Elsevier adaptive quizzing quiz performance AQ 2/4 Chapter 34 | 2023 UPDATE

Elsevier adaptive quizzing quiz performance AQ 2/4 Chapter 34 | 2023 UPDATE Exit Performance AQ 2/4 Chapter 34 Due Feb 4, 2023 by 9:00 am 36 out of 36 questions answered correctly Incorrect (0) Correct (36) When a patient is encouraged to talk with others who have had similar problems, the nurse is suggesting which of the following? Milieu group Support group Time-limited group Cognitive-behavioral group Rationale Support groups are composed of members who have had or are currently sharing similar experiences, such as a bereavement group or a group of women with breast cancer. This is the only group with the focus on a shared problem; cognitive- behavioral, time-limited, and milieu are incorrect groups. p. 617, Box 34.4 At what point in the life of a group lasting 12 sessions should confidentiality be explained and discussed? At the first session As the working phase begins Just before the group terminates At the time each patient is interviewed Rationale Confidentiality is part of the ground rules that are established at the beginning of the group sessions. As the working phase begins, just before the group terminates, and at the time each patient is interviewed occur in difference stages of the group's development. p. 613 When evaluating members of a therapeutic group, what statement by a member does the nurse identify as being consistent with monopolizing behavior? "No, I do not have anything to say at the moment." "Please keep quiet and just listen to what I am saying." "My headache is irritating and simply refuses to go away." "What makes you believe that I should listen to your advice?" Rationale A monopolizing member does not give anybody else a chance to be heard. Such a member is extremely talkative. In an attempt to deal with anxiety, the person may monopolize the group with one's own compulsive speech. A complaining member may continually bring somatic problems such as a nagging headache to the group and still reject any help. A silent member prefers to stay silent and observe others during any group discussions. A demoralizing member may talk angrily to the leader and show no concern for others. Such a member shows hostile behavior. pp. 617-618 A patient has been enrolled in group psychotherapy. What feature about the group is appropriate? Therapeutic groups manage patient governance and advocacy matters. Basic-level registered nurses can be leaders of such therapeutic groups. Group psychotherapy is helpful when individual psychotherapy is unsuccessful. The purpose of group psychotherapy is to treat those with psychiatric disorders. Rationale The main aim of group psychotherapy is to treat those with psychiatric disorders. Patient governance and advocacy matters are managed in therapeutic community meetings. Basic-level registered nurses cannot become leaders of such groups. Since this group is used to bring about personality changes, only a trained leader (often an advanced practice nurse) can lead such a group. Group psychotherapy is conducted concurrently with individual psychotherapy. p. 616, Table 34.5 When conducting group therapy for narcissistic personality disorder patients, the nurse takes up the task role of an energizer. What specific task role does the energizer perform? Measure the group's work against objectives Try to preserve group harmony during conflicts Attempt to mediate conflicts between the members Encourage the group to make decisions or take action Rationale As an energizer, the nurse encourages the group to make decisions or take action. Generally, the evaluator measures the group's work against the objectives set. Mediating conflicts between the members is not a task role. It is a maintenance role where the nurse acts as a harmonizer. In the maintenance role of a compromiser, the nurse tries to preserve harmony within the group whenever there is a conflict. p. 614, Table 34.3 Which statement is not true regarding self-help and support groups? People who have had a particular problem can help others with the same problem. Self-help and support groups are designed to serve people with a common problem. Professional leadership is inappropriately expensive for treatment of minor problems. Promotion of dialogue, self-disclosure, and encouragement can produce change in members. Rationale Self-help and support groups do not exist to address minor problems. Problems successfully treated by self-help and support groups include addictions, eating disorders, and adjustment to life changes caused by major illnesses. Being able to help others with the same problem, promoting of dialogue, self-disclosure, and encouragement, and self-help and support groups designed to serve people with a common problem are true statements regarding self-help groups. p. 616, Table 34.5 A nurse is the leader for a medication group for patients diagnosed with bipolar disorder. No new patients will be added as the group progresses, and so the group is considered which of the following? Open Closed Homogeneous Heterogeneous Rationale A closed group admits no new members. p. 612, Box 34.3 The nurse recognizes that which of the following describes a closed group? Will demonstrate cohesiveness Will discuss topics that will be restricted Will not add new members once it is formed Has a membership that is limited to one gender Rationale A closed group is one to which no members are added once the group has begun. Discussing topics that will be restricted, having a membership that is limited to one gender, and demonstrating cohesiveness may or may not be characteristics of the group. p. 612, Box 34.3 Sharing similar experiences is a curative factor identified by Yalom as which of the following? Universality Ventilation Reenactment Recapitulation Rationale Universality is the