Chapter 27: Behavior Change and Cognitive Interventions My Nursing Test Banks

Chapter 27: Behavior Change and Cognitive Interventions

Test Bank

MULTIPLE CHOICE

1. A patient says, My partner doesnt love me! Even the roses I get are the wrong color. It doesnt matter if I am not happy. The nurse responds:

a.

How do you want your partner to show you that youre 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 doesnt love you because the gifted roses were of the wrong color?

ANS: D

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 patients statements allows the patient to listen with a third ear and take a view that places the event in perspective.

DIF: Cognitive Level: Analysis REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. A patient says, Ive been sick a lot this last year but Im 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 youve been sick but youre the best seller. That makes you a valued employee.

b.

Its hard to get up one day and find that youre the oldest person in any group. Its only natural that youd be sicker than everyone else.

c.

Youre still the best seller. Its important not to be suspicious of what is probably only a necessary change in health insurance coverage.

d.

So you think that while youre still the best seller the fact youve been sick a lot this year is a problem? You feel that your employers change in health insurance indicates they want you to leave?

ANS: D

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 patients perspective in a neutral, nonjudgmental style of communication helps the patient to take this first step. The antecedent and feared consequences also are identified.

DIF: Cognitive Level: Analysis REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

3. A patient tearfully says to a nurse, I dont want to go on living now that my spouse has left me for someone else after 20 years. Our children are grown and dont need me. I just want to die. Which response is the most therapeutic?

a.

Youre young, and you will manage well. I know several people your age whove actually done better after divorcing their spouses.

b.

It always seems bleak when we lose someone weve loved. Dont worry, it will work outwe just need to think this through.

c.

So your spouse is off having a midlife crisis and you are here thinking of killing yourself. Lets 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 lets focus on your feelings of hopelessness right now.

ANS: D

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.

DIF: Cognitive Level: Analysis REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

4. A patient tells a nurse, I want my own private room because my roommate is always watching football on television. He probably thinks Im gay because I dont like football. Which communication best reflects a cognitive behavioral assessment by the nurse?

a.

You feel your roommate thinks youre gay because you dont like football and he spends his time watching football? How will getting a private room change things?

b.

Its hard to feel excluded, but isolating yourself is not the answer. Perhaps you might try watching football with him.

c.

Dont you think your roommate will be more likely to think youre gay if you get a private room?

d.

Well, you must realize that most men like football, but that doesnt mean he will think you are gay.

ANS: A

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 patients perspective and asks how the ineffective problem solving will change things.

DIF: Cognitive Level: Application REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

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

ANS: C

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.

DIF: Cognitive Level: Application REF: Text Page: 563

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

6. Which response best indicates that a nurse is employing reframing with a patient who responds angrily and aggressively when family members confront the patients 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?

ANS: D

In reframing, the nurse changes the meaning of a behavior in order to change the patients response. In this situation, the nurse helps the patient to view the familys behavior as concern rather than as an attack.

DIF: Cognitive Level: Application REF: Text Page: 567

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. 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.

ANS: C

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 individuals viewpoint.

DIF: Cognitive Level: Comprehension REF: Text Page: 568

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. 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

ANS: D

Meditation requires a quiet milieu, a passive attitude, a focus word or scene, and a comfortable position.

DIF: Cognitive Level: Comprehension REF: Text Page: 563

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. 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

ANS: C

Token economy, a form of positive reinforcement, has been used successfully to reward patients for performing behaviors such as the activities of daily living.

DIF: Cognitive Level: Application REF: Text Page: 568

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10. 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.

ANS: A

Social skills training is often helpful for patients who have trouble with assertiveness and with managing their anger.

DIF: Cognitive Level: Analysis REF: Text Page: 568

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

11. 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.

ANS: B

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 patients original statement.

DIF: Cognitive Level: Application REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

12. A high school student says to the school nurse, If I dont 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.

Its 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.

ANS: D

The patient is projecting perfectionism onto the criteria for college acceptance. Perfectionism is a cognitive distortion, and this is best explored by reflecting the patients distortion back to have the patient reexamine his or her thinking.

DIF: Cognitive Level: Analysis REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

13. A patient says, The people I work with hate me even though Im given the hardest assignment. My boss makes it look like Im doing less than the others. An appropriate response by the nurse would be:

a.

It seems like youre in a very difficult position. No job is worth that kind of stress. Why not change jobs?

b.

You cant have the hardest assignment and yet your co-workers dont see that and hate you. How can you be so sure that youre 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 wont see that its hard, and theyll hate you.

ANS: D

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.

DIF: Cognitive Level: Analysis REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14. A patient says, When I lost weight, everyone was so nice to me. Now that Ive regained the weight, people dont want anything to do with me. They think Im just a fat pig. The nurses 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 dont 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?

ANS: A

The patient is cognitively distorting by externalizing self-worth. The most therapeutic communication is the one that summarizes the patients viewpoint and reflects it back for the patient to hear in a nonjudgmental way.

DIF: Cognitive Level: Analysis REF: Text Page: 564

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15. A patient says, There arent many things in life that Im really afraid of, but Im so afraid that Ill have another panic attack when I least expect it. Which question indicates the nurse is using decatastrophizing?

a.

