Deck 26: Therapies: Theory and Clinical Practice

Question 1

A patient asks the nurse manager to help resolve a situation between her and another patient.Which action would best support the patient's feelings of safety when experimenting with new ways of being?

A) Encouraging the patient to report the incident to the other patient's physician
B) Intervening on the patient's behalf and sorting out the incident with the other patient
C) Suggesting that the patient ignore the situation since the other patient was probably not aware of her behavior
D) Offering to be present and help the patient discusses her feelings about the incident with the other patient

Answer 1

Offering to be present and help the patient discusses her feelings about the incident with the other patient

Question 2

Which statement would the nurse use to describe the primary purpose of boundaries?

A) Boundaries define responsibilities and duties to one's self in relation to others.
B) Boundaries determine objectives of the various working stage of the relationship.
C) Boundaries differentiate the assumed roles of both the nurse and of the patient.
D) Boundaries prevent undesired material from emerging during the interaction.

Answer 2

Boundaries define responsibilities and duties to one's self in relation to others.

Question 3

The patient and the nurse have agreed on problems to be addressed during a short course of outpatient therapy.At the beginning of the appointment,the patient states,"I'd like to work on the issue of relationships today." Which assessment can be made?

A) Nurse-patient roles have not been clearly delineated.
B) The nurse should suggest several alternative behaviors.
C) The patient must be able to manage emotions before continuing.
D) The relationship is moving from orientation to working phase.

Answer 3

The relationship is moving from orientation to working phase.

Question 4

When sharing her feelings about separating from a therapy group,the patient stated,"I feel a bit sad and empty that I won't be seeing you folks again." What is the most accurate evaluation of the patient's statement?

A) It indicates regression and her lack of readiness to terminate.
B) Unconsciously, she is hoping she will be permitted to continue the group.
C) She is demonstrating normal feelings associated with termination of therapy.
D) She needs further evaluation by her therapist to determine readiness to terminate.

Question 5

Which statement best defines the nurse's initial role as the patient's source of help in addressing interpersonal problems?

A) "I'll work with your doctor to help you get better."
B) "I'll be working with you to help solve your marital troubles."
C) "Your medications will help you feel better as soon as they take effect."
D) "You will be expected to attend the group activities while you are here."

Question 6

Which action will best facilitate the development of trust between a nurse and patient?

A) Responding positively to the patient's demands
B) Following through with whatever was promised
C) Clarifying with the patient whenever there is doubt
D) Staying available to the patient for the entire shift

Question 7

To plan care for a patient with a psychiatric disorder,the nurse keeps in mind that the primary nursing role related to therapeutic activities is:

A) Assisting the patient in accomplishing the activity
B) Ensuring that the patient will comply with the rules of the activity
C) Ensuring that the patient can accomplish the activity in a timely manner
D) Providing a support system for the patient if they fail to complete the activity

Question 8

By the end of the orientation phase,which outcome can be identified for a newly admitted patient? The patient will demonstrate:

A) Ability to problem solve one issue
B) Trust in at least one nurse on the unit
C) Positive transference with a staff member
D) Ability to ask for help in meeting needs

Question 9

A nurse,leading an inpatient group dealing with women's issues,identifies a patient who is assuming the role of aggressor.Which behavior characterizes this role?

A) Attempting to manipulate others
B) Mediating conflicts and disagreements
C) Criticizing the contributions of others
D) Seeking a position between contending sides

Question 10

A patient tells the nurse,"I really like you.You're the only true friend I have." The patient's remarks call for the nurse to revisit the issue of:

A) Trust
B) Safety
C) Boundaries
D) Countertransference

Question 11

During the first family therapy session,the mother of a child being treated for truancy and emotional outbursts asks the nurse,"Why are you bothering to ask the rest of us questions? My son is the one with the problems." The best response for the nurse would be:

A) "We'll get more accurate information if the entire family is involved."
B) "It may seem strange to you, but we'll get better results doing it this way."
C) "When one family member is sick, the whole family system is sick as well."
D) "Every family member's perceptions are very important to the total picture."

Question 12

The treatment team was engaged in planning how group therapy could be included as a part of the structured daily activities of the unit.A new team member asked,"Why is it so important to include group therapy for the patients?" The most accurate response would be based on the assumption that:

A) Hidden agendas frequently surface in group sessions.
B) Some persons do not relate well on an individual basis.
C) Group therapy is far more cost-effective for the patients.
D) Psychopathology has its source in disordered relationships.

Question 13

Which statement by a 16-year-old is considered as positive evidence that the family's involvement in therapy is moving them towards effective functioning?

A) "My dad has finally stopped giving me advice on how to live my life."
B) "I stopped playing football since practice required me to be away from home so often."
C) "Since my mother quit her job, she is more available to keep the home running smoothly."
D) "Eating dinner with my parents on Sunday nights has helped us be more aware of each other's needs."

