Deck 19: Cognitive Therapy

Question 1

A high school basketball player sustains a serious knee injury and states to the school nurse,"I will never get to college if I don't receive a basketball scholarship." Which nursing reply would assist the student to see a broader range of possibilities?

A) "Let's look at the alternatives for funding your college education."
B) "I know you are feeling helpless now, but you are looking at this from only one perspective."
C) "Can your family afford knee surgery?"
D) "You now need to prioritize your academics and not focus on basketball."

Answer 1

"Let's look at the alternatives for funding your college education."

Question 2

A client recovering from alcohol toxicity is using minimization.Which statement reflects this cognitive distortion?

A) "I can't give up alcohol right now because I just gave up smoking."
B) "I just read that red wine has health benefits."
C) "I may have a minor problem, but I can handle it."
D) "I don't drink as much as my wife, and nobody thinks she has a problem."

Answer 2

"I may have a minor problem, but I can handle it."

Question 3

A welder has been selected as employee of the year.The welder wants to ask for a promotion but is hampered by poor self-esteem.The employee health nurse provides assistance.Which technique should the nurse use to help the employee request the promotion?

A) Socratic questioning
B) Activity scheduling
C) Distraction
D) Cognitive rehearsal

Answer 3

Cognitive rehearsal

Question 4

When using a cognitive approach,a nurse would include which point in teaching a client about panic disorder?

A) "You might want to stay in the house when you notice the symptoms beginning."
B) "Medications such as lorazepam (Ativan) should be taken when symptoms start."
C) "Remind yourself that symptoms of a panic attack are time limited and will end."
D) "Keep a journal in order to note feelings surrounding the panic attacks."

Question 5

A client admitted to a Veterans Administration (VA)hospital with a diagnosis of major depressive disorder tells the nurse,"I failed my battalion by giving the wrong order.Fortunately,no one was injured." Which nursing diagnosis should the nurse assign to this client?

A) Chronic low self-esteem
B) Risk for self-directed violence
C) Powerlessness
D) Situational low self-esteem

Question 6

The director of nursing (DON)sets up a meeting with the newly appointed nurse manager,who,to this point,has done an excellent job.The nurse manager anticipates job termination.What is the best description of the cognitive error being employed by the nurse manager?

A) Thinking from an "all-or-nothing" perspective
B) Always thinking the worst will occur without considering positive outcomes
C) Viewing only selected negative evidence while editing out positive aspects
D) Undervaluing the positive significance of an event

Question 7

An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder.The nurse plans to use activity scheduling to address this client's concerns.What is the purpose of this nursing intervention?

A) To identify important areas needing concentration during therapy
B) To increase self-esteem and decrease feelings of helplessness
C) To modify maladaptive behaviors by the use of role-play
D) To divert away from intrusive thoughts and depressive ruminations

Question 8

A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning.When told of this situation,the nursing instructor plans to use the cognitive technique of "examining the evidence." Which response exemplifies this technique?

A) "Let's look at the potential reasons why your partner has not participated."
B) "How would you define irresponsibility?"
C) "Has it occurred to you that your partner may be working on the project at home?"
D) "Are you telling me that you feel totally responsible for this project?"

Question 9

An advanced practice nurse recommends that a client participate in cognitive therapy.The client asks,"What's cognitive therapy and how can it help me?" Which is the nurse's most appropriate reply?

A) "It is a system of techniques in which you use positive thinking to improve your mood."
B) "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences."
C) "It is an interpersonal treatment approach that specifically targets magical thinking."
D) "It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors."

Question 10

A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis.What assessment data will the nurse document on this client?

A) "Thought patterns are triggered by specific stressful stimuli."
B) "Thought patterns contain the client's fundamental beliefs and assumptions."
C) "Thought patterns are flexible and based on personal experience."
D) "Thought patterns include a predominance of automatic thoughts."

Question 11

A nursing instructor is teaching about dichotomous thinking.Which student statement indicates that learning has occurred?

A) "Dichotomous thinking is when an individual views situations as being 'good or bad' or 'black or white.'"
B) "Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances."
C) "Dichotomous thinking is when an individual exaggerates the negative significance of an event."
D) "Dichotomous thinking is when an individual undervalues the positive significance of an event."

Question 12

A nursing assistant has failed a prerequisite course toward admission to nursing school and states,"I will always be only a nursing assistant and never an RN." Her nursing advisor understands this is an example of which automatic thought?

A) Arbitrary inference
B) Overgeneralization
C) Dichotomous thinking
D) Personalization

Question 13

A nursing student states,"The instructor gave me a failing grade on my research paper.I know it's because the instructor doesn't like me." Which cognitive error does a nurse recognize in this student's statement?

