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Origin: Chapter 03- Conceptual Frameworks and Theories, 1 Chapter: 03 Client Needs: B Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Nursing process Objective: 01 Page and Header: 42, Theories: Who Cares and So What? 1. A psychiatric–mental health nurse is aware of the importance of theories in the development and delivery of care. Which of the following is the best definition of a theory? A) A group of related concepts or ideas B) A person's or group's beliefs about how something happens or works C) A prediction about two or more concepts D) A researchable question related to health care Ans: B Feedback: A theory is a person's or group's beliefs about how something happens or works. Theories have different explanations to account for human behavior. They also promote interventions consistent with the tenets of their theories. Origin: Chapter 03- Conceptual Frameworks and Theories, 2 Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing process Objective: 01 Page and Header: 42, Theories: Who Cares and So What? 2. Which of the following explains why theories are important to psychiatric–mental health nursing? A) Theories provide more treatment options for clients. B) Theories add professionalism to health care. C) Theories simplify treatment decisions for most clients. D) Theories lead to the expansion of knowledge. Ans: D Feedback: Theories lead to the collection of relevant empirical (factual) data or relations not yet observed, leading to the expansion of knowledge in a field. Theories also incorporate known empirical findings within a logically consistent and reasonably simple framework. They do not necessarily simplify treatment. Increased professionalism is not a central attribute of theories. Origin: Chapter 03- Conceptual Frameworks and Theories, 3 Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 44, General Principles 3. A client has been told by a psychologist that memories in his unconscious are contributing to his depression. This reasoning implies that the psychologist ascribes to what theory? A) Psychoanalytic theory B) Behavior theory C) Cognitive–behavioral theory D) The humanistic perspective Ans: A Feedback: Central to psychoanalytic theory is the idea of the unconscious. A goal of psychoanalysis is to expand awareness of unconscious functioning and its relation to everyday living. The other listed theories do not prioritize the role of the unconscious to the same degree. Origin: Chapter 03- Conceptual Frameworks and Theories, 4 Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 47, Reinforcement 4. A client's current plan of care includes interventions that are rooted in the concepts of reinforcement. Which theory of human behavior is being prioritized during this client's care? A) Humanistic theory B) Sociocultural theory C) Behavioral theory D) Psychoanalytic theory Ans: C Feedback: Behavior theory maintains that all human behavior is learned. Its major focus is on how environmental conditions result in the acquisition, modification, maintenance, and elimination of adaptive and maladaptive behaviors. Reinforcement is a central focus of behavioral theory. Origin: Chapter 03- Conceptual Frameworks and Theories, 5 Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 51, Humanistic Theory 5. A client and her therapist have been discussing the notion that her psychopathology results from the blocking or distortion of personal growth, excessive stress, and unfavorable social conditions. This discussion is congruent with what theory? A) Humanistic theory B) Interpersonal theory C) Biophysiological theory D) Sociocultural theory Ans: A Feedback: Humanistic theory recognizes the importance of learning and other psychological processes that traditionally have been the focus of research. With their positive view of human nature, humanists believe that psychopathology results from the blocking or distortion of personal growth, excessive stress, and unfavorable social conditions. Origin: Chapter 03- Conceptual Frameworks and Theories, 6 Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 02 Page and Header: 47, Reinforcement 6. During marital counseling, a man complains that his wife often “bombards” him with problems as soon as he settles down at home after work, which results in a prolonged argument. The wife admits that she does this but states she feels neglected and that her husband does not take the family problems seriously. She doesn't want her marriage to turn out like her parents' marriage. The wife admits that she sometimes provokes an argument in order to gain her husband's attention. How would a behaviorist most likely explain the wife's actions? A) She has repressed painful memories about her emotionally distant father and is working out her anger at the parent in the marital relationship. B) Her thoughts about her parents' unhappy marriage are a justification for her behavior. C) She has an underlying anxiety disorder. D) The long argument in which she and her husband participate positively reinforces her behavior. Ans: D Feedback: Behavioral theory considers how reinforcement influences