Ch. 3 Flashcards
A 26-month-old child displays negative behaviors. The parent says, “My child refuses toilet training and shouts, ‘No!’ when given direction. What do you think is wrong?” Select the nurse’s best reply.
a.
“This is normal for your child’s age. The child is striving for independence.”
b.
“The child needs firmer control. Punish the child for disobedience and say, ‘No.’”
c.
“There may be developmental problems. Most children are toilet trained by age 2 years.”
d.
“Some undesirable attitudes are developing. A child psychologist can help you develop a remedial plan.”
ANS: A
These negative behaviors are typical of a child around the age of 2 years whose developmental task is to develop autonomy. The remaining options indicate the child’s behavior is abnormal.
DIF: Cognitive Level: Application REF: Pages: 28-30
A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, “No!” when given directions. Using Freud’s stages of psychosexual development, a nurse would assess the child’s behavior is based on which stage?
a.
Oral
b.
Anal
c.
Phallic
d.
Genital
ANS: B
In Freud’s stages of psychosexual development, 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 13 and 20 years.
DIF: Cognitive Level: Comprehension REF: Pages: 28-30
A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, “No!” when given direction. The nurse’s counseling with the parent should be based on the premise that the child is engaged in which of Erikson’s psychosocial crises?
a.
Trust versus Mistrust
b.
Initiative versus Guilt
c.
Industry versus Inferiority
d.
Autonomy versus Shame and Doubt
ANS: D
The crisis of Autonomy versus Shame and Doubt is related 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, and Industry versus Inferiority is the crisis of the 6- to 12-year-old child.
DIF: Cognitive Level: Comprehension REF: Pages: 28-30
A 4-year-old child grabs toys from siblings, saying, “I want that toy now!” The siblings cry, and the child’s parent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the child’s behavior as a product of impulses originating in the:
a.
id.
b.
ego.
c.
superego.
d.
preconscious.
ANS: A
The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the parent’s wrath. The superego would oppose the impulsive behavior as “not nice.” The preconscious is a level of awareness.
DIF: Cognitive Level: Application REF: Pages: 28-30
The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. A nurse supports the use of praise because according to the Freudian theory, these qualities will likely be internalized and become part of the child’s:
a.
id.
b.
ego.
c.
superego.
d.
preconscious.
ANS: C
In the Freudian theory, the superego contains the “thou shalts” or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. 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 easily retrieved with conscious effort.
DIF: Cognitive Level: Comprehension REF: Pages: 26-30
A nurse supports parental praise of a child who is behaving in a helpful way. When the individual behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
a.
Guilt
b.
Anxiety
c.
Loneliness
d.
Self-esteem
ANS: D
The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options are incorrect; each represents a negative feeling.
DIF: Cognitive Level: Comprehension REF: Pages: 26-30
A patient comments, “I never know the right answer” and “My opinion is not important.” Using Erikson’s theory, which psychosocial crisis did the patient have difficulty resolving?
a.
Initiative versus Guilt
b.
Trust versus Mistrust
c.
Autonomy versus Shame and Doubt
d.
Generativity versus Self-Absorption
ANS: C
These statements show severe self-doubt, indicating that the crisis of gaining control over the environment is not being successfully met. 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.
DIF: Cognitive Level: Application REF: Pages: 28-30
Which patient statement would lead a nurse to suspect that the developmental task of infancy was not successfully completed?
a.
“I have very warm and close friendships.”
b.
“I’m afraid to let anyone really get to know me.”
c.
“I am always right, so don’t bother saying more.”
d.
“I’m ashamed that I didn’t do it correctly in the first place.”
ANS: B
According to Erikson, the developmental task of infancy is the development of trust. The patient’s statement that he or she is afraid of becoming acquainted with others clearly shows a lack of ability to trust other people. Having warm and close friendships suggests the developmental task of infancy was successfully completed. The third option suggests rigidity rather than mistrust. The fourth option suggests failure to resolve the crisis of Initiative versus Guilt.
