WGU D344 EXam 2026 Questions with 100% corrrect answers + rationales

What is a paradigm?

A worldview or widely accepted value system.

What does a paradigm encompass in a given discipline?

A network of theory, research, education, and practice.

What are the components of the nursing metaparadigm?

Nurse, person, environment, health.

What does the 'nurse' component of the nursing metaparadigm refer to?

- Nursing is both art and science.

- In PMHNP care, it’s about forming therapeutic alliances, promoting recovery, and integrating psychotherapy + pharmacology + holistic care.

How is 'person' defined in the nursing metaparadigm?

Human beings who are multidimensional.

- Seen holistically — mind, body, and spirit interwoven. - In PMHNP practice, “person” includes the patient’s subjective experience, sense of identity, and psychological world.

What does 'environment' refer to in the nursing metaparadigm?

- Includes home, community, hospital, and even social determinants of health.

- For mental health: environment includes family dynamics, stigma, trauma, and socioeconomic stressors.

What does 'health' refer to in the nursing metaparadigm?

- Wellness–illness continuum — health as balance and integration.

- PMHNPs view mental health as fluid — shaped by coping, resilience, and life context.

What is the definition of a theory?

An organized set of concepts that explains a phenomenon or set of phenomena.

What two components comprise nursing science?

Theory and research.

How can theories be tested?

Through a deductive process or can guide research studies through an inductive process.

Erikson’s stages of human development Infancy up to 1yr

Trust vs Mistrust

Form meaningful relationships, future hope, trust others

Erikson’s stages of human development childhood 1-3 yrs

Autonomy vs

Shame & Doubt

Self-control, self-esteem, willpower

Erikson’s stages of human development Late childhood 3-6 yrs

Initiative vs Guilt

Self-directed behavior, goal formation, sense of purpose

Erikson’s stages of human development School-age 6-12 yrs

Industry vs

Inferiority

Ability to work, sense of competency and achievement

Erikson’s stages of human development Adolescence 12-20 yrs

Identity vs Role

confusion

Personal sense of identity

Erikson’s stages of human development Early adulthood 20-35 yrs

Intimacy vs

Isolation

Committed relationships, capacity to love

Erikson’s stages of human development Middle adulthood 35-65 yrs

Generativity vs

Self-absorption or

Stagnation

Ability to give time and talents to others, ability to care for others, ability

to grow

Erikson's stages of human development Late adulthood >65 yrs

Integrity vs

Despair

Fulfillment and comfort with life, willingness to face death, insight and

balanced perspective on life's events

Psychodynamic/Psychoanalytic theories (Freud, Jung, Adler, Horney, Fromm)

All behavior is purposeful and meaningful. There are conscious and unconscious mental processes that influence thoughts and behavior, believes unconscious can be accessed through dreams and free association.

Childhood experiences shape adult personality. Most of the conflict is unconscious but experienced consciously as anxiety

goal is to develop understanding of the unconscious mental processes and use this understanding to address

mental health issues. (defense mechanisms, transference, countertransference)

3 structures of the mind and personality:

Id (I want) – present at birth, largely unconscious/sexual/aggressive/infantile drives, immediate gratification, primary drives or instincts, urges, fantasies

Ego (I think, I evaluate) – begins to develop at birth as infant struggles to deal with environment,

preconscious and conscious, reality principle, rational mind, logical and abstract thinking, responsible for use of defense mechanisms

Superego (I should, I ought) – begins to fully develop around age 6 as a result of contact with external authority figures, good vs bad/right vs wrong, aspirations, ideals, morals, regulated by guilt and shame

3 structures of the mind and personality:

Id (I want) – present at birth, largely unconscious/sexual/aggressive/infantile drives, immediate gratification, primary drives or instincts, urges, fantasies

Ego (I think, I evaluate) – begins to develop at birth as infant struggles to deal with environment,

preconscious and conscious, reality principle, rational mind, logical and abstract thinking, responsible for use of defense mechanisms

Superego (I should, I ought) – begins to fully develop around age 6 as a result of contact with external authority figures, good vs bad/right vs wrong, aspirations, ideals, morals, regulated by guilt and shame