behavior. Through reinforcement, a person learns to perform a certain response (behavior) either to receive a reward or to avoid a punishment. The reward in this case is that the wife gets the needed attention from her husband even though it is in the form of an argument. A behaviorist would not likely emphasize the justifications for either person's behavior. Origin: Chapter 03- Conceptual Frameworks and Theories, 7 Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 48, Generalization and Discrimination 7. An adult man recalls that he was teased as a child about his inability to participate in sports. He began to avoid situations in which others might evaluate his behavior. He seeks treatment now because he is an accomplished musician but cannot perform for an audience. According to behavioral theory, his behavior is an example of which of the following concepts? A) Discrimination B) Modeling C) Generalization D) Shaping Ans: C Feedback: Generalization happens when a conditioned response becomes associated with similar stimuli. For example, if a response such as a child's polite behavior (saying “please” or “thank you”) happens at home repeatedly, the child is very likely to display that behavior in circumstances outside the home given similar conditions. Some people who become frightened in specific social situations may begin to avoid similar situations and gradually develop social phobia, in which they avoid all social situations; this may account for this man's fear. Origin: Chapter 03- Conceptual Frameworks and Theories, 8 Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Nursing process Objective: 03 Page and Header: 49, Rationale–Emotive Therapy 8. The nurse is working with a client who admits to having low self-esteem. The care team has determined that cognitive restructuring will likely enhance the client's self-esteem. Which of the following best describes the goals of this intervention? A) Avoid negative self-talk B) Replace negative self-talk with positive statements C) Change distorted thinking and the subsequent behaviors D) Use adaptive defense mechanisms Ans: C Feedback: The goals of cognitive restructuring are for clients to monitor their maladaptive thoughts and beliefs, look for evidence supporting their beliefs, dispute their maladaptive self-statements, substitute adaptive thoughts, and thus change their patterns of distorted thinking and, consequently, their behavior. Origin: Chapter 03- Conceptual Frameworks and Theories, 9 Chapter: 03 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 03 Page and Header: 48, Modeling and Shaping 9. A 55-year-old woman is being treated for narcissistic personality disorder. The therapist demonstrates caring and appropriate regard for the client. The therapist's behavior is an example of which concept of behavior theory? A) Shaping B) Discrimination C) Modeling D) Conditioning Ans: C Feedback: Modeling involves demonstrating desired behavior patterns to a learner. Therapists model behaviors when they teach social skills, such as caring and appropriate regard for others. The therapist models regard for others with the expectation that the learner will copy that behavior. The caring behavior is then reinforced. Given sufficient practice of the caring behavior paired with its reinforcement, regard for others gradually becomes part of the client's behavioral inventory. Origin: Chapter 03- Conceptual Frameworks and Theories, 10 Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Nursing Process Objective: 02 Page and Header: 45, Table 3.1 10. In a group therapy session, group members confront a 35-year-old woman about her abuse of prescription pain medications. The woman states that, because a physician has prescribed her medication, she is not a drug addict. The nurse identifies this as an example of which of the following defense mechanisms? A) Regression B) Projection C) Denial D) Sublimation Ans: C Feedback: Denial is refusing to recognize a reality that might be troublesome or traumatic. Regression refers to going back to an earlier and happier time of development. Projection is when a person refuses to recognize behavior in oneself and instead “projects” it or sees it in someone else. Sublimation means taking repressed feelings and transforming it into positive and constructive pursuits. Origin: Chapter 03- Conceptual Frameworks and Theories, 11 Chapter: 03 Client Needs: C Cognitive Level: Application Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 45, Table 3.1 11. During an admission interview with an adult mental health client, the client begins to talk in a childish voice and says she'd like to be playing with her dolls. What defense mechanism is this client demonstrating? A) Regression B) Suppression C) Repression D) Projection Ans: A Feedback: Regression refers to going back to an earlier and happier time of development. Suppression involves wishing to put something unpleasant out of awareness and voluntarily doing so. Repression involves involuntarily placing material of life experience out of the conscious. Projection is when a person refuses to recognize behavior in oneself and instead “projects” it