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:
A) "If making the honor role every term was the admissions criterion, very few people would get into college."
B) "I can understand your concern. The pressures are truly great to assure acceptance into college today."
C) "It's true that a consistent record of academic achievement will ensure college acceptance."
D) "It sounds as if you believe that colleges will only admit students that are perfect academically."

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:
A) authoritarian role assumed by the therapist.
B) consistent collaboration with the patient.
C) subjective experiences of the patient.
D) approach to treatment.

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:
A) "How do you want your partner to show you that you're loved?"
B) "When was the last time your partner made you feel really loved?"
C) "Everyone deserves to be shown by their partners that they are loved. What did your partner have to say in his defense?"
D) "Let me see if I understand you. You think your partner doesn't love you because the gifted roses were of the wrong color?"

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?
A) "You feel your roommate thinks you're gay because you don't like football and he spends his time watching football? How will getting a private room change things?"
B) "It's hard to feel excluded, but isolating yourself is not the answer. Perhaps you might try watching football with him."
C) "Don't you think your roommate will be more likely to think you're gay if you get a private room?"
D) "Well, you must realize that most men like football, but that doesn't mean he will think you are gay."

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?
A) Implosion therapy
B) Relaxation technique
C) Interoceptive exposure
D) Progressive muscle relaxation

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?
A) Playing soft background music
B) Ten-second deep breathing and exhaling
C) Ten-second tensing and relaxing of muscle groups
D) Providing a word or scene on which the patient can focus

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?
A) Altering cognitive perceptions
B) Reinforcing cognitive congruence
C) Performing assigned tasks in a cooperative manner
D) Pairing desired behaviors with undesired behaviors

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:
A) "It sounds as if your interpersonal relationships improved when you lost weight and now that you have regained the weight, you feel people don't want to be with you."
B) "Yes, there is a stigma about obesity. People are judged harshly for their weight."
C) "So, if you lose all the weight again do you think your relationships will improve?"
D) "Do you really believe that your friends think that you are a 'fat pig'?"

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?
A) A parent who kisses a child who is crying to make the crying stop
B) An adolescent who runs away from home because of trouble in school
C) A parent who praises a child for putting toys away after playtime
D) An adolescent who drives within the speed limit to avoid getting a ticket

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:
A) "It seems like you're in a very difficult position. No job is worth that kind of stress. Why not change jobs?"
B) "You can't have the hardest assignment and yet your co-workers don't see that and hate you. How can you be so sure that you're hated?"
C) "I think you should sit down and talk out your feelings with your boss. Perhaps you can come to a more agreeable situation with your co-workers."
D) "Let me see if I understand. Your assignment appears to be easy, but it is really difficult. You feel your co-workers won't see that it's hard, and they'll hate you."

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?
A) Ignoring a temper tantrum
B) Taking away an allowance for not keeping a clean room
C) Sending children to their rooms after fighting with each other
D) Not allowing children to play with friends because homework is not completed

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?
A) Eyes
B) Toes
C) Hands
D) Mouth

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:
A) "I think you might want to change your thinking since no one is perfect."
B) "It seems as if you think of people as being either all good or all bad."
C) "So, when did you start seeing your husband as a very bad person?"
D) "It is good to be able to both externalize and objectify your anger."

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:
A) shaping.
B) modeling.
C) role playing.
D) positive reinforcement.

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?
A) Ignoring a temper tantrum
B) Taking away the privilege to watch television until homework is finished
C) Grounding a child for a month after a very poor report card is received
D) Making a young child sit in a corner after fighting with a younger sibling

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:
A) "A social skills training program would be helpful."
B) "Do you really want to stop being rude when you become angry?"
C) "Patients who have trouble controlling their tempers are often helped by talking with a counselor."
D) "I could recommend for you to enter into therapy with a psychiatrist who is an expert in communications theory."

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?
A) "Would you like to take a 10-minute time-out to get your anger under control?"
B) "It is good that you can display anger. Now, can you tell us what it is you really want to say?"
C) "Would you consider joining Alcoholics Anonymous and offering this up to a higher power?"
D) "Can you feel the love and concern that prompted your family to say these things to you?"

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?
A) "Okay, let's talk about the worst case scenario. What if you're driving in a snow storm with your children in the car and you have an attack?"
B) "I can understand your concern. But keep telling yourself not to worry because panic attacks go away as quickly as they appear."
C) "I can understand that your anxiety over the possibility of experiencing another panic attack could paralyze you with fear."
D) "Let me understand this. You're not afraid of much, but these attacks cause you to be fearful?"

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?
A) "You're young, and you will manage well. I know several people your age who've actually done better after divorcing their spouses."
B) "It always seems bleak when we lose someone we've loved. Don't worry, it will work out-we just need to think this through."
C) "So your spouse is off having a midlife crisis and you are here thinking of killing yourself. Let's focus on how to make you feel better."
D) "I am very concerned about you wanting to die because your spouse left. Rather than trying to solve all the problems immediately let's focus on your feelings of hopelessness right now."

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:
A) "So you've been sick but you're the best seller. That makes you a valued employee."
B) "It's hard to get up one day and find that you're the oldest person in any group. It's only natural that you'd be sicker than everyone else."
C) "You're still the best seller. It's important not to be suspicious of what is probably only a necessary change in health insurance coverage."
D) "So you think that while you're still the best seller the fact you've been sick a lot this year is a problem? You feel that your employer's change in health insurance indicates they want you to leave?"

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

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:

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

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:

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?

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?

Which strategy will help evoke relaxation when using meditation?

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

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:

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

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:

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?

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

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:

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:

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?

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:

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?

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?

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?

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: