Test Bank For Psychiatric Nursing 8th Edition by Keltner

Test Bank for Psychiatric Nursing 8th Edition by Keltner
Test Bank for Psychiatric Nursing 8th Edition by

Keltner
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Chapter 10: Working With Groups of Patients
Keltner: Psychiatric Nursing, 8th Edition
MULTIPLE CHOICE
1. A psychiatric nurse clinician on an inpatient unit plans to lead a special-problems group

for withdrawn patients. Which information will be of most assistance as the nurse prepares
for this assignment?
a. Inpatient groups rarely have a lasting beneficial effect.
b. Inpatient groups have short-term, goal-oriented sessions.
c. Inpatient groups are helpful for patients with verbal skills.
d. Inpatient groups facilitate insight into deeply rooted life issues.
ANS: B
Because inpatient stays are so short and accountability is a major treatment issue, inpatient
groups typically have short-term, goal-oriented sessions designed to teach patients more
adaptive strategies for coping with life’s problems. Beneficial effects are often lasting.
Patients with or without verbal skills may be helped by selected types of groups.
Insight-oriented therapy is conducted on an outpatient basis and usually occurs over the
long term.
DIF: Cognitive level: Understanding TOP: Nursing process: Planning

MSC: Client Needs: Psychosocial Integrity
2. A patient in a support group says, “I’m tired of being sick. Everyone always helps me, but
I’ll be glad when I can help someone else.” This statement reflects what therapeutic
factor?
a. Altruism
b. Universality
c. Cohesiveness
d. Corrective recapitulation
ANS: A
Altruism refers to the experience of being helpful or useful to others, a condition that the
patient anticipates will happen. The other options are also therapeutic factors identified by
Yalom.
DIF: Cognitive level: Understanding TOP: Nursing process: Assessment

3. A positive outcome achieved after attending a special-problems group is evidenced by

which patient statement?
a. “You’re a great group leader and kept things moving smoothly.”
b. “This experience wasn’t as bad as I thought it would be.”
c. “I rely on the group to help me make decisions.”
d. “I learned how my anger affects other people.”
ANS: D
Learning more about one’s behavior and its effects on others is an appropriate outcome for
group therapy. The other options do not reflect patient growth.
DIF: Cognitive level: Applying TOP: Nursing process: Evaluation
4. After attending a group, which statement by a patient shows evidence of benefits

associated with universality?
a. “I’ve learned to identify my anxious feelings.”
b. “The group really gave me the support to change.”
c. “I’ve learned that I can be helpful to others.”
d. “My problems are not unique. I’m not alone.”
ANS: D
Universality refers to patients’ realization that they are not alone and unique, and that
others experience similar problems, feelings, and concerns. The remaining options do not
reflect that sense of belonging.
DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation

5. Which intervention would be most appropriate for the nurse to implement when
conducting a maintenance group?
a. Helping patients identify better coping strategies
b. Accepting, empathizing, and showing concern
c. Asking patients to identify topics for the group
d. Confronting ingrained behaviors and defenses
ANS: B
Support means accepting, empathizing, and showing concern while listening and talking
with patients. The nurse’s focus is on responding to patients’ needs. Maintenance and
support groups have the purpose of reinforcing or maintaining existing strengths, rather
than confronting or changing behaviors, which makes identification of better coping
strategies and confronting ingrained behaviors and defenses less acceptable answers.
Sessions are usually structured and goal-oriented, so patients might not be offered the
opportunity to talk about any topic of their choice.
DIF: Cognitive level: Applying TOP: Nursing process: Implementation

6. An anxious, withdrawn patient is experiencing auditory hallucinations. The nurse should

arrange for the patient to be enrolled in which group?
a. Recreation
b. Insight-oriented
c. Reality orientation
d. Stress management
ANS: C
A reality orientation group is a type of support group for patients who have confusion and
short attention spans and who might be frightened, anxious, and isolated. The focus is on
the “here and now,” which is an aid to reality testing. The other types of groups would not
be as beneficial since they require the members to be more stable both cognitively and
emotionally.
DIF: Cognitive level: Applying TOP: Nursing process: Planning
7. What is the primary purpose of referring a patient to an activity group?

