Keltner: Psychiatric Nursing, 6th Edition

Keltner: Psychiatric Nursing, 6th Edition
Chapter 37: Behavior and Somatic herapies

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"#$%P$E C&'%CE
() * patient usually spo!e sarcastically to sta++ and others) he goal ,as +or the patient to
spea! pleasantly and sincerely) he sta++ responded to the patient only ,hen the patient
spo!e ,ithout sarcasm) -hich techni.ue ,as used/
a) Negative conse.uence
0) 1enerali2ation
c) E3tinction
d) ime4out
*NS: C
E3tinction involves the ,ithdra,al o+ attention +rom a patient ,hen he or she is not 0ehaving
appropriately) 5ata given in the scenario do not support the choice o+ any other options)
Negative conse.uence is the presentation o+ an event immediately +ollo,ing a response that
decreases the pro0a0ility that the response ,ill occur again) ime4out removes the patient
+rom an environment in ,hich he or she is receiving rein+orcement +or an inappropriate
0ehavior) 1enerali2ation is not a 0ehavior modi+ication techni.ue)
5%6: Cognitive level: *pplication 7E6: 8(8
'P: Nursing process: %mplementation "SC: NC$E9: Psychosocial %ntegrity
:) * patient arrived late to group session +or 3 days) he nurse and patient agreed that i+ the
patient arrived on time +or group the ne3t : days, the patient ,ould 0e permitted to sleep
late) -hich techni.ue ,as used/
a) Contingency contracting
0) o!en economy
c) Sel+4control
d) Shaping
*NS: *
%n contingency contracting, the therapist and patient participate in setting target 0ehaviors
and selecting rein+orcers, speci+ying ;ointly ,hat, ho,, ,hen, and ,here 0ehavioral change
,ill occur) he scenario does not support the choice o+ any o+ the other options)
5%6: Cognitive level: *pplication 7E6: 8(<
3) * stimulus is de+ined as:
a) the 0ehavior 0eing analy2ed)
0) an event that immediately precedes a 0ehavior)
c) an event +ollo,ing a 0ehavior that strengthens the 0ehavior)
d) an event not associated ,ith rein+orcement or conse.uences)
Elsevier items and derived items = :>((, :>>7, :>>3, (???, (??<, (??( 0y "os0y, an %mprint o+ Elsevier, %nc)
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*NS: B
he correct option provides the actual de+inition o+ stimulus) he other options re+er to issues
such as target 0ehaviors and positive rein+orcement)
5%6: Cognitive level: Comprehension 7E6: 8(8
8) he treatment plan +or a patient speci+ies the use o+ negative rein+orcement) o apply this
techni.ue, the nurse must:
a) strengthen a response 0y rein+orcement in the presence o+ a speci+ic situation)
0) remove a stimulus +ollo,ing a 0ehavior thus decreasing the pro0a0ility o+ the
0ehavior recurring)
c) rein+orce successive responses to increase the pro0a0ility o+ a 0ehavior ,ith lo,
occurrence)
d) present a rein+orcing stimulus +ollo,ing a 0ehavior, thus increasing the pro0a0ility
o+ the 0ehavior recurring)
*NS: B
he correct response de+ines negative rein+orcement) he distracters de+ine conditioning, the
Premac! principle, and shaping)
<) -hich phenomenon e3empli+ies intermittent rein+orcement/
a) #sing a vending machine to 0uy snac!s
0) Putting gold stars on a child@s 0ehavior chart
c) 5ropping .uarters in a slot machine in a gam0ling casino
d) 7e+using to 0uy a toy +or a child having a temper tantrum
*NS: C
%ntermittent rein+orcement is the presentation o+ the rein+orcer +ollo,ing the target response
according to a ratio schedule) he slot machine pays o++ according to a predetermined
schedule, not a+ter every coin is inserted) he vending machine is supposed to dispense a
product each time money is inserted) Putting gold stars on the 0ehavior chart is continuous
rein+orcement, and re+using to 0uy a toy is a negative conse.uence)
6) Select the correct de+inition o+ e3tinction)
a) Providing rein+orcement contingent on a speci+ic 0ehavior
0) Strengthening another 0ehavior that is incompati0le ,ith the target 0ehavior
c) he gradual decrease in the num0er o+ times a 0ehavior is seen ,hen it is no longer
rein+orced
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d) Presentation o+ an event immediately +ollo,ing a response that decreases the
pro0a0ility o+ a response recurring
*NS: C
E3tinction is the gradual decrease in the rate o+ responses ,hen rein+orcement is no longer
availa0le) he distracters re+er to negative conse.uences, reciprocal inhi0ition, and
contingency contracting)
7) he nurse plans to add s!ills training to a patient@s plan o+ care) -hich intervention is an
e3ample o+ s!ills training/
a) *ssertiveness classes
0) 7ela3ation recordings
c) Contingency contracting
d) * sheltered ,or!shop e3perience
*NS: *
S!ills training is the process o+ ac.uiring ne,, appropriate 0ehaviors) %t is e3empli+ied 0y
assertiveness training) he techni.ues o+ positive rein+orcement, shaping, modeling, and
imitation are used) he other options are not e3amples o+ s!ills training)
5%6: Cognitive level: Comprehension 7E6: 8(< 'P: Nursing process:
Planning
"SC: NC$E9: Psychosocial %ntegrity
A) Select the 0est e3ample o+ a to!en economy)
a) Punish temper out0ursts ,ith time4out contingencies)
0) *llo, second servings only +or patients ,illing to ,or! in the canteen)
c) 5eny dessert to any patient ,ho ,as not a,a!e and dressed at a speci+ied time)
d) *ssign privileges according to chips earned +or per+orming speci+ied 0ehaviors)
*NS: 5
o!ens that are tangi0le, conditioned rein+orcers are given to patients contingent on speci+ic
target 0ehaviors) o!ens can 0e e3changed +or positive rein+orcers such as privileges or
snac!s) he other options descri0e situations in ,hich 0ehaviors are rein+orced directly
,ithout the use o+ to!ens as secondary rein+orcers)
5%6: Cognitive level: Comprehension 7E6: 8(<
?) * nurse prepares to teach rela3ation techni.ues to a patient ,ith high an3iety) -hich
principle applies to this intervention/
a) he a0ility to rela3 is genetically determined)
0) 6ear can 0e suppressed ,ith rela3ation techni.ues)
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c) #sing negative sel+4tal! is an ad;unct to rela3ation)
d) Simultaneous an3iety and rela3ation are not possi0le)
*NS: 5
7eciprocal inhi0ition involves strengthening alternative responses to an3iety) Being an3ious
and 0eing rela3ed are mutually e3clusive conditions, so teaching someone to rela3 gives that
person tools to com0at an3iety) *n3iety can 0e suppressed ,ith rela3ation techni.ues, 0ut
+ear cannot)
5%6: Cognitive level: *nalysis 7E6: 8(<
(>) Be+ore systematic desensiti2ation can occur, the patient and therapist must:
a) plan a progressive e3posure hierarchy)
0) determine ho, shaping ,ill ta!e place)
c) schedule modeling and imitation sessions)
d) calculate the pro0a0ility o+ decreasing undesira0le 0ehavior)
*NS: *
he techni.ue o+ systematic desensiti2ation is dependent on the use o+ a progressive
e3posure hierarchy) he patient uses rela3ation techni.ues to suppress the +ear response
during the graduated e3posure)
5%6: Cognitive level: *pplication 7E6: 8(<48(6 'P: Nursing process:
Planning
(() * patient has claustropho0ia) -hich techni.ue may 0e help+ul in reducing the patient@s
distress/
a) 7ein+orcing incompati0le 0ehaviors
0) Systematic desensiti2ation
c) Negative conse.uences
d) hought stopping
*NS: B
5uring systematic desensiti2ation, the patient ,ould e3perience graduated e3posure to
imagined, increasingly smaller places ,hile using rela3ation techni.ues to !eep an3iety
under control) Eventually, the patient can con+ront the +eared stimulus ,ithout e3periencing
over,helming an3iety) he other techni.ues are not use+ul +or treating claustropho0ia)
5%6: Cognitive level: *pplication 7E6: 8(<48(6 'P: Nursing process:
Planning
(:) he ma;or di++erence 0et,een systematic desensiti2ation and +looding is that +looding
uses:
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a) immersion) Systematic desensiti2ation uses graduated e3posure)
0) graduated e3posure) Systematic desensiti2ation uses immersion)
c) immersion) Systematic desensiti2ation uses contingency contracting)
d) e3tinction) Systematic desensiti2ation uses di++erential rein+orcement)
*NS: *
6looding is a process ,here0y patients imagine or place themselves in the +ear+ul situation)
