Test Bank Priorities in Critical Care Nursing 8th edition Urden Stacy Lough

Test Bank Priorities in Critical Care Nursing 8th edition Urden Stacy LoughContents Chapter 01: Caring for the Critically Ill Patient ......................................................................................................... 1 Chapter 02: Ethical and Legal Issues ........................................................................................................................ 6 Chapter 03: Patient and Family Education ............................................................................................................... 11 Chapter 04: Psychosocial Alterations ....................................................................................................................... 18 Chapter 05: Nutritional Alterations ......................................................................................................................... 25 Chapter 06: Gerontologic Alterations ...................................................................................................................... 32 Chapter 07: Pain and Pain Management .................................................................................................................. 40 Chapter 08: Sedation and Delirium Management .................................................................................................... 47 Chapter 09: End-of-Life Care .................................................................................................................................. 53 Chapter 10: Cardiovascular Clinical Assessment and Diagnostic Procedures ............................................................ 59 Chapter 11: Cardiovascular Disorders ..................................................................................................................... 72 Chapter 12: Cardiovascular Therapeutic Management ............................................................................................. 82 Chapter 13: Pulmonary Clinical Assessment and Diagnostic Procedures ................................................................... 92 Chapter 14: Pulmonary Disorders ........................................................................................................................... 99 Chapter 15: Pulmonary Therapeutic Management ................................................................................................. 108 Chapter 16: Neurologic Clinical Assessment and Diagnostic Procedures ................................................................. 117 Chapter 17: Neurologic Disorders and Therapeutic Management ........................................................................... 126 Chapter 18: Kidney Clinical Assessment and Diagnostic Procedures ...................................................................... 134 Chapter 19: Kidney Disorders and Therapeutic Management ................................................................................. 141 Chapter 20: Gastrointestinal Clinical Assessment and Diagnostic Procedures ......................................................... 148 Chapter 21: Gastrointestinal Disorders and Therapeutic Management .................................................................... 156 Chapter 22: Endocrine Clinical Assessment and Diagnostic Procedures .................................................................. 164 Chapter 23: Endocrine Disorders and Therapeutic Management ............................................................................. 171 Chapter 24: Trauma ............................................................................................................................................. 178 Chapter 25: Burns ................................................................................................................................................ 186 Chapter 26: Shock, Sepsis, and Multiple Organ Dysfunction Syndrome .................................................................. 195 Chapter 27: Hematologic Disorders and Oncologic Emergencies ............................................................................ 204 Chapter 01: Caring for the Critically Ill Patient MULTIPLE CHOICE 1. What type of practitioner has a broad depth of specialty knowledge and expertise and manages complex clinical and system issues? a. Registered nurses b. Advanced practice nurses c. Clinical nurse leaders d. Intensivists ANS: B Advanced practice nurses (APNs) have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. Intensivists are medical practitioners who manage the critical ill patient. Registered nurses (RNs) are generally direct care 1 | P a g eproviders. Clinical nurse leaders (CNLs) generally do not manage system issues. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: N/A TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 2. What type of practitioner is instrumental in ensuring care that is evidence based and that safety programs are in place? a. Clinical nurse specialist b. Advanced practice nurse c. Registered nurses d. Nurse practitioners ANS: A Clinical nurse specialists (CNSs) serve in specialty roles that use their clinical, teaching, research, leadership, and consultative abilities. They are instrumental in ensuring that care is evidence based and that safety programs are in place. Advanced practice nurses (APNs) have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and systems issues. Registered nurses are generally direct care providers. Nurse practitioners (NPs) manage direct clinical care of groups of patients. PTS: 1 Remembering DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 3. Which professional organization administers critical care certification exams for registered nurses? a. State Board of Registered Nurses b. National Association of Clinical Nurse Specialist c. Society of Critical Care Medicine d. American Association of Critical-Care Nurses ANS:D American Association of Critical-Care Nurses (AACN) administers certification exams for registered nurses. The State Board of Registered Nurses (SBON) does not administer certification exams. National Association of Clinical Nurse Specialists (NACNS) does not administer certification exams. Society of Critical Care Medicine (SCCM) does not administer nursing certification exams for registered nurses. PTS: 1 Remembering DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 4. The American Association of Critical-Care Nurses (AACN) has developed short directives that can be used as quick references for clinical use that are known as: a. critical care protocol. b. practice policies. c. evidence-based research. d. practice alerts. ANS: D The American Association of Critical-Care Nurses (AACN) has promulgated several evidence- based practice summaries in the form of “practice alerts.” Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse 2 | P a g eand patient preferences. Critical care protocol and practice policies are established by individual institutions. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Planning TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 5. What type of therapy is an option to conventional treatment? a. Alternative b. Holistic c. Complementary d. Individualized ANS: A The term alternative denotes that a specific therapy is an option or alternative to what is considered conventional treatment of a condition or state. The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments. Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Implementation TOP: Caring for the Critically Ill Patient MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 6. Guided imagery and massage are both examples of what type of treatment? a. Alternative therapy b. Holistic care c. Complementary care d. Individualized care ANS: C The term complementary was proposed to describe therapies that can be used to complement or support conventional treatments. Guided imagery, massage, and animal-assisted therapy are all examples of complementary care. The term alternative denotes that a specific therapy is an option or alternative to what is considered conventional treatment of a condition or state. Holistic care focuses on human integrity and stresses that the body, mind, and spirit are interdependent and inseparable. Individualized care recognizes the uniqueness of each patient’s preferences, condition, and physiologic and psychosocial status. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Implementation TOP: Caring for the Critically Ill Patient MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 7. A patient was admitted to a rural critical care unit in Montana. Critical care nurses are assisting with monitoring and care of the patient from the closest major city. What is this type of practice termed? a. Tele-nursing b. Tele-ICU c. Tele-informatics d. Tele-hospital ANS: B Tele-ICU is a form of telemedicine. Telemedicine was initially used in outpatient areas, remote rural geographic locations, and areas where there was a dearth of medical providers. 3 | P a g eCurrently, there are tele-ICUs in areas where there are limited resources on- site. However, experts (critical care nurses, intensivists) are located in a central distant site. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Evaluation TOP: Caring for the Critically Ill Patient MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential 8. Which core competency for interprofessional practice can be described as working with individuals of other professions to maintain a climate of mutual respect and shared values? a. Interprofessional teamwork and team-based care b. Values and ethics for interprofessional practice c. Interprofessional communication d. Roles and responsibilities for collaborative practice ANS: B Values and ethics for interprofessional practice mean working with individuals of other professions to maintain a climate of mutual respect and shared values. Roles and responsibilities for collaborative practice include using knowledge of one’s own role and the roles of other professions to appropriately assess and address the health care needs of the patients and populations served. Interprofessional communication includes communicating with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to maintaining health and treatment of disease. Interprofessional teamwork and team- based care means applying relationship-building values and principles of team dynamics to perform effectively in different team roles to plan and deliver patient population-centered care that is safe, timely, efficient, effective, and equitable. PTS: 1 Remembering DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 9. Which nursing intervention continues to be one of the most error-prone for critical care nurses? a. Inappropriate care b. c. Intimidating and disruptive clinician behavior Injury to patients by falls d. Medication administration ANS: D Medication administration continues to be one of the most error-prone nursing interventions for critical care nurses. Intimidating and disruptive clinician behaviors can lead to errors and preventable adverse patient outcomes. Patient safety has been described as an ethical imperative and one that is inherent in health care professionals’ actions and interpersonal processes; examples include inappropriate care and injury to patients by falls. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Implementation TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control 10. A practitioner and nurse are performing a dressing change on an unresponsive patient in room 14. The practitioner asks the nurse for an update on the patient in room 13. Which action should the nurse take next? a. Give the update to the practitioner. 4 | P a g eb. Refuse to give the update because of Health Insurance Portability and Accountability Act (HIPAA) requirements. c. Give the update because the patient is unconscious. d. Refuse to give the update because of Occupational Safety and Health Administration (OSHA) requirements. ANS: B Most specific to critical care clinicians is the privacy and confidentiality related to protection of health care data. This has implications when interacting with family members and others and the often very close work environments, tight working spaces, and emergency situations. A patient’s unconscious state is not a reason for another patient’s care to be discussed in his or her presence. Research shows hearing is the last sense to deteriorate. Occupational Safety and Health Administration (OSHA) has to do with safety in the workplace, not privacy and confidentiality. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 11. Which units can provide high-quality and cost-effective care for patients who are less complex, more stable, and have a decreased need for physiologic monitoring? a. Intensive care units b. Triage units c. Progressive care units d. Medical surgical units ANS: C A growing trend in acute care settings is the designation of progressive care units, considered to be part of the continuum of critical care. These units can serve as a bridge between intensive care units and medical-surgical units, while providing high-quality and cost- effective care at the same time. Patients who are ideal candidates for progressive care are less complex, more stable, have a decreased need for physiologic monitoring, and more self-care capabilities. PTS: 1 Understanding DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care MULTIPLE RESPONSE 1. What considerations are taken into account in evidence-based nursing practice? (Select all that apply.) a. Clinical expertise of the nurse b. Availability of staff and facility equipment c. Research evidence on the topic d. Patient knowledge of the disease e. Patient preference regarding care ANS: A, C, E Evidence-based nursing practice considers the best research evidence on the care topic along with clinical expertise of the nurse and patient preferences. For instance, when determining the frequency of vital sign measurement, the nurse would use available research and nursing judgment (stability, complexity, predictability, vulnerability, and resilience of the patient). Availability of staff and facility equipment and the patient’s knowledge of the disease do not factor into evidence-based nursing practices. 5 | P a g ePTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Planning TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 2. The concept of diversity encompasses what thoughts and actions? (Select all that apply.) a. Sensitivity to ethnic differences b. Openness to different lifestyles c. Openness to different values d. Reticence to different beliefs e. Lack of concern regarding different opinions ANS: A, B, C Diversity includes not only ethnic sensitivity but also sensitivity to openness to difference lifestyles, opinions, values, and beliefs. Reticence and lack of concern are not part of the concept of diversity. PTS: 1 DIF: Cognitive Level: Evaluating OBJ: Nursing Process Step: N/A TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 3. According to Kupperschmidt, what factors are needed to become a skilled communicator? (Select all that apply.) a. Becoming candid b. Becoming reflective c. Setting goals d. Surveying the team e. Becoming aware of self-deception ANS: A, B, E Kupperschmidt and colleagues posed a five-factor model for becoming a skilled communicator: becoming aware of self-deception, becoming authentic, becoming candid, becoming mindful, and becoming reflective, all of which lead to being a skilled communicator. PTS: 1 DIF: Cognitive Level: Evaluating OBJ: Nursing Process Step: N/A TOP: Caring for the Critically Ill Patient MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care Chapter 02: Ethical and Legal Issues MULTIPLE CHOICE 1. What is the difference between ethics and morals? a. Ethics is more concerned with the “why” of behavior. b. Ethics provides a framework for evaluation of the behavior. c. Ethics is broader in scope than morals. d. Ethics focuses on the right or wrong behavior based on values. ANS: A Ethics are concerned with the basis of the action rather than whether the action is right or wrong, good or bad. PTS: 1 Understanding DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 6 | P a g e2. A patient’s wife has been informed by the practitioner that her spouse has permanent quadriplegia. The wife states that she does not want anyone to tell the patient about his injury. The patient asks the nurse about what has happened. The nurse has conflicting emotions about how to handle the situation. What is the nurse experiencing? a. Autonomy b. Moral distress c. Moral doubt d. Moral courage ANS: B The nurse has been placed in a situation initially causing moral distress and is struggling with determining the ethically appropriate action to take. Moral courage is the freedom to advocate for oneself, patients, and peers. Autonomy is an ethical principle. Moral doubt is not part of the American Association of Critical-Care Nurses (AACN) framework The 4A’s to Rise Above Moral Distress. PTS: 1 Understanding DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 3. Critical care nurses can best enhance the principle of autonomy by performing which action? a. Presenting only the information to prevent relapse in a patient b. Assisting with only tasks that cannot be done by the patient c. Providing the patient with all of the information and facts d. Guiding the patient toward the best choices for care ANS: C Patients and families must have all the information about a certain situation to make an autonomous decision that is best for them. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 4. The principle of respect for persons incorporates which additional concepts? a. Confidentiality and privacy b. Truth and reflection c. Autonomy and justice d. Beneficence and nonmaleficence ANS:A Confidentiality of patient information and privacy in patient interactions must be protected and honored by health care providers out of respect for persons. Confidentiality is a right involving the sharing of patient information with only those involved in the patient’s care. Privacy includes confidentiality but goes further to include the right to privacy of person and personal space, such as ensuring that a patient is adequately covered during a procedure. PTS: 1 Understanding DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 5. 7 | P a g e Which statement regarding the Code of Ethics for Nursing isaccurate? a. The Code of Ethics for Nurses is usurped by state or federal laws. b. It allows the nurse to focus on the good of society rather than the uniqueness of the patient. c. The Code of Ethics for Nurses was recently adopted by the American Nurses Association. d. It provides society with a set of expectations of the nursing profession. ANS:D The Code of Ethics for Nursing provides a framework for the nurse to follow in ethical decision making and provides society with a set of expectations of the nursing profession. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 6. Ethical decisions are best made by performing which action? a. Following the guidelines of a framework or model b. Having the patient discuss alternatives with the physician or nurse c. Prioritizing the greatest good for the greatest number of persons d. Careful consideration by the Ethics Committee after all diagnostic data are reviewed ANS: A To facilitate the ethical decision-making process, a model or framework must be used so that all involved will consistently and clearly examine the multiple ethical issues that arise in critical care. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 7. What is the first step of the ethical decision-making process? a. Consulting with an authority b. Identifying the health problem c. Delineating the ethical problem from other types of problems d. Identifying the patient as the primary decision maker ANS: B Step one involves identifying the major aspects of the patient’s medical and health problems. Consulting an authority is not always necessary in the process. Delineating the ethical problem from other types of problems may not be necessary. Identification of the patient as primary decision maker is not part of the process. PTS: 1 Remembering DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 8. What is the legal standard of care for a nurse’s actions? a. Minimal competency under the state Nurse Practice Act b. The ability to distinguish what is right or wrong for the patient c. The demonstration of satisfactory knowledge of policies and procedures 8 | P a g ed. The care that an ordinary prudent nurse would perform under the same circumstances ANS: D The legal standard of care for nurses is established by expert testimony and is generally “the care that an ordinarily prudent nurse would perform under the same circumstances.” PTS: 1 Understanding DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 9. A patient is admitted with chest pain with evidence of elevated ST segments. The nurse bases the plan of care on the diagnosis of pneumonia. What type of negligence may be present? a. Assessment failure b. Planning failure c. Implementation failure d. Evaluation failure ANS: B Basing nursing care on an erroneous diagnosis is a failure in planning. Standards of care include assessment, the collection of relevant data pertinent to the patient’s health or situation; diagnosis, analysis of the assessment data in determining diagnosis and care issues; implementation, coordinating care delivery and plan and using strategies to promote health and a safe environment; and evaluation, evaluation of the progress of the patient toward attaining outcomes. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: Planning and Effective Care Environment: Coordinated Care 10. What is an injury resulting from the failure to meet an ordinary duty called? a. Negligence b. Malpractice c. Assault d. Battery ANS: A Injury resulting from the failure to meet an ordinary duty or standard of care is negligence. Malpractice is a specialized form of negligence. Assault and battery are examples of intentional acts. PTS: 1 Understanding DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 11. A night nurse is notified by the laboratory that the patient has a critical magnesium level of 1.1 mEq/L. The patient has a do-not-resuscitate order. The nurse does not notify the practitioner because of the patient’s code status. In doing so, the nurse is negligent for what? a. Failure to analyze the level of care needed by the patient b. Failure to respect the patient’s wishes c. Wrongful death d. Failure to take appropriate action ANS: D Nurses caring for acutely and critically ill patients must appropriately notify physicians of situations warranting treatment actions. Furthermore, the full no-code, do-not-resuscitate order 9 | P a g e TOP: Ethical and Legal Issues MSC: NCLEX: Safedoes not exclude this patient from receiving treatment to correct the critical laboratory value. Failure to take appropriate action in cases involving acutely and critically ill patients has included not only physician-notification issues but also failure to follow physician orders, failure to properly treat, and failure to appropriately administer medication. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 12. Two nurses are talking about a patient’s condition in the cafeteria. In doing so, these nurses could be accused of what? a. Failure to take appropriate action b. Failure to timely communicate patient findings c. Failure to preserve patient privacy d. Failure to document patient information ANS: C Nurses have a duty to preserve patient privacy, and failure to do so is a breach of patient confidentiality and failure to preserve patient privacy. Nurses should also refrain from having discussions about specific patients with anyone except other health care professionals involved in the care of the patient. When discussing specific patients with other health care professionals, it is imperative that patient-specific discussions occur in nonpublic settings. Discussions about specific patients are never appropriate in public areas such as elevators, cafeterias, gift shops, and parking lots. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Assessment and Effective Care Environment: Coordinated Care 13. A nurse fails to recognize an intubated patient’s need for suctioning. The endotracheal tube becomes clogged, and the patient has a respiratory arrest. What type of negligence may be present? a. Assessment failure b. Planning failure c. Implementation failure d. Evaluation failure ANS: A Nurses have a duty to assess and analyze the care required by each patient they care for. Failure to do so puts the nurse at risk for negligence related to failure to assess the patient’s needs. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: Assessment TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 14. On the way to surgery, a patient expresses doubt about proceeding with the planned procedure. The patient states that the doctor did not explain it very well and she would like to talk to her again before starting the procedure. The nurse knows the surgery schedule is very tight, reassures the patient that everything will be all right, and administers the preoperative sedation. This scenario describes what possible type of negligence? a. Assessment failure 10 | P a g e TOP: Ethical and Legal Issues MSC: NCLEX: Safeb. Planning failure c. Implementation failure d. Evaluation failure ANS: D The nurse has a duty to act as a patient advocate, in this case by holding the preoperative sedation until the doctor and the patient can speak and the patient is satisfied that she has the necessary information to make this decision. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care MULTIPLE RESPONSE 1. Which of the following is/are criteria for defining an ethical dilemma? (Select all that apply.) a. An awareness of different options b. An issue in which only one viable option exists c. The choice of one option compromises the option not chosen d. An issue that has different options ANS: A, C, D The criteria for identifying an ethical dilemma are threefold: (1) an awareness of the different options, (2) an issue that has different options, and (3) the choice of one option over another compromises the option not chosen. PTS: 1 Remembering DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care 2. What elements or criteria must be present for negligence cases to go forward? (Select all that apply.) a. Duty to another person b. Acknowledgement of wrong doing c. Harm that would not have occurred in the absence of the breach d. Breach of duty e. Damages that have a monetary value ANS: A, C, D, E There are four criteria or elements for all negligence cases: (1) duty to another person; (2) breach of that duty; (3) harm that would not have occurred in the absence of the breach (causation); and (4) damages that have a monetary value. All four elements must be satisfied for a case to go forward. Acknowledgement of wrong doing is not required. PTS: 1 Remembering DIF: Cognitive Level: OBJ: Nursing Process Step: N/A TOP: Ethical and Legal Issues MSC: NCLEX: Safe and Effective Care Environment: Coordinated Care Chapter 03: Patient and Family Education MULTIPLE CHOICE 1. A patient is scheduled for a cardiac catheterization this afternoon. The nurse wants to provide her with some basic information before going in the room to talk about her specific procedure. Which teaching strategy is most appropriate for this situation? a. Discussion b. Demonstration and practice c. Audiovisual media d. Written materials 11 | P a g eANS: C Media are used to educate patients on a variety of educational needs, such as medications, disease processes, procedures, symptom management, weight monitoring, laboratory tests, diet, surgery, and health maintenance issues. Patient education videos require the patient’s attention for only a few minutes and supply the learner with “nice-to-know” and “need-to- know” information. Demonstration and practice is not appropriate for this procedure because the patient is not performing the cardiac catheterization. Discussion and written material will help enhance the learning with the audiovisual media; however, this is not an interactive media. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Intervention Health Promotion and Maintenance 2. A nurse has been progressively working with a patient on the exercises he needs to do at home when he is discharged. The nurse wants to ensure he will remember what to do when he is at home. Which teaching strategy is most appropriate for this situation? a. Discussion b. Demonstration and practice c. Audiovisual media d. Written materials ANS: D Written media, such as brochures, pamphlets, patient pathways, and booklets, are common in outpatient and inpatient areas of health care. Demonstration and practice would be useful throughout the hospitalization to make sure the patient is performing the exercises correctly. Discussion and audiovisual media would be appropriate in the assessment and intervention portion of learning; however, written material may be reviewed by the patient after returning home. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Intervention TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 3. Which is the first step of the education process? a. Gathering data to assist in the assessment of learning needs b. Identifying the major learning needs for the patient c. Identifying learning needs related to the medical diagnosis d. Evaluating the effects of prior teaching ANS: A The first step of the education process is assessment, which involves gathering a database to assist the nurse in meeting the patient’s and family’s needs. Learning needs can be defined as gaps between what the learner knows and what the learner needs to know, such as survival skills, coping skills, and ability to make care decisions. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Assessment TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 4. Which educational content area is appropriate during the first hours of hospitalization? 12 | P a g e TOP: Patient and Family Education MSC: NCLEX:a. Pathophysiology of the admitting diagnosis b. Dietary modifications c. Purpose of bedside equipment d. Medication side effects A N S : C Initial interventions are targeted to promote comfort and familiarity with the environment and surroundings. The plan should focus on survival skills, orientation to the environment and equipment, communication of prognosis, procedure explanations, and the immediate plan of care. Information regarding diagnosis, dietary modifications, and medication will be addressed after the patient is through the initial contact phase and is in the continuous care phase of education. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Implementation TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 5. How should a nurse respond when a patient asks if he or she is going to die? a. Avoid the question by leaving the room. b. Defer the question to the physician. c. Answer honestly with information that is understandable and in simple terms. d. Speak with the family first before answering the patient. ANS: C During this time of elevated stress, the nurse may have to refocus the patient or family to help concentrate efforts on coping with the present instead of dwelling on possibilities of the future. Not addressing these immediate concerns could result in further anxiety, affect their ability to cope, and prevent open and honest communication. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Assessment TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 6. Which intervention can support a learning environment in the critical care unit? a. Provide a variety of caregivers to enhance the availability of different information. b. Allow frequent uninterrupted rest periods to enhance obtaining structured sleep. c. Provide the patient lists of facts that can enhance understanding of the disease. d. Teach according to a structured plan to enhance comprehension. ANS: B Sleep cycle alterations caused by sleep deprivation or sensory overload related to continuous noise from machines or people affect the patient’s ability to concentrate and comprehend information. Allowing frequent uninterrupted rest periods assists the patient in obtaining structured sleep. Assignment of multiple caregivers may negatively affect the ability of the patient and family to form a trusting relationship with the nursing staff. Teach whatever the patient wants to learn and avoid lists of facts. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation TOP: Patient and Family Education and Maintenance 13 | P a g e MSC: NCLEX: Health Promotion7. In which situation are group discussions most effective as a teaching strategy? a. Patients have a variety of medical diagnoses. b. Patients are in the acute phase of their illness. c. Patients are in the hospital only 3 days or less. d. Patients are at similar stages of adaptation. ANS: D Hospitalized patients with similar problems and at similar stages of adaptation can benefit from discussion groups. The patient and each member of the family may be experiencing different stages in the adaptation process at the same time. The education encounter may need to be modified to meet the needs of the patient and family. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Planning TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 8. According to Maslow’s hierarchy of needs, the need to know and understand information is considered what type of need? a. High-level b. Low-level c. Physiologic d. Critical ANS: A Experiencing the stress of a physiologic need requires immediate attention and is considered a lower level, immediate need. The need to know and understand is a high-level need and can only be met if no lower level needs require attention. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Assessment TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 9. The patient is asked to complete an admission form. The patient hands the form to his spouse and asks her to complete the form, stating, “I forgot my glasses.” What might be inferred from the patient’s actions? a. Patient has functional health literacy. b. Patient needs a word recognition test. c. Patient has low health literacy. d. Patient needs a reading comprehension test. ANS: C Behaviors such as handing a form to family member to complete, claiming to be too tired, or “forgetting” one’s glasses are a few behaviors that may be used by individuals to hide their limitations or low health literacy. Word recognition tests consist of lists of health care terms that patients are asked to read. Reading comprehension tests assess understanding of health care information presented but do not demonstrate the individual’s ability to apply this information. Functional health literacy tests assess the individual’s level of comprehension and ability to put into action what he or she has learned. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Assessment TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 10. Which of the following issues should be addressed with patients who have been unconscious? a. Sensations b. Pathophysiology c. Rehabilitation d. Attitudes 14 | P a g eANS: A Providing information regarding environment, procedures, sensations, and time of day is benevolent and may help decrease immediate physiologic stress. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Implementation TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 11. What topic should be included in the education of a patient’s family members during their first visit? a. When to call the practitioner b. Availability of support groups c. Expectations about self-care d. What the patient may look like ANS: D The focus of the any education during the first visit should include what the patient may look like. When to call the practitioner, availability of support groups, and expectation for self-care should be included into later teaching sessions. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment TOP: Patient and Family Education MSC: NCLEX: Psychosocial Integrity 12. A patient has been in the ICU for several weeks and is now ready for transfer to the progressive care unit. The patient is apprehensive and has communicated to the nurse that he does not want to leave the ICU because he is afraid that his needs will not be met on the new unit. Which educational objective would be best to use in this situation? a. The patient will state two reasons why he is being transferred by the end of the day. b. The patient will confront his fears and deal with them within 1 day of transfer. c. The patient will state the name of his “new” nurse by the end of the day. d. The patient will be introduced to at least two of his “new” caregivers by the time of transfer. ANS: D The patient needs to trust the new caregivers on the progressive care unit. Introducing the new caregivers will help decrease his anxiety about an unfamiliar environment. Objectives must be realistic in expectation and timeline. Anxiety and fear of change will decrease the patient’s cognitive level. PTS: 1 DIF:Cognitive Level: Analyzing OBJ: Nursing Process Step: Planning TOP: Patient and Family Education MSC: NCLEX: Psychosocial Integrity 13. An older adult patient received a liver transplant 3 days ago. The patient is extubated and hemodynamically stable. His spouse is coming for a visit, and the nurse has some time to discuss immune suppression drug therapy with both of them. The patient is hearing and sight impaired. The spouse brought the patient’s hearing aids 2 days ago and will bring the patient’s glasses