Question 1

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.Using Freudian theory,the nurse can interpret this behavior as a product of impulses originating in the:

Accepted Answer

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.

Question 2

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?

Accepted Answer

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 or 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.

Question 3

A nurse influenced by Peplau's interpersonal theory works with an anxious,withdrawn patient.Interventions should focus on:

Accepted Answer

The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others.The distracters apply to theories of cognitive,behavioral,and biological therapy.

Question 4

A 2-year-old child often displays negative behaviors.The parent says,"My child refuses toilet training and shouts 'No!' when given directions.What do you think is wrong?" Select the nurse's best reply.

Accepted Answer

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.

Question 5

A patient says,"I never know the answers," and "My opinion doesn't count." The nurse correctly assesses that this patient had difficulty resolving which psychosocial crisis?

Accepted Answer

These statements show severe self-doubt,indicating that the crisis of gaining control over the environment was not 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.

Question 6

A 26-month-old displays negative behavior,refuses toilet training,and often says,"No!" Which psychosocial crisis is evident?

Accepted Answer

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.

Question 7

The parent of a child with schizophrenia tearfully asks the nurse,"What could I have done differently to prevent this illness?" Select the nurse's best response.

Accepted Answer

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.

Question 8

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.

Accepted Answer

The situation describes psychodynamic psychotherapy.The distracters use other techniques.

Question 9

Consider a therapist's statement: "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?

Accepted Answer

The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet interpersonal security needs.Behaviorism and classical conditioning theories do not apply.A psychosexual formulation would focus on uncovering unconscious material that relates to the patient problem.

Question 10

A psychiatric technician says,"Common sense is the most important part of working with people who have mental illness.Theories are just something to fill up textbooks." The nurse wants to educate the technician by identifying which common use of Sullivan's theory?

Accepted Answer

The structure of the therapeutic environment has as 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 use of restraint or seclusion.Assessment based on developmental level is more the result of Erikson's theories.Sequencing nursing actions based on patient priority needs is related to Maslow's hierarchy of needs.

Question 11

Which patient statement would lead the nurse to suspect unsuccessful completion of the developmental task of infancy?

Accepted Answer

According to Erikson,the developmental task of infancy is the development of trust.The correct response is the only statement clearly showing lack of ability to trust others.Warm,close relationships suggest the developmental task of infancy was successfully completed;rigidity and self-absorption are reflected in the belief one is always right;and shame for past actions suggests failure to resolve the crisis of initiative versus guilt.

Question 12

Although ego defense mechanisms and security operations are unconsciously determined and designed to relieve anxiety,the major difference is:

Accepted Answer

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.

Question 13

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 the use of praise related to these behaviors.These qualities will likely be internalized and become part of the child's:

Accepted Answer

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.

Question 14

A nurse uses Maslow's hierarchy of needs to plan care for a patient with mental illness.Which problem will receive priority? The patient:

Accepted Answer

The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning.

Question 15

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:

Accepted Answer

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 other distracters relate to Maslow and behavioral theory.

Question 16

Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute.Which technique applies?

Accepted Answer

Operant conditioning involves giving positive reinforcement for a desired behavior.Treats are rewards and reinforce speech through positive reinforcement.

Question 17

A 26-month-old displays negative behavior,refuses toilet training,and often says,"No!" Which stage of psychosexual development is evident?

Accepted Answer

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.

Question 18

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 most likely result?

Accepted Answer

The individual will be living up to the ego ideal,which will result in positive feelings about self.The other options are incorrect because each represents a negative feeling.

Question 19

A patient expresses the desire to be cared for by others and often behaves in a helpless fashion.The patient's needs relate to which stage of psychosexual development?

Accepted Answer

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.

Question 20

A patient is suspicious and frequently manipulates others.To which psychosexual stage do these traits relate?

Accepted Answer

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.

Quiz 2: Relevant Theories and Therapies for Nursing Practice