DIF: Cognitive Level: Analysis REF: Pages: 28-30|Page: 35
A nurse assesses that a patient is suspicious and frequently manipulates others. Using the Freudian theory, these traits are related to which psychosexual stage?
a.
Oral
b.
Anal
c.
Phallic
d.
Genital
ANS: A
According to Freud, each of the behaviors mentioned develops 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, and a strong sense of personal identity.
DIF: Cognitive Level: Application REF: Pages: 27-30
An adult expresses the wish to be taken care of and often behaves in a helpless fashion. This adult has needs related to which of Freud’s stages of psychosexual development?
a.
Latency
b.
Phallic
c.
Anal
d.
Oral
ANS: D
According to Freud, fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in a 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.
DIF: Cognitive Level: Application REF: Pages: 27-30
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. I don’t have time to help others.” These comments contrast which developmental tasks?
a.
Trust versus Mistrust
b.
Industry versus Inferiority
c.
Intimacy versus Isolation
d.
Generativity versus Self-Absorption
ANS: D
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. The developmental crisis of Trust versus Mistrust would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate the developmental crisis of Industry versus Inferiority would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviors that would be contrasted in the crisis of Intimacy versus Isolation would be emotional isolation and the ability to love and commit to oneself.
DIF: Cognitive Level: Application REF: Pages: 28-30
Cognitive therapy was provided for a patient who frequently said, “I’m stupid.” Which statement by the patient indicates the therapy was effective?
a.
“I’m disappointed in my lack of ability.”
b.
“I always fail when I try new things.”
c.
“Things always go wrong for me.”
d.
“Sometimes I do stupid things.”
ANS: D
“I’m stupid” is an irrational thought. A more rational thought is, “Sometimes I do stupid things.” The latter thinking promotes emotional self-control. The incorrect options reflect irrational thinking.
DIF: Cognitive Level: Application REF: Page: 32
A student nurse tells the instructor, “I don’t need to interact with my patients. I learn what I need to know by observation.” The instructor can best interpret the nursing implications of Sullivan’s theory to the student by responding:
a.
“nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills.”
b.
“observing patient interactions can help you formulate priority nursing diagnoses and appropriate interventions.”
c.
“I wonder how accurate your assessment of the patient’s needs can be if you do not interact with the patient.”
d.
“noting patient behavioral changes is important because these signify changes in personality.”
ANS: A
Sullivan believed that 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 third response pertains to Maslow’s theory. The fourth response pertains to behavioral theory.
DIF: Cognitive Level: Application REF: Page: 26|Pages: 37-38
A psychiatric technician says, “Little of what takes place on the behavioral health unit seems to be theory based.” A nurse educates the technician by identifying which common use of Sullivan’s theory?
a.
Structure of the therapeutic milieu of most behavioral health units
b.
Frequent use of restraint and seclusion as behavior management tools
c.
Assessment tools based on age-appropriate versus arrested behaviors
d.
Method nurses use to determine the best sequence for nursing actions
ANS: A
The structure of the therapeutic environment has, as its foci, an accepting atmosphere and provision of opportunities for practicing interpersonal skills. Both constructs are directly attributable to Sullivan’s theory of interpersonal relationships. Sullivan’s interpersonal theory did not specifically consider the use of restraint or seclusion. Assessment based on the developmental level is more the result of Erikson’s theories. Sequencing nursing actions based on the priority of patient needs is related to Maslow’s hierarchy of needs.
DIF: Cognitive Level: Application REF: Page: 26|Pages: 37-38
A nurse uses Maslow’s hierarchy of needs to plan care for a psychotic patient. Which problem will receive priority? The patient:
a.
refuses to eat or bathe.
b.
reports feelings of alienation from family.
c.
is reluctant to participate in unit social activities.
d.
needs to be taught about medication action and side effects.
ANS: A
The need for food and hygiene is physiological and therefore takes priority over psychological or meta-needs in care planning.
DIF: Cognitive Level: Analysis REF: Pages: 31-32
