Chapter 31: Therapeutic Groups My Nursing Test Banks

Chapter 31: Therapeutic Groups

Test Bank

MULTIPLE CHOICE

1. Which question should a nurse pose initially to a patient being considered for inclusion into a therapeutic group that focuses on the management of bipolar disorder?

a.

Do you find it difficult to talk to people about your manic periods?

b.

Can you share with me what it is you hope to gain from this group?

c.

Can you tell me how this diagnosis has affected your daily life?

d.

What is your opinion about joining a therapeutic group?

ANS: D

A screening interview for a therapeutic group is conducted to assess the candidates eligibility for inclusion into the group. Determining whether the patient has any preconceived opinions about such a therapeutic environment would be the initial appropriate action.

DIF: Cognitive Level: Application REF: Text Page: 621

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

2. Which statement should a nurse make in the orientation stage of the initial phase of a therapeutic group?

a.

Id like to take this opportunity to review the goals for this group.

b.

You all are experiencing similar challenges, and this group will help you develop a support network.

c.

The group is about sharing both your challenges and your successes with each other.

d.

Please be sure to attend as many meetings as possible; it is important that you be here for yourself and the group.

ANS: A

In the orientation stage, the groups facilitator clarifies the groups primary tasks and helps the group to agree to the contracted goals. The remaining options are discussed in other phases once the patient has agreed to the initial terms.

DIF: Cognitive Level: Analysis REF: Text Pages: 621-622

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

3. Which statement by the nurse reflects the best understanding of the issues that are addressed when establishing the contract for a therapeutic group?

a.

What is said in this group is confidential and will not be discussed outside the meeting.

b.

The group contract cannot be broken and will not be altered once it is agreed on by the entire group.

c.

You may bring food and beverages to the meeting, but we will be responsible for cleaning up the room when we are finished.

d.

In order to best think about what we learn in this group each of you will be asked to write your thoughts in a personal journal.

ANS: A

Issues that commonly are included in a groups contract include goals, confidentiality, meeting times, honesty, structure, and communication rules.

DIF: Cognitive Level: Application REF: Text Pages: 621-622

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

4. One patient in a social skills group shares, I feel like Im the only one who says anything in here. Which statement made by the nurse facilitator would have the greatest therapeutic effect on the group?

a.

Can anyone in this group respond to the statement?

b.

The reason you feel this way is because you do all the talking.

c.

Does everyone agree that no other members have participated in discussion?

d.

I agree that you have contributed greatly to the discussion in todays group.

ANS: D

The facilitator uses confrontation by indicating that it is true that the patient has done all the talking in the group today. This is done by a good facilitator in order to spark the other group members into contributing to the statement in a safe environment. Good group facilitators will use active dimensions of empathy, genuineness, and confrontation. The above is an example of confrontation without judgment and with genuineness and empathy.

DIF: Cognitive Level: Analysis REF: Text Page: 625

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

5. A patient in a therapeutic group expresses resistance by stating, I need to drop out of this group because I dont think Im getting enough from it. Which outcome would be most appropriate for this patient?

a.

The patient stays in the group and works out problems.

b.

The patient leaves the group and enters individual therapy.

c.

The patient stays in the group but enters long-term psychotherapy.

d.

The patient leaves the group and enters one that provides more one-on-one time.

ANS: A

Patients are screened before admission to a group to assure that it is a therapeutic modality for the patient. Being able to persist in a therapeutic group and work through problems is a successful outcome. The other options identify alternatives to persisting and achieving success with the original modality.

DIF: Cognitive Level: Application REF: Text Pages: 623-624

TOP: Nursing Process: Outcome Identification

MSC: NCLEX: Psychosocial Integrity

6. A group member says to a nurse facilitator, Why dont you say something? Its not just me; there are others in this group who feel that you could do more in here. Which statement shows the best therapeutic communication on the part of the nurse?

a.

So, you and others feel that I could do more in here?

b.