a. Assess the patient’s social skills.
b. Provide cognitive and sensory stimulation.
c. Encourage socialization and communication.
d. Educate the patient about use of leisure time.
ANS: C
Activity groups are vehicles to facilitate patient interaction and communication with others
and provide enjoyment. Although the other options are true, they are secondary in nature.
DIF: Cognitive level: Understanding TOP: Nursing process: Planning

8. A patient admitted to an inpatient unit after a suicide attempt says, “I feel so overwhelmed.
There are so many issues I have to deal with.” The nurse should schedule the patient to
attend which type of group to meet their initial needs?
a. Social skills
b. Psychodrama
c. Problem-solving
d. Medication information
ANS: C
Problem-solving groups teach the skills necessary to solve problems. A patient with
multiple problems will benefit from learning the process for problem-solving, because the
multiple problems to which he or she refers probably will not be resolved during a short
inpatient stay. The scenario does not pose problems with social skills or medication.
Psychodrama is rarely offered in an inpatient setting.

9. A patient says, “I wish I could express my depressed feelings rather than keeping them
inside.” The nurse should schedule the patient to attend which type of group?
a. Social skills
b. Special problems
c. Reality orientation
d. Relapse prevention
ANS: B
Scheduling the patient for group sessions with others with depression would allow the
patient to address this need in a supportive, understanding environment. The patient does
not need reality orientation or social skills and has not expressed a need for relapse
prevention information.

10. What is a realistic outcome for group members of a psychoeducational group?

a. Discuss ways to manage their illness.
b. Develop a high level of trust and cohesiveness.
c. Understand unconscious motivation for behavior.
d. Demonstrate insight about development of their illness.
ANS: A
Patients have problems associated with everyday living in the community, so discussing
ways to manage the illness would be an important aspect of psychoeducation. Discussing
concerns about daily life would be a goal to which each could relate. Developing trust and
cohesion is desirable but is not the priority outcome of a psychoeducational group.
Understanding unconscious motivation would not be addressed. Insight would be difficult
for a patient with residual schizophrenia because of the tendency toward concrete thinking.
DIF: Cognitive level: Understanding TOP: Nursing process: Implementation

11. A talkative member of a support group for patients diagnosed with bipolar disorder has
monopolized the group discussion for 15 minutes. How should the nurse leading the group
best intervene?
a. Maintaining silence. It is important for group members to give feedback to each
other
b. Encouraging the patient to continue. Patients learn from each other in group
sessions
c. Saying, “You must allow some of the other members of the group to talk. You
cannot monopolize the conversation”
d. Addressing the patient by name and saying, “I’m glad you shared your thoughts
with us. Let’s hear what others think”
ANS: D
This intervention provides support for the dominant patient but opens the floor for
contributions from others. Doing nothing or encouraging the patient to continue would be
ineffective strategies, because they fail to recognize the needs of others in the group.
DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation

12. During a support group meeting focusing on strategies to manage symptoms, a patient asks
the nurse leader how to deal with angry outbursts from a supervisor. What response
technique should the nurse discuss?
a. Answer the question, and then move on to another topic.
b. Offer to answer the question privately after the group session.
c. Inform the patient that only illness-related problems can be discussed in the group.
d. Matter-of-factly explain that the topic being discussed is the importance of
medication.
ANS: D
Some patients ask distracting questions, seeking answers directly from the leader. The
nurse leader preserves the group process by returning the focus to the group and the topic
being discussed. Only the correct option accomplishes this.

13. The nurse asks members of a group for recovering alcoholics how they handle the urge to
drink. Which communication technique is the nurse using?
a. Summarizing
b. Presenting reality
c. Encouraging comparison
d. Seeking consensual validation
ANS: C
Distinguishing among the techniques listed shows that the nurse is encouraging
comparisons. Asking members to compare and contrast their experiences promotes group
sharing. None of the other options focus on the comparison identified in the question.

14. After a patient’s first group session, the nurse asks, “How was the experience of
participating in group for you?” Which communication technique is the nurse using?
a. Summarizing
b. Seeking clarification
c. Making observations
d. Encouraging evaluation
ANS: D
Distinguishing among the techniques listed shows that the nurse is encouraging evaluation
when asking a patient to make a judgment about the experience. This opens the door to
further exploration of thoughts and feelings.

