2204 Cognitive Therapy
Test 2 Psych NCLEX style questions
Terms in this set (25)
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?
A. "The therapist provides information about the process of cognitive therapy."
B. "The therapist uses guided imagery in an effort to elicit automatic thoughts."
C. "The therapist provides information about how cognitive therapy works."
D. "The therapist uses reading assignments to reinforce learning."
Cognitive therapy prepares the client to become his or her own cognitive therapist. The didactic portion of the therapy provides educational material to reinforce learning about the therapy and how it affects psychiatric disorders.
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?
A. "Thought patterns are triggered by specific stressful stimuli."
B. "Thought patterns contain the client's fundamental beliefs and assumptions."
C. "Thought patterns are flexible and based on personal experience."
D. "Thought patterns include a predominance of automatic thoughts."
According to Beck, automatic thoughts consist of rapid responses to a situation without rational analysis. These thoughts are often negative and based on erroneous logic.
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?
B. Dichotomous thinking
C. Arbitrary inference
Minimization is the cognitive error that undervalues positive events and experiences. The client cannot give credit for personal strengths.
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?
A. Dichotomous thinking
B. Catastrophic thinking
In magnification, negative events are exaggerated. It is irrational to assume that there is a relationship between failing a paper and being personally disliked by the instructor.
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?
A. "It is a system of techniques in which you use positive thinking to improve your mood."
B. "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences."
C. "It is a interpersonal treatment approach that specifically targets magical thinking."
D. "It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors."
Cognitive therapy is meant to be a time-limited intervention in which the therapist works in collaboration with the client to modify thinking to eliminate cognitive errors that reinforce emotional disturbances.
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?
A. Socratic questioning
B. Activity scheduling
D. Cognitive rehearsal
Cognitive rehearsal allows the employee to uncover potential automatic thoughts in advance of his or her meeting to request a promotion. This allows the employee to develop strategies to modify any dysfunctional thinking.
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?
A. To identify important areas needing concentration during therapy
B. To increase self-esteem and decrease feelings of helplessness
C. To modify maladaptive behaviors by the use of role-play
D. To divert away from intrusive thoughts and depressive ruminations
Activity scheduling is used to identify recurring daily patterns that may need to be addressed in therapy.
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?
A. Examination of the evidence
C. Generating alternatives
Using the technique of generating alternatives will assist the client to recognize a wider range of possible explanations for her husband's behavior.
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?
A. "Let's look at the potential reasons why your partner has not participated."
B. "How would you define irresponsibility?"
C. "Has it occurred to you that your partner may be working on the project at home?"
D. "Are you telling me that you feel totally responsible for this project?"
When using the technique of examining the evidence, the student and nurse review automatic thoughts and study the evidence to support or counter the belief.
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?
A. Arbitrary inference
C. Dichotomous thinking
Overgeneralization occurs when sweeping conclusions are made based on one incident. Because the student failed a prerequisite nursing course, the student over generalizes that the goal of being an RN will never be attained.
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?
A. "Let's look at the alternatives for funding your college education."
B. "I know you are feeling helpless now, but you are looking at this from only one perspective."
C. "Can your family afford knee surgery?"
D. "You now need to prioritize your academics and not focus on basketball."
When the nurse helps the student to see a broader range of possibilities, the nurse is using the cognitive technique of generating alternatives
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?
A. "My baby is refusing to nurse, and I know it's because she hates me."
B. "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me."
C. "My baby is wonderful, but I'm upset and depressed because I wanted twins."
D. "My baby has an elevated bilirubin, and I know it will get worse and she will die."
In selective abstraction the individual focuses attention on evidence that is viewed as a failure (not having twins) rather than any successes (a healthy baby) that have occurred.
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?
A. Chronic low self-esteem
B. Risk for self-directed violence
D. Situational low self-esteem
Emotional responses are largely dependent on cognitive appraisals of the significance of environmental cues. The nursing diagnosis of situational low self-esteem is used for individuals who have a negative perception of self-worth in response to a current situation. This client's cognitive appraisal of the situation has led to the diagnosis of major depression and low self-esteem.
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?