You sound enraged. Lets discuss what is making you so angry with me.

c.

I dont remember the group contract requiring that I actively participate in the discussions.

d.

If I understand you correctly, you and others in this group feel that I should take a more active role in group sessions?

ANS: D

The most therapeutic nursing communication is the one that paraphrases and reflects back the affective domain to the group. When group members express anger or frustration with the group, it is important for the leader to give permission for the group to be angry and for the group to observe that anger does not destroy the leader.

DIF: Cognitive Level: Application REF: Text Page: 625

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

7. Which of these observations would indicate to the nurse facilitator that some members of a therapeutic anger management group are demonstrating resistance?

a.

Four of the group members share that the discussion is making them sad.

b.

Three members claim, We dont have problems controlling our tempers.

c.

Two of the members are overheard discussing their fear of disappointing the nurse.

d.

Several members share that they have physically and verbally abused their significant others in the past.

ANS: B

Group resistance may be observed when members form subgroups, conflict occurs, resistance occurs, or self-disclosure occurs. Individual resistance is demonstrated when a single member of the group denies having the problem the group is focusing on. Other examples include shared silence among members, scapegoating, wishing for magical solutions, and unusual amounts of group dependency.

DIF: Cognitive Level: Analysis REF: Text Page: 624

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

8. A member of a social skills group says, Im leaving town. Ive been offered a better job, and I want to create new memories with new friends. Which nursing intervention would initially be the most therapeutic facilitation of this members termination from the group?

a.

Thank the member for sharing before focusing on the groups agenda.

b.

Provide adequate time for the members to exchange goodbyes with each other.

c.

Direct group reflection regarding the ultimate termination of the group itself.

d.

Allow the members to share any negative feelings regarding the termination.

ANS: B

When a member of the group prematurely terminates, it is initially important for the group members to have time to say goodbye, followed by a discussion related to their feelings and growth in the group and reminiscing. Avoiding this would hinder the emotional growth of the group members.

DIF: Cognitive Level: Application REF: Text Page: 624

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

9. After facilitating a therapeutic group, the nurse leader separately documents both individual and group data. Which observation would the nurse leader include in an individual note?

a.

Group focused on results of medication noncompliance.

b.

Member successfully identified the likely causes for recent relapse.

c.

Three group members asked to change the time of scheduled sessions.

d.

Decision was made to discuss reasons for acceptable absenteeism at next session.

ANS: B

Individual group member responses, such as the attainment of a goal, would be appropriately documented in an individual note. Group phenomena belong in the group session notes and include membership (absences, tardiness); pertinent behavior discussed by the group; group themes; important group process issues; and any critical leadership strategies required. The therapist also might predict future strategies and behaviors.

DIF: Cognitive Level: Application REF: Text Pages: 624-625

TOP: Nursing Process: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. Which nursing intervention would the nurse employ to help reduce group resistance?

a.

Review accepted guidelines in the groups orientation stage.

b.

Make group acceptance criteria as nonrestricting as possible.

c.

Employ pretesting and posttesting regarding each session topic.

d.

Avoid personal consequences for member absenteeism and tardiness.

ANS: A

Clear group guidelines that have been reviewed during the screening process and with the group will help reduce group resistance.

DIF: Cognitive Level: Application REF: Text Pages: 621-622

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

11. A nurse who facilitates a group for parents of children diagnosed with schizophrenia joins a peer support group for advanced practice psychiatric nurses. Which comment indicates that the nurse is using this group appropriately?

a.

I love my work, but if you measure your success by the money you earn, nursing is not the profession for you.

b.

Are any of you married or have young children? Working as a nurse is certainly challenging if you have children at home.

c.

I am feeling so ineffective since a members child was found dead after having spent the night sleeping outside in the cold.

d.

Do any of you have a family member or friend who has been diagnosed with schizophrenia? We can talk about your concerns after the meeting.

