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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.