Deck 7: Models for Working with Psychiatric Patients

Question 1

A nurse clinician uses rational-emotive therapy with a patient who is chronically depressed. The initial step in this process is to help the patient:

A) identify developmental tasks and progress.
B) manage environmental stressors more effectively.
C) explore childhood influences on the patient's emotional state.
D) recognize how irrational beliefs are related to painful feelings.

Answer 1

recognize how irrational beliefs are related to painful feelings.

Question 2

A patient says, "It's my fault because I always make bad decisions. I should never have taken that job." Using a rational-emotive approach, how would the nurse respond?

A) "What can you do to solve your problems at work?"
B) "You're experiencing a great deal of stress right now. How can you manage it more effectively?"
C) "Can you describe a time in your childhood when your parents blamed you for things you didn't do?"
D) "Consider the words you are using to talk about yourself. Let's try to change those words to more positive ones."

Answer 2

"Consider the words you are using to talk about yourself. Let's try to change those words to more positive ones."

Question 3

A young adult lives with his parents, has few interpersonal relationships, and says, "Most people can't be trusted." This person makes decisions only after consulting with his parents. Using Erikson's developmental theory, the nurse can draw which conclusion?

A) The patient has evidence of inferiority and lacks a sense of direction.
B) Developmental deficits in early life have impaired the patient's adult functioning.
C) The patient's developmental problems will probably lead to a serious mental illness.
D) It is impossible for the patient to proceed to the next developmental stage until mastering earlier stages.

Answer 3

Developmental deficits in early life have impaired the patient's adult functioning.

Question 4

When interacting with patients, it is important for the nurse to recognize that defense mechanisms:

A) keep id impulses from gaining control.
B) protect the ego from excessive anxiety.
C) access unconscious feelings and memories.
D) prevent conflict among the id, ego, and superego.

Question 5

A patient uses defense mechanisms excessively. The nurse should expect to find evidence that:

A) the patient has difficulty with problem solving.
B) the patient has an increased risk for psychosis.
C) emotions are experienced with great intensity.
D) reality is denied.

Question 6

A nurse plans an intervention to supports a patient's ego. This intervention is therapeutic, because the individual's ego:

A) provides rational, logical reality testing.
B) is primarily concerned with right and wrong.
C) uses primary process imagery to meet basic needs.
D) is derived from the individual's pattern of thinking.

Question 7

A patient experiences severe panic attacks and uses denial, repression, and displacement. Nursing interventions should be directed toward:

A) teaching more effective coping strategies.
B) setting limits on use of the defense mechanisms.
C) assisting the patient to change values and beliefs.
D) helping the patient uncover unconscious conflicts.

Question 8

An older retired executive reports, "I am unable to say 'no' when asked to help with community causes. These projects overtax my strength, but if I don't do them, who will?" The nurse can assess that this person is having difficulty with critical tasks related to which developmental stage?

A) Trust versus mistrust
B) Integrity versus despair
C) Identity versus role diffusion
D) Autonomy versus shame and doubt

Question 9

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 defiance and saying 'no.'"
C) "There may be developmental problems. Most children are toilet trained by age 2."
D) "Some undesirable attitudes are developing. A child psychologist can help you develop a remedial plan."

Question 10

A patient asks, "Why is it important to uncover memories and conflicts hidden in the unconscious?" A Freudian therapist would explain that bringing unconscious information to consciousness will:

A) resolve developmental issues, fears, and crises.
B) allow an individual control over the id and superego.
C) suppress painful feelings and increase rational thinking.
D) provide insight into behavior and allow meaningful change to occur.

Question 11

Which statement by an adult would lead a nurse to suspect deficits in mastery of the developmental task of infancy?

A) "I have many warm and close friendships."
B) "I am afraid to let anyone really get to know me."
C) "I am always right. Keep your opinion to yourself."
D) "I am ashamed I did that wrong. Please forgive me."

Question 12

During an interdisciplinary team meeting, a nurse says, "The patient's psychological distress seems to result from automatic thoughts that cause self-defeating behaviors." The nurse is conceptualizing the patient's problem from the viewpoint of which model?