Systematic desensiti2ation is a process o+ graduated e3posure to a +eared stimulus)
(3) %n a to!en economy, ,hen a patient does not meet an e3pected 0ehavioral goal or
0ehaves inappropriately, sta++ should:
a) give a time4out)
0) remove a re,ard)
c) revise patient goals)
d) e3tend the time +rame)
*NS: B
7ein+orcers, such as re,ards or to!ens that ,ere presented +or desired 0ehaviors, are
removed +or inappropriate 0ehaviors)
5%6: Cognitive level: Comprehension 7E6: 8(<
(8) -hen a patient acts out, the plan is to use negative conse.uences and ,ithdra, a
privilege) -hen a negative conse.uence is used, the nurse should monitor +or:
a) an aggressive response)
0) reluctant acceptance o+ the conse.uence)
c) ,ithdra,ing +rom interaction ,ith sta++)
d) attempting to 0argain +or lesser conse.uences)
*NS: *
Emotional or aggressive responses are possi0le ,hen a negative conse.uence is invo!ed) he
nurse ,ill need to 0e on high alert +or aggressive 0ehavior)
(<) * patient 0ecomes angry and thro,s +ood during a meal) he sta++ re.uires the patient to
clean the dining area) -hich 0ehavior modi+ication techni.ue ,as used/
a) Conditioning
0) 7eciprocal inhi0ition
c) Negative conse.uence
d) Contingency contracting
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*NS: C
he negative conse.uence to 0e applied in this situation ,ould 0e having the patient clean up
the +ood)
5%6: Cognitive level: *pplication 7E6: 8(8 'P: Nursing process:
Evaluation
(6) -hich e3ample accurately depicts the use o+ contingency contracting/
a) * nurse and patient agree that ,hen the patient comes to the medication ,indo, on
time, the patient is granted e3tra time in the e3ercise room)
0) -hen a patient ,ith 0orderline personality disorder sel+4mutilates, privileges to
leave the unit are revo!ed)
c) * patient goes to a psychoeducational class independently to practice assertiveness
s!ills)
d) * psychotic patient thro,s +ood at 0rea!+ast and is placed in seclusion)
*NS: *
Contingency contracting involves the nurse and patient ,or!ing together to set target
0ehaviors and select rein+orcers) he other options do not suggest that the nurse and patient
have mutually agreed on the schedule and rein+orcers to 0e used)
(7) * patient in the dayroom responds to other patients and sta++ ,ith sarcasm) ,o other
patients encourage this patient ver0ally and nonver0ally) -hich action demonstrates the
use o+ the time4out techni.ue/
a) "odeling accepta0le 0ehavior
0) a!ing the sarcastic patient to the .uiet room
c) Sending the encouraging patients to their rooms
d) Scheduling the sarcastic patient to attend assertiveness class
*NS: B
ime4out is a negative conse.uence techni.ue in ,hich the person is removed +rom the
setting in ,hich ongoing rein+orcers are availa0le) &aving the patient go to his room
e3empli+ies the time4out techni.ue) None o+ the other options +it the de+inition o+ time4out)
(A) -hich statement 0y a patient indicates that teaching a0out upcoming electroconvulsive
therapy BECC ,as e++ective/
a) D,o treatments ,ill pro0a0ly 0e re.uired)E
0) D% ,ill need a catheter to empty my 0ladder)E
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c) Dhe memory loss % have ,ill 0e temporary)E
d) D% may continue to have sei2ures +or a0out 3 months)E
*NS: C
"emory loss +rom EC is temporary) Sei2ures are only associated ,ith the treatment) "ost
patients need 6 to (: treatments) EC does not a++ect urinary elimination)
5%6: Cognitive level: *pplication 7E6: 8(7 F 8(? 'P: Nursing process:
Evaluation
(?) Prior to an EC treatment, ,hat is the nurse@s priority action/
a) 5etermine ,hether or not the patient has a communica0le disease)
0) '0tain the patient@s in+ormed consent +or treatment)
c) Educate the +amily a0out the treatment)
d) *ssess cardiac and respiratory +unction)
*NS: 5
Patient assessment is ,ithin the scope o+ practice o+ the nurse) he priority assessment
relates to cardiac and respiratory +unction) he physician must o0tain the patient@s in+ormed
consent) 6amily education is important, 0ut not the priority) Communica0le disease is
irrelevant to EC)
5%6: Cognitive level: *nalysis 7E6: 8(748(?
