Question 1

A high school student says to the school nurse,"If I don't make the honor roll every term,a college will never want me." The most therapeutic nurse response is:

Accepted Answer

The patient is projecting perfectionism onto the criteria for college acceptance.Perfectionism is a cognitive distortion,and this is best explored by reflecting the patient's distortion back to have the patient reexamine his or her thinking.

Question 2

An important characteristic of cognitive behavioral therapy is its focus on the:

Accepted Answer

An important characteristic of cognitive behavioral therapy is the mutuality between the therapist and patient (i.e.,the collaboration in defining the problem,identifying goals,formulating treatment strategies,and evaluating progress).Other characteristics include an emphasis on an objective assessment process,a supportive rather than curative focus,and a facilitative role of the therapist.

Question 3

A patient says,"My partner doesn't love me! Even the roses I get are the wrong color.It doesn't matter if I am not happy." The nurse responds:

Accepted Answer

The patient is demonstrating cognitive distortions by thinking in extremes and magnifying the problem and solution.The most therapeutic communication is the one that seeks clarification.Presenting the patient's statements allows the patient to "listen with a third ear" and take a view that places the event in perspective.

Question 4

A patient tells a nurse,"I want my own private room because my roommate is always watching football on television.He probably thinks I'm gay because I don't like football." Which communication best reflects a cognitive behavioral assessment by the nurse?

Accepted Answer

The patient is demonstrating personalization and engaging in ineffective problem solving.The most therapeutic communication is the one in which the nurse identifies the problem from the patient's perspective and asks how the ineffective problem solving will change things.

Question 5

Which relaxation technique will a nurse implement for a patient who reports panic attacks that "come over me for no apparent reason" but denies being agoraphobic?

Accepted Answer

Interoceptive exposure is used to desensitize patients to specific symptoms that they experience when anxious,such as tachycardia,blurred vision,and shortness of breath.After establishing a hierarchy of the symptoms,the patient does the things that cause him or her to experience extreme anxiety.These are then paired with a movement such as running in place or spinning around.This method has been proven successful with patients whose panic attacks seem spontaneous and unprovoked,which causes increased worry.However,it is not successful for agoraphobic patients.

Question 6

Which strategy will help evoke relaxation when using meditation?

Accepted Answer

Meditation requires a quiet milieu,a passive attitude,a focus word or scene,and a comfortable position.

Question 7

Which behavior would a nurse focus upon when using a token economy as a method of positive reinforcement?

Accepted Answer

Token economy,a form of positive reinforcement,has been used successfully to reward patients for performing behaviors such as the activities of daily living.

Question 8

A patient says,"When I lost weight,everyone was so nice to me.Now that I've regained the weight,people don't want anything to do with me.They think I'm just a fat pig." The nurse's initial response should be:

Accepted Answer

The patient is cognitively distorting by externalizing self-worth.The most therapeutic communication is the one that summarizes the patient's viewpoint and reflects it back for the patient to hear in a nonjudgmental way.

Question 9

A nurse teaches a group of parents about positive and negative reinforcement in shaping behavior.Which is an example of a positive reinforcer?

Accepted Answer

A positive reinforcement is a rewarding stimulus,such as praise.A negative reinforcement also increases the frequency of the appropriate behavior by reinforcing the power of the behavior to control an aversive,rather than rewarding,stimulus.The remaining options are all negative reinforcements.

Question 10

A patient says,"The people I work with hate me even though I'm given the hardest assignment.My boss makes it look like I'm doing less than the others." An appropriate response by the nurse would be:

Accepted Answer

This is a difficult situation.The patient is cognitively distorting the situation.Catastrophizing is thinking the worst about people and events.There may be other distortions,but using cognitive behavioral therapy involves separating issues for the patient to examine.

Question 11

A nurse explains the technique of extinction to parents who are seeking to reduce the frequency of unwanted behaviors in their children.What is an example of this type of strategy?

Accepted Answer

Extinction is the process of eliminating a behavior by ignoring it or not rewarding it.

Question 12

A nurse instructing a group of patients in the sequence of progressive muscle relaxation tells the group to tense and relax which area first?

Accepted Answer

The hands are tensed and relaxed first,followed by the biceps and triceps,shoulders,neck,mouth,eyes,breathing,back,midsection,thighs,stomach,calves and feet,and finally toes.

Question 13

A patient states,"When I married my husband I thought he was perfect,but now I know that he is certainly far from perfect." The nurse reframes the statement by responding:

Accepted Answer

Dichotomous thinking is a cognitive distortion that involves thinking in extremes (i.e.,things are either all good or all bad).Reframing involves focusing on other aspects of the problem or encouraging the patient to see the issue from a different perspective.The nurse should avoid judgmental statements.The remaining options do not reframe or restate the patient's original statement.

Question 14

During a group session a nurse mimics the disruptive behavior of a patient to demonstrate its affect on group work.The teaching strategy the nurse is implementing is:

Accepted Answer

Role playing is defined as the process by which patients rehearse problematic issues and obtain feedback about their behavior.In this situation,the patient switches roles with the nurse and is given an opportunity to see issues from another individual's viewpoint.

Question 15

A nurse explains the technique of response cost to parents who are seeking to reduce the frequency of unwanted behaviors in their children.What is an example of this type of strategy?

Accepted Answer

With response cost,the frequency of a behavior is likely to decrease because of a loss or penalty following a behavior.Extinction is the process of eliminating a behavior by ignoring it.Punishment is an aversive stimulus that occurs after the behavior and reduces its future occurrence.

Question 16

A patient frequently experiences angry outbursts and asks,"Is there anything I can do to stop being rude every time I get angry?" The nurse responds:

Accepted Answer

Social skills training is often helpful for patients who have trouble with assertiveness and with managing their anger.

Question 17

Which response best indicates that a nurse is employing reframing with a patient who responds angrily and aggressively when family members confront the patient's abusive drinking behavior?

Accepted Answer

In reframing,the nurse changes the meaning of a behavior in order to change the patient's response.In this situation,the nurse helps the patient to view the family's behavior as concern rather than as an attack.

Question 18

A patient says,"There aren't many things in life that I'm really afraid of,but I'm so afraid that I'll have another panic attack when I least expect it." Which question indicates the nurse is using decatastrophizing?

Accepted Answer

Decatastrophizing is also called the "what-if" technique.The goal of this technique is to help the patient see that the consequences of life's actions are generally not catastrophic.

Question 19

A patient tearfully says to a nurse,"I don't want to go on living now that my spouse has left me for someone else after 20 years.Our children are grown and don't need me.I just want to die." Which response is the most therapeutic?

Accepted Answer

The patient is demonstrating the cognitive distortions of dichotomous thinking (thinking in extremes) and overgeneralization.The patient is clearly in crisis and may be experiencing suicidal ideation.By identifying the most important problem and giving the patient permission to view one problem at a time with the therapist,the nurse is supporting effective problem solving by the patient.Using a cognitive behavioral approach,the nurse is able to perform a lethality assessment and then help the patient to expand alternatives and become a more flexible thinker.

Question 20

A patient says,"I've been sick a lot this last year but I'm still the biggest seller.I think my boss wants me to leave because a big change in our health insurance plan was implemented last week." The nurse responds:

Accepted Answer

The patient is demonstrating the cognitive distortion of personalization and arbitrary inference.The therapeutic communication that reflects a cognitive behavioral assessment is the one that first asks,"What is the problem?" Identifying the problem from the patient's perspective in a neutral,nonjudgmental style of communication helps the patient to take this first step.The antecedent and feared consequences also are identified.

Quiz 27: Behavior Change and Cognitive Interventions