phenomenon of understanding that one's problems are not unique, which helps group members feel secure and understood. p. 611 The leader opens the discussion at the first meeting of a new group. Which comment would be appropriate for this phase? "Let's begin by establishing the ground rules for our group." "Let's start by asking each person here to define his or her problems." "I would like each person to explain why you are attending this group." "Bringing family members to our group will help us achieve our goals." Rationale Establishing ground rules helps to build trust in a group and set the group's norms and expectations. This is an appropriate leader behavior in the orientation phase. Members of a new group have not established trust and would be unwilling to define their problems. Visitors would alter the group's identity and jeopardize trust. p. 613 When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior as which of the following? Altruistic Universality Subgrouping Contingency seeking Rationale Subgrouping involves formation of a splinter group within the larger group. Members of the subgroup show more loyalty to each other than to the larger group. p. 612, Box 34.3 A patient with tenacious suicidal behavior has been advised dialectical behavioral treatment (DBT). What does the nurse need to know about DBT? The patient is encouraged to observe others in the group. The patient is seen by the therapist for DBT once every day. Treatment can be provided by a basic-level registered nurse. Emotional skills can be improved, leading to reduced risk of self-destructive behavior. Rationale DBT improves interpersonal, behavioral, cognitive, and emotional skills, and reduces self-destructive behaviors. The patient is seen for DBT every week rather than once every day. The patients are discouraged from making observations about others in the group. Instead, they are encouraged to consider everything that is presented in the group in terms of their own use of skills, emotional challenges, and areas of growth. The treatment is provided by those with specialized training and advanced education such as advanced practice registered nurses. Basic-level nurses do not lead such psychotherapy groups. p. 616, Table 34.5 A therapeutic group is in its working phase. What does the nurse identify as the most appropriate role of the group leader during this phase of the group development? Point out similarities between the members Encourage members to get to know each other Help members to identify post termination goals Help members to gain confidence in problem-solving Rationale During the working phase, the group leader encourages the members to focus on problem solving, and guides and supports them in conflict resolution. Through successful conflict resolution, the members gain confidence in problem-solving activities. In the orientation phase, the members may be excessively silent or overbearing because they are yet to establish trust with one another. The leader encourages them to get to know each other by pointing out the similarities between the members. In the termination phase, the leader encourages members to reflect upon the progress of the group and helps the members to identify the post termination goals. p. 613 A nurse has been instructed to give group therapy to patients with intellectual disabilities. The nurse follows a laissez-faire style of leadership and asks the patients to paint scenery during group therapy. Which appropriate action does the nurse follow while conducting the group therapy? The nurse gives clear directions to the patients while painting. The nurse allows the patients to paint anything during group therapy. The nurse advises the patients to interact with others to share their ideas. The nurse checks that the patients do not interact during the group therapy. Rationale The three leadership styles a nurse can choose while conducting group therapy are autocratic leader, democratic leader, or laissez-faire leader. The laissez-faire leadership style is followed during group therapy which involves art. The nurse allows the patients to paint as they wish. It helps to explore their thoughts, perceptions, and feelings and effectively design the treatment. The nurse avoids giving directions to the patients during the therapy, as the patient may feel rejected and resist portraying feelings and perceptions. In democratic leadership, the nurse encourages the patients to interact with one another and share their feelings. In autocratic leadership, the nurse controls the patients and does not allow them to interact with one another. During group therapy like painting, the patients must not be advised and restricted from interacting with others. The nurse allows the patients to behave as they wish and the nurse must observe and document the patients' feelings and interpersonal skills. p. 615 A primary healthcare provider instructs the nurse on how to conduct group therapy for psychiatric patients. Which appropriate action does the nurse follow for effective group therapy? The nurse arranges the seats in rows of different height. The nurse plans similar group activities for the outpatients and inpatients. The nurse includes the patients having common psychiatric illness in a group. The nurse makes small groups and conducts activities in a large, spacious room. Rationale Patients with similar mental illnesses should be in the same group to help the nurse plan the most appropriate group activity for them. The patients can share their life experiences, feelings and concerns. The nurse should conduct group activities in appropriate surroundings. The nurse should not conduct therapy for a small group in a spacious room, as the nurse cannot concentrate on the patients, and the patients may become distracted. The seating arrangements for the group must be done in a circle, as it conveys equality among the members of the group and the leader. Arranging the seats at different heights can make the patient feel different from other members of the group. The nurse should not follow similar group activities for outpatients and inpatients, as the needs of inpatients are significantly different from the outpatients. p. 611, Box 34.1 What is the group leader's responsibility in the termination phase? Encouraging group members to reflect on progress made. Removing him- or herself from the group so they can function independently. Allowing members to exchange contact information so they may remain as a support for each other. Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique. Rationale In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify post termination goals. Contact with other members in the group outside of the group is not therapeutic and usually is discouraged. The group leader does not remove him- or herself from the group process. Group members do not fill out evaluation forms in group therapy. p. 613 A nurse leads a community meeting on an inpatient unit. What is the nurse's goal for this meeting? Teaching patients about ways to express anger Promoting and maintaining a therapeutic milieu Helping patients to express and resolve intrapersonal conflicts Teaching patients about the purpose and side effects of medication Rationale With the promotion of patient rights and advocacy, a common group consistently held on inpatient units is the therapeutic community meeting. As every interaction occurring on an inpatient milieu has the potential to be therapeutic, the community meeting is the essential venue at which unit happenings are processed and integrated into treatment. Helping a patient express and resolve intrapersonal conflicts is the goal of individual psychotherapy. Teaching patients about medication or ways to express anger are goals of a psychoeducational group. p. 616, Table 34.5 A patient says to the nurse, "Since my spouse died, I'm having trouble concentrating. I want to stay home alone all the time but I know it would help me to be with others." Which group should the nurse suggest? Bereavement An internet support group Co-Dependents Anonymous National Alliance on Mental Illness (NAMI) family support group Rationale Bereavement groups provide support for those who have experienced the loss of a loved one. An internet support group may provide support but it may not be specific to grief and would not engage the patient in face-to-face interactions as well as a bereavement group. Co-Dependents Anonymous is a twelve-step self-help group. NAMI groups provide patient and family support, education, and advocacy. p. 617, Box 34.4 Group members are having difficulty deciding what topic to cover in today's session. The nurse leader says, "We are talking about fear of rejection today." Which communication technique has the nurse leader used? Support Reflection Summarization Giving information Rationale Giving information provides resources and information that supports treatment goals. In this instance, the nurse has helped focus the discussion. Support gives positive feedback and acknowledgement. Reflection encourages the group member to explore and expand on feelings (rather than thoughts or events). Summarization closes a discussion or group session by pointing out key issues and insights. p. 617, Box 34.6 A patient is scheduled to start group therapy today. The patient asks, "What does group work mean? My healthcare provider said I would be going to group and doing group work." How does the nurse best respond? "You will attend group therapy and find solutions for each other's problems." "Group work is the work that you do beforehand so you can present it to the group when you meet." "You will give and receive feedback from a group of your peers who also may have similar problems to work through." "You will share your issues with the group and then split up to work separately on solutions based on the ideas the other members provide." Rationale Group work is a method whereby individuals with a common purpose come together and benefit by mutually giving and receiving feedback within the dynamic and unique group context. Finding solutions for each other's problems, splitting up to work separately on solutions, and doing work beforehand do not describe group work. p. 612, Box 34.2 While conducting group therapy for patients in the working phase, the nurse observes some progress in the group interaction. What observation by the nurse indicates that the group can now share what they have learned? Group members can identify others' mistakes perfectly. They feel good and say, "We are ready for the next level." They show some confidence and start supporting each other. They share their views on how they have progressed during the phase. Rationale In the working phase, the group leader encourages the group members to share their differences and growth is based on conflict resolution and how the group members learn to support each other. That helps to improve the members' individual confidence. When members complain about others in the group, by pointing out their errors, it is not a sign of growth. It is not the members who decide if they are ready for the next phase of the group therapy. It is the leader who decides that. The group members' opinion about their own progress is not as important as the leader's observation of a change and ability to resolve conflicts and support others. p. 613 When the group leader suggests that a patient, "Choose the problem that is troubling you most at this time and tell us about it," the leader is promoting which of the following? Insight Focusing Reframing Feedback Rationale Focusing helps the group consider one problem rather than trying to attend to multiple