS: D
“I’m stupid” is an irrational thought. A more rational thought
is, “Sometimes I do stupid things.” The latter thinking promotes emotional
self-control. The incorrect options reflect irrational thinking.
DIF: Cognitive Level:
Application
REF: Page: 32
TOP: Nursing Process: Evaluation
MSC: NCLEX: Psychosocial Integrity
13. A
student nurse tells the instructor, “I don’t need to interact with my patients.
I learn what I need to know by observation.” The instructor can best interpret
the nursing implications of Sullivan’s theory to the student by responding:
|
a. |
“nurses cannot be isolated.
We must interact to provide patients with opportunities to practice
interpersonal skills.” |
|
b. |
“observing patient
interactions can help you formulate priority nursing diagnoses and
appropriate interventions.” |
|
c. |
“I wonder how accurate your
assessment of the patient’s needs can be if you do not interact with the
patient.” |
|
d. |
“noting patient behavioral
changes is important because these signify changes in personality.” |
ANS: A
Sullivan believed that the nurse’s role includes educating
patients and assisting them in developing effective interpersonal
relationships. Mutuality, respect for the patient, unconditional acceptance,
and empathy are cornerstones of Sullivan’s theory. The nurse who does not
interact with the patient cannot demonstrate these cornerstones. Observations
provide only objective data. Priority nursing diagnoses usually cannot be
accurately established without subjective data from the patient. The third
response pertains to Maslow’s theory. The fourth response pertains to
behavioral theory.
DIF: Cognitive Level:
Application
REF: Page: 26|Pages: 37-38
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
14. A
psychiatric technician says, “Little of what takes place on the behavioral
health unit seems to be theory based.” A nurse educates the technician by
identifying which common use of Sullivan’s theory?
|
a. |
Structure of the
therapeutic milieu of most behavioral health units |
|
b. |
Frequent use of restraint
and seclusion as behavior management tools |
|
c. |
Assessment tools based on
age-appropriate versus arrested behaviors |
|
d. |
Method nurses use to
determine the best sequence for nursing actions |
ANS: A
The structure of the therapeutic environment has, as its foci,
an accepting atmosphere and provision of opportunities for practicing
interpersonal skills. Both constructs are directly attributable to Sullivan’s
theory of interpersonal relationships. Sullivan’s interpersonal theory did not
specifically consider the use of restraint or seclusion. Assessment based on
the developmental level is more the result of Erikson’s theories. Sequencing
nursing actions based on the priority of patient needs is related to Maslow’s
hierarchy of needs.
DIF: Cognitive Level:
Application
REF: Page: 26|Pages: 37-38
TOP: Nursing Process: Implementation
MSC: NCLEX: Safe, Effective Care Environment
15. A
nurse uses Maslow’s hierarchy of needs to plan care for a psychotic patient.
Which problem will receive priority? The patient:
|
a. |
refuses to eat or bathe. |
|
b. |
reports feelings of
alienation from family. |
|
c. |
is reluctant to participate
in unit social activities. |
|
d. |
needs to be taught about
medication action and side effects. |
ANS: A
The need for food and hygiene is physiological and therefore
takes priority over psychological or meta-needs in care planning.
DIF: Cognitive Level:
Analysis
REF: Pages: 31-32 TOP: Nursing Process: Planning
MSC: NCLEX: Safe, Effective Care Environment
16. Operant
conditioning will be used to encourage speech in a child who is nearly mute.
Which technique would a nurse include in the treatment plan?
|
a. |
Ignore the child for using
silence. |
|
b. |
Have the child observe
others talking. |
|
c. |
Give the child a small
treat for speaking. |
|
d. |
Teach the child relaxation
techniques, then coax speech. |
ANS: C
Operant conditioning involves giving positive reinforcement for
a desired behavior. Treats are rewards to reinforce speech. Ignoring the child
will not change the behavior. Having the child observe others describes
modeling. Teaching relaxation techniques and then coaxing speech is an example
of systematic desensitization.
