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PrepU Chapter 3

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The client has a longstanding history of depression. A psychoanalytic theorist might say what about the client?
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The client may be unconsciously repressing feelings of anger that arise due to early childhood abuse experiences, and these feelings emerge as depression.
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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?
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Trust and belonging
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A client expresses a parataxic perception when she …
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refuses to attend group sessions led by male clinicians stating, “Men think they’re smarter than me.”
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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?
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All groups
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Among other problems, a client states the client is lonely and doesn’t know how to interact with others. The nurse suggests that the client join an ongoing therapy group the nurse conducts. The client agrees reluctantly and, over the next several weeks, the group and therapist focus on the new client’s issues. At this time, the nurse notes that the group is becoming less functional. Which statement best explains why?
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The nurse is not skilled in group techniques.
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The nurse is working with a family that has indicated a desire to learn better communication skills. The nurse role-plays assertive communication techniques with each family member. The role-play is an example of which type of family intervention?
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Behavioral
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According to Maslow, mentally healthy people who achieve self-actualization are able to do what?
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Use varied approaches to solve problems
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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?
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Suppression
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Which phase of individual psychotherapy involves establishing mutual boundaries of the relationship between the client and the mental health nurse?
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Introductory
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Which concept states that if a certain behavior is rewarded with praise, the behavior will probably be repeated?
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Operant conditioning
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Which part of Freud’s personality structure is associated with ethics, standards, and self-criticism?
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Superego
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In viewing the stages of the family life cycle, those families in later life undergo which emotional transition?
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Accepting the shifting of generational roles
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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?
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Ego
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When describing the influence of Harry Stack Sullivan on psychiatric-mental health nursing, which would an instructor address as a major concept?
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Interpersonal relations
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Ivan P. Pavlov is associated with the term …
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Classical conditioning
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A basic function of psychiatric nurses is to implement a group that focuses on helping individuals coping with their illness. This refers to …
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a supportive therapy group
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Which theorist developed the psychoanalytic theory?
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Sigmund Freud
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Which theorist’s contribution led nurses to recognize that personality development begins at birth?
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Erik Erikson
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A nurse working in a psychiatric facility identifies the goal of cognitive therapy (CT) to be what?
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Restructure how a person perceives events
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The nurse is caring for a 4-year-old child during a well-child visit. According to the Sullivan’s stages of development, which behavior would the nurse expect to find in this child?
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The child performs actions to earn praise from parents.
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Which are two of the most important reasons that nurses utilize theories in their approach to helping clients with psychiatric disorders?
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Theories provide knowledge expansion in the field, and they are a way of incorporating known findings into a framework for understanding clients.
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Which statement would indicate that the group is in the working phase of development?
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“I don’t understand why Mary doesn’t see my point of view, and frankly it really irritates me when she does that!”
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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?
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Group building and maintenance
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The working stage of group therapy is marked by which characteristic?
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Conflict and cooperation among group members.
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A nurse demonstrates a sound understanding of the use of ego defense mechanisms by providing which explanation?
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Can be either a therapeutic or a pathological way to manage stress
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Which is the key common element in the various psychotherapeutic approaches?
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An effective client-therapist relationship
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A client is engaging in conscious resistance to the psychiatric unit’s rules when the client does what?
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Stating that, “I don’t make my bed at home and I’m not making it here.”
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Which statement is inconsistent with the concept of milieu therapy, originally developed by Henry Stack Sullivan?
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Clients work independently to solve day-to-day problems.
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A nurse therapist feels sad after sessions with a client. The client’s passiveness reminds the nurse of a family member who led a very unhappy life. What is the term for this emotional dynamic?
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Countertransference
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While a nurse is performing an admission assessment for a client in an inpatient mental health setting, the client states, “All of my problems are caused by my parents.” The client statement reflects which factor that influences mental health?
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Emotional development
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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?
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Improved family quality of life
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A client has recently joined a group and presented a scenario in which the client ran out of funds to pay the rent this month. The therapist states, “Has anyone else in the group had this experience? Can you share any ideas about how you resolved this situation when it happened to you?” The therapist’s intervention utilizes which theory to intervene?
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Problem-solving group
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Individual psychotherapy consists of three phases. Which statement by the group therapist would reflect that the group is in the working phase of therapy?
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“James, when Shane speaks, it seems you become angry and tend to withdraw.”
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During which phase of group development does the group realize its purpose?
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Working
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The nurse is beginning a group counseling session with an open group system. The nurse should explain to the group members that one advantage of an open group system is that …
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new members can join the group at any time.
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Who developed cognitive therapy for persons with depression?
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Aaron Beck
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Cognitive techniques focus on the client’s patterns of which type of thinking?
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Automatic
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In which stage do members of the group test each other to see whether they can trust one another and the leader?
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Beginning
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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 goes into the staff coffee room and slams several cupboard doors. A custodian enters and remarks, “You seem pretty upset.” Nurse A replies, “I am not at all upset.” In this instance, Nurse A is probably using:
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denial
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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?
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The client demonstrates new interpersonal skills to promote the development of intimate relationships
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Interpersonal theorists, such as Harry Stack Sullivan, emphasize which tenet?
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Interpersonal socialization of humans throughout their developmental stages
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Of the following, which is not typically applied to individual therapy?
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Promoting cohesion
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Which group characteristic is lacking in the following statement: “Our group never talks about really emotional issues. I mean, no one ever cries.”
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Group cohesiveness
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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?
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Behavioral theory
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Based on the theory of transference, if a client’s childhood experiences teach the client to mistrust authority figures, the client will do what as an adult?
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Resist advice given by the mental health care professionals
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Which should be considered the fundamental principle of family therapy?
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A family is a system of interrelated dependent relationships.
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Which indicates that the nurse, acting as a leader for a group of recovering clients with alcohol abuse, is addressing the responsibility of maintaining the group’s process?
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Keeping the group on task by restating goals
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The psychiatrist states that repressed memories in the client’s unconscious are causing depression. This reasoning implies that the psychiatrist uses which theory?
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Psychoanalytic theory
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Learned maladaptive behavior is a concept central to which theory of human behavior?
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Behavioral theory
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A client has completed treatment for an addiction to prescription pain medications. As part of the client’s therapy, the family participates in a family therapy program. Which reason would best explain the need for a family system approach to therapy?
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The dynamics of the entire family have and will continue to shift to accommodate a change.
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The nurse therapist is setting goals for a family in therapy. One goal is for the family to adopt a healthy family structure. Which would be an appropriate outcome criterion for this goal?
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Conflicts are resolved in a rational manner
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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?
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Transference
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The nurse observes an elderly client teaching an adolescent how to crochet a pot holder. The nurse evaluates this behavior as evidence of resolution of Erickson’s developmental stage of what?
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Generativity vs. stagnation
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An 81-year-old resident of a long-term care facility has confided in the nurse that the client is profoundly fearful of death. Within Erikson’s psychosocial theory, this statement may suggest a failure to resolve which developmental conflict?
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Ego integrity vs. despair
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Cognitive interventions are based on the concept of cognition. Who developed cognitive behavioral therapy?
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Aaron Beck
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Calling the client by name and spending time with the client are examples of what?
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Positive regard
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The nurse is providing hygiene care for a 70-year-old client in a nursing home who states that the client does not like the physician. Later, when the physician enters the room, the nurse notes that the client is very friendly with the physician, complimenting the physician’s care. Which defense mechanism is this client displaying?
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Reaction-formation
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Aaron T. Beck is associated with …
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Cognitive therapy
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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?
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Survival
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Which client would the nurse assess as having the priority need for attendance at a life and social skills group?
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A 38-year-old homeless man with a history of chronic paranoid schizophrenia
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The nurse is planning care for a family with a child having peer difficulties due to the child’s conduct. The nurse applies principles of family therapies by …
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addressing the child and family as a single inseparable unit.
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Many families take years to understand that a member is mentally ill and identify the warning signs of relapse. During this period, they try to normalize puzzling behaviors. This is called …
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denial
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A nurse shows an understanding of the impact of nursing theory on nursing practice when making which statement?
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“Theory provides the focus for my nursing care of depressed clients.”
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A psychiatric nurse who was sexually assaulted by a tall, blonde man finds herself becoming severely anxious whenever a man with those characteristics is admitted to the unit. Which symptom is the nurse is exhibiting?
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Countertransference
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Which stage of cognitive development is being achieved when a child demonstrates the ability to think and reason in abstract terms?
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Formal operations
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Individual roles in group dynamics have what effect on group functioning?
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Disrupt group functioning
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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?
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Working
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The nurse is planning a social skills training group for clients with schizophrenia. Which techniques should be used to help the clients gain social skills?
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Provide rewards for small approximations of the desired behaviors.
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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?
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Teacher
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Which developmental conflict correlates with the toddler, according to Erikson’s eight stages of man?
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Autonomy vs. shame and doubt
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Which cognitive theorist conceptualized distorted cognitions as a basis for depression?
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Aaron Beck
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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?
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When the client’s anxiety decreases to a mild level
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For Freud, the therapist’s emotional reactions to the client based on personal unconscious needs and conflicts is termed …
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Countertransference
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Nursing students are learning about the stages of Freud’s psychosexual model. Place the stages in the correct sequence, from first to last.
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Oral stage Anal stage Phallic stage Latency stage Genital stage
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To facilitate the understanding of a crisis, which intervention should the nurse employ?
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Listen and assist the client to articulate his or her feelings
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Why are the developmental theories important to nursing practice?
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They outline the process of human growth and development.
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Which nursing theory focuses on the nurse-client relationship and development of problem-solving skills?
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Interpersonal theory
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A nurse working on a psychiatric unit is helping clients to understand how individual perceptions determine a person’s response or behavior in stressful situations. Which therapeutic approach is the nurse employing?
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Cognitive therapy
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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?
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Reflecting on the nurse’s own thinking to identify times where the nurse may project individual feelings on to the client
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How would Ellis describe a rational belief?
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An evaluative cognition that is expressed as a wish, like, or dislike that may or may not be attained.
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According to psychoanalytic theory, matters of right and wrong are controlled by the conscious. What term does Freud use to identify the conscious?
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Superego
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A 55-year-old client is being treated for narcissistic personality disorder. The therapist shows caring and appropriate regard for the client. The therapist’s behavior is an example of which concept of behavior theory?
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Modeling
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Which group member attempts to stimulate the group to action or decision?
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Energizer
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While working with an older male client, a nurse begins to think of the client as a grandfather and responds to the client as a grandchild. The nurse is developing what type of emotional reaction?
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Countertransference
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The most superficial and accessible levels of cognition and generally the first to be targeted in treatment are …
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Automatic thoughts
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The “ABCD” approach, used in rational-emotive therapy, includes the following four components:
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Activating stimulus; identify how to fill the ‘blank’ about an automatic thought; disproportionate response; disputation of maladaptive beliefs.
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Which is not an area of focus within psychiatric rehabilitation?
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Reduction in acute symptoms of psychosis
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When the psychiatric nurse is aware of the cultural beliefs of a client diagnosed with bipolar disorder, the therapeutic process is most enhanced by what?
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Facilitating the nurse’s understanding of how these beliefs affect the client’s perception of the disorder
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When assuming the responsibility for leading a couples therapy group, the nurse-therapist helps clients deal appropriately with their emotions, behaviors, and beliefs as well as which goal?
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Being aware of how they affect the relationship with their partner
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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?
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Change distorted thinking and the subsequent behaviors
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Health promotion and health maintenance interventions related to psychiatric-mental health nursing include what?
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Teaching stress-reduction techniques
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Which theorist viewed interpersonal relations as a basis of human development and behavior?
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Harry Stack Sullivan
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Within a group, facilitating verbal and nonverbal communication to meet treatment goals individually and with the entire group refers to the …
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group leader.
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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?
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“We’re spending quite a bit of time exploring the themes in my dreams.”
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Some behavioral therapists believe that seclusion and restraint are forms of punishment. It may be assumed that these therapists view seclusion and restraint as:
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an unpleasant stimulus that happens after a certain unwanted behavior.
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A 22-year-old client states, “I just don’t know who I am.” Which stage of development, according to Erikson, would the client have had difficulty completing?
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Identity vs. identity diffusion
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For a client who has anxiety, the individual psychotherapy process moves into the working phase when which occurs?
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The client expresses a willingness to discuss what the client thinks is the cause of the anxiety
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Which culture is more comfortable at distances greater than 2 or 3 feet?
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Asian
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Which action reflects group development in the initial stage?
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Seeking similarities
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A nurse is meeting with a therapy group for the first time. The nurse notes that members are silent and fidgety. Which statement by the nurse would be best in this situation?
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“I notice there is a lot of silence and some discomfort. This is pretty common in new groups and is perfectly OK. Who would like to share how they feel right now?”
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Which explains why theories are important to psychiatric-mental health nursing?
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Theories lead to the expansion of knowledge.
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The concept that irrational beliefs lead to negative emotions underlies which psychotherapeutic approach?
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Rational emotive behavior therapy
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A new program has been launched with the goal of fostering the development of life skills for community-dwelling clients with mental illness, aiming to teach them how to shop, cook, and manage money more effectively. This program demonstrates what approach to practice?