Question 14

In response to the nurse's statement,"Tell me about your family," the patient became silent and displayed nonverbally that he is uncomfortable.Which statement by the nurse reflects sensitivity to the patient?

A) "I'm so sorry. I didn't realize your family was a problem for you."
B) "Learning to express negative feelings will assist you in getting well."
C) "Perhaps you can talk about your feelings to the physician next time you meet."
D) "That seems to be a difficult subject for you. We can discuss when you are ready."

Question 15

Which patient would the group co-leaders determine is demonstrating Yalom's therapeutic factor termed universality?

A) Patient A, who states he realizes he is not the only person who has a problem with loneliness
B) Patient B, who displays dysfunctional interaction patterns learned in his family of origin
C) Patient C, who states he finally feels a strong sense of belonging
D) Patient D, who openly expresses his anger about his work

Question 16

A patient attending group therapy mentions,"In the beginning,I was so sick that everyone had to help me.For the last few days,it's felt good to be able to give something back to the group." This statement can be assessed as an example of Yalom's factor of:

A) Altruism
B) Harmonizing
C) Cohesiveness
D) Imitative behavior

Question 17

The nurse is determining whether the patient's needs could be best met in a task or a process group.The decision is based on the understanding that a task group focuses on:

A) Content issues
B) The "here and now"
C) Communication styles
D) Relations among the members

Question 18

Which intervention best reflects the nursing role regarding effective implementation of behavioral therapy goals?

A) Administering the prescribed medications accurately
B) Interacting effectively with members of the health care team
C) Being aware of all the patient related therapeutic modalities
D) Evaluating patient behaviors to reward economic tokens appropriately

Question 19

A new nurse asks the mentor,"How can I be sure I'm developing a therapeutic environment for my unit?" The mentor uses as a basis for the response the fact that a therapeutic milieu is characterized by:

A) Rigid adherence to timelines and unit routine
B) Relaxation of boundaries when doing so is accepted by all
C) The focus of the staff is directed to the most critically disturbed patients
D) Specific patient-centered goals are established mutually by patient and staff

Question 20

A nurse and patient are entering the termination phase in the group experience.An important nursing intervention will be to:

A) Encourage the group to describe goals for change.
B) Inquire whether the group needs more time to accomplish goals.
C) Assist the group to explore alternative coping strategies for problems.
D) Discuss feelings about leaving the group and the support found with the group.

Question 21

A novice mental health nurse shares that,"I'll never get used to playing cards or other games with patients.It seems like a poor use of scarce nursing time." The best response for the nurse's mentor would be:

A) "Perhaps you'll want to rethink your transfer to this unit if you're really uncomfortable."
B) "Your comments make a point about scarce resources. I'll ask the treatment team to review our position on activities."
C) "Activity co-leadership puts us in a position to help patients develop social skills and support them as they take small risks."
D) "Managed care has cost us activities therapists. Activities are necessary to give patients something to do, so we have to fill in."

Question 22

In the ECT treatment preparation period the morning of treatment,the nurse should:

A) Adequately hydrate the patient.
B) Assess the patient's cognitive function.
C) Have the patient exercise for 10 minutes.
D) Ensure that the patient produces a urine sample.

Question 23

When asked,"Why do you go to music therapy every morning at 10?" The nurse explains that the nurse's role in music therapy as:

A) Fostering and encouraging performance talent
B) Teaching patients about various styles of music
C) Noting patient verbal and nonverbal expression of feelings
D) Selecting and playing numbers that will reduce anxiety and stress

Question 24

When leading a therapeutic group,the nurse demonstrates an understanding of the need to act as the group's executive when:

A) Restating rules when a new member joins
B) Being available to orient the new members
C) Helping a member defuse the anger they are experiencing
D) Working with a member to help improve their communication skills

Question 25

Which activity therapy should the nurse recommend to the treatment team to assist the patient to relieve tension and achieve increased body awareness?

A) Psychodrama
B) Music therapy
C) Dance therapy
D) Recreation

Question 26

To effectively plan care for a patient,the nurse will understand that activity and adjunct therapies may be more useful in some situations than verbal therapies because adjunct therapies:

A) Are readily available in the treatment setting
B) Do not require specific training or expertise to facilitate
C) Provide the patient the opportunity to use ego-protective mechanisms
D) Allow the patient to express feelings on multiple levels at the same time

Question 27

About an hour after the patient has ECT,he complains of having a headache.The nurse should:

A) Notify the physician stat.
B) Administer an as needed (prn) dose of acetaminophen.
C) Take the patient through a progressive relaxation sequence.
D) Advise going to activities to expend energy and relieve tension.

Question 28

The nurse is collecting the paintings from the patients after the art session is over.After art therapy,a patient hands the nurse a paper that consists of several black scribbles.Which statement demonstrates the nurse understands the goals and objectives of the therapy?

A) "Do you want to complete your painting?"
B) "I see that you don't take this very seriously."
C) "Can you tell me what happened to prompt such work?"
D) "Thank you. I'll put this away in a safe place for you."