A. Thinking from an "all-or-nothing" perspective
B. Always thinking the worst will occur without considering positive outcomes
C. Viewing only selected negative evidence while editing out positive aspects
D. Undervaluing the positive significance of an event
Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. The nurse manager has quickly jumped to the conclusion that the meeting will result in job termination.
A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred?
A. "Dichotomous thinking is when an individual views situations as being 'good or bad' or 'black or white.'"
B. "Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances."
C. "Dichotomous thinking is when an individual exaggerates the negative significance of an event."
D. "Dichotomous thinking is when an individual undervalues the positive significance of an event."
An individual who is using dichotomous thinking views situations in terms of "all or nothing," "good or bad," or "black or white."
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?
A. "Are other issues from your past affecting your ability to move on?"
B. "Describe your current feelings about your loss."
C. "Let's talk about something that will help you move on."
D. "Can anyone predict when a car accident will happen?"
When the nurse attempts to encourage the client to reframe thoughts, the nurse is using a cognitive approach.
Which client statement would exemplify the cognitive changes that you would expect to see in mild anxiety?
A. "Right now I feel as sharp as a tack."
B. "I'm having a tough time focusing."
C. "Sometimes I feel like I'm having an out-of-body experience."
D. "All I seem to focus on is my anger."
Cognitive ability will be enhanced with mild anxiety. Mild anxiety prepares the individual for heightened responses to environmental stimuli.
When using a cognitive approach, which point would a nurse include when teaching a client about panic disorder?
A. "You might want to stay in the house when you notice the symptoms beginning."
B. "Medications such as lorazepan (Ativan) should be taken when symptoms start."
C. "Remind yourself that symptoms of a panic attack are time limited and will end."
D. "Keep a journal in order to note feelings surrounding the panic attacks."
When a nurse reminds a client that symptoms of a panic attack are time limited and will end, the nurse is using the cognitive approach of presenting rational thinking.
Using a cognitive approach, which is an effective nursing intervention for assisting clients to manage their anger without the use of violence?
A. Assist the client to identify thoughts that trigger anger and substitute reality-based thinking.
B. Provide consequences, such as removal from group therapy, in response to angry outbursts.
C. Administer antipsychotic medications and use limit-setting such as a room restriction.
D. Administer anti-anxiety medication and encourage participation in a group on medication actions.
By assisting the client to identify thoughts that trigger anger and encourage the substitution of more reality-based thinking, the nurse can help the client to alter dysfunctional beliefs that predispose the client to distort experiences.
A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion?
A. "I can't give up alcohol right now because I just gave up smoking."
B. "I just read that red wine has health benefits."
C. "I may have a minor problem, but I can handle it."
D. "I don't drink as much as my wife and nobody thinks she has a problem."
The statement, "I may have a minor problem, but I can handle it." is an example of the use of the cognitive distortion of minimization. Minimization is the undervaluing of the positive significance of an event.
A client is experiencing auditory hallucinations. Using a cognitive strategy, which should the nurse encourage the client to do?
A. "Try singing Happy Birthday until the voices are gone."
B. "Document what the voices are saying to note cause and effect."
C. "Try listening to music using headphones for distraction."
D. "Remind yourself that the voices are symptoms of your disease."
The focus of cognitive therapy is on the modification of distorted cognitions and maladaptive behaviors.
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?
A. "You have an anti-anxiety medication ordered. It may make you feel better."
B. "It sounds like you are feeling really frustrated."
C. "Can you explain further your thinking about your situation?"
D. "No one cares about you?"
When a nurse asks for an explanation about a client's thinking, the nurse is using a cognitive approach to assessment. The focus of cognitive interventions is on the modification of distorted cognitions and maladaptive behaviors.
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
ANS: B, D, E
In cognitive therapy, the therapist's objective is to use a variety of methods to create change in a client's thinking and belief system in an effort to bring about lasting emotional and behavioral change.
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."
ANS: A, B, C
In a daily record of dysfunctional thoughts, clients (1) identify automatic thoughts and (2) generate a more rational response. In this way, the tool serves to help them (3) modify or make changes in their thinking. A daily record of dysfunctional thoughts does not eliminate the occurrence of irrational beliefs or monitor thoughts solely related to self-esteem.
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)."
ANS: A, C
When a nurse teaches about medications the nurse is using a cognitive approach. A core concept of cognitive theory relates to the mental process of thinking and reasoning.
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