Deck 7: Models for Working With Psychiatric Patients

Question 1

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

A) "I wish I had more 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 not ashamed of cheating at work."

Answer 1

"I am afraid to let anyone really get to know me."

Question 2

The nurse who uses the interpersonal model as a basis for practice will focus assessment on identifying which patient issue?

A) Intrapsychic conflicts
B) Relationship problems
C) How the environment affects behavior
D) The patient's achievement of development tasks

Answer 2

Relationship problems

Question 3

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

Answer 3

Rationalization

Question 4

During an interdisciplinary team meeting, a nurse shares that, "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 5

A nurse plans an intervention to support a patient's ego. What makes supporting ego a therapeutic intervention?

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

Question 6

The parent of a 26-month-old child 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 7

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 8

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 9

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 10

A young adult who has few interpersonal relationships, says, "Most people can't be trusted." This person makes decisions only after consulting with his parents. Using Erikson 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.

Question 11

A patient experiencing severe panic attacks uses denial, repression, and displacement. Which nursing statement reflects an appropriate intervention regarding this patient's needs?

A) "We are going to focus on exposing you to more effective coping strategies."
B) "You will benefit from setting limits on use of the defense mechanisms."
C) "We will discuss the benefit of changing values and beliefs."
D) "Let's discuss helping you uncover the unconscious conflicts causing you trouble."

Question 12

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 help yourself 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."

Question 13

When interacting with patients, it is important for the nurse to recognize that defense mechanisms are used for what outcome?

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 14

A patient asks, "Why is it important to uncover memories and conflicts hidden in the unconscious?" According to Freud, what effect does this intervention support?

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

Question 15

A patient uses defense mechanisms excessively. The nurse should expect to find evidence that the patient is demonstrating what resulting effect?

A) The patient has difficulty with problem-solving.
B) The patient has an increased risk for psychosis.
C) The patient's emotions are experienced with great intensity.
D) The patient regularly denies reality.

Question 16

What should be the initial assessment in the rational-emotive therapy process implemented to help the chronically depressed patient?

A) Presence of developmental tasks and progress
B) The management of environmental stressors
C) The childhood influences on the patient's emotional state
D) The presence of irrational beliefs related to painful feelings

Question 17

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

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 18

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 19

When a nurse uses the interpersonal model as a basis for practice, which goal is most appropriate for the patient care plan?

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 20

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 what defense mechanism?

A) Displacement
B) Compensation
C) Conversion
D) Regression

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 achieving what patient goal?

A) Altering the patient's irrational thoughts
B) Enhancing the patient's willingness to change behavior
C) Managing the patient's anxiety through satisfying interpersonal interactions
D) Mastering critical developmental tasks the patient did not attained earlier in life

Question 22

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 theory to this student by responding which statement?

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."

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