ANS: C

Peer support groups provide an avenue for professional nurses who facilitate stressful groups to share their problems and the stresses related to their work. Appropriate topics include case consultation, sharing of information about educational opportunities, discussion of management skills, general sharing of information, and discussion of strategies to reduce professional isolation. Less appropriate topics for such a group are personal comments that are more social in nature and probing comments that relate to personal rather than professional concerns.

DIF: Cognitive Level: Application REF: Text Page: 626

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

12. Which length of time should a nurse allocate for a session focusing on the drug fluphenazine (Prolixin) with a medication group for cognitively impaired patients diagnosed with schizophrenia?

a.

20 minutes

b.

50 minutes

c.

60 minutes

d.

130 minutes

ANS: A

The optimum length of time for a group session comprised of lower-functioning patients is 20 to 40 minutes, and 60 to 120 minutes is the optimum length of time for higher-functioning groups.

DIF: Cognitive Level: Comprehension REF: Text Page: 618

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

13. The nurse is leading a therapy session dealing with group guidelines. The nurse is confident that a chronically late patient is demonstrating a maintenance role when she states:

a.

I guess the reason Im chronically late is that I dont particularly value what we do in here. Who believes that this stuff really works outside this group?

b.

I know that I struggle to be on time, too. Can we agree to try to be on time and that we will start the group session after waiting only 5 minutes?

c.

Although the rules were agreed on by everyone when the group was formed, I believe we should review them now.

d.

I thought we agreed last week that the rule was that everyone needed to be on time if possible.

ANS: B

Maintenance roles include the roles of harmonizer and rule maker. The correct option reflects both roles. The remaining options demonstrate disharmony or rule breaking.

DIF: Cognitive Level: Application REF: Text Page: 619

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

14. During a group session one member accuses another of making fun of him to a nonmember. The other member denies the claim, adding, I wasnt talking about you at all. Which response by the nurse would have the greatest therapeutic value to the issue of group confidentiality?

a.

Im very disappointed to hear that confidentiality is not taken seriously by members of this group.

b.

It sounds as though neither of you are acting in a manner that is mutually respectful. What do the rest of you think?

c.

It appears that we need to revisit the guidelines for group meetings. Do we all agree that what is discussed in this group needs to stay in the group?

d.

While there may be times when we are tempted to talk with others about things discussed in group, it is not allowed because it could result in hurt feelings.

ANS: C

It is important that all members of the group agree about the groups confidentiality. Not taking sides with one of the group members is an important rule to follow as a group facilitator. By encouraging the group members to share thinking in a matter-of-fact way, the nurse reduces the emotional components and promotes the groups cohesiveness.

DIF: Cognitive Level: Analysis REF: Text Page: 620

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

15. Which comment by the nurse would be most therapeutic when a group member challenges a nurse leaders authority?

a.

Who do you think should be the group leader, if not me?

b.

So youre asking, Who made me the leader?

c.

Do you want to be the group leader?

d.

You resist my authority?

ANS: B

It is important for the nurse leader to provide a safe place for group members to challenge authority. The nurse leader must be clear in the derivation of his or her authority and feel sufficiently comfortable in the leader role to allow it to be humanized. Direct and clear clarification is most helpful here. The nurse can follow the answer with criteria for the leader role and what the group can expect from him or her. Humor can help to diffuse any tension or frustration and allow the group member to feel supported in directly verbalizing feelings within the group. Seeking to control can be manipulative or intimidating, and challenging the group would be aggressive.

DIF: Cognitive Level: Analysis REF: Text Page: 618 | Text Page: 622

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

16. Which goal applies to a brief therapy group?

a.

Determine the underlying cause of the chief problem.

b.

Identify maladaptive behaviors that hinder recovery.

c.

Substitute ineffective strategies with effective ones.

d.

Facilitate members abilities to effectively manage self-care.

ANS: C

The goal of brief therapy groups is to identify the ineffective problem-solving approaches and replace them with more adaptive ones. These groups are favored by managed care as a cost-effective method of treatment. The focus is always on the actions that members can take now to improve their situations.