'P: Nursing process: *ssessment "SC: NC$E9: Physiological %ntegrity
:>) -hich medication should the nurse anticipate administering 3> to 8< minutes 0e+ore EC
to reduce oral secretions/
a) Succinylcholine B*nectineC
0) "ethohe3ital BBrevitalC
c) Propranolol B%nderalC
d) *tropine
*NS: 5
*tropine or another drug ,ith anticholinergic action ,ill 0e given to reduce oral secretions
and decrease the possi0ility o+ aspiration) *tropine produces a mild tachycardia to minimi2e
vagal stimulation produced 0y EC) *nectine, a s!eletal muscle rela3ant, and methohe3ital,
an anesthetic, ,ould 0e given immediately 0e+ore the introduction o+ current) Propranolol
,ould not 0e given 0e+ore EC)
'P: Nursing process: %mplementation "SC: NC$E9: Physiological %ntegrity
:() -hich documentation indicates that a patient@s EC treatments ,ere e++ective/
a) DPatient@s current ,eight is (83 l0s) -eight on admission ,as (3A l0s)E
0) DPatient is una0le to remem0er events immediately 0e+ore EC)E
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c) DPatient is e3pressing +eelings o+ helplessness and hopelessness)E
d) DPatient is sleeping 3 to 8 hours uninterrupted nightly)E
*NS: *
5epression is the most li!ely reason the EC ,as administered) $oss o+ appetite and ,eight
loss usually precede admission +or depression) 1aining < pounds indicates improvement)
7etrograde amnesia is e3pected associated ,ith EC) he other distracters indicate that the
depression continues)
5%6: Cognitive level: *nalysis 7E6: 8(748(A 'P: Nursing process:
Evaluation
::) -hich nursing intervention is most appropriate in the immediate post4EC period/
a) *ssist the patient to sit up and then am0ulate)
0) 7epeatedly stimulate the patient to open eyes)
c) 7eorient to time, place, and person as the patient a,a!ens)
d) Continue to ventilate until the patient has 0een a,a!e +or < minutes)
*NS: C
Post4EC patients are groggy ,hen recovering +rom the anesthesia and the EC itsel+)
1entle reorientation allays an3iety associated ,ith +eeling con+used) he other options are
unnecessary or inappropriate)
:3) $o0otomies and psychosurgery contri0uted to ,hich perspective in *merican society
a0out mental illness and mental illness treatments/
a) Parity
0) Stigma
c) &umane
d) Compassionate
*NS: B
$o0otomies and psychosurgery, no, vie,ed as 0ar0aric, contri0uted to the stigma o+ mental
illness and related treatments)
5%6: Cognitive level: *nalysis 7E6: 8(?48:> 'P: Nursing process:
Evaluation
"SC: NC$E9: Sa+e, E++ective Care Environment
:8) -hen a patient as!s a0out 0right light therapy to treat seasonal a++ective disorder, the
nurse should respond that it involves:
a) ga2ing intently at photographs +or 3> minutes daily)
0) e3posure to intense light +or several hours daily)
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c) sitting in the midday sun +or (< minutes daily)
d) tanning t,ice ,ee!ly +or 3 months)
*NS: B
Bright light therapy, the e3posure to intense arti+icial light, helps relieve the symptoms o+
depression associated ,ith seasonal a++ective disorder) he other options do not accurately
descri0e this therapy)
5%6: Cognitive level: Comprehension 7E6: 8:>
:<) * nurse records a health history +or a patient +or ,hom transcranial magnetic stimulation
B"SC is 0eing considered) -hich assessment .uestion has priority/
a) D*re your depressive episodes associated ,ith the seasons/E
0) D&ave you e3perienced ,eight loss ,ith your depression/E
c) D5o you have metal implants any,here in your 0ody/E
d) D-hat surgeries have you had in the past/E
*NS: C
Gust as ,ith an "7%, this procedure might not 0e possi0le i+ the patient has metal implants,
0ecause a magnetic +ield is created) he other .uestions are not relevant to "S)
5%6: Cognitive level: *pplication 7E6: 8:(
:6) he nurse preparing a patient +or 0right light therapy should:
a) provide eye shields)
0) have the patient apply sunscreen)
