CHAPTER 06: PSYCHOSOCIAL AND SPIRITUAL ALTERATIONS AND MANAGEMENT {Urden: Critical Care Nursing, 9th Edition}

C HAPTER 06: P SYCHOSOCIAL AND
S PIRITUAL A LTERATIONS AND
M ANAGEMENT
Urden: Critical Care Nursing, 9th Edition



MULTIPLE CHOICE


1. 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 washin g his face and hands. The patient yells at the
nurse, “You do it! Can’t you see that m y legs are broken?” What
ps ychosocial disturbance is the patient exhibiting?
a. Self-concept
b. Self-esteem
c. Body image
d. Personal identit y



ANS: B



Illness and trauma can rob the person of perspective and shrinks both
the familiar world and the one of possibility, often leading to low self -
esteem and feelings of powerlessness, helplessness, and depression. A
low self-regard impairs one’s abilit y to adapt. The person may refuse
to participate in self -care, exhibit self-destructive behavior, or be too
compliant.

, PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 78
OBJ: Nursing Process Step: Diagnosis TOP:
Psychosocial MSC: NC LEX: Psychosocial Integrit y



2. An adult patient sustains t hird- 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 repeatedl y whines
and throws “temper tantrums” in an attempt to keep her nurse at th e
bedside. What coping mechanism is the patient exhibiting?
a. Regression
b. Identit y disturbance
c. Denial
d. Trust



ANS: A



Regression is a normal reaction to severe burns. The person may
become childlike in interactions with staff. Behaviors such as whining,
clinging to staff, and attempting to keep the nurse at the bedside
constantl y are not uncommon. A personal identit y disturbance, as a
type of altered self-concept, is defined as an inabilit y of a person to
differentiate the self as a unique and separate human be ing from others
within a social environment.



PTS: 1 DIF: Cognitive Level: Appl ying REF: p. 80
OBJ: Nursing Process Step: Diagnosis TOP:
Psychosocial MSC: NC LEX: Psychosocial Integrit y

, 3. 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 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 medicall y
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: Appl ying REF: p. 84
OBJ: Nursing Process Step: Diagnosis TOP:
Psychosocial MSC: NC LEX: Ps ychosocial Integrit y



4. What happens when the critical illness is so severe that the patient or
famil y becomes overwhelmed?
a. Anxiet y
b. Spiritual distress