Test Bank Chapter 5: Psychosocial Alterations: Urden: Thelan's Critical Care Nursing, 5 Edition

Urden: Thelan’s Critical Care Nursing, 5th Edition
Test Bank
Chapter 5: Psychosocial Alterations
MULTIPLE CHOICE
1. According to the transactional theories on stress, what does a person do first when
confronted by stress?
a. Uses coping mechanisms to deal with the stress
b. Makes a cognitive appraisal of its intensity
c. Determines what the response will be to the stress
d. Denies the stress exists
ANS: B
The person confronted by stress first makes a cognitive appraisal of its intensity.
DIF: Cognitive Level: Knowledge REF: 60-61

OBJ: Nursing Process Step: Assessment TOP: Psychosocial
MSC: NCLEX: Psychosocial Integrity
2. Mr. V has recently been weaned off mechanical ventilation after 3 weeks on a
ventilator. He is now refusing to have the ventilator removed from the room. What
type of alteration is Mr. V 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.
DIF: Cognitive Level: Evaluation REF: 62

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 the body has betrayed him or her
c. Acceptance and ownership of problems
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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.
DIF: Cognitive Level: Application REF: 62-63

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.
DIF: Cognitive Level: Knowledge REF: 63

5. An intervention for the 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 the patient with learned helplessness include setting limits on behavior,
encouraging independence and participation in self-care, counseling, and involving
family members in establishing realistic goals.
DIF: Cognitive Level: Application REF: 64

OBJ: Nursing Process Step: Intervention TOP: Psychosocial
6. Regression as a coping mechanism for the critical care patient

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.

7. Which of the following concepts 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 the expectation that a desire will be fulfilled. It supports patients and helps them
endure physical and psychologic insults.
DIF: Cognitive Level: Comprehension REF: 71

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 as the belief that the staff will get them
through the illness. Fostering trust in the health care team will strengthen the patient’s
ability to cope with his or her illness.
DIF: Cognitive Level: Synthesis REF: 71

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.

Ms. A has been admitted to the critical care unit with a severed spinal cord at the T2
level. She has been in halo traction with immobilization for the past week.
10. The physician explains to Ms. A that the spinal cord has been severed and that she
will not be able to walk again. Ms. A becomes overtly hostile to everyone. She is
demonstrating
a. regression.
b. loss of autonomy.
c. ineffective coping.
d. delirium.
ANS: C
Ineffective coping may be suggested by patient behaviors of overt hostility, severe
aggression, or noncompliance with suggested treatment.
DIF: Cognitive Level: Comprehension REF: 69-70

11. Ms. A states “I cannot wait until I can get on my feet and walk again.” Which defense
mechanism is present in this statement?
a. Denial
b. Suppression
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.

12. Ms. A continually tries to get out of bed and states “My legs are only sleeping” Which
of the following nursing diagnoses would be appropriate for Ms. A?
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.
DIF: Cognitive Level: Evaluation REF: 62

COMPLETION
1. __________ has also been called ICU psychosis and acute brain failure.
ANS:
Delirium
Rationale: Acute delirium has been called many things, including ICU psychosis, acute
brain failure, and postcardiotomy delirium.

OBJ: Nursing Process Step: Assessment TOP: Psychosocial Alterations
2. __________ therapies are focused on helping maintain wellness and facilitate the
body’s own healing responses.
ANS:
Complementary
Rationale: Complementary therapies are focused on helping to maintain wellness and
facilitate the body’s own healing responses.