Id (I want) –

present at birth, largely unconscious/sexual/aggressive/infantile drives, immediate gratification, primary drives or instincts, urges, fantasies

Ego (I think, I evaluate) –

begins to develop at birth as infant struggles to deal with environment,

preconscious and conscious, reality principle, rational mind, logical and abstract thinking, responsible for use of defense mechanisms

Superego (I should, I ought) –

begins to fully develop around age 6 as a result of contact with external authority figures, good vs bad/right vs wrong, aspirations, ideals, morals, regulated by guilt and shame

Old Age Parrots Love Grapes (Mnemonic)

freud 5 stages

oral

anal

phallic

latency

genital

oral stage

0-18 mos

Sucking, chewing, feeding, crying

Schizophrenia, substance

abuse, paranoia

Anal Stage

(18mos-3yrs)

Sphincter control, activities of expulsion and

retention

Depressive disorders

Phallic Stage

3 - 6 yrs

Exhibitionism, masturbation with focus on Oedipal

conflict, castration anxiety, female fear of lost

maternal love

Sexual identity disorders

Latency Stage

6 yrs - puberty

Peer relationships, learning, motor-skills,

development, socialization

Inability to form social

relationships

Genital Stage

Puberty forward

Integration and synthesis of behaviors from early

stages, primary genital-based sexuality

Sexual perversion

disorders

Cognitive Theory (Piaget)

Human development evolves through cognition, learning, comprehending

• Native endowment, biological, environmental factors influence child’s development

• focused on understanding that human behavior is guided primarily by thought processes

• 4 stages of cognitive development:

Sensorimotor (birth – 2yrs) Object permanence – objects have existence independent of child’s

involvement with them

Preoperational (2 -7yrs) Language and symbolism, magical thinking

Concrete Operations (7 - 12yrs) Logic, concepts of reversibility (one thing can turn into another and back again) and conservation (shape may change but characteristics of object

remain ex. clay)

Formal Operations (12yrs – adult) Abstract thinking, formal and logical thinking

Cognitive Theory (Piaget) Sensorimotor (birth - 2yrs)

Object permanence - objects have existence independent of child's involvement with them

Cognitive Theory (Piaget) Preoperational (2 -7yrs)

Language and symbolism, magical thinking

Cognitive Theory (Piaget) Concrete Operations (7 - 12yrs)

Logic, concepts of reversibility (one thing can turn into another and back again)

and

conservation (shape may change but characteristics of object remain ex. clay)

Cognitive Theory (Piaget) Formal Operations (12yrs - adult)

Abstract thinking, formal and logical thinking

How do interpersonal relationships influence personality development?

Personality is not formed in isolation — it emerges through interaction

Every human relationship acts as a mirror, a teacher, and a sculptor of the self.

What occurs when the self-system interferes with one's need for satisfaction and security?

Mental illness occurs.

is the feeling associated with the relief from anxiety — it is the foundation for interpersonal trust and growth."

Interpersonal security.

What are the two drives for behavior according to Sullivan's theory?

According to Harry Stack Sullivan, all human behavior is motivated by two basic drives

(1) The drive for satisfaction — the need to meet biological and interpersonal needs; and

DEF: Biological drive to fulfill needs and reduce tension

PURPOSE: To obtain tenderness, comfort, and pleasure

CLINICAL IMPLICATION: Unmet satisfaction needs can produce irritability, impulsivity, or psychosomatic symptoms

(2) The drive for security — the need to avoid anxiety and maintain interpersonal safety through relationships.

DEF: Social drive to reduce anxiety and maintain interpersonal safety

PURPOSE: To preserve self-esteem and acceptance

CLINICAL IMPLICATION: Excessive security drive can cause avoidance, dependency, or distorted self-image

What are the 7 stages of development according to Sullivan's theory?

Infancy, Childhood, Juvenile, Preadolescence, Early adolescence, Late adolescence.

(Sullivan's theory) what is the focus of the Infancy stage (birth - 18 mos)?

