Test Bank For Critical Care Nursing Diagnosis and Management 8th Edition Linda Urden Kathleen Stacy Mary Lough

Test Bank for Critical Care Nursing Diagnosis and Management, 8th Edition, Linda Urden Kathl
Test Bank for Critical Care Nursing Diagnosis and

Management, 8th Edition, Linda Urden Kathleen
Stacy Mary Lough
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anagement-8th-edition-linda-urden-kathleen-stacy-mary-lough/
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Chapter 06: Psychosocial and Spiritual Alterations and Management
Urden: Critical Care Nursing, 8th Edition
MULTIPLE CHOICE
1. According to the transactional theories on stress, what does a person do first when confronted
by stress?
a. Determines coping mechanisms to deal with the stress
b. Determines the perceived degree of threat imposed
c. Determines what the response will be to the stress
d. Denies the stress exists
ANS: B
An alarm reaction is initiated by the hypothalamus, which, upon receiving sensory and
chemical information regarding the presence of a stressor, signals the release of
corticotrophin-releasing factor (CRF). During the resistance stage, the person’s systems fight
back, leading to adaptation and a return of normal functioning. If the stressors continue,
exhaustion occurs, a stage in which reserves have been depleted. Reversal of stress exhaustion
can be accomplished by restoration of one’s reserves through the use of medications,
nutrition, and other stress reduction measures.
PTS: 1 DIF: Cognitive Level: Remembering REF: pp. 79-80

OBJ: Nursing Process Step: Assessment TOP: Psychosocial
MSC: NCLEX: Psychosocial Integrity
2. A patient has recently been weaned off mechanical ventilation after 3 weeks of treatment. The
patient is now refusing to have the ventilator removed from the room. What type of alteration
is the patient experiencing?
a. Disturbed self-esteem
b. Regression
c. Hopelessness
d. Disturbed body image
ANS: D
Body image disturbances arise when disruption exists in the way individuals perceive their
bodies. Patients temporarily requiring mechanical ventilation must extend their body images
to include the ventilator. When the ventilator is no longer needed, the patient should no longer
perceive the ventilator as part of the self. Illness robs a person of perspective, often leading to
low self-esteem and feelings of powerlessness, helplessness, and depression. Low self-esteem
impairs one’s ability to adapt.
PTS: 1 DIF: Cognitive Level: Applying REF: p. 78

OBJ: Nursing Process Step: Diagnosis TOP: Psychosocial
3. A patient with low self-esteem may manifest which behaviors?

a. Refusal to participate in care
b. Feelings that his or her body has betrayed him or her
c. Acceptance and ownership of problems
d. Disruption in the perception of the body
ANS: A
Patients with low self-esteem may refuse to participate in self-care, exhibit self-destructive
behavior, or be too compliant. Feelings that his or her body has betrayed him or her is an
example of disruption in the perception of the body.

4. Which statement regarding patients with an external locus of control is true?

a. They believe that they can influence the outcome of their illness.
b. They should be forced to take control of their discharge planning.
c. They usually start out with an internal locus of control until a major illness occurs.
d. They believe that events are related to chance or fate.
ANS: D
People with an external locus of control tend to believe that events are related to chance or
fate. Individuals who have an internal locus of control perceive themselves to be responsible
for the outcome of events. People vary in the amount of control they prefer.
PTS: 1 DIF: Cognitive Level: Remembering REF: p. 79

5. Which intervention should be included in the patient management plan for a patient with
powerlessness?
a. Maintain control of the environment
b. Set limits on the behavior
c. Maintain a routine schedule so that the patient can anticipate activities
d. Prepare the patient for transfer to the medical floor
ANS: B
Interventions for patients with powerlessness include setting limits on behavior, encouraging
independence and participation in self-care, counseling, and involving family members in
establishing realistic goals. Powerlessness can be manifested by a refusal to participate in
decision making, disengagement from plan of care, expressions of self-doubt, or a seeming
lack of interest in recovery.
PTS: 1 DIF: Cognitive Level: Applying