DIF: Cognitive Level: Application
REF: Page: 31
TOP: Nursing Process: Planning
MSC: NCLEX: Psychosocial Integrity
17. The
parent of a child who has schizophrenia tearfully asks a nurse, “What could I
have done differently to prevent this illness?” Select the nurse’s most caring
response.
|
a. |
“Although schizophrenia is
caused by impaired family relationships, try not to feel guilty. No one can
predict how a child will respond to parental guidance.” |
|
b. |
“Most of the damage is
done, but there is still hope. Changing your parenting style can help your
child learn to cope more effectively with the environment.” |
|
c. |
“Schizophrenia is a
biological illness with similarities to diabetes and heart disease. You are
not to blame for your child’s illness.” |
|
d. |
“Most mental illnesses
result from genetic inheritance. Your genes are more at fault than your
parenting.” |
ANS: C
Patients and families need reassurance that the major mental
disorders are biological in origin and are not the “fault” of parents. Knowing
the biological nature of the disorder relieves feelings of guilt over being
responsible for the illness. The incorrect responses are neither wholly
accurate nor reassuring; they fall short of being reassuring and place the
burden of having faulty genes on the shoulders of the parents.
DIF: Cognitive Level:
Application
REF: Page: 26|Page: 36
TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
18. A
nurse uses Peplau’s interpersonal therapy while working with an anxious,
withdrawn patient. Interventions should focus on:
|
a. |
changing the patient’s
perceptions about self |
|
b. |
improving the patient’s
interactional skills |
|
c. |
using medications to
relieve anxiety |
|
d. |
reinforcing specific
behaviors |
ANS: B
The nurse-patient relationship is structured to provide a model
for adaptive interpersonal relationships that can be generalized to others.
Changing the patient’s perceptions about his- or herself would be appropriate
for cognitive therapy. Reinforcing specific behaviors would be used in
behavioral therapy. Using medications would be the focus of biological therapy.
DIF: Cognitive Level:
Application
REF: Page: 33|Pages: 37-38
TOP: Nursing Process:
Planning
MSC: NCLEX: Psychosocial Integrity
19. A
patient underwent psychotherapy weekly for 3 years. The therapist used free
association, dream analysis, and facilitated transference to help the patient
understand unconscious processes and foster personality changes. Which type of
therapy was used?
|
a. |
Short-term dynamic
psychotherapy |
|
b. |
Transactional analysis |
|
c. |
Cognitive therapy |
|
d. |
Psychoanalysis |
ANS: D
The therapy described is traditional psychoanalysis. Short-term
dynamic psychotherapy would last less than 1 year. Neither transactional
analysis nor cognitive therapy makes use of the techniques described.
DIF: Cognitive Level:
Comprehension REF: Pages: 26-27
TOP: Nursing Process:
Assessment MSC:
NCLEX: Psychosocial Integrity
20. An
advanced practice nurse determines a group of patients would benefit from
therapy in which peers and interdisciplinary staff all have a voice in
determining the level of the patients’ privileges. The nurse would arrange for:
|
a. |
milieu therapy |
|
b. |
cognitive therapy |
|
c. |
short-term dynamic 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
other therapies are all individual therapies that do not fit the description.
DIF: Cognitive Level:
Comprehension REF: Page:
42 TOP: Nursing
Process: Planning
MSC: NCLEX: Psychosocial Integrity
21. A
nurse psychotherapist works with an anxious, dependent patient. The therapeutic
strategy most consistent with the framework of psychoanalytic psychotherapy is:
|
a. |
emphasizing medication
compliance |
|
b. |
identifying the patient’s
strengths and assets |
|
c. |
offering psychoeducational
materials and groups |
|
d. |
focusing on feelings
developed by the patient toward the nurse |
ANS: D
Positive or negative feelings of the patient toward the nurse or
therapist represent transference. Transference is a psychoanalytic concept that
can be used to explore previously unresolved conflicts. Emphasizing medication
compliance is more related to biological therapy. Identifying patient strengths
and assets would be consistent with supportive psychotherapy. The use of
psychoeducational materials is a common “homework” assignment used in cognitive
therapy.
DIF: Cognitive Level:
Application
REF: Page: 21
TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity
22. A
person tells a nurse, “I was the only survivor in a small plane crash, but
three business associates died. I got anxious and depressed and saw a counselor
three times a week for a month. We talked about my feelings related to being a
survivor, and now I’m fine, back to my old self.” Which type of therapy was
used?
|
a. |
Milieu therapy |
|
b. |
Psychoanalysis |
|
c. |
Behavior modification |
|
d. |
Interpersonal therapy |
ANS: D
Interpersonal therapy returns the patient to the former level of
functioning by helping the patient come to terms with the loss of friends and
guilt over being a survivor. Milieu therapy refers to environmental therapy.
Psychoanalysis calls for a long period of exploration of unconscious material.
Behavior modification focuses on changing a behavior rather than helping the
patient understand what is going on in his or her life.
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