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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

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?

Accepted Answer

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.

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?

Accepted Answer

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.

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?

Accepted Answer

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.

Question 14

Anxiety can cause emotional changes in which part of the brain?

Accepted Answer

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.

Question 15

Which nursing intervention can help family members who are extremely upset?

Accepted Answer

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.

Question 16

Which therapeutic technique may be used to enhance coping in the critical care environment?

Accepted Answer

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.

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?

Accepted Answer

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.

Question 18

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

Accepted Answer

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.

Question 19

Which statement regarding regression as a coping mechanism for critical care patients is accurate?

Accepted Answer

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.

Question 20

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

Accepted Answer

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.

Quiz 6: Psychosocial and Spiritual Alterations and Management