or sees it in someone else. Origin: Chapter 03- Conceptual Frameworks and Theories, 12 Chapter: 03 Client Needs: B Cognitive Level: Application Difficulty: Difficult Integrated Process: Nursing Process Objective: 03 Page and Header: 46, Conditioning 12. The nurse is conducting a series of workshops on life skills for clients with mental illness. Which of the following is an example of operant conditioning that could be used to help the clients gain appropriate social skills? A) Provide rewards for small approximations of the desired behaviors B) Use positive reinforcement for all of the clients' behaviors C) Use punishment to show the consequences of unacceptable behavior D) Withdraw reinforcement when a client demonstrates undesirable behavior Ans: A Feedback: People respond to achieve something rewarding or to avoid something aversive. In operant conditioning, the response precedes the stimulus. Clients would learn that socially appropriate behavior leads to certain rewards from staff. Thus, they increase that behavior to subsequently increase those positive events. It would be unrealistic for the client to perform the behavior entirely before receiving any reward. Learning is more effective with the use of positive rewards rather than negative reinforcement or punishment. Positive reinforcement is ineffective if applied to all behavior, whether acceptable or unacceptable. Origin: Chapter 03- Conceptual Frameworks and Theories, 13 Chapter: 03 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 02 Page and Header: 44, General Principles 13. During a group session, the nurse therapist experiences frustration and anger related to a client's repeated efforts to redirect the conversation away from the other participants' needs and toward his own priorities. The nurse therapist's “blind spot” is an example of which of the following processes? A) Distorted cognition B) Countertransference C) Respondent conditioning D) Transference Ans: B Feedback: Countertransference refers to the feelings and thoughts that service providers have toward the client. In Countertransference, the provider may harbor certain images of the client that result in “blind spots,” which can be destructive or disruptive to the therapeutic process. Transference refers to feelings and thoughts that clients have toward the service provider. Respondent conditioning happens when a response and a stimulus become connected through repetition. Distorted cognitions are self-defeating thoughts that lead to self-defeating behaviors. Origin: Chapter 03- Conceptual Frameworks and Theories, 14 Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Easy Integrated Process: Teaching/Learning Objective: 02 Page and Header: 47, Reinforcement 14. A parent is trying to teach her child appropriate social behavior by rewarding her child with praise. What type of reinforcement is this individual using? A) Operant reinforcement B) Respondent reinforcement C) Negative reinforcement D) Positive reinforcement Ans: D Feedback: In both positive and negative reinforcement, the person is rewarded for an appropriate response. With positive reinforcement, the response happens by adding something to increase probability. Negative reinforcement involves the termination or removal of a consequence after a desired response to increase the probability of a behavior. Operant and respondent are terms used to describe conditioning, not reinforcement. Origin: Chapter 03- Conceptual Frameworks and Theories, 15 Chapter: 03 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 02 Page and Header: 44, General Principles 15. A client has begun a course of psychoanalysis. According to psychoanalytic theory, the client's notions of right and wrong are controlled by: A) The id B) The superego C) The ego D) Latency Ans: B Feedback: The superego is essentially what Freud thought of as conscience. The id, the original system of the personality, consists of everything psychological a person inherits at birth, including the instincts. The ego mediates between the id and the external world. The ego's function is to meet the needs of the id but in a way that ensures the person's well-being. Origin: Chapter 03- Conceptual Frameworks and Theories, 16 Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 51, General Principles 16. During a client's care conference, a psychiatrist states, “The client's psychopathology is the result of a physiologic condition involving a deviation within her central nervous system.” To what theory does this psychiatrist likely subscribe? A) Sociocultural theory B) Biophysiological theory C) Psychoanalytical theory D) Behavioral theory Ans: B Feedback: The biophysiological perspective proposes that psychopathology results from a physiological condition, primarily a deviation within the central nervous system. The reasons for these deviations are multifaceted, involving a complex interplay of genetics, temperament, development, brain circuitry, molecular biology, and environment. Origin: Chapter 03- Conceptual Frameworks and Theories, 17 Chapter: 03 Client Needs: C Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Nursing Process Objective: 