Flashcards in Chapter 03: Relevant Theories and Therapies for Nursing Practice Deck (37)
A parent says, “My 2-year-old child refuses toilet training and shouts “No!” when given directions. What do you think is wrong?” Select the nurse’s best reply.
a. “Your child needs firmer control. It is important to set limits now.”
b. “This is normal for your child’s age. The child is striving for independence.”
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 plan.”
This behaviour is typical of a child around the age of 2 years, whose developmental task is to develop autonomy. The distracters indicate the child’s behaviour is abnormal.
A 26-month-old displays negative behaviour, refuses toilet training, and often says, “No!” Which stage of psychosexual development is evident?
The anal stage occurs from age 1 to 3 years and has as its focus toilet training and learning to delay immediate gratification. The oral stage occurs between birth and 1 year. The phallic stage occurs between 3 and 5 years, and the genital stage occurs between age 13 and 20 years.
A 26-month-old displays negative behaviour, refuses toilet training, and often says, “No!” Which psychosocial crisis is evident?
a. Trust versus mistrust
b. Initiative versus guilt
c. Industry versus inferiority
d. Autonomy versus shame and doubt
The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.
A 4-year-old grabs toys from siblings and says, “I want that now!” The siblings cry, and the child’s parent becomes upset with the behaviour. According to Freudian theory, this behaviour is a product of impulses originating in which system of the personality?
The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behaviour and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother’s wrath. The superego would oppose the impulsive behaviour as “not nice.” The preconscious is a level of awareness. This item relates to an audience response question.
The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. The nurse supports this use of praise related to these behaviours. These qualities are likely to be internalized and become part of which system of the personality?
The superego contains the “should nots,” or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviours. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality-testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort. This item relates to an audience response question.
A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
The individual will be living up to the ego ideal, which will result in positive feelings about self rather than feelings of inferiority. The other options are incorrect because each represents a negative feeling.
An adult says, “I never know the answers,” and “My opinion doesn’t count.” Which psychosocial crisis was unsuccessfully resolved for this adult?
a. Initiative versus guilt
b. Trust versus mistrust
c. Autonomy versus shame and doubt
d. Generativity versus self-absorption
These statements show severe self-doubt, indicating that the crisis of gaining control over the environment was not met successfully. Unsuccessful resolution of the crisis of initiative versus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versus mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of generativity versus self-absorption results in self-absorption that limits the ability to grow as a person.
Which patient statement would lead the nurse to suspect unsuccessful completion of the developmental task of infancy?
a. “I have very warm and close friendships.”
b. “I’m afraid to allow anyone to really get to know me.”
c. “I’m always absolutely right, so don’t bother saying more.”
d. “I’m ashamed that I didn’t do things correctly in the first place.”
According to Erikson, the developmental task of infancy is the development of trust. The correct response is the only statement clearly showing lack of ability to trust others. Warm, close relationships suggest the developmental task of infancy was successfully completed; rigidity and self-absorption are reflected in the belief one is always right; and shame for past actions suggests failure to resolve the crisis of initiative versus guilt.
A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate?
The behaviours in the question develop as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the opposites of these traits.
Which stage of psychosexual development is most relevant to the patient that expresses a desire to be cared for by others and often behaves in a helpless fashion?
Fixation at the oral stage sometimes produces dependent infantile behaviours in adults. Latency fixations often result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an audience response question.
A nurse listens to a group of recent retirees. One says, “I volunteer with Meals on Wheels, coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy taking care of myself to volunteer to help others.” Which developmental task do these statements contrast?
a. Trust and mistrust
b. Intimacy and isolation
c. Industry and inferiority
d. Generativity and self-absorption
Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption. One exemplifies generativity; the other embodies self-absorption. This developmental crisis would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviours that would be contrasted are emotional isolation and the ability to love and commit oneself.
Although ego defence mechanisms and security operations are mainly unconscious and designed to relieve anxiety, the major difference is which of the following?
a. Defence mechanisms are intrapsychic and not observable.
b. Defence mechanisms cause arrested personal development.
c. Security operations are masterminded by the id and superego.
d. Security operations address interpersonal relationship activities.
Sullivan’s theory explains that security operations are interpersonal relationship activities designed to relieve anxiety. Because they are interpersonal, they are observable. Defence mechanisms are unconscious and automatic. Repression is entirely intrapsychic, but other mechanisms result in observable behaviours. Frequent, continued use of many defence mechanisms often results in reality distortion and interference with healthy adjustment and emotional development. Occasional use of defence mechanisms is normal and does not markedly interfere with development. Security operations are ego-centred. This item relates to an audience response question.
A student nurse says, “I don’t need to interact with my patients. I learn what I need to know by observation.” An instructor can best interpret the nursing implications of Sullivan’s theory to this student by responding with which of the following?
a. “Interactions are required in order to help you develop therapeutic communication skills.”
b. “Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills.”
c. “Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions.”
d. “It is important to pay attention to patients’ behavioural changes because these signify adjustments in personality.”
The nurse’s role includes educating patients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy are cornerstones of Sullivan’s theory. The nurse who does not interact with the patient cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the patient. The other distracters relate to Maslow and behavioural theory. This item relates to an audience response question.
