A patient is being treated in an interdisciplinary clinic. During interactions with a patient who is receiving cognitive behavior therapy, which of the following would the nurse concentrate on first?

Correct Answer: C

Rationale: The correct answer is C: Identifying the underlying beliefs. In cognitive behavior therapy, identifying the underlying beliefs is crucial as they drive the patient's thoughts and behaviors. By focusing on these core beliefs first, the nurse can help the patient understand the root causes of their issues and work towards challenging and modifying them effectively. A: Identifying alternative explanations of an event - This step usually comes after identifying the underlying beliefs. B: Exploring evidence to support or refute the beliefs - This step comes after identifying the beliefs and is not the initial focus. D: Examining the real implications if the beliefs are true - This step is important but is typically addressed after identifying and working on the underlying beliefs.

Correct Answer: B

Rationale: The correct answer is B, "I find that hard to believe." This statement demonstrates the therapeutic communication technique of voicing doubt by expressing skepticism in a non-confrontational manner. It allows the client to further elaborate on their thoughts and feelings, fostering open communication and exploration of underlying issues. Choice A paraphrases the client's statement, choice C assumes the client's feelings, and choice D shifts the focus to finding a solution rather than exploring the client's perspective.

Correct Answer: C

Rationale: The correct answer is C: Identifying the underlying beliefs. In cognitive behavior therapy, identifying the underlying beliefs is crucial as they drive the patient's thoughts and behaviors. By focusing on these core beliefs first, the nurse can help the patient understand the root causes of their issues and work towards challenging and modifying them effectively. A: Identifying alternative explanations of an event - This step usually comes after identifying the underlying beliefs. B: Exploring evidence to support or refute the beliefs - This step comes after identifying the beliefs and is not the initial focus. D: Examining the real implications if the beliefs are true - This step is important but is typically addressed after identifying and working on the underlying beliefs.

Correct Answer: B

Rationale: The correct answer is B because a consistently sad, discouraged, and hopeless mood is a hallmark symptom of many mental illnesses, such as depression. This persistent negative mood is a red flag for potential mental health concerns. A: Reports of occasional sleeplessness and anxiety are common and can be caused by various factors, not solely indicative of mental illness. C: Being able to differentiate between 'as if' and 'for real' is related to cognitive functioning and does not directly point to mental illness. D: Difficulty making decisions can be a symptom of mental illness, but it is not as specific as a consistently sad, discouraged, and hopeless mood in indicating potential mental health issues.

Correct Answer: C

Rationale: The correct answer is C: Axis III. Axis III in the DSM-IV-TR is used for medical conditions that are relevant to the individual's mental health diagnosis. In this case, the woman's diabetes would be listed on Axis III because it is a medical condition that can impact her mental health and treatment. Diabetes is a physical health issue that can affect emotional well-being and may influence the course of her psychiatric treatment. A: Axis I is for clinical disorders such as mood disorders or anxiety disorders. B: Axis II is for personality disorders and mental retardation. D: Axis IV is for psychosocial and environmental stressors. Therefore, the correct placement for the woman's diabetes mellitus in her DSM-IV-TR diagnosis would be on Axis III.