Oral gratification; anxiety occurs for the first time.

(Sullivan's theory) what is the focus of the Childhood stage (18 mos - 6 yrs)?

Delayed gratification.

(Sullivan's theory) what is the focus of the Juvenile stage (6 - 9 yrs)?

Forming of peer relationships.

(Sullivan's theory) what is the focus of the Preadolescence stage (9 - 12 yrs)?

Same-sex relationships.

(Sullivan's theory) what is the focus of the Early adolescence stage (12 - 14 yrs)?

Opposite-sex relationships.

(Sullivan's theory) what is the focus of the Late adolescence stage (14 - 21 yrs)?

Self-identity developed.

What is the main idea of Social Learning Theory?

New behaviors are learned by observing the behavior of others and the consequences of their behavior.

What factors influence behavior according to Bandura's social cognitive theory?

According to Bandura’s Social Cognitive Theory, behavior is shaped by a reciprocal interplay of personal (cognitive and emotional), behavioral, and environmental factors — where learning occurs through observation, imitation, and self-efficacy-driven regulation.

🩺 Clinical Pearl

When you’re helping a patient change behavior (e.g., quit smoking, manage anxiety, adhere to meds):

Strengthen self-efficacy

Modify environmental triggers/supports

Reinforce small behavioral successes

That’s Bandura’s triangle of change in motion — psychology with wings. 🕊️

What is self-efficacy?

is the belief in one’s ability to perform a behavior successfully to achieve desired outcomes.

High self-efficacy → confidence, persistence, resilience

Low self-efficacy → avoidance, hopelessness, failure to initiate change

Clinical Application:

PMHNPs enhance self-efficacy through modeling success, setting achievable goals, providing feedback, and celebrating small wins.

“You’ve managed your anxiety before; you can do it again.” — that’s Bandura in action.

What do developmental theories like Piaget and Erikson focus on?

The stages of human development over time.

What does the Humanistic approach in psychology focus on?

(Self-awareness, growth, potential

in psychology focuses on the whole person and their inherent potential for self-growth, self-awareness, and meaning-making, emphasizing free will, subjective experience, and personal responsibility as the keys to psychological health.

Who developed the hierarchy of needs?

Abraham Maslow

What is a key concept of Carl Rogers' approach?

Unconditional Positive Regard

Accepting the client without judgment or conditions — valuing them as inherently worthy regardless of behavior or diagnosis.

Empathy

Deep, accurate understanding of the client’s inner world and emotional experience.

Congruence (Genuineness)

The nurse or therapist is authentic and transparent, not hiding behind professional distance or pretense.

Aligns seamlessly with trauma-informed care and recovery-oriented practice.

When these three conditions are present, the client’s self-concept aligns more closely with their true self, leading to emotional healing and self-acceptance.

What does congruence mean in the context of a PMHNP's relationship with clients?

The PMHNP should not put up a façade or deceive clients about their feelings.

General Adaptation Syndrome (GAS) is Hans Selye’s model (1936).

What is the general adaptation syndrome?

physiological response to stress — how we react, adapt, and, if pushed too far, begin to break down.

It’s the biological choreography of stress — from alarm, to resistance, to exhaustion.

What is the general systems theory (GST)?

Developed by Ludwig von Bertalanffy (1968) — a biologist who argued that all living things are open systems that interact with their environments.

Core Idea:

The human being — and by extension, families, groups, and communities — is an open, dynamic system constantly exchanging energy, matter, and information with the environment.

This means human systems are not isolated; they adapt, grow, and maintain balance through interaction.

They maintain homeostasis through interdependence, feedback, and adaptation, with changes in one part of the system influencing the whole.

What are the three principles proposed by Martha Rogers?

Resonancy

🩺 PMHNP example: When a client experiences deep anxiety, their energy field is disordered — rapid, erratic, high-frequency patterns.

Therapeutic presence, breathing, or meditation can help shift resonance toward calmer, coherent rhythms.

Helicy

Change occurs continuously, unpredictably, and in an increasingly diverse and innovative pattern.