today. Which teaching strategy would be least effective in the ICU setting? a. Patient education channel b. Written materials c. Lecture 15 | P a g ed. Discussion ANS: C Lecture is not the strategy of choice for this situation; it does not work well in the ICU. Teaching must be done at the bedside by using as many of the senses as possible. Written material, discussion, demonstration, and use of media are common teaching strategies used in the ICU. PTS: 1 DIF: Cognitive Level: Evaluating OBJ: Nursing Process Step: Implementation TOP: Patient and Family Education and Maintenance MSC: NCLEX: Health Promotion 14. During which phase do HIPAA, advance directives, and visitation policies occur for the patient or family members? a. Transfer to a different level of care b. End-of-life care c. Initial contact or first visit d. Continuous care ANS: C During preparation for the first visit, the nurse would instruct the patient or family on HIPAA, advanced directives, and visitation policy. Transfer to a different level of care includes orientation to the receiving unit. Continuous care includes discussion of day-to-day routines, procedures, and treatment process. End-of-life care includes discussion of palliative care or hospice. PTS: 1 DIF: Cognitive Level: Evaluating OBJ: Nursing Process Step: Planning TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 15. Which statement BEST describes the education process? a. It follows the distinct order of the nursing process, with each step of the process separate and without repetition. b. c. d. It requires formal blocks of learning time that are planned during the shift. It is a continuous activity that occurs during hospitalization and beyond. It ends at the point of discharge. ANS: C In the teaching-learning process, the steps of the nursing process (assessment, diagnosis, goals or outcomes, interventions, and evaluation) may occur simultaneously and repetitively. The teaching-learning process is a dynamic, continuous activity that occurs throughout the entire hospitalization and may continue after the patient has been discharged. PTS: 1 DIF:Cognitive Level: Understanding OBJ: Nursing Process Step: N/A TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 16. Which statement best describes the efficacy of group discussion as a patient teaching strategy for educating both a patient newly diagnosed with diabetes and a patient who has had the disease for years? a. It is an efficient use of the nurse’s time. b. 16 | P a g e It will address the same teaching topics with both patients.c. d. It will be effective because both patients undoubtedly have identical goals. It is not an appropriate teaching strategy. ANS: D Educational needs between the two patients will differ. Group discussion is only effective when the goals of the education plan are the same for all patients involved. A patient newly diagnosed with diabetes will require education on topics that are potentially well known to a patient diagnosed years ago. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Planning TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 17. A patient who is mechanically ventilated patient is being actively weaned. As she begins to wake up for the first time, she becomes increasingly agitated, pulling at her gown, kicking her feet, and grimacing. What action should the nurse take next? a. Administer additional sedation until the patient stops kicking. b. Initiate wrist restraints to prevent the patient from pulling. c. Tell the patient to stop moving around to avoid accidental extubation. d. Provide the patient with simple facts to assist with understanding of the situation. ANS: D The need for oxygen and survival predominates over all other human needs. According to Maslow’s hierarchy of human needs, lower-level, physiologic needs must be satisfied before an individual can move on to higher-level issues. Experiencing a significant physiologic stressor may completely consume all the patient’s available energy and thoughts, affecting his or her ability to interact, comprehend, and respond. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation TOP: Patient and Family Education MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 18. A lack of true understanding can often be misread by the nurse as noncompliance. Which question demonstrates an effective method to assess a patient’s understanding? a. Do you take your heart medication every morning? b. Can you tell me what you know about your different heart medications? c. Do you take all your medications? d. Do you ever miss taking your medication? ANS: B Open-ended questions provide the nurse an opportunity to assess actual knowledge gaps rather than assume knowledge by obtaining a yes or no response. These types of questions also assist the patient and family to tell their story of the illness and communicate their perceptions of the experience. Questions that elicit only a yes or no response close off communication and do not provide for an interactive teaching-learning session. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Assessment Health Promotion and Maintenance MULTIPLE RESPONSE 1. Sources of physiologic stress in the acutely ill include (Select all that apply.) a. Hypotension b. Hypoxia c. Fever 17 | P a g e TOP: Patient and Family Education MSC: NCLEX:d. Neurologic deficits e. Eupnea ANS: A, B, C, D Physiologic alterations in heart rate and blood pressure can be measured and taken into consideration during the teaching-learning encounter. Sources of physiologic stress in acutely ill patients include medications, pain, hypoxia, decreased cerebral and peripheral perfusion, hypotension, fluid and electrolyte imbalances, infection, sensory alterations, fever, and neurologic deficits. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment TOP: Patient and Family Education MSC: NCLEX: Health Promotion and Maintenance 2. Which questions can a nurse use to obtain assessment information to determine the immediate need for education? (Select all that apply.) a. “How can we help you today?” b. “Can you tell me why you take each medication?” c. “Are you in pain?” d. “Are these people your main support system?” e. “How well do you understand the directions?” ANS: A, B, D Generally, with practice and effort, it can be determined what educational information is needed in a brief period without much disruption in the routine care of the patient. Questions that elicit a “yes” or “no” response close off communication and do not provide an interactive teaching-learning session. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: Assessment Health Promotion and Maintenance Chapter 04: Psychosocial Alterations 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 OBJ: Nursing Process Step: Assessment TOP: Psychosocial Alterations MSC: NCLEX: Psychosocial 18 | P a g e TOP: Patient and Family Education MSC: NCLEX:Integrity 2. Nearly 25% of people surviving a critical illness and an intensive care unit stay subsequently exhibit symptoms of posttraumatic stress disorder (PTSD). A patient with PTSD may manifest which behavior? a. Intrusive recall of the event 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 After an exposure to a traumatic event, people may experience intrusive recall of the distressing event. This recall is often triggered by a noise, sound, sight, smell, event, or memory. Nightmares and distressing memories during which a trauma is reexperienced provoke intense psychological and physiologic distress. People with PTSD can also exhibit numbing responses, including detachment, isolation, restricted affect, and depression. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment TOP: Psychosocial Alterations MSC: NCLEX: Psychosocial Integrity 3. A subjective state in which an individual sees extremely limited or no alternatives and is unable to mobilize energy on his or her behalf is known as: a. despair. b. hopelessness. c. powerlessness. d. loss of control. ANS: B Hopelessness is a subjective state in which an individual sees extremely limited or no alternatives and is unable to mobilize energy on his or her own behalf. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Diagnosis TOP: Psychosocial Alterations MSC: NCLEX: Psychosocial Integrity 4. 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. c. d. It indicates deterioration of the physical state. It is adaptive when the patient calls every 15 minutes, even for trivial matters. 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. PTS: 1 DIF: Cognitive Level: 19 | P a g eApplying OBJ: Nursing Process Step: Assessment TOP: Psychosocial MSC: NCLEX: Psychosocial Integrity 5. Which concept supports patients and helps them endure the physical and psychological 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 OBJ: Nursing Process Step: Diagnosis NCLEX: Psychosocial Integrity 6. 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. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity TOP: Psychosocial Alterations 7. 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. 20 | P a g e TOP: Psychosocial Alterations MSC:PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity TOP: Psychosocial Alterations 8. 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. PTSD c. Regression d. Distrust ANS: A The patient is experiencing denial or an “conscious and unconscious attempts to disavow knowledge or the meaning of an event to reduce anxiety and fear.” Critically ill patients or their family members may use denial as a defense mechanism to protect against and manage an overwhelming sense of threat brought on by illness, injury, or impending death. The patient is not exhibiting signs of regression, PTSD, or distrust. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: Diagnosis NCLEX: Psychosocial Integrity 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. Hopelessness c. Denial d. Distrust ANS: A Regression is an unconscious defense mechanism characterized by a retreat, in the face of stress, to behaviors characteristic of an earlier developmental level and would be 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. The patient is not exhibiting signs of hopelessness, denial, or distrust. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: Diagnosis NCLEX: Psychosocial Integrity 10. 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 21 | P a g e TOP: Psychosocial Alterations MSC: TOP: Psychosocial Alterations MSC: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. PTS: 1 DIF: Cognitive Level: Applying OBJ: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity TOP: Psychosocial Alterations 11. 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 psychological 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. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Diagnosis TOP: Psychosocial Alterations MSC: NCLEX: Psychosocial Integrity 12. 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. PTS: 1 DIF: Cognitive Level: Remembering OBJ: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological Therapies 13. 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. PTSD 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 22 | P a g e TOP: Psychosocial Alterationsincrease 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. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Diagnosis TOP: Psychosocial Alterations MSC: NCLEX: Psychosocial Integrity 14. Anxiety can cause emotional changes in which part of the brain? a. Parasympathetic nervous system b. Neurotransmitters c. Cerebral cortex d. Midbrain ANS: B The physiologic effects of anxiety can produce negative effects in critically ill patients by activating the sympathetic nervous system and hypothalamic-pituitary-adrenal axis. Anxiety elicits changes in the neurotransmitters in the brain that regulate mood—including acetylcholine, norepinephrine, dopamine, serotonin, and gamma-aminobutyric acid—along with their corresponding receptors. PTS: 1 DIF: Cognitive Level: Understanding OBJ: Nursing Process Step: Assessment TOP: Psychosocial Alterations MSC: NCLEX: Psychosocial Integrity 15. 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 OBJ: Nursing Process Step: Diagnosis NCLEX: Psychosocial Integrity 16. 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. Loss of control b. Spiritual distress c. Anxiety d. Powerlessness ANS: B 23 | P a g e TOP: Psychosocial Alterations MSC: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. PTS: 1 DIF: Cognitive Level: Analyzing OBJ: Nursing Process Step: Diagnosis NCLEX: Psychosocial Integrity 17. 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