REF: p. 79|Appendix A|Nursing Management Plan: Powerlessness
OBJ: Nursing Process Step: Intervention TOP: Psychosocial
6. Which statement regarding regression as a coping mechanism for critical care patients is
accurate?
a. It is necessary to some degree to allow staff to administer care.
b. It indicates deterioration of the physical state.
c. It is adaptive when the patient calls every 15 minutes, even for trivial matters.
d. It is best avoided to ensure successful recovery.
ANS: A
Regression allows patients to give up their usual roles, autonomy, and privacy to become
passive recipients of medical and nursing care. Behaviors such as whining, clinging to staff,
needing the nurse constantly at the bedside, and giving evidence of an inability to
self-modulate feelings of anxiety or fear can interfere with patient recovery and negatively
impact nurse–patient relationships.

7. Which concept supports patients and helps them endure the physical and psychologic insults
of their critical illness?
a. Regression
b. Denial
c. Hope
d. Trust
ANS: C
Hope is a subjective, dynamic internal process essential to life. Considered to be a spiritual
process, hope is an energy that arises out of a sense of being meaningfully connected to one’s
self, others, and powers greater than the self. With hope, a person is able to transition from a
state of vulnerability to a point of being able to live as fully as possible. Regression is an
unconscious defense mechanism characterized by a retreat, in the face of stress, to behaviors
characteristic of an earlier developmental level. Denial is defined as the “conscious and
unconscious attempts to disavow knowledge or the meaning of an event to reduce anxiety and
fear.” Trust manifests itself in critical care patients’ belief that the people they depend on will
get them through the illness and will be able to manage any untoward event that might occur.
PTS: 1 DIF: Cognitive Level: Understanding REF: p. 79

OBJ: Nursing Process Step: Diagnosis TOP: Psychosocial Alterations
8. Which therapeutic technique may be used to enhance coping in the critical care environment?
a. Encourage the patient to let the staff have total control of the patient’s care
b. Encourage the patient to deny the presence of the illness
c. Inform the patient that everything will be all right
d. Foster trust in the interprofessional health care team
ANS: D
Trust manifests itself in critical care patients’ belief that the people they depend on will get
them through the illness and will be able to manage any untoward event that might occur. A
patient needs to trust the nurse’s competence in the physical and technical aspects of care and
rely on what the nurse says.

9. Which nursing intervention can help family members who are extremely upset?
a. Encouraging the family to visit as much as possible
b. Conveying what the patient is experiencing to the family
c. Supporting the family members away from the bedside
d. Assuring the family that the staff will take care of the technical aspects of the
patient’s care
ANS: C
If family members are so upset that they completely lose composure, a brief attempt at
supporting them away from the bedside may be adequate. In doing so, nurses may determine
that family members need a consistent outside source of support and may make a referral
according to department guidelines.

10. A patient has been admitted with a severed spinal cord injury at the T2 level. The patient has
been in halo traction with immobilization for the past week. The practitioner explains to the
patient that the spinal cord has been severed and that the patient will not be able to walk again.
The patient becomes overtly hostile to everyone. What psychosocial concept is the patient
demonstrating?
a. Regression
b. Loss of autonomy
c. Ineffective coping
d. Hope
ANS: C
Ineffective coping is defined as an impairment of a person’s adaptive behaviors and
problem-solving abilities when meeting life’s demands and necessary roles. Manifestations of
ineffective coping in critical illness include verbalization of an inability to cope, anxiety, and
being unable to meet basic needs. Regression is an unconscious defense mechanism
characterized by a retreat, in the face of stress, to behaviors characteristic of an earlier
developmental level. Hope is a subjective, dynamic internal process essential to life.
Considered to be a spiritual process, hope is an energy that arises out of a sense of being
meaningfully connected to one’s self, others, and powers greater than the self.

