Chapter 27: Behavior Change and Cognitive Interventions

Chapter 27: Behavior Change and Cognitive Interventions

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

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

a.	“How do you want your partner to show you that you’re 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 doesn’t 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 patient’s 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, “I’ve been sick a lot this last year but I’m 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 you’ve been sick but you’re the best seller. That makes you a valued employee.”
b.	“It’s hard to get up one day and find that you’re the oldest person in any group. It’s only natural that you’d be sicker than everyone else.”
c.	“You’re still the best seller. It’s important not to be suspicious of what is probably only a necessary change in health insurance coverage.”
d.	“So you think that while you’re still the best seller the fact you’ve been sick a lot this year is a problem? You feel that your employer’s 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 patient’s 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 don’t want to go on living now that my spouse has left me for someone else after 20 years. Our children are grown and don’t need me. I just want to die.” Which response is the most therapeutic?

a.	“You’re young, and you will manage well. I know several people your age who’ve actually done better after divorcing their spouses.”
b.	“It always seems bleak when we lose someone we’ve loved. Don’t worry, it will work out—we just need to think this through.”
c.	“So your spouse is off having a midlife crisis and you are here thinking of killing yourself. Let’s 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 let’s 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 I’m gay because I don’t like football.” Which communication best reflects a cognitive behavioral assessment by the nurse?

a.	“You feel your roommate thinks you’re gay because you don’t like football and he spends his time watching football? How will getting a private room change things?”
b.	“It’s hard to feel excluded, but isolating yourself is not the answer. Perhaps you might try watching football with him.”
c.	“Don’t you think your roommate will be more likely to think you’re gay if you get a private room?”
d.	“Well, you must realize that most men like football, but that doesn’t 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 patient’s 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