Chapter 27: Behavior Change and Cognitive Interventions

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 problemand 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.