A) Interpersonal
B) Psychoanalytic
C) Stress-adaptation
D) Cognitive-behavioral

Question 13

When the nurse conducts a developmental assessment with a new patient, the assessment can be expected to yield information regarding what?

A) The use of defense mechanisms
B) The degree of mastery of critical tasks
C) Strategies to help the patient make rational decisions
D) The mobilization of defenses against the patient's stressors

Question 14

A patient diagnosed with lung cancer continues to smoke and says, "I think my cancer is more the result of a bad gene than of smoking." The patient shows the use of which defense mechanism?

A) Denial
B) Compensation
C) Intellectualization
D) Reaction formation

Question 15

The nurse who uses the interpersonal model as a basis for practice will focus assessment on identifying:

A) intrapsychic conflicts.
B) relationship problems.
C) how the environment affects behavior.
D) the patient's achievement of development tasks.

Question 16

A patient tells the nurse, "The reason I use drugs is because everybody nags me to do things that don't interest me." The patient shows use of which defense mechanism?

A) Sublimation
B) Introjection
C) Identification
D) Rationalization

Question 17

A young adult reports overwhelming guilt about minor social errors, feels self-pity, and says, "I stay on the sidelines of life so I can avoid the embarrassment of being noticed." The nurse can assess deficits in mastery of critical tasks associated with which developmental stage?

A) Trust versus mistrust
B) Industry versus inferiority
C) Autonomy versus shame and doubt
D) Generativity versus self-absorption

Question 18

Which goal is most likely to be chosen by the nurse for a patient who uses the interpersonal model as a basis for practice?

A) The patient will develop mature, satisfying relationships that are relatively free of anxiety.
B) The patient will rid himself of irrational beliefs, including "shoulds," "oughts," and "musts."
C) The patient will learn to meet basic needs responsibly.
D) The patient will manage stress adaptively.

Question 19

A patient is mute, curled in a fetal position, and incontinent of urine. The patient eats small amounts only if spoon-fed. The nurse assesses this behavior as most indicative of:

A) displacement.
B) compensation.
C) conversion.
D) regression.

Question 20

A young adult has a realistic sense of self, a commitment to reasonable career goals, a satisfying intimate-partner relationship, and a circle of loyal friends. This person says, "I volunteer for important projects in my community." The nurse can draw which conclusion?

A) There is lack of mastery of critical tasks associated with the stage of industry versus inferiority.
B) Mastery of critical tasks associated with the stage of identity versus role diffusion is evident.
C) Fear of criticism and affection affect mastery of critical tasks associated with intimacy.
D) The person vacillates between dependence and independence.

Question 21

An individual diagnosed with alcohol dependence will begin motivational enhancement therapy. The nurse will explain this therapy to significant others as a way of:

A) altering the patient's irrational thoughts.
B) enhancing the patient's willingness to change behavior.
C) managing anxiety through satisfying interpersonal interactions.
D) mastering critical developmental tasks not attained earlier in life.

Question 22

After being informed of a diagnosis of lung cancer, a patient says in a cheerful voice, "I feel fine. I will do some reading online about it. Right now, I want to take a nap." The nurse assesses the use of which defense mechanisms? Select all that apply.

A) Repression
B) Undoing
C) Introjection
D) Reaction formation
E) Intellectualization
F) Suppression

Question 23

After an episode of self-mutilation, a patient diagnosed with borderline personality disorder will begin individual therapy and group skills training. The goals are to decrease use of dissociation, increase distress tolerance, and regulate affect. Which type of therapy is evident?

A) Rational-emotive behavioral
B) Motivational enhancement
C) Dialectical behavioral
D) Interpersonal

Question 24

A student goes to a party the night before a test and then fails the exam. After seeing the score, the student slams a book on the table and says, "I have to work so much and have no time to study. It wouldn't matter anyway because the teacher is unreasonable." The nurse identifies use of which defense mechanisms? Select all that apply.

A) Denial
B) Compensation
C) Rationalization
D) Projection
E) Displacement
F) Reaction formation

Question 25

A student nurse says, "I don't need to interact with my patients. I learn by observing them." The instructor can best interpret the nursing implications of Sullivan's theory to this 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) "It is important to note patient behavioral changes because these signify changes in personality."