c) !eep the patient NP' +or 6 hours 0e+ore treatment)
d) assess +or recent use o+ photosensiti2ing medication)
*NS: 5
#se o+ photosensiti2ing medication is a contraindication +or use o+ 0right light therapy) Eye
shields are not used, 0ecause the therapeutic e++ect is mediated 0y the eyes, not the s!in)
Sunscreen is unnecessary) 6asting 0e+ore treatment is unnecessary)
5%6: Cognitive level: *pplication 7E6: 8:>
:7) -hen should a nurse schedule a patient +or 0right light therapy/
a) Early morning
0) "idday
c) *+ternoon
d) Evening
*NS: *
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he literature suggests that 0right light therapy is more e++ective i+ treatment is given in the
early morning)
5%6: Cognitive level: Comprehension 7E6: 8:> 'P: Nursing process:
Planning
"#$%P$E 7ESP'NSE
() *ssessment sho,s that a patient en;oys ,atching television, practices meditation, li!es
chocolate, and plays card games enthusiastically) #sing the Premac! principle, ,hich
rein+orcers should the nurse choose to encourage the patient to 0e on time +or therapy
sessions/ Select all that apply)
a) 3> minutes o+ ,atching television
0) 3> minutes o+ e3ercise time
c) *n e3tra dessert at a meal
d) ( hour o+ reading time
e) * card game
*NS: *, E
he Premac! principle tells us that an activity that the patient +inds en;oya0le can 0e used to
rein+orce another 0ehavior that occurs less +re.uently) *ctivities the patient en;oys include
card games and H ,atching) he other responses are either not activities or have not 0een
identi+ied 0y the patient as 0eing desira0le)
5%6: Cognitive level: *pplication 7E6: 8(8 'P: Nursing process:
Planning
:) -hich assessment parameters are most important +or the nurse to monitor during and
immediately a+ter EC/ Select all that apply)
a) CS6 pressure
0) Pulse o3imetry
c) #rinary output
d) Blood pressure
e) Electrode placement
*NS: B, 5
he pulse o3imeter monitors o3ygen saturation, an important parameter 0ecause the patient
is 0eing ventilated during and immediately a+ter treatment) BP is monitored to assess any
additional 0urden placed on the cardiovascular system 0y the induced sei2ure) he distracters
are not priorities)
5%6: Cognitive level: *pplication 7E6: 8(748(?
'P: Nursing process: %mplementation "SC: NC$E9: Physiological %ntegrity
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'&E7
() 'n the morning o+ EC, a patient scheduled +or treatment says, D% ate 0rea!+ast) hey
served me a tray, so % thought my treatment ,as canceled)E Correctly se.uence the
nurse@s actions)
3) 5ocument the events)
8) Prepare an incident report)
:) Noti+y the health care provider)
() *s! the patient, D&o, much did you eat and drin!/E
*NS: 5, C, *, B
Patients should 0e NP' +or at least 6 hours 0e+ore treatment to decrease the possi0ility o+
aspiration during or a+ter treatment) he nurse should +irst assess ho, much the patient ate
and dran!) Ne3t, the health care provider should 0e noti+ied) he treatment may 0e cancelled
or delayed) he events should then 0e documented) *n incidentIoccurrence report should 0e
prepared since this event represents an une3pected variance in the course o+ care)
5%6: Cognitive level: *nalysis 7E6: 8(748(?
'P: Nursing process: %mplementation "SC: NC$E9: Sa+e, E++ective Care Environment
:) Se.uence these treatments +or mental illness on a historical timeline +rom earliest to most
recent)
:) $o0otomy
() %nsulin coma therapy
3) 7epetitive transcranial magnetic stimulation
*NS: B, *, C
%nsulin coma therapy ,as used in the (?3>s) $o0otomies ,ere used in the (?8>s and (?<>s)
7epetitive transcranial magnetic stimulation came into use a+ter :>>>)
5%6: Cognitive level: Comprehension 7E6: 8(6 F 8(?48:>
'P: Nursing process: %mplementation "SC: NC$E9: Sa+e, E++ective Care Environment
11
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Chapter 37: Behavior and Somatic herapies

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