A nurse consistently encourages a patient to do his or her own activities of daily living (ADLs). If the patient is unable to complete an activity, the nurse helps until the patient is once again independent. This nurse’s practice is most influenced by which theorist?
a. Betty Neuman
b. Patricia Benner
c. Dorothea Orem
d. Joyce Travelbee
Orem emphasizes the role of the nurse in promoting self-care activities of the patient; this has relevance to the seriously and persistently mentally ill patient.
A nurse uses Maslow’s hierarchy of needs to plan care for a patient with mental illness. Which problem will receive priority?
a. The patient refuses to eat or bathe.
b. The patient reports feelings of alienation from family.
c. The patient is reluctant to participate in unit social activities.
d. The patient is unaware of medication action and adverse effects.
The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning.
Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies?
a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques.
Operant conditioning involves giving positive reinforcement for a desired behaviour. Treats are rewards and reinforce speech through positive reinforcement.
The parent of a child diagnosed with schizophrenia tearfully asks the nurse, “What could I have done differently to prevent this illness?” Select the nurse’s best response.
a. “Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance.”
b. “Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child’s illness.”
c. “There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment.”
d. “Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.”
Patients and families need reassurance that the major mental disorders are biological in origin and are not the “fault” of parents. The parent’s comment suggests feelings of guilt or inadequacy. The nurse’s response should address these feelings as well as provide information. One distracter places the burden of having faulty genes on the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring.
A nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on which of the following?
a. Rewarding desired behaviours
b. Use of own capacities
c. Changing the patient’s self-concept
d. Administering medications to relieve anxiety
The nurse–patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. The theory centres on helping the patient learn to use his or her capacities to live more productively. The distracters apply to theories of cognitive, behavioural, and biological therapy.
A patient had psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method.
a. Rational-emotive behaviour therapy
b. Psychodynamic therapy
c. Cognitive-behavioural therapy
d. Operant conditioning
The techniques are aspects of psychodynamic therapy. The distracters use other techniques.
Consider this comment from a therapist: “The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation.” Which perspective is evident in the speaker?
a. Theory of interpersonal relationships
b. Classical conditioning theory
c. Psychosexual theory
d. Behaviourism theory
The theory of interpersonal relationships recognizes the anxiety and depression as that which arises from social insecurity or that prevents biological needs from being satisfied. Behaviourism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material that relates to the patient problem.
A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with psychoanalytic psychotherapy?
a. Identifying the patient’s strengths and assets
b. Praising the patient for describing feelings of isolation
c. Focusing on feelings developed by the patient toward the therapist
d. Providing psychoeducation and emphasizing medication adherence
Positive or negative feelings of the patient toward the therapist indicate transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common “homework” assignment used in cognitive therapy.
A person says, “I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counsellor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and I’m better now.” Which type of therapy was used?
a. Milieu therapy
c. Behaviour modification
d. Interpersonal psychotherapy
Interpersonal psychotherapy returned the patient to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy. Psychoanalysis would call for a long period of exploration of unconscious material. Behaviour modification would focus on changing a behaviour rather than helping the patient understand what is going on in his life.
Which technique is most applicable to aversion therapy?
c. Role modeling
d. Positive reinforcement
Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behaviour with a noxious stimulus, punishment, and avoidance training.
A patient says to the nurse, “My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child.” Which term applies to the patient’s comment?
c. Reality testing
Transference refers to feelings a patient has toward the health care worker that were originally held toward significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker has toward the patient. The superego represents the moral component of personality; it seeks perfection.
A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this patient?
b. Milieu therapy
c. Systematic desensitization
d. Short-term dynamic therapy
Systematic desensitization is a type of therapy aimed at extinguishing a specific behaviour, such as those associated with a fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Milieu therapy involves environmental factors.
Which approach would be best to provide therapy in which peers as well as staff have a voice in determining patients’ privileges and psychoeducational topics?
a. Milieu therapy
b. Cognitive therapy
c. Short-term dynamic therapy
d. Systematic desensitization
Milieu therapy is based on the idea that all members of the environment contribute to the planning and functioning of the setting. The distracters are individual therapies that do not fit the description.
A patient repeatedly stated, “I’m stupid.” Which statement by that patient would show progress resulting from cognitive behavioural therapy?
a. “Sometimes I do stupid things.”
b. “Things always go wrong for me.”
c. “I always fail when I try new things.”
d. “I’m disappointed in my lack of ability.”
“I’m stupid” is a cognitive distortion. A more rational thought is “Sometimes I do stupid things.” The latter thinking promotes emotional self-control. The distracters reflect irrational or distorted thinking. This item relates to an audience response question.
A patient says, “All my life I’ve been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent.” Which of the following is this patient experiencing?
a. A self-esteem deficit
b. A cognitive distortion
c. A deficit in motivation
d. A deficit in love and belonging
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. See related audience response question.
A patient is fearful of riding on elevators. The therapist first rides an escalator with the patient. The therapist and patient then stand in an elevator with the door open for five minutes and later with the elevator door closed for five minutes. Which technique has the therapist used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rational emotive therapy
Systematic desensitization is a form of behaviour modification therapy that involves the development of behaviour tasks customized to the patient’s specific fears. These tasks are presented to the patient while using learned relaxation techniques. The patient is incrementally exposed to the fear.