Okay, lets talk about the worst case scenario. What if youre 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. Youre not afraid of much, but these attacks cause you to be fearful?

ANS: A

Decatastrophizing is also called the what-if technique. The goal of this technique is to help the patient see that the consequences of lifes actions are generally not catastrophic.

DIF: Cognitive Level: Application REF: Text Pages: 566-567

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

16. 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

ANS: C

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.

DIF: Cognitive Level: Application REF: Text Pages: 567-568

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

17. 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

ANS: A

Extinction is the process of eliminating a behavior by ignoring it or not rewarding it.

DIF: Cognitive Level: Application REF: Text Page: 565

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18. 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

ANS: B

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.

DIF: Cognitive Level: Comprehension REF: Text Page: 565

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

19. 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.

ANS: B

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.

DIF: Cognitive Level: Comprehension REF: Text Pages: 564-565

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20. 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

ANS: C

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.

DIF: Cognitive Level: Application REF: Text Page: 563

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

21. A nurse determines that a patient with a fear of insects has mastered the first step in a systematic desensitization process when the patient is able to:

a.

relax the muscles of the body.

b.

look at a picture of an insect in a book.

c.

rate anxiety produced by various insects.

d.

touch a clear glass bottle containing an insect.

ANS: A

With systematic desensitization, the patient must first be able to relax the muscles. Next, the patient constructs a hierarchy of the anxiety-producing situation (insects) by ranking them from 1 to 10. The patient then proceeds to work through the hierarchy, using muscle relaxation to maintain a relaxation response in the face of fearful stimuli.

DIF: Cognitive Level: Application REF: Text Page: 563

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

22. A nurse would implement social skills training for a patient with which problem?

a.

Anxiety

b.

Binge eating

c.

Poor impulse control

d.

Obsessive-compulsive disorder

ANS: C

Social skills training is most often used with patients who lack social skills, assertiveness (assertiveness training), or impulse control (anger management) and those with antisocial behavior.

DIF: Cognitive Level: Analysis REF: Text Page: 568

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

23. Which strategy for assisting patients to learn new behavior is considered by some to be questionable?

a.

Shaping

b.

Token economy

c.

Aversion therapy

d.

Contingency training

ANS: C

Aversion therapy applies an aversive or noxious stimulus when a maladaptive behavior occurs. Aversion therapy has sometimes been criticized as unethical and detrimental to patients well-being since it subjects the patient to physically and emotionally unpleasant or even harmful experiences.

DIF: Cognitive Level: Comprehension REF: Text Page: 568

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

24. The most appropriate nursing intervention for a patient in the third stage of change is:

a.

helping the patient see the benefit of changing the problematic behavior.

b.

assisting the patient with the development of realistic treatment goals.

c.

developing relapse prevention plans in anticipation of potential failures.

d.

providing nurse-patient interactions that discuss change in a relaxed environment.

ANS: B

During the third stage of change (preparation) the patient has made a decision to change and is assessing how that decision feels. Patients can be helped to select realistic treatment goals and different ways to reach those goals. They need to be actively involved in designing their own strategies for change.

DIF: Cognitive Level: Analysis REF: Text Page: 561

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

25. What is the correct order for performing progressive muscle relaxation (PMR)?

a.

Tensing and relaxing muscle groups from the middle of the body outward to the extremities

b.

Relaxing and tensing muscle groups from the middle of the body outward to the extremities

c.

Tensing and releasing muscle groups from the facial muscles and moving down to the muscles in the feet

d.

Relaxing and tightening muscle groups from the facial muscles and moving down to the muscles in the feet

ANS: C

PMR uses a process of tensing and releasing muscle groups, starting from facial muscles and moving down the body to the muscles in the feet. Patients are taught to perform the technique systematically to gain control over anxiety-provoking thoughts and muscle tension.

DIF: Cognitive Level: Comprehension REF: Text Page: 563

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1. Which clinical manifestation would indicate to a nurse that a patient has been employing relaxation training successfully? (Select all that apply.)

a.

Decreased blood pressure

b.

Decreased bowel sounds

c.

Decreased respirations

d.

Decreased apical pulse

e.

Decreased pupil size

ANS: A, C, D, E

The manifestations of relaxation include reduced blood pressure, pulse, peripheral temperature, and respirations; peripheral vasoconstriction; and constricted pupils. Bowel sounds would not necessarily be affected.

DIF: Cognitive Level: Application REF: Text Page: 563

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

2. When describing cognitive behavioral therapy, it would be stressed that nursing is responsible for: (Select all that apply.)

a.

providing direct patient care.

b.

assisting in actual psychotherapy sessions.

c.

participating in planning the treatment program.

d.

teaching family members how to use cognitive behavioral techniques.

e.

reinforcing the expectations of the planned interventions of the treatment plan.

ANS: A, C, D, E

Three basic roles for nurses involved in cognitive behavioral therapy at all levels of practice (novice through generalist and specialist) are as follows: providing patient care, planning treatment programs, and teaching others the use of cognitive behavioral strategies.

DIF: Cognitive Level: Comprehension REF: Text Pages: 568-569

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

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