Test Bank Critical Care Nursing 7th Edition Urden Stacy Lough

Test Bank Critical Care Nursing, 7th Edition, Urden Stacy Lough
Test Bank Critical Care Nursing, 7th Edition, Urden

Stacy Lough
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acy-lough/
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Chapter 06: Psychosocial and Spiritual Alterations and Management
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: p. 89

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 c. Hopelessness
b. Regression 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: Creating REF: p. 92

OBJ: Nursing Process Step: Diagnosis TOP: Psychosocial
3. A patient with low self-esteem may manifest which of the following 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.
PTS: 1 DIF: Cognitive Level: Applying REF: p. 92

4. Patients with an external locus of control

a. believe that they can influence the outcome of their illness.
b. should be forced to take control of their discharge planning.
c. usually start out with an internal locus of control until a major illness occurs.
d. 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.

5. An intervention for a patient with learned helplessness is to

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 learned helplessness 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. 94, Appendix A, Nursing Management Plan: Powerlessness
OBJ: Nursing Process Step: Intervention TOP: Psychosocial
6. Regression as a coping mechanism for critical care patients

a. is necessary to some degree to allow staff to administer care.
b. indicates deterioration of the physical state.
c. is adaptive when the patient calls the nurse every 15 minutes, even for trivial
matters.
d. 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 of the following concepts supports patients and helps them endure the physical and
psychological insults of their critical illness?
a. Regression c. Hope
b. Denial 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. 93

OBJ: Nursing Process Step: Diagnosis TOP: Psychosocial Alterations
8. Which of the following techniques may be used to enhance coping?

a. Encouraging the patient to let the staff have total control of the patient’s care
b. Encouraging denial of the illness
c. Letting the patient know everything will be all right
d. Fostering trust in the 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.
PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 96

9. Interventions to help family members who are extremely upset include

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.
PTS: 1 DIF: Cognitive Level: Applying REF: p. 98, Box 6-3

10. A patient has been admitted to the critical care unit with a severed spinal cord injury at the
T2 level. The patient has been in halo traction with immobilization for the past week. The
physician 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. The patient is
demonstrating
a. regression. c. ineffective coping.
b. loss of autonomy. 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.

patient states, “I can’t wait until I can get on my feet and walk again.” Which defense
mechanism is present in this statement?
a. Denial c. Regression
b. PTSD 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, 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.

patient continually tries to get out of bed and states, “My legs are only sleeping.” Which of the
following nursing diagnoses would be appropriate for the patient?
a. Disturbed body image c. Situational low self-esteem
b. Powerlessness 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 his right and left 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?” The
patient is exhibiting a disturbance in
a. self-concept. c. body image.
b. self-esteem. 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. The patient’s coping mechanism is consistent with
a. regression. c. denial.
b. identity disturbance. 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 into the ICU with the diagnosis of gunshot wound to the head, suicide
attempt. While the patient is in the ICU the nurse’s interventions should include
a. limiting interaction with the patient due to antisocial behaviors exhibited by the
suicidal attempt.
b. ignoring 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. _____ occurs when the critical illness is so severe that the patient or family becomes
overwhelmed.
a. Anxiety c. Stress overload
b. Spiritual distress 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. Commonly used medications for withdrawal symptoms include

a. chlordiazepoxide and folic acid. c. lorazepam and promethazine.
b. chlordiazepoxide and lorazepam. 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
a. powerlessness. c. anxiety.
b. hopelessness. d. PTSD.
ANS: D
Family members are at risk for developing post-traumatic 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 the

a. hypothalamus. c. cerebral cortex.
b. limbic system. 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 to the CCU complaining of pain from a femur fracture and is anxious
and agitated. The patient is receiving steroids and theophylline for exacerbation of asthma.
The nurse should assess the patient for
a. anxiety. c. regression.
b. low self-esteem. 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. 91

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.” The nurse realizes the patient
a. has lost control of the situation.
b. is expressing spiritual despair.
c. is becoming anxious with the situation.
d. will become withdrawn from his or her care.
ANS: B
Some individuals in spiritual despair 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. A nurse can demonstrate caring and support to a patient through demonstration or expression
of
a. superior clinical skills. c. empathy and physical contact.
b. uncertainty with prognosis. d. 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. Because of the nature of the environment, _____ is a serious concern in the critical care
environment.
a. family involvement c. sleep deprivation
b. use of complementary therapies d. calm environment
ANS: C
Sleep deprivation is a serious concern in critical care environments. Including patients and
family members in critical care interdisciplinary rounds has been shown to improve
perceptions of accessibility and communication. Alterations in the physical environment of
critical care units can provide a sense of calm, enhance patient coping, and facilitate healing.
The type of complementary or integrative therapies used depends on a patient’s preferences,
coping style, physical capabilities, and personality type. Music therapy, relaxation, guided
imagery, therapeutic massage, visualization, prayer, biofeedback, and mindfulness meditation
are potentially useful for critically ill patients.

MULTIPLE RESPONSE
1. Psychologic and spiritual interventions have the power to engage a patient’s (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. Identify actions that a critical care nurse can 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.
Test Bank Critical Care Nursing, 7th Edition, Urden Stacy Lough

OBJ: Nursing Process Step: Intervention TOP: Psychosocial Alterations
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PTS: 1 DIF: Cognitive Level: Remembering REF: p. 89

PTS: 1 DIF: Cognitive Level: Creating REF: p. 92

PTS: 1 DIF: Cognitive Level: Applying REF: p. 92

4. Patients with an external locus of control

PTS: 1 DIF: Cognitive Level: Remembering REF: p. 94

5. An intervention for a patient with learned helplessness is to

PTS: 1 DIF: Cognitive Level: Applying

6. Regression as a coping mechanism for critical care patients

PTS: 1 DIF: Cognitive Level: Applying REF: p. 94

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 93

8. Which of the following techniques may be used to enhance coping?

PTS: 1 DIF: Cognitive Level: Evaluating REF: p. 96

9. Interventions to help family members who are extremely upset include

PTS: 1 DIF: Cognitive Level: Applying REF: p. 98, Box 6-3

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 94

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 95

PTS: 1 DIF: Cognitive Level: Creating REF: p. 92

PTS: 1 DIF: Cognitive Level: Creating REF: p. 92

PTS: 1 DIF: Cognitive Level: Applying REF: p. 99

PTS: 1 DIF: Cognitive Level: Remembering REF: p. 88

17. Commonly used medications for withdrawal symptoms include

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 90

19. Anxiety can cause emotional changes in the

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 91

PTS: 1 DIF: Cognitive Level: Analyzing REF: p. 91

PTS: 1 DIF: Cognitive Level: Applying REF: p. 93

PTS: 1 DIF: Cognitive Level: Understanding REF: p. 95

PTS: 1 DIF: Cognitive Level: Remembering REF: p. 97

PTS: 1 DIF: Cognitive Level: Applying REF: p. 88

PTS: 1 DIF: Cognitive Level: Applying REF: p. 100

Visit TestBankBell.com to get complete for all chapters

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