15. A patient in a detoxification unit asks, “What good will it do to go to Alcoholics

Anonymous and talk to other people with the same problem?” The nurse’s best response
would be to explain that self-help groups such as AA provide opportunities for what
beneficial experience?
a. Newly discharged alcoholics can learn about the disease of alcoholism.
b. People with common problems share their experiences with alcoholism and
recovery.
c. Patients with alcoholism receive insight-oriented treatment about the etiology of
their disease.
d. Professional counselors provide guidance to individuals recovering from
alcoholism.
ANS: B
The patient needs basic information about the purpose of a self-help group. The basis of
self-help groups is sharing by individuals with similar problems. Self-help is based on the
belief that an individual with a problem can be truly understood and helped only by others
who have the same problem. The other options fail to address this or provide incorrect
information.

16. Which patient would benefit most from a group that focuses on reality orientation?
a. Adolescent with mixed drug and alcohol abuse
b. Adult with undifferentiated schizophrenia
c. Older adult with depression
d. Young adult in crisis
ANS: B
Reality orientation groups are helpful for patients who are confused and unable to perceive
and interpret reality accurately. The patient with undifferentiated schizophrenia is the
choice of patients for the reality group, because misperception of reality and poor reality
testing are usually part of the patient’s clinical picture. None of the other options focus on
this component of therapy.
DIF: Cognitive level: Analyzing TOP: Nursing process: Planning

17. Which type of group is a staff nurse with 2 months’ psychiatric experience best qualified
to conduct?
a. Social skills group
b. Family therapy group
c. Medication education group
d. Insight-oriented psychotherapy group
ANS: C
All nurses receive information about patient teaching strategies and basic information
about psychotropic medications, making a medication education group a logical group for
a beginner to conduct. All the other options require more advance mental health care
knowledge and experience than a novice nurse processes.

18. Which comment made by a member of a support group, best contributes to group
cohesiveness and effectiveness?
a. “Talking about my problems helps me think of ways to solve them. Let me explain
them to everyone.”
b. “We aren’t making progress because our group leader has as many problems as we
do.”
c. “No one in this group wants to hear anything else about your financial problems.”
d. “We started out talking about guilt, but we wandered off from that subject.”
ANS: D
Group leaders must recognize and manage a group process and content. Cohesiveness
helps the group achieve its goals. The speaker has made an observation of the group
process. Distracting, dominant, or hostile comments distract from the curative factor of
universality.
DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation

19. Which comment would be most appropriate for the group leader to begin the discussion at
the first meeting of a new group?
a. “Let’s start by establishing some rules for our group.”
b. “Let’s begin with each person here defining his or her problem.”
c. “I want each person to explain why he or she is attending this group.”
d. “Talking to family about our group will help us achieve our goals.”
ANS: A
The leader must set ground rules for the group before members can effectively participate.
Bringing family members would jeopardize confidentiality. Members share feelings after
the group develops an identity and cohesiveness.

20. Which comment should the leader of a newly formed group include in the initial meeting?
a. “It is important for everyone to arrive on time for our group.”
b. “Talking to family members about our group will help us achieve our goals.”
c. “Everyone is expected to share a personal experience at each group meeting.”
d. “Groups provide more cost-effective treatment in this time of budget constraints.”
ANS: A
Arriving on time is important to the group process. Talking to family members would
jeopardize confidentiality. Although groups are cost-effective, blaming the budget would
not help members feel valued. Setting an expectation to share may be intimidating for a
withdrawn patient.

21. While a member of a group shares painful feelings of guilt, another member begins
humming and tapping the side of the chair. Select the leader’s best initial statement to best
manage the disruptive patient.
a. To the speaking patient, “Please realize that not everyone is comfortable with what
you are sharing.”
b. To the entire group, “Humming and tapping can’t be tolerated. It is disruptive to
our group.”
c. To the entire group, “Please leave the group now if you can’t show empathy for
the speaker.”
d. To the disruptive member, “You seem uncomfortable with our discussion.”
ANS: D
While the leader must help group members show respect for each other, identifying the
possible feelings of the disruptive or hostile person addresses the process in the group and
is the initial action required. It will invite self-expression in a more constructive way or
extinguish the behavior. If the disruption continues, the leader may need to confront the
behavior or excuse the disruptive person.