Integrality

The continuous mutual interaction and inseparability between the human and environmental fields.

theory of Cultural Care (Madeline Leininger)

Founder of transcultural nursing theory.

She argued that health, illness, caring, and healing are deeply embedded in cultural values, beliefs, and practices.

care is the unifying focus and essence of nursing, regardless of culture

Health and well-being can be predicted through cultural care

What is the Theory of Interpersonal Relationships also known as?

Therapeutic Nurse-Client Relationship Theory (Peplau)

What is the basis of Peplau's Therapeutic Nurse-Client Relationship Theory?

It is based in part on Sullivan's interpersonal theory.

What does Peplau believe the person is composed of?

A developing self-system composed of biochemical, physiological, and interpersonal characteristics and needs.

What produces anxiety according to Peplau's theory?

Anxiety is produced when one feels threatened in some way.

How does behavior relate to anxiety in Peplau's theory?

Behavior represents the person trying to adapt to internal or environmental forces.

What is the nursing role in Peplau's Therapeutic Nurse-Client Relationship Theory?

To assist in understanding anxiety and learn new behaviors to use the anxiety for a positive outcome.

What is empathetic linkage in the context of Peplau's theory?

The nonverbal transmission of feelings such as anxiety, anger, and disgust from client to PMHNP.

Jean Watson's Caring Theory

best known for her Theory of Human Caring (sometimes called the Caring Science Theory).

🔑 Core Ideas

Caring is central to nursing: Not just a technique, but a moral and philosophical foundation.

Transpersonal Caring: The nurse–patient relationship goes beyond the physical — it’s about connecting spirit-to-spirit, seeing the patient as a whole person, not just a diagnosis.

Health as harmony: Health is not just the absence of disease, but alritas Processes

She originally outlined 10 carative factors, later reframed into 10 caritas processes (caritas meaning "to cherish, to love"):

Practice loving-kindness.

Be authentically present.

Cultivate your own spiritual practices.

Develop a trusting relationship.

Be open to expression of feelings.

Use creative problem-solving in caring.

Engage in transpersonal teaching-learning.

Provide a healing environment (physical + energetic).

Assist with basic human needs, with dignity.

Open to miracles and existential dimensions of life and death.

Practice loving-kindness.

Be authentically present.

Cultivate your own spiritual practices.

Develop a trusting relationship.

Be open to expression of feelings.

Use creative problem-solving in caring.

Engage in transpersonal teaching-learning.

Provide a healing environment (physical + energetic).

Assist with basic human needs, with dignity.

Open to miracles and existential dimensions of life and death.

Orem's Theory of Self Care

Her Self-Care Deficit Nursing Theory (SCDNT), often simply called the Theory of Self-Care, is all about the balance between a person’s ability to care for themselves and the nurse’s role in filling the gap.

🔑 Core Concepts

Self-Care

The activities individuals do on their own to maintain life, health, and well-being (eating, hygiene, medication management, mobility, etc.).

Self-Care Agency

A person’s ability (knowledge, motivation, resources, skills) to perform self-care.

Therapeutic Self-Care Demand

Everything a person needs to do for health at a given time.

Self-Care Deficit

The gap between what a person can do and what they need to do — this is where nursing comes in.

Nursing Systems (Orem’s big contribution):

Wholly compensatory system: Nurse does all the care (e.g., unconscious patient).

Partly compensatory system: Nurse and patient share care (e.g., stroke rehab).

Supportive-educative system: Nurse mainly teaches and supports (e.g., new diabetic learning insulin injections).

self-care deficiency

• recommends patients incapable of maintaining self-care should be provided with nursing care.

Parse's Theory

she takes us into the more existential, human science side of nursing. 🌌

Her work is called the Human Becoming Theory.

Parse wasn’t interested in nursing as a set of tasks or even just a caring philosophy — she wanted to articulate the deep meaning of what it means to be a person experiencing health, life, and relationships.

• nurse’s role is to guide individuals to explain the meaning of their own experiences

• recommends experiences not problems be the focus in community mental health nursing.