been in halo traction with immobilization for the past week. The practitioner has explained to
the patient that the spinal cord has been severed and that the patient will not be able to walk
again. The patient states, “I can’t wait until I can get on my feet and walk again.” Which
defense mechanism is the patient exhibiting in this statement?
a. Denial
b. Posttraumatic stress disorder (PTSD)
c. Regression
d. Trust
ANS: A
Denial is an unconscious defense mechanism that reduces anxiety by eliminating or reducing
the seriousness of the perceived threat. As with stress overload, posttraumatic stress disorder
(PTSD) is not a disordered response to stress resulting from a failure of a person’s will,
strength, endurance, or courage. Regression is an unconscious defense mechanism
characterized by a retreat, in the face of stress, to behaviors characteristic of an earlier
developmental level. Trust manifests itself in critical care patients’ belief that the people they
depend on will get them through the illness and will be able to manage any untoward event
that might occur.

been in halo traction with immobilization for the past week. The patient continually tries to
get out of bed and states, “My legs are only sleeping.” Which nursing diagnoses would be
appropriate for the patient?
a. Disturbed body image
b. Powerlessness
c. Situational low self-esteem
d. Ineffective role performance
ANS: A
Body image disturbances arise when disruption exists in the way individuals perceive their
bodies. Self-esteem refers to how well one’s behavior correlates with a sense of the ideal self
and is most closely linked to one’s sense of self-worth. Patients who have a pervasive sense
that they can do nothing to change or control their circumstances are at risk for feeling
powerless.

13. A patient is in the critical care unit having undergone surgery a week ago for multiple
fractures to the legs secondary to a fall from a rooftop. The patient refuses to participate in
morning care activities such as brushing his own teeth or washing his face and hands. The
patient yells at the nurse, “You do it! Can’t you see that my legs are broken?” What
psychosocial disturbance is the patient exhibiting?
a. Self-concept
b. Self-esteem
c. Body image
d. Personal identity
ANS: B
Illness and trauma can rob the person of perspective and shrinks both the familiar world and
the one of possibility, often leading to low self-esteem and feelings of powerlessness,
helplessness, and depression. A low self-regard impairs one’s ability to adapt. The person may
refuse to participate in self-care, exhibit self-destructive behavior, or be too compliant.

14. An adult patient sustains third- and fourth-degree burns to more than 70% of her body related
to a house fire. The patient begins a pattern of behavior similar to that of a young child, in
which she repeatedly whines and throws “temper tantrums” in an attempt to keep her nurse at
the bedside. What coping mechanism is the patient exhibiting?
a. Regression
b. Identity disturbance
c. Denial
d. Trust
ANS: A
Regression is a normal reaction to severe burns. The person may become childlike in
interactions with staff. Behaviors such as whining, clinging to staff, and attempting to keep
the nurse at the bedside constantly are not uncommon. A personal identity disturbance, as a
type of altered self-concept, is defined as an inability of a person to differentiate the self as a
unique and separate human being from others within a social environment.

15. A patient is admitted with the diagnosis of gunshot wound to the head due to a suicide
attempt. While the patient is in the critical care unit, the plan of care should include which
intervention?
a. Limiting interaction with the patient due to antisocial behaviors exhibited by the
suicidal attempt
b. Overlooking the patient’s need to talk about the incident
c. Validating the patient’s worth and self-esteem
d. Discontinuing any psychotropic medications
ANS: C
While the patient is in the unit, primary nursing interventions include validating the patient’s
worth and self-esteem and helping him or her regulate emotional states and behaviors.
Patients who have attempted suicide are often stigmatized, and caregivers can resent caring
for a person whose critical condition is self-inflicted. A suicide attempt indicates, however,
that the patient was experiencing personal and spiritual distress to the point of wanting to end
his or her life. The critical care team should make every effort to continue medications for
mental health conditions during the critical care stay unless medically contraindicated. If the
patient is unable to take oral medications, the team should attempt to find an alternative route
if possible.

16. What happens when the critical illness is so severe that the patient or family becomes
overwhelmed?
a. Anxiety
b. Spiritual distress
c. Stress overload
d. Hopelessness
ANS: C
Stress overload does not occur because the patient or family members have coping deficits or
psychologic disorders. Rather, the stressors of critical illness are so numerous and severe that
people become overwhelmed. Anxiety, hopelessness, and spiritual distress are examples of
stress-related nursing diagnoses that occur because of an inability of coping mechanisms or
strategies.