22. As members disperse at the conclusion of a productive group meeting, one member says,
“Let’s have a big group hug.” What is the leader’s most appropriate response?
a. “Hugging is not permitted.”
b. “I am glad you found the meeting so helpful.”
c. “Thanks for that suggestion, but not everyone may be comfortable with hugs.”
d. “The group is over now. Members may not have continued contact with each
other.”
ANS: C
The leader must facilitate maintenance of the group norms. Some persons may feel
comfortable with hugs; others may not. The leader should not prohibit the behavior but
rather should gently set limits that recognize the needs of all.

23. When preparing to lead an anger management group, the nurse is demonstrating
knowledge in what type of group?
a. Psychoeducational
b. Self-help
c. Activity
d. Support
ANS: A
Psychoeducational groups include anger management, relapse prevention, medication
education, and living skills.

MULTIPLE RESPONSE
1. When a patient voices a delusion during a group session, how can the nurse effectively
handle the situation? (Select all that apply.)
a. Demonstrating empathy
b. Presenting reality
c. Exploring the delusional content
d. Focusing on the underlying need expressed
e. Asking the group what they think about the delusion.
ANS: A, B, D
Responding to the voicing of a delusion during a group session is best handled by using
empathy, focusing on the underlying need, and presenting reality. Delusional thinking
does not respond to logic or criticism.

2. A leader beginning the discussion at the first meeting of a new group can appropriately
include what statement? (Select all that apply.)
a. “We use groups to provide treatment, because it’s a more cost-effective use of staff
in this time of budget constraints.”
b. “When someone shares a personal experience, it’s important to keep the
Test Bank for Psychiatric Nursing 8th Edition by Keltner
information confidential.”
c. “Talking to family members about our group discussions will help us achieve our
goals.”
d. “Everyone is expected to share a personal experience at each group meeting.”
e. “It is important for everyone to arrive on time for our group.”
ANS: B, E
Confidentiality of personal experiences should be maintained. Arriving on time is
important to the group process. Talking to family members would jeopardize
confidentiality. While groups are cost-effective, blaming the budget would not help
members feel valued. Setting an expectation to share may be intimidating for a withdrawn
patient.

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1. A psychiatric nurse clinician on an inpatient unit plans to lead a special-problems group

DIF: Cognitive level: Understanding TOP: Nursing process: Planning

DIF: Cognitive level: Understanding TOP: Nursing process: Assessment

3. A positive outcome achieved after attending a special-problems group is evidenced by

4. After attending a group, which statement by a patient shows evidence of benefits

DIF: Cognitive level: Understanding TOP: Nursing process: Evaluation

DIF: Cognitive level: Applying TOP: Nursing process: Implementation

6. An anxious, withdrawn patient is experiencing auditory hallucinations. The nurse should

7. What is the primary purpose of referring a patient to an activity group?

DIF: Cognitive level: Understanding TOP: Nursing process: Planning

DIF: Cognitive level: Applying TOP: Nursing process: Planning

DIF: Cognitive level: Applying TOP: Nursing process: Planning

10. What is a realistic outcome for group members of a psychoeducational group?

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation

DIF: Cognitive level: Applying TOP: Nursing process: Implementation

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation

15. A patient in a detoxification unit asks, “What good will it do to go to Alcoholics

DIF: Cognitive level: Applying TOP: Nursing process: Implementation

DIF: Cognitive level: Analyzing TOP: Nursing process: Planning

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation

DIF: Cognitive level: Analyzing TOP: Nursing process: Evaluation

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation

DIF: Cognitive level: Applying TOP: Nursing process: Implementation

DIF: Cognitive level: Analyzing TOP: Nursing process: Implementation

DIF: Cognitive level: Applying TOP: Nursing process: Implementation

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation

DIF: Cognitive level: Understanding TOP: Nursing process: Implementation

DIF: Cognitive level: Applying TOP: Nursing process: Implementation

Visit TestBankBell.com to get complete for all chapters

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