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A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, 'No!' when given direction. The nurse's counseling with the parent should be based on the premise that the child is engaged in which of Erikson's psychosocial crises?
- A. Trust versus Mistrust
- B. Initiative versus Guilt
- C. Industry versus Inferiority
- D. Autonomy versus Shame and Doubt
Correct Answer: D
Rationale: The crisis of Autonomy versus Shame and Doubt is related to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus Mistrust is the crisis of the infant, Initiative versus Guilt is the crisis of the preschool and early school-aged child, and Industry versus Inferiority is the crisis of the 6- to 12-year-old child.
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A patient comments, 'I never know the right answer' and 'My opinion is not important.' Using Erikson's theory, which psychosocial crisis did the patient have difficulty resolving?
- A. Initiative versus Guilt
- B. Trust versus Mistrust
- C. Autonomy versus Shame and Doubt
- D. Generativity versus Self-Absorption
Correct Answer: C
Rationale: These statements show severe self-doubt, indicating that the crisis of gaining control over the environment is not being successfully met. Unsuccessful resolution of Initiative versus Guilt results in guilt, Trust versus Mistrust in poor relationships, and Generativity versus Self-Absorption in self-absorption.
A person received an invitation to be in the wedding of a friend who lives across the country. The individual is afraid of flying. What type of therapy should the nurse recommend?
- A. Psychoanalysis
- B. Milieu therapy
- C. Systematic desensitization
- D. Short-term dynamic therapy
Correct Answer: C
Rationale: Systematic desensitization extinguishes specific fears like flying. Psychoanalysis and short-term therapy explore conflicts, and milieu involves environmental adjustments.
The parent of a child diagnosed with schizophrenia tearfully asks a nurse, 'What could I have done differently to prevent this illness?' Select the nurse's most caring response.
- A. Although schizophrenia is caused by impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance.'
- B. Most of the damage is done, but there is still hope. Changing your parenting style can help your child learn to cope more effectively with the environment.'
- C. Schizophrenia is a biological illness with similarities to diabetes and heart disease. You are not to blame for your child's illness.'
- D. Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.'
Correct Answer: C
Rationale: Schizophrenia is biological, not caused by parenting. This response reassures parents, relieving guilt. The other options inaccurately blame family dynamics or genes without empathy.
The parent of a 4 year old rewards and praises the child for helping a younger sibling, being polite, and using good manners. A nurse supports the use of praise because, according to the Freudian theory, these qualities will likely be internalized and become what part of the child's personality?
- A. Id
- B. Ego
- C. Superego
- D. Preconscious
Correct Answer: C
Rationale: In the Freudian theory, the superego contains the 'thou shalts' or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The preconscious is a level of awareness.
A person tells a nurse, 'I was the only survivor in a small plane crash, but three business associates died. I got anxious and depressed and saw a counselor three times a week for a month. We talked about my feelings related to being a survivor, and now I am at peace with the situation.' Which type of therapy was used?
- A. Milieu therapy
- B. Psychoanalysis
- C. Behavior modification
- D. Interpersonal therapy
Correct Answer: D
Rationale: Interpersonal therapy helps process loss and guilt, restoring functioning. Milieu is environmental, psychoanalysis is long-term, and behavior modification changes specific behaviors.