OBJ: Nursing Process Step: Intervention TOP: Psychosocial Alterations

MATCHING
Match the following terms with the correct definition.

a. ANXIETY
b. POWERLESSNESS
c. HOPELESSNESS
d. LEARNED HELPLESSNESS
1. Subjective state where one cannot act on his or her own behalf
2. Perception that one’s own actions will not affect outcomes
3. Loss of motivation caused by repeated experiences with loss of control
4. Normal subjective response to perceived or actual threat
1. ANS: C DIF: Cognitive Level: Analysis REF: 61-64

2. ANS: B DIF: Cognitive Level: Analysis REF: 61-64

3. ANS: D DIF: Cognitive Level: Analysis REF: 61-64

4. ANS: A DIF: Cognitive Level: Analysis REF: 61-64

Match each coping mechanism to the correct definition.

a. REGRESSION
b. SUPPRESSION
c. DENIAL
d. TRUST
e. HOPE

5. Belief that the nurse will get the patient through the crisis
6. Intentionally pushing thoughts and ideas out of the consciousness
7. Expectation that a desire will be fulfilled
8. Retreat to a behavior characteristic of an earlier developmental level
9. Disavowing knowledge or the meaning of events
5. ANS: D DIF: Cognitive Level: Analysis REF: 70-71

6. ANS: B DIF: Cognitive Level: Analysis REF: 70-71

7. ANS: E DIF: Cognitive Level: Analysis REF: 70-71

8. ANS: A DIF: Cognitive Level: Analysis REF: 70-71

9. ANS: C DIF: Cognitive Level: Analysis REF: 70-71

OTHER
1. Which of the following behaviors might indicate the onset of hypoactive delirium?
Select all that apply.
a. Mumbling to one's self
b. Trying to get out of bed
c. Hallucinating
d. Making inappropriate gestures
e. Picking at IVs and dressings

ANS:
a, c, d
Rationale: The hypoactive form of delirium is differentiated from the hyperactive form
by somnolence and slowness to respond, whereas the hyperactive form is characterized
by motion.
DIF: Cognitive Level: Application REF: 66-67


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Test Bank Chapter 5: Psychosocial Alterations: Urden: Thelan's Critical Care Nursing, 5 Edition

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Urden: Thelan’s Critical Care Nursing, 5th Edition

Chapter 5: Psychosocial Alterations

DIF: Cognitive Level: Knowledge REF: 60-61

DIF: Cognitive Level: Evaluation REF: 62

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Application REF: 62-63

4. Patients with an external locus of control

DIF: Cognitive Level: Knowledge REF: 63

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

DIF: Cognitive Level: Application REF: 64

6. Regression as a coping mechanism for the critical care patient

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Application REF: 70

DIF: Cognitive Level: Comprehension REF: 71

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

DIF: Cognitive Level: Synthesis REF: 71

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

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Application REF: 72

DIF: Cognitive Level: Comprehension REF: 69-70

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Evaluation REF: 62

DIF: Cognitive Level: Comprehension REF: 66

DIF: Cognitive Level: Comprehension REF: 73

Copyright © 2006 Mosby, Inc.

Match the following terms with the correct definition.

2. Perception that one’s own actions will not affect outcomes

3. Loss of motivation caused by repeated experiences with loss of control

4. Normal subjective response to perceived or actual threat

1. ANS: C DIF: Cognitive Level: Analysis REF: 61-64

2. ANS: B DIF: Cognitive Level: Analysis REF: 61-64

3. ANS: D DIF: Cognitive Level: Analysis REF: 61-64

4. ANS: A DIF: Cognitive Level: Analysis REF: 61-64

Match each coping mechanism to the correct definition.

Copyright © 2006 Mosby, Inc.

6. Intentionally pushing thoughts and ideas out of the consciousness

7. Expectation that a desire will be fulfilled

8. Retreat to a behavior characteristic of an earlier developmental level

9. Disavowing knowledge or the meaning of events

5. ANS: D DIF: Cognitive Level: Analysis REF: 70-71

6. ANS: B DIF: Cognitive Level: Analysis REF: 70-71

7. ANS: E DIF: Cognitive Level: Analysis REF: 70-71

8. ANS: A DIF: Cognitive Level: Analysis REF: 70-71

9. ANS: C DIF: Cognitive Level: Analysis REF: 70-71

Copyright © 2006 Mosby, Inc.

DIF: Cognitive Level: Application REF: 66-67

Copyright © 2006 Mosby, Inc.

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