Question 1

Prolonged periods of anxious waiting,disrupted sleep patterns,witnessing emergency interventions,and financial concerns could put family members at risk for developing what problem?&#10;A) Powerlessness&#10;B) Hopelessness&#10;C) Anxiety&#10;D) Posttraumatic stress disorder

Accepted Answer

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.

Question 2

According to the transactional theories on stress,what does a person do first when confronted by stress?&#10;A) Determines coping mechanisms to deal with the stress&#10;B) Determines the perceived degree of threat imposed&#10;C) Determines what the response will be to the stress&#10;D) Denies the stress exists

Accepted Answer

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.

Question 3

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 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

Disturbed body image

Accepted Answer

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.

Question 4

Which concept supports patients and helps them endure the physical and psychologic insults of their critical illness?&#10;A) Regression&#10;B) Denial&#10;C) Hope&#10;D) Trust

Accepted Answer

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.

Question 5

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

Accepted Answer

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.

Question 6

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

Accepted Answer

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.

Question 7

Which medications are commonly used for alcohol withdrawal symptoms?&#10;A) Chlordiazepoxide and folic acid&#10;B) Chlordiazepoxide and lorazepam&#10;C) Lorazepam and promethazine&#10;D) Promethazine and thiamine

Accepted Answer

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.

Question 8

Which intervention should be included in the patient management plan for a patient with powerlessness?&#10;A) Maintain control of the environment&#10;B) Set limits on the behavior&#10;C) Maintain a routine schedule so that the patient can anticipate activities&#10;D) Prepare the patient for transfer to the medical floor

Accepted Answer

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.

Question 9

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

Accepted Answer

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.

Question 10

What happens when the critical illness is so severe that the patient or family becomes overwhelmed?&#10;A) Anxiety&#10;B) Spiritual distress&#10;C) Stress overload&#10;D) Hopelessness

Accepted Answer

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.

Question 11

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 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

Accepted Answer

The answer of A patient has been admitted with a...

Question 12

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?&#10;A) Limiting interaction with the patient due to antisocial behaviors exhibited by the suicidal attempt&#10;B) Overlooking the patient's need to talk about the incident&#10;C) Validating the patient's worth and self-esteem&#10;D) Discontinuing any psychotropic medications

Accepted Answer

The answer of A patient is admitted with the diagnosis...

Question 13

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

Accepted Answer

The answer of A patient has been admitted with a...

Question 14

Anxiety can cause emotional changes in which part of the brain?&#10;A) Hypothalamus&#10;B) Limbic system&#10;C) Cerebral cortex&#10;D) Pituitary gland

Accepted Answer

The answer of Anxiety can cause emotional changes in which...

Question 15

Which nursing intervention can help family members who are extremely upset?&#10;A) Encouraging the family to visit as much as possible&#10;B) Conveying what the patient is experiencing to the family&#10;C) Supporting the family members away from the bedside&#10;D) Assuring the family that the staff will take care of the technical aspects of the patient's care

Accepted Answer

The answer of Which nursing intervention can help family members...

Question 16

Which therapeutic technique may be used to enhance coping in the critical care environment?&#10;A) Encourage the patient to let the staff have total control of the patient's care&#10;B) Encourage the patient to deny the presence of the illness&#10;C) Inform the patient that everything will be all right&#10;D) Foster trust in the interprofessional health care team

Accepted Answer

The answer of Which therapeutic technique may be used to...

Question 17

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

Accepted Answer

The answer of A patient is in the critical care...

Question 18

A patient with low self-esteem may manifest which behaviors?&#10;A) Refusal to participate in care&#10;B) Feelings that his or her body has betrayed him or her&#10;C) Acceptance and ownership of problems&#10;D) Disruption in the perception of the body

Accepted Answer

The answer of A patient with low self-esteem may manifest...

Question 19

Which statement regarding regression as a coping mechanism for critical care patients is accurate?&#10;A) It is necessary to some degree to allow staff to administer care.&#10;B) It indicates deterioration of the physical state.&#10;C) It is adaptive when the patient calls every 15 minutes, even for trivial matters.&#10;D) It is best avoided to ensure successful recovery.

Accepted Answer

The answer of Which statement regarding regression as a coping...

Question 20

Which statement regarding patients with an external locus of control is true?&#10;A) They believe that they can influence the outcome of their illness.&#10;B) They should be forced to take control of their discharge planning.&#10;C) They usually start out with an internal locus of control until a major illness occurs.&#10;D) They believe that events are related to chance or fate.

Accepted Answer

The answer of Which statement regarding patients with an external...

Question 21

A patient tells his family,&#34;I don't know why I was placed on this earth just to suffer from cancer all my life.I just want to die.&#34; What psychosocial issue is the patient experiencing?&#10;A) Lost control&#10;B) Spiritual distress&#10;C) Anxiety&#10;D) Powerlessness

Accepted Answer

The answer of A patient tells his family,&#34;I don't know...

Question 22

Through what mechanism can a nurse demonstrate caring and support to a patient?&#10;A) Demonstrating superior clinical skills&#10;B) Ensuring continuity of care&#10;C) Providing empathy and physical contact&#10;D) Organizing and prioritizing care

Accepted Answer

The answer of Through what mechanism can a nurse demonstrate...

Question 23

What outcomes do psychosocial and spiritual interventions have the power to employ in a patient?&#10;A) Hope&#10;B) Fear&#10;C) Will to survive&#10;D) Energy&#10;E) Ability to meet life's challenges.

Accepted Answer

The answer of What outcomes do psychosocial and spiritual interventions...

Question 24

What serious concern regarding the critical care environment affects the patient's ability to cope and heal?&#10;A) Lack of consistent visiting policies&#10;B) Misuse of complementary therapies&#10;C) Deprivation of sleep&#10;D) Mishandling of integrative therapies

Accepted Answer

The answer of What serious concern regarding the critical care...

Question 25

What actions can a critical care nurse take to decrease stressors at work?&#10;A) Request temporary assignments in a less stressful setting&#10;B) Use self-reflection when feeling overwhelmed&#10;C) Maintain good physical health&#10;D) Ignore feelings of frustration and anger&#10;E) Use stress management techniques

Accepted Answer

The answer of What actions can a critical care nurse...

Deck 6: Psychosocial and Spiritual Alterations and Management