04 Page and Header: 54, Toward a Comprehensive, Multidisciplinary Understanding of Psychopathology 17. A teenage boy with a recent history of mental illness and legal problems states that he grew up in a poor and violent neighborhood. According to Cichetti's theoretical framework, what are these factors known as? A) Protective factors B) Proximal factors C) Risk factors D) Distal factors Ans: C Feedback: Risk factors are variables that impede development and cause hardship (eg, extreme poverty). Protective factors are variables that serve as buffers and have a helpful influence (eg, supportive family). Origin: Chapter 03- Conceptual Frameworks and Theories, 18 Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 03 Page and Header: 52, Sociocultural Theory 18. A therapist has integrated knowledge of a client's unique sociocultural history into the diagnosis and treatment of her mental illness. The therapist has demonstrated an awareness of: A) Demographic anthropology B) Sociocultural anthropology C) Koro anthropology D) Medical anthropology Ans: D Feedback: A rapidly growing discipline known as medical anthropology deals with the cross-cultural study of medical systems and the influence of ecological, biologic, and sociocultural factors on health and disease. Origin: Chapter 03- Conceptual Frameworks and Theories, 19 Chapter: 03 Client Needs: C Cognitive Level: Knowledge Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 56, Community Characteristics (Exosystem) 19. The nurse is assessing a client's socioeconomic and socioeconomic background and has learned that the client grew up in a violence-riddled neighborhood with few support services. Which system did the nurse assess? A) Microsystem B) Exosystem C) Macrosystem D) Otogenic Ans: B Feedback: The exosystem consists of community characteristics. The microsystem includes family characteristics. Origin: Chapter 03- Conceptual Frameworks and Theories, 20 Chapter: 03 Client Needs: C Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 04 Page and Header: 52, The Stress–Diathesis Model 20. A 22 year-old woman has been diagnosed with post-traumatic stress disorder (PTSD) following a military tour of duty. According to the stress–diathesis model, what variable should be considered in addition to the stressors that the woman faced during her service? A) The woman's possible hereditary predisposition to PTSD B) The incidence of PTSD among her peers who served alongside her C) The presence or absence of comorbid mental illnesses D) The influence of the woman's environment before and after her tour of duty Ans: A Feedback: The stress–diathesis model, a popular variation of the biophysiological model, assumes that a disposition (or vulnerability) toward a certain disorder may result from a combination of genetics and early learning. In this model, the effects of life events cannot be understood without considering innate diatheses. These diatheses are prioritized over mental illness in her peers, the presence of comorbidities, or the woman's environment. Origin: Chapter 03- Conceptual Frameworks and Theories, 21 Chapter: 03 Client Needs: C Cognitive Level: Evaluation Difficulty: Difficult Integrated Process: Nursing Process Objective: 02 Page and Header: 49, Rational–Emotive Theory 21. A rational–emotive therapy (RET) therapist has begun a course of therapy with an adult female client who has been diagnosed with obsessive-compulsive disorder (OCD). The therapist is likely to teach the client to: A) Manage her symptoms using the powers of mind control and “centering” B) Recognize the thinking patterns that precede her undesirable behaviors C) Impose moderate punishment on herself to block exacerbations of her symptoms D) Redefine the way that she expects herself to think and behave Ans: B Feedback: RET therapists teach clients to conduct a kind of functional analysis of their own behaviors in which they examine the antecedent condition, or the cognition that precedes behaviors and results in self-statements. This model does not use punishment, mind control, or a redefinition of behavior expectations. Origin: Chapter 03- Conceptual Frameworks and Theories, 22 Chapter: 03 Client Needs: C Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Communication and Documentation Objective: 02 Page and Header: 44, General Principles 22. Evan is a psychiatric–mental health nurse who has been providing inpatient care for Gordon, an adult male client, for several weeks. Which of the Gordon's recent statements would suggest the presence of transference? A) “You have to watch out for people with sticky fingers around here; my stuff's always disappearing.” B) “My meds are making things worse for me, not better.” C) “Most of the nurses here are great, but Evan doesn't have a clue what he's doing.” D) “I'm certain I'd be feeling better if was transferred to a different hospital.” Ans: C Feedback: Transference refers to feelings and thoughts that clients have toward the nurse, psychiatrist, or other service provider. In this case, there is a negative image of the nurse in the client's mind. None of the other given statements refer to a specific individual.