problems at one time. p. 616, Table 34.5 At what phase of group development would the nurse hear the following interchange? Patient 1: "I do not feel comfortable here." Patient 2: "I wonder what we are supposed to talk about." Patient 3: "Let's ask the leader to explain things again." Working Orientation Termination Preorientation Rationale During orientation, the members get to know one another. Initially, they experience anxiety and are unsure of the expectations. p. 613 In a therapy group, the nurse is using existential theory by focusing on the here and now experience to enhance the members' awareness of feelings and their meanings. What statement is an example of a here and now activation? "You have been sitting quietly. What are your thoughts or feelings?" "You were in tears last week. Can you discuss it with the group now?" "You looked upset when another member spoke. Why were you upset?" "You looked disturbed when they spoke. Did it bring up something from your past?" Rationale When the nurse notices a member is sitting quietly and asks about the member's thoughts or feelings, the statement focuses on the member's current behavior which is the essence of here-and-now activation. When the nurse asks if the member wants to discuss the reason for the member's behavior during a previous meeting, the statement requires recall of an incident in the past and its explanation in retrospect. The immediacy of here-and-now experience is not there. When the nurse notices a particular behavior and asks the reason for it, the statement asks for an explanation of the "why" of a behavior. Existential theory focuses on "what" rather than the "why" of a behavior. When the nurse notices the member's behavior and asks how it relates to the past, the statement probes into the member's past experiences rather than focusing on here-and-now experiences. p. 618, Table 34.7 The nurse closes a group therapy session by talking about every important issue, individual achievements, and learning. What communication technique does the nurse use? Reflection Clarification Confrontation Summarization Rationale In group therapy, nurses use various communication tools and techniques. Here, the nurse is talking about the key things that happened during that therapy session, and about what the members have learned during the session. This is summarization. Confrontation is about encouraging the group members to explore the difference in thoughts and behaviors. Reflection deals with communication by sharing of feelings. Clarification is a technique where the nurse asks the members to properly expand and explain what they said during a conversation. p. 617, Table 34.6 The nurse leading a group says, "One purpose of our group is for members to share experiences that caused distress." Which phase of group development is evident? Working Orientation Maintenance Termination Rationale In the orientation phase, the group is forming. The group leader's role is to structure an atmosphere of respect, confidentiality, and trust. The purpose of the group is stated, and members are encouraged to get to know one another. In the working phase, the group leader's role is to encourage focus on problem solving consistent with the purpose of the group. Maintenance refers to member roles rather than a phase of group development. In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify post-termination goals. p. 613 A patient diagnosed with borderline personality disorder who is attending a court-ordered therapy group projects an angry affect. The patient doesn't speak much, but when he or she does it is usually to make a snide comment about another member of the group or the group's leader. What is the best way for the leader to handle this? Remove the patient from the group because he or she is disrupting the group process for other participants. Spend one entire group session focused on the patient and try to get him or her to open up to other members in depth. Respond neutrally to the patient's comments, ask for group feedback, and talk to him or her privately to form a connection. Confront the patient firmly each time he or she makes a rude comment and let the patient know he or she will be taken out of group if this behavior continues. Rationale The group leader should listen to the comments objectively and without becoming defensive. The leader may choose to speak to the group member in private and ask what is causing the anger to form a connection with the patient, which may result in less disruptive behavior in group. In the group setting, the leader can focus on positive group members whose comments may reduce the hostility of the negative group member. Part of the group process includes problem-solving skills and getting group feedback for issues. Spending an entire session discussing one patient is inappropriate in a group setting. Confrontation done on a continual basis would disrupt the group process and focus heavily on the hostile patient. p. 618 The nurse is conducting a group therapy session for depressive patients. The nurse reports to the primary healthcare provider that the group has a few monopolizing members. Which signs did the nurse observe? The patients avoid expressing emotions. The patients report about other members in the group. The patients stop interacting, as the tension in the group increases. The patients are extremely talkative and do not allow other members to interact. Rationale Patients with anxiety try to monopolize the group as a response. They are extremely talkative and do not allow other members of the group to interact with the nurse. The other members of the group lose interest and withdraw, due to the monopolizing members. The monopolizing members are expressive and repeatedly share feelings and thoughts with other members in the group. The monopolizing