17. Which medications are commonly used for alcohol withdrawal symptoms?
a. Chlordiazepoxide and folic acid
b. Chlordiazepoxide and lorazepam
c. Lorazepam and promethazine
d. Promethazine and thiamine
ANS: B
Commonly used medications include chlordiazepoxide and lorazepam for withdrawal
symptoms and ondansetron and promethazine for nausea. Thiamine, folic acid, and
multivitamins should be added to intravenous fluids.

18. Prolonged periods of anxious waiting, disrupted sleep patterns, witnessing emergency
interventions, and financial concerns could put family members at risk for developing what
problem?
a. Powerlessness
b. Hopelessness
c. Anxiety
d. Posttraumatic stress disorder
ANS: D
Family members are at risk for developing posttraumatic stress reactions related to prolonged
periods of uncertainty, anxious waiting, disrupted sleep patterns, financial concerns,
witnessing emergency interventions, and confronting fears of loss and death. Anxiety is a
normal and common subjective human response to a perceived or actual threat, which can
range from a vague, generalized feeling of discomfort to a state of panic and loss of control.
Conditions that increase a person’s risk for feeling hopeless include a loss of dignity,
long-term stress, loss of self-esteem, spiritual distress, and isolation, all of which can be
present in a critical care experience. Patients who have a pervasive sense that they can do
nothing to change or control their circumstances are at risk for feeling powerless.

19. Anxiety can cause emotional changes in which part of the brain?
a. Hypothalamus
b. Limbic system
c. Cerebral cortex
d. Pituitary gland
ANS: B
The neurotransmitters’ complex and elusive integration of these responses within the central
nervous system relies on communication among the cerebral cortex, limbic system, thalamus,
hypothalamus, pituitary gland, and the reticular activating system. Whereas the cortex is
involved with cognition, attention, and alertness, emotional responses to stress are located in
the limbic system.

20. A patient is admitted complaining of pain from a femur fracture and is anxious and agitated.
The patient is receiving steroids and theophylline for exacerbation of asthma. What disorder
should the nurse suspect the patient may be experiencing?
a. Anxiety
b. Low self-esteem
c. Regression
d. Suicidal ideations
ANS: A
Pain triggers anxiety, and increased anxiety intensifies pain experiences. This reciprocal
relationship varies, depending on whether pain is produced by disease processes or invasive
procedures, is acute or chronic in nature, or if the pain is anticipated. Medications such as
theophylline, anticholinergics, dopamine, levodopa, salicylates, and steroids can also
contribute to feelings of anxiety. Self-esteem refers to how well one’s behavior correlates with
a sense of the ideal self and is most closely linked to one’s sense of self-worth. Regression is
an unconscious defense mechanism characterized by a retreat, in the face of stress, to
behaviors characteristic of an earlier developmental level.
PTS: 1 DIF: Cognitive Level: Analyzing REF: p. 77

21. A patient tells his family, “I don’t know why I was placed on this earth just to suffer from
cancer all my life. I just want to die.” What psychosocial issue is the patient experiencing?
a. Lost control
b. Spiritual distress
c. Anxiety
d. Powerlessness
ANS: B
Some individuals with spiritual distress may question their existence, verbalize their wish to
die, or display anger toward religious traditions. Patients who have a pervasive sense that they
can do nothing to change or control their circumstances are at risk for feeling powerless.
Anxiety is a normal and common subjective human response to a perceived or actual threat,
which can range from a vague, generalized feeling of discomfort to a state of panic and loss of
control.

22. Through what mechanism can a nurse demonstrate caring and support to a patient?
a. Demonstrating superior clinical skills
b. Ensuring continuity of care
c. Providing empathy and physical contact
d. Organizing and prioritizing care
ANS: C
Many patients interpret a nurse’s expressions of empathy and physical contact as evidence of
caring and support. Caring, compassionate verbal and nonverbal communication patterns give
substance to nursing activities that promote expert psychosocial and spiritual care
interventions. None of the top challenges have to do with technical issues of medical
management. Instead, the top challenges include inadequate patterns of communication
between the critical care team and family members, insufficient staff knowledge of effective
communication, unrealistic family and provider expectations, family disagreements, lack of
advance directives, voiceless patients, and suboptimal space for having meaningful
conversations.

