Chapter 19

Question 1

A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content?

Answer 1

“The therapist uses guided imagery in an effort to elicit automatic thoughts.”

Question 2

A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client?

Answer 2

“Thought patterns include a predominance of automatic thoughts.”

Question 3

A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the client’s thinking is reflective of which cognitive error?

Answer 3

Minimization

Question 4

A nursing student states, “The instructor gave me a failing grade on my research paper. I know it’s because the instructor doesn’t like me.” Which cognitive error does a nurse recognize in this student’s statement?

Answer 4

Magnification

Question 5

An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, “What’s cognitive therapy and how can it help me?” Which is the nurse’s most appropriate reply?

Answer 5

“It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors.”

Question 6

A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion?

Answer 6

Cognitive rehearsal

Question 7

An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client’s concerns. What is the purpose of this nursing intervention?

Answer 7

To identify important areas needing concentration during therapy

Question 8

When a client’s husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husband’s tardiness. What technique is the nurse using?

Answer 8

Generating alternatives

Question 9

A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of “examining the evidence.” Which response exemplifies this technique?

Answer 9

“Let’s look at the potential reasons why your partner has not participated.”

Question 10

A nursing assistant has failed a prerequisite course toward admission to nursing school and states, “I will always be only a nursing assistant and never an RN.” Her nursing advisor understands this is an example of which automatic thought?

Answer 10

Overgeneralization

Question 11

A high school basketball player sustains a serious knee injury and states to the school nurse, “I will never get to college if I don’t receive a basketball scholarship.” Which nursing reply would assist the student to see a broader range of possibilities?

Answer 11

“Let’s look at the alternatives for funding your college education.”

Question 12

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction?

Answer 12

“My baby is wonderful, but I’m depressed because I wanted twins.”

Question 13

A client admitted to a Veterans Administration (VA) hospital with a diagnosis of major depressive disorder tells the nurse, “I failed my battalion by giving the wrong order. Fortunately, no one was injured.” Which nursing diagnosis should the nurse assign to this client?

Answer 13

Situational low self-esteem

Question 14

The director of nursing (DON) sets up a meeting with the newly appointed nurse manager, who, to this point, has done an excellent job. The nurse manager anticipates job termination. What is the best description of the cognitive error being employed by the nurse manager?

Answer 14

Always thinking the worst will occur without considering positive outcomes

Question 15

A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred?

Answer 15

“Dichotomous thinking is when an individual views situations as being ‘good or bad’ or ‘black or white.’”

Question 16

A client states, “I keep having horrible nightmares about the car accident that killed my daughter. I shouldn’t have taken her with me to the store.” Using a cognitive approach, which nursing reply would be most therapeutic?

Answer 16

“Can anyone predict when a car accident will happen?”

Question 17

Which client statement would exemplify the level of cognitive function that you would expect to see in mild anxiety?

Answer 17

“Right now I feel as sharp as a tack.”

Question 18

When using a cognitive approach, a nurse would include which point in teaching a client about panic disorder?

Answer 18

“Remind yourself that symptoms of a panic attack are time limited and will end.”

Question 19

Using a cognitive approach, a nurse would choose which intervention for assisting clients to manage their anger without the use of violence?

Answer 19

Assist the client to identify thoughts that trigger anger and substitute reality-based thinking.

Question 20

A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion?

Answer 20

“I may have a minor problem, but I can handle it.”

Question 21

A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of these?

Answer 21

“Remind yourself that the voices are symptoms of your disease.”

Question 22

A client diagnosed with borderline personality disorder states, “Get out of here. No one cares about me or my situation!” Which nursing reply is an example of a cognitive intervention?

Answer 22

“Can you explain further your thinking about your situation?”

Question 23

A nursing instructor is lecturing about cognitive therapy. Which of the following are objectives when implementing this therapy? Select all that apply.
A. To modify automatic thoughts to promote minimization of negative cognitions
B. To apply a variety of methods to create change in an individual’s thinking
C. To apply cognitive principles in order to change an individual’s basic schema
D. To modify belief systems in an effort to bring about emotional change
E. To modify belief systems in an effort to bring about behavioral change

Answer 23

B, D, E

Question 24

A nurse practitioner uses cognitive therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts. Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? Select all that apply.
A. “The purpose of this exercise is to identify automatic thoughts.”
B. “The purpose of this exercise is to identify rational alternatives.”
C. “The purpose of this exercise is to modify cognitive errors.”
D. “The purpose of this exercise is to eliminate irrational beliefs.”
E. “The purpose of this exercise is to monitor thoughts related to self-esteem.”

Answer 24

A, B, C

Question 25

Which of the following client statements would indicate that teaching about benzodiazepines has been successful? Select all that apply.

A. “I can’t drink alcohol when taking lorazepam (Ativan).”
B. “If I abruptly stop taking buspirone (BuSpar), I may have a seizure.”
C. “Valium can make me drowsy, so I shouldn’t drive for awhile.”
D. “My new diet cannot include aged cheese or pickled herring.”
E. “When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax).”

Answer 25

A, C