members do not report about others. The patients who complain but reject help are called complaining members. The monopolizing patients become impulsive and repeatedly talk as the tension in the group increases due to anxiety. pp. 617-618 When a group member supports and encourages another group member and feels "good" about doing so, which group phenomenon is at work? Altruism Ventilation Universality Group acceptance Rationale Altruism involves putting another's needs before one's own and feeling good about doing so. This is the only term that accurately describes that emotional state. p. 612, Table 34.1 The nurse is conducting group therapy for patients with schizophrenia. During group therapy, the nurse finds and connects various ideas and suggestions for conducting effective therapy. Which nursing function does this indicate? Orienter Evaluator Recorder Coordinator Rationale The nurse has to play different roles and perform different functions while being a part of the group therapy. The role of coordinator is to find and connect various ideas and suggestions for conducting effective group therapy for the patients. The function of the orienter is to document the progress of the patients in the group therapy and to check whether the goals of the treatment are achieved. The evaluator evaluates the work done by the members of the team and directs them to reach the objectives. The recorder acts as a memory of the group and keeps notes of the patients' behavior and progress. p. 614, Table 34.3 A veteran nurse has been asked to lead an art therapy group in the therapist’s absence. After determining no tools in the room are harmful, the nurse tells the group to create whatever they like using whatever tools they choose. What type of leadership is this? Autocratic Democratic Laissez-faire No leadership style Rationale A laissez-faire leadership style involves very little control by the leader. This style would not be optimal for all therapeutic sessions, but works well with creative endeavors. Autocratic style is the least likely style to use in psychotherapy, as the leader controls the situation and discourages interaction among members. Democratic leadership includes extensive group interaction and is the most common form of leadership in psychotherapy. The nurse is the leader even if he or she is not exerting a large amount of influence. p. 615 A patient is describing a traumatic and painful experience to members of a therapeutic group. Which communication technique should the nurse discourage? Support Empathizing Confrontation Active listening Rationale Confrontation should be avoided after a difficult disclosure. The nurse should guide the group in empathy, active listening, and support. p. 617 A strategy the group leader may use to encourage a nonparticipating member to speak during a session is to share which of the following with the patient? "What you are thinking is very important to the group." "Your opinions about what just happened are important." "You are letting the group down when you fail to contribute." "You must be feeling safe enough to enter the discussion by now." Rationale The leader needs to be patient and, in a nonthreatening manner, encourage members to make contributions. Telling the patient that what he or she is thinking is very important to the group is a nonthreatening way to encourage the patient to contribute. Telling the patient that he or she is letting the group down, that his or her opinions of what just happened are important, and that he or she should be feeling safe enough to share are more threatening and may place the patient on the defensive and encourage further withdrawal. p. 618 When a group member notices another member crying and suggests, "It looks as though you need the floor to tell us what is so upsetting to you," the behavior being demonstrated is which of the following? Altruism Ventilation Universality Reality testing Rationale Altruism involves putting another's needs before one's own. p. 612, Table 34.1 A nurse is conducting group therapy for Alzheimer patients in a nursing home. Which appropriate action does the nurse follow during the orientation phase of therapy? Select all that apply. The nurse states the purpose of the group to the patients. The nurse frequently reminds the patients about the group rules. The nurse avoids pointing out the similarities among the patients. The nurse requests that the patients avoid talking with one another. The nurse introduces him or herself and the patients to one another. Rationale The first phase of group development after a group is formed is called the orientation phase. The nurse states the purpose of the group and makes introductions. It helps the patients to feel comfortable and establish trust within the group. The nurse frequently reminds the group about the rules, as people with psychiatric illness and Alzheimer disease may have difficulty paying attention. Frequent reminders help the patients to effectively participate in the group activity. The nurse should encourage the patients to talk and discuss among themselves rather than approaching the nurse. The nurse should point out the similarities between group members to help facilitate connections. It helps the patients to relate with each other and effectively communicate with the other members of the group. p. 613 An advanced practice nurse running a group on the adolescent unit makes no attempt to control the topic or the member's behavior and makes no comment unless asked a direct question. This is an example of what style of leadership? Autocratic Authoritarian Democratic Laissez-faire Rationale A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. Autocratic leaders control the group, pick the topic, and don't allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making. p. 615 1 topics covered