Question 29

For which patient is the nurse most likely to need to schedule a pre-ECT workup and teaching?

A) Patient A, who is newly diagnosed with dysthymic disorder
B) Patient B, who has melancholic depression that responded well to ECT 2 years ago
C) Patient C, who was unresponsive to a 6-week trial of SSRI antidepressant therapy
D) Patient D, who has depression associated with diagnosis of inoperable brain tumor

Question 30

Which statement by a patient who has given informed consent for ECT confirms that the patient understands the side effects of this treatment?

A) "I won't remember the pain."
B) "It will take several weeks before I feel good again."
C) "My short-term memory loss will be only temporary."
D) "I will be at increased risk for developing epilepsy later."

Question 31

The physician has ordered atropine 0.5 mg intramuscularly (IM)for a patient to be administered 30 minutes prior to ECT.The rationale for use of this medication is that it reduces secretions and:

A) Protects against vagal bradycardia
B) Improves the scope of convulsive activity
C) Reduces the need for recovery room staff
D) Prevents incontinence of bladder and bowel

Question 32

When another patient serves as "alter ego" during an outpatient group session,the nurse documents that the group had been engaged in:

A) Role-playing
B) Psychodrama
C) Cognitive therapy
D) Consensus building

Question 33

What is the primary reason for the nurse to have an understanding of the various types of activity and adjunct therapies?

A) The nurse chooses the most cost-effective therapy group.
B) The nurse is expected to encourage patients' involvement in the therapies.
C) The nurse is responsible for placing the patient in the appropriate group.
D) The nurse needs to be supportive of the treatment team members who direct these therapies.

Question 34

Which statement made by a patient just prior to being transported for a scheduled ECT treatment would result in cancellation of the treatment?

A) "I'll be so glad when this treatment is over."
B) "Will I remember having this treatment?"
C) "Did eating some crackers cause any problems?"
D) "I'm so tired of being depressed; I don't think I can go on."

Question 35

A novice nurse who will be assessing a patient after electroconvulsive therapy (ECT)asks her mentor,"What sort of memory impairment is present after several ECT treatments?" The best response for the mentor would be:

A) "It's hard to say. Treatment affects everyone differently."
B) "Usually the patient has severe difficulty remembering remote events."
C) "Patients have mild difficulty remembering recent events, like what was eaten for breakfast."
D) "Both recent and remote memory is affected, producing profound confused, cognitive states."

Question 36

Immediately after electroconvulsive therapy (ECT),nursing care of the patient is most similar to care of a patient:

A) With severe dementia
B) With delirium tremens
C) Recovering from conscious sedation
D) Recovering from general anesthesia

Question 37

When a novice nurse asks why the unit has a multidisciplinary approach to therapeutic activities,the nurse should explain that multidisciplinary collaboration:

A) Produces a higher level of insurance reimbursement
B) Reduces the incidence of aggressive behavior by patients
C) Produces quicker results and earlier discharge to the community
D) Produces better outcomes than when only one perspective is used

Question 38

A patient is scheduled to attend an occupational therapy group to work on the identified goal of "recognizing and using more effective coping techniques." What measure can the nurse use to continue to support the patient's attainment of this goal after he returns to the unit?

A) Isolating him from more seriously ill patients
B) Praising him for positive behavioral changes
C) Avoiding setting limits that would increase his anxiety level
D) Permitting him to make mistakes prior to intervening on his behalf

Question 39

When a patient asks the nurse,"How can jolting me with an electrical shock possibly do me any good?" the answer most reflective of current biologic theory would be:

A) "ECT must sound like a very frightening treatment alternative to you."
B) "ECT produces a change in brain chemistry that results in improved mood."
C) "ECT interrupts brain impulses that are causing hallucinations and delusions."
D) "ECT provides you with external punishment so you can stop punishing yourself."

Question 40

How can the nurse encourage an extremely shy patient to participate therapeutically in a dance activity group?

A) Offer to dance with the patient.
B) Ask the patient if this is the first dance he has attended.
C) Sit with the patient away from the group.
D) Encourage another patient to ask him to dance.

Question 41

What milieu factor would need most attention from the nurse who is caring for a patient who has received six ECT treatments and has two more scheduled?

A) Safety
B) Trust attainment
C) Therapeutic activities
D) Boundary maintenance

Question 42

Which behaviors are reflective of legitimate phases of a group's development? Select all that apply.

A) Stating the goals of the group
B) Establishing who will assume the leadership role
C) Inviting family members to attend and provide their input
D) Feeling safe enough to discuss painful personal situations
E) Showing concern about assuming personal responsibility for life

Question 43

Which intervention will the nurse implement in the first half hour after the patient has received ECT?

A) Continually stimulate patient to respond, using physical and verbal means.
B) Continue bagging patient to improve respiratory function until patient is responsive for 10 minutes.
C) Reorient as necessary to time, place, and person as level of consciousness improves.
D) Encourage walking and eating breakfast as quickly as possible.