What is Bowlby's Theory?

Bowlby's Theory is attachment theory in developmental psychology.

What is the primary need described in Bowlby's Theory?

Humans are born with a need to form a close emotional bond with a caregiver.

When does the bond between a child and caregiver typically develop according to Bowlby's Theory?

The bond develops during the first six months of a child's life.

What is necessary for the bond to develop according to Bowlby's Theory?

The caregiver must be appropriately responsive.

Who developed the Health Belief Model?

Marshall Becker

What is the perception of susceptibility in the Health Belief Model?

It considers negative consequences, how harmful a condition is, risk factors, and the target population.

What does perceived severity refer to in the Health Belief Model?

It is the belief about how serious a condition is and its consequences, including the extent of harm.

What are perceived benefits of treatments in the Health Belief Model?

It refers to the efficacy of advised actions to reduce the seriousness of a disease or harmful state.

What are perceived barriers to change in the Health Belief Model?

Factors such as cost, transportation, and embarrassment that prevent individuals from getting screenings.

What does self-efficacy mean in the context of the Health Belief Model?

It refers to the belief that one can achieve the change needed for health improvement.

Health Belief Model

(Marshall Becker)

perception of susceptibility

perceived severity

perceived benefits of treatments

perceived barriers to change

self-efficacy/expectations of efficacy

Cues to action

What is the Biopsychosocial Model?

It is the opposite of the biomedical model and presents a holistic view of a person, including biological, sociological, and psychological factors.

What are the three factors included in the Biopsychosocial Model?

Biological, Sociological, and Psychological factors.

What is the goal of the Biopsychosocial Model?

To develop a realistic patient-centered care plan with the best health outcomes.

What are some biological factors in the Biopsychosocial Model?

Genetic vulnerability, physical health, disability, neurochemistry, diet/lifestyle, immune response, drug effects, stress response.

What are some psychological factors in the Biopsychosocial Model?

Attitudes/beliefs, emotions, self-esteem, trauma, coping skills, social skills, grief, perceptions, personality.

What are some sociological factors in the Biopsychosocial Model?

School, work, interpersonal relationships, socio-economic status, peer group, lifestyle, societal norms, culture, education, family circumstances, abuse, neglect.

What is the Transtheoretical Model of Change?

A model that describes the stages individuals go through to change behavior.

What is the first stage of the Transtheoretical Model of Change?

Precontemplation - no intention to change.

What is the second stage of the Transtheoretical Model of Change?

Contemplation - aware of the problem, thinking about change but no commitment.

What is the third stage of the Transtheoretical Model of Change?

Preparation/Determination - made the decision to change and ready for action.

What is the fourth stage of the Transtheoretical Model of Change?

Action - engaging in specific and overt actions to change.

What is the fifth stage of the Transtheoretical Model of Change?

Relapse.

What is the sixth stage of the Transtheoretical Model of Change?

Maintenance - engaging in behaviors to prevent relapse.

What is the first level of Maslow's Hierarchy of Needs?

Physiological/survival needs, including food, shelter, water, warmth, and rest.

What is the second level of Maslow's Hierarchy of Needs?

Safety needs, including security and safety from emotional and physical harm.

What is the third level of Maslow's Hierarchy of Needs?

Love and belonging needs, including intimate relationships, friends, and affection.

What is the fourth level of Maslow's Hierarchy of Needs?

Esteem needs, including prestige, feeling of accomplishment, and sense of worth.

What is the fifth level of Maslow's Hierarchy of Needs?

Self-actualization, which is achieving one's full potential; only about 2% of people reach this.

Maslow's Hierarchy of needs

• physiological/survival - food, shelter, water, warmth, rest

• safety - security, safety from emotional and physical harm

• love & belonging - intimate relationships, friends, affection

• esteem - prestige, feeling of accomplishment, sense of worth

• self-actualization - achieving one's full potential (only about 2% of people reach this)

What is Group Therapy?

A therapeutic approach that involves a group of individuals discussing their issues together.

What is one benefit of Group Therapy related to self-insight?

Increases self-insight