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Needs-oriented approach
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Which is the most effective goal for clients who are learning about the adaptive use of the ego defense mechanism?
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Reduce fear and protect self-esteem
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A client asks the nurse to help the client understand what a psychologist meant when the psychologist said that the client displaced anger. Which is the best definition for displacement the nurse can provide?
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Transferring feelings—such as frustration, hostility, or anxiety—from an idea, person, or object to one that is less threatening
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Which statement alerts the nurse to the use of suppression by a 19-year-old who lost a leg in a car accident?
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“I don’t remember anything about what happened to me.”
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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?
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The client is beginning to develop inner control over aggressive impulses.
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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?
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Altruism
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A nursing instructor is integrating Piaget’s theory of cognitive development into the discussion of learning and mental health issues affecting adolescents. The instructor would identify this age group as in what stage?
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Formal operations
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The nurse is assessing a family seeking mental health services for their 15-year-old child. To determine the subgroups in the family, the nurse should assess the family’s
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communication patterns.
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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?
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Encouraging the client to identify destructive thoughts and practice mindfulness
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Freud thought that the main defense mechanism in paranoia (delusional disorder) was what?
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Projection
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When the client, age 3, has a temper tantrum, the client’s parents remove toys from the playroom for 1 hour. A behavioral theorist would consider this which type of intervention?
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Punishment
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It is evident that a client has entered Piaget’s stage of formal operations when the client …
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speaks about a recent ballad as being reflective of the client’s life story.
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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?
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Help regain confidence in her pervious ability to cope with the stress of being a single parent
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Which type of group therapy is organized to help members who share a common problem to cope with it?
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Support
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Which term is used to describe the degree to which members work together cooperatively to accomplish a common purpose?
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Group cohesiveness
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A psychiatric-mental health nurse is providing care for a client who lives in the community. Which precondition is necessary before Peplau’s interpersonal theory becomes an accurate framework for the nurse’s practice?
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Prolonged contact between the nurse and the client
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All of the following are interventions included in cognitive therapy techniques, except which?
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Listing primary defenses used in life
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The nurse is aware of the changing demographics and growth of ethnic subcultures of the community and is trying to ensure that the needs for psychotherapy are effectively met. How should the nurse best work toward this goal?
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Foster cultural competency among those caregivers who perform psychotherapy and counseling.
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A 15-year-old client has been cutting the client’s forearms in recent months, a pattern of behavior that has had far-reaching consequences for all the members of the client’s family. The client and the client’s family are scheduled to begin therapy with a nurse-therapist who utilizes a behaviorist approach. Which aspect of this situation will the nurse-therapist most likely emphasize?
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The perceived benefits that the client receives from the behavior
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While participating in a group therapy session, one group member consistently asks for clarification of the topic the group is discussing. The nurse leading the group interprets this behavior as reflecting which group role?
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Information seeker
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Which is an example of group cohesiveness?
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Members wearing T-shirts that they made to a group session
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A client is using cognitive therapy as an adjunct treatment for bipolar disorder. Which would be an overall goal for this client related to the use of cognitive therapy for this condition?
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The client will engage in self-care independent of professional assistance.
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The initiator-contributor, information seeker, information giver, and coordinator are examples of what?
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Task roles
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Which represents the best definition of a theory?
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A person’s or group’s beliefs about how something happens or works
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To provide culturally sensitive care, the nurse should consider which when developing psychiatric interventions?
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A client’s background, beliefs, and concerns
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Which statement by the client is most suggestive of the use of unconscious resistance as a defense?
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“Sorry I’m late again. They keep changing the bus schedule on me!”
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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?
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Open
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Which is accurate regarding growth inhibiting individual roles of group members?
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They detract from group functioning
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The nurse recognizes the appropriateness of the Interpersonal nursing theory when the client is being treated in:
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a long-term care setting.
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What action by the psychiatric mental health nurse best demonstrates the behaviorist theories of B. F. Skinner?
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Offering to take a client for an outside smoke break if the client agrees to eat a nutritious meal at the scheduled meal time
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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?
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Perception of an event
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An 81-year-old resident of a long-term care facility has confided in the nurse that the client is profoundly fearful of death. Within Erikson’s psychosocial theory, this statement may suggest a failure to resolve which developmental conflict?
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Ego integrity vs. despair
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The nurse is planning a social skills training group for clients with schizophrenia. Which techniques should be used to help the clients gain social skills?
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Provide rewards for small approximations of the desired behaviors.
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The initiator-contributor, information seeker, information giver, and coordinator are examples of what?
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Task roles