A) Dichotomous thinking
B) Catastrophic thinking
C) Magnification
D) Overgeneralization

Question 14

A successful business executive continually thinks that job accomplishments are not adequate.A nurse recognizes that the client's thinking is reflective of which cognitive error?

A) Minimization
B) Dichotomous thinking
C) Arbitrary inference
D) Personalization

Question 15

Using a cognitive approach,a nurse would choose which intervention for assisting clients to manage their anger without the use of violence?

A) Assist the client to identify thoughts that trigger anger and substitute reality-based thinking.
B) Provide consequences, such as removal from group therapy, in response to angry outbursts.
C) Administer antipsychotic medications and use limit-setting such as a room restriction.
D) Administer anti-anxiety medication and encourage participation in a group on medication actions.

Question 16

When a client's husband comes home late from work,the wife immediately fears infidelity.The advanced practice nurse therapist encourages the wife to consider other explanations for her husband's tardiness.What technique is the nurse using?

A) Examination of the evidence
B) Decatastrophizing
C) Generating alternatives
D) Reattribution

Question 17

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy,8-pound baby girl.Which statement by the mother indicates to the nurse the use of the cognitive error,selective abstraction?

A) "My baby is refusing to nurse, and I know it's because she hates me."
B) "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me."
C) "My baby is wonderful, but I'm depressed because I wanted twins."
D) "My baby has an elevated bilirubin, and I know it will get worse and she will die."

Question 18

A client states,"I keep having horrible nightmares about the car accident that killed my daughter.I shouldn't have taken her with me to the store." Using a cognitive approach,which nursing reply would be most therapeutic?

A) "Are other issues from your past affecting your ability to move on?"
B) "Describe your current feelings about your loss."
C) "Let's talk about something that will help you move on."
D) "Can anyone predict when a car accident will happen?"

Question 19

Which client statement would exemplify the level of cognitive function that you would expect to see in mild anxiety?

A) "Right now I feel as sharp as a tack."
B) "I'm having a tough time focusing."
C) "Sometimes I feel like I'm having an out-of-body experience."
D) "All I seem to focus on is my anger."

Question 20

A nursing instructor is teaching about the didactic aspects of cognitive therapy.Which student statement indicates a deficit in meeting the learning objectives of this content?

A) "The therapist provides information about the process of cognitive therapy."
B) "The therapist uses guided imagery in an effort to elicit automatic thoughts."
C) "The therapist provides information about how cognitive therapy works."
D) "The therapist uses reading assignments to reinforce learning."

Question 21

A nurse practitioner uses cognitive therapy with depressed clients.The nurse asks clients to keep a daily record of dysfunctional thoughts.Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? Select all that apply.

A) "The purpose of this exercise is to identify automatic thoughts."
B) "The purpose of this exercise is to identify rational alternatives."
C) "The purpose of this exercise is to modify cognitive errors."
D) "The purpose of this exercise is to eliminate irrational beliefs."
E) "The purpose of this exercise is to monitor thoughts related to self-esteem."

Question 22

Which of the following client statements would indicate that teaching about benzodiazepines has been successful? Select all that apply.

A) "I can't drink alcohol when taking lorazepam (Ativan)."
B) "If I abruptly stop taking buspirone (BuSpar), I may have a seizure."
C) "Valium can make me drowsy, so I shouldn't drive for awhile."
D) "My new diet cannot include aged cheese or pickled herring."
E) "When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax)."

Question 23

A nursing instructor is lecturing about cognitive therapy.Which of the following are objectives when implementing this therapy? Select all that apply.

A) To modify automatic thoughts to promote minimization of negative cognitions
B) To apply a variety of methods to create change in an individual's thinking
C) To apply cognitive principles in order to change an individual's basic schema
D) To modify belief systems in an effort to bring about emotional change
E) To modify belief systems in an effort to bring about behavioral change

Question 24

A client is experiencing auditory hallucinations.Using a cognitive strategy,the nurse would encourage the client to do which of these?

A) "Try singing Happy Birthday until the voices are gone."
B) "Document what the voices are saying, to note cause and effect."
C) "Try listening to music using headphones for distraction."
D) "Remind yourself that the voices are symptoms of your disease."

Question 25

A client diagnosed with borderline personality disorder states,"Get out of here.No one cares about me or my situation!" Which nursing reply is an example of a cognitive intervention?

A) "You have an anti-anxiety medication ordered. It may make you feel better."
B) "It sounds like you are feeling really frustrated."
C) "Can you explain further your thinking about your situation?"
D) "No one cares about you?"