23. What serious concern regarding the critical care environment affects the patient’s ability to
cope and heal?
a. Lack of consistent visiting policies
b. Misuse of complementary therapies
c. Deprivation of sleep
d. Mishandling of integrative therapies
ANS: C
Alterations in the physical environment of critical care units can provide a sense of calm,
enhance patient coping, and facilitate healing. Sleep deprivation is a serious concern in critical
care environments. To prevent light exposures that awaken patients, nurses should group care
activities to limit nighttime interruptions and collaborate with lab personnel to decrease sleep
interruptions.

MULTIPLE RESPONSE
Test Bank for Critical Care Nursing Diagnosis and Management, 8th Edition, Linda Urden Kathl
1. What outcomes do psychosocial and spiritual interventions have the power to employ in a
patient? (Select all that apply.)
a. Hope
b. Fear
c. Will to survive
d. Energy
e. Ability to meet life’s challenges.
ANS: A, C, D, E
Psychologic and spiritual interventions have the power to engage a patient’s hope, energy,
will to survive, and ability to meet life’s challenges. Fear is a coping deficit.

OBJ: Nursing Process Step: Assessment TOP: Psychosocial Alterations
2. What actions can a critical care nurse take to decrease stressors at work? (Select all that
apply.)
a. Request temporary assignments in a less stressful setting
b. Use self-reflection when feeling overwhelmed
c. Maintain good physical health
d. Ignore feelings of frustration and anger
e. Use stress management techniques
ANS: A, B, C, E
Stress management techniques help to restore energy and enjoyment in caring for patients. In
some instances, nurses choose to work temporarily in less emotionally stressful settings.
Nurses can maintain their physical health by eating well, exercising, engaging in relaxing
activities, laughing, and getting enough sleep. Nurses should first use self-reflection when
they feel overwhelmed, considering the possible reasons for their feelings.
PTS: 1 DIF: Cognitive Level: Applying REF: pp. 84-85

OBJ: Nursing Process Step: Intervention TOP: Psychosocial Alterations
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PTS: 1 DIF: Cognitive Level: Remembering REF: pp. 79-80

PTS: 1 DIF: Cognitive Level: Applying REF: p. 78

3. A patient with low self-esteem may manifest which behaviors?

PTS: 1 DIF: Cognitive Level: Applying REF: p. 78

4. Which statement regarding patients with an external locus of control is true?

PTS: 1 DIF: Cognitive Level: Remembering REF: p. 79

PTS: 1 DIF: Cognitive Level: Applying

PTS: 1 DIF: Cognitive Level: Applying REF: p. 80

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 79

PTS: 1 DIF: Cognitive Level: Applying REF: p. 79

PTS: 1 DIF: Cognitive Level: Applying REF: p. 83

PTS: 1 DIF: Cognitive Level: Applying REF: p. 80

PTS: 1 DIF: Cognitive Level: Applying REF: p. 80

PTS: 1 DIF: Cognitive Level: Applying REF: p. 78

PTS: 1 DIF: Cognitive Level: Applying REF: p. 78

PTS: 1 DIF: Cognitive Level: Applying REF: p. 80

PTS: 1 DIF: Cognitive Level: Applying REF: p. 84

PTS: 1 DIF: Cognitive Level: Remembering REF: p. 75

PTS: 1 DIF: Cognitive Level: Remembering REF: p. 84

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 76

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 77

PTS: 1 DIF: Cognitive Level: Analyzing REF: p. 77

PTS: 1 DIF: Cognitive Level: Applying REF: p. 79

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 81

PTS: 1 DIF: Cognitive Level: Remembering REF: p. 83

PTS: 1 DIF: Cognitive Level: Applying REF: p. 75

PTS: 1 DIF: Cognitive Level: Applying REF: pp. 84-85

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