DIF: Cognitive Level: Comprehension REF: Text Page: 626

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

17. What outcome would be most important for a nurse facilitator to include in a plan of care for a support group for parents of children with attention-deficit/hyperactivity disorder (ADHD)? Parents will be able to:

a.

parent all children in the family with equality.

b.

share feelings with other members of the group.

c.

assist hyperactive children to modify their behavior.

d.

discipline all children with equal negative reinforcement.

ANS: B

The primary purpose of support groups is to help members to cope with personal life stresses. In a support group, members examine dysfunctional thoughts, feelings, and behaviors by sharing and talking things out with other members.

DIF: Cognitive Level: Application REF: Text Page: 626

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

18. A member in a psychotherapy group tells another member, Im tired of hearing you whine all the time. Why wont you just try to stick with the topic we are trying to discuss? The nurse recognizes that the criticized member of the group best understands the goal of group work when he is heard stating:

a.

You are always criticizing me. Dont talk to me like that.

b.

I understand that you have a hard time talking with people. I do too.

c.

You seem to always say nasty things that will hurt peoples feelings. Maybe you should think before you speak.

d.

Ive learned that speaking without thinking often results in hurt feelings. We all need to think before we speak.

ANS: D

The goal of a psychotherapy group is the treatment of emotional, cognitive, or behavioral dysfunction. Group techniques and processes are used to help members learn about their behavior with other people and how it relates to core personality traits. The intent is for the members to change their behavior, not just understand or seek support for it.

DIF: Cognitive Level: Application REF: Text Page: 626

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

19. Which is an appropriate nurse-led educational group?

a.

Smoking cessation group

b.

Parents without partners

c.

A medication group

d.

Grieving a loss

ANS: C

Using the process of elimination, the medication group is the only educational group among the options. The remaining options are self-help or activity groups.

DIF: Cognitive Level: Comprehension REF: Text Page: 626

TOP: Nursing Process: Planning

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

20. Which documentation by a nurse leader best indicates that the group was demonstrating an appropriate pattern of interaction during the group process?

a.

Not all group members chose to communicate equally on the topics discussed.

b.

Members removed unused chairs because they felt the chairs were a distraction.

c.

Group members shared today while the group was in session.

d.

The absence of one member was noted by the group.

ANS: B

The group leader would document observable verbal and nonverbal elements of the groups communication, including spatial and seating arrangements, common themes expressed by the group, how often and to whom members communicate, how members are heard in the group, and what problem-solving processes occur in the group. The remaining options do not meet the criteria for documentation of communication patterns during the group process.

DIF: Cognitive Level: Analysis REF: Text Page: 619

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

21. Which example best describes an unresolved issue that should be further discussed at a future group meeting?

a.

The seating of the two new members to the group

b.

The identification of the goals successfully accomplished

c.

An individual termination that was not anticipated by group members

d.

The group leaders role now that the group has been meeting for 4 weeks

ANS: C

When there is an unanticipated termination of a group member, the entire group needs to process the event in order to progress effectively with the work of the group.

DIF: Cognitive Level: Application REF: Text Page: 624

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

MULTIPLE RESPONSE

1. A male nurse and female psychiatric medical resident are leading a therapeutic group. Which statement made by a group member, would indicate acceptance regarding group leadership? (Select all that apply.)

a.

Im glad the resident is a female. We women will have the power for a change.

b.

I guess I dont always treat you both with the respect that professionals deserve.

c.

Its not often that you see a doctor and a nurse working together leading a group.

d.

Im glad there are two of you since two viewpoints are always better than one.

e.

Its really good to see a male finally being willing to share power with a female.

ANS: B, C, D

The patient is projecting feelings of powerlessness and possibly resentment to the group, and this may be a splitting mechanism as well. The remaining options do not present a challenge to the co-leadership of the team.

DIF: Cognitive Level: Analysis REF: Text Pages: 623-624

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

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