Ch 40: Stress, Coping, and Adaptation

A client is refusing to get out of bed the day after hip surgery. The nurse knows that for the intervention to be safe, therapeutic, and nonthreatening, she will need to not only enlist the client's cooperation, but also her willing participation. Which stress reduction technique does the nurse acknowledge as the best choice in this situation?

Anticipatory guidance

When nurses become overwhelmed in their jobs and develop symptoms of anxiety and stress, they are experiencing what condition?

Burnout

A client expresses to the nurse that she constantly feels irritated and loses her temper. During the course of the interview, the nurse finds that the client takes care of her mother who was confined to bed following a stroke. The client struggles to balance caring for her family and her mother. Which nursing diagnosis would the nurse most likely identify for this client?

Caregiver Role Strain

The nurse walks into the client's room and finds her sobbing uncontrollably. When the nurse asks what the problem is, the client responds "I am so scared. I have never known anyone who goes into a hospital and comes out alive." On this client's care plan the nurse notes a nursing diagnosis of Ineffective Coping related to stress. What is the best outcome the nurse can expect for this client?

Client will adapt relaxation techniques to reduce stress.

The nurse involved in coordinating a support group for spinal cord injury clients learns that one of the participants in the support group was a college athlete prior to his diving accident. The client informs the group that he earned a scholarship based upon his athletic abilities and not his academic performance, and after the injury, he focused his energies on his studies. He has been on the dean's list for two semesters. What defense mechanism is illustrated in this scenario?

Compensation

A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor?

Coping mechanism

A nurse is caring for a pregnant client in labor. Which technique should the nurse instruct the client to do to mange stress?

Deep breathing

A man has noticed bright red blood in his bowel movements for over a month. He says to himself, "Oh, it's just my hemorrhoids." What defense mechanism is the man using?

Denial

Aleah is a 22-year-old college student who recently engaged in sexual intercourse with a new partner. When the nurse tells her that she is pregnant, she states, "That's not possible, I got my period last week." This is an example of what defense mechanism?

Denial

The children of a woman 60 years of age are distraught at her apparent lack of recovery following a stroke several weeks earlier. The client's daughter has frequently directed harsh criticism toward the nurses, accusing them of a substandard effort in rehabilitating her mother despite their best efforts. What defense mechanism may the client's daughter be exhibiting?

Displacement

A 78-year-old widower was recently relocated to an assisted living facility. His aunt used to live in this facility and always talked fondly about her fellow residents and the staff. However, the nurse has noticed that the client has spent most of his time in his room alone. What type of stress is the nurse most concerned about with this client?

Environmental stress

The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. At what stage of stress is the client?

Exhaustion stage

A nurse is working with a 67-year-old Asian American woman on diet changes to help with weight loss. She is explaining her role in the family as the one who prepares the meats for the family, while her daughter is responsible for preparing vegetables. Based on the nurse's knowledge of traditional Asian cultures, the nurse knows what to be true?

Families operate in a collectivistic manner.

A nurse assigned to a newly admitted client realizes that the client finds the facility environment extremely stressful. What would be most appropriate for the nurse to do to decrease sensory stimulation of the client?

Keep down the conversational noise in the hallway.

A teenager is unable to eat breakfast and is pacing in the house 2 hours before his appointment for his driving road test. He takes the test and passes. The driving test administrator says to the teen, "You did very well. You weren't nervous at all, were you?" What level of anxiety was the teen experiencing prior to and during his road test?

Mild anxiety

A recently retired client reports that he has been able to sleep only 3 hours a night and that he has nausea, frequent urination, and headaches. He is asking the nurse what she thinks is going on with his health. What is the most probable cause of his symptoms?

Moderate anxiety

A client who is a drug addict visits a health care facility for treatment. During counseling, he discloses that he took to drugs because it helped him deal with stressful situations. The nurse explains that he is not using the correct coping strategy to overcome his stress-related problems. What kind of strategy has the client used in this case?

Nontherapeutic coping strategy

A nurse teaches a client deep-breathing exercises to help control his anxiety. This is considered what type of stress management technique?

Relaxation

A client with cancer has recovered from tumor removal surgery and is now stable while undergoing a chemotherapy treatment schedule. She is not having any symptoms at this time and is continuing to work and enjoy social events. What stage of the general adaptation syndrome (GAS) would the nurse place her in?

Resistance

A nurse is assessing a client who has recently lost her husband. During the interview the nurse realizes that the client is unable to cope with the loss. The client finds it difficult to organize daily tasks or solve problems effectively. Which suggestion would be most appropriate for the nurse to suggest as a crisis intervention?

Seek assistance from family and friends.

A client visits a health care facility reporting work-related stress that alters his mood when he comes home. The nurse suggests that the client make changes to his home décor to include vibrant colors and bright lighting, and listen to soothing music when he returns home. Which stress-reducing technique is the nurse following in this case?

Sensory manipulation technique

A friend has lost her job and is becoming increasingly anxious to the point of crisis. What type of crisis is she experiencing?

Situational

A nurse is meeting with a young woman who has recently lost her mother, lost her job, and moved with her husband to a new city. She is reporting acute anxiety and depression. What does the nurse know about stress that would be helpful with this client's situation?

Sometimes too many stressors disrupt homeostasis and if adaptation fails, the result is disease.

What phase of the general adaptation syndrome (GAS) is a client in when he uses all of his adaptive mechanisms for dealing with stress, leaving no defense against the distress?

Stage of exhaustion

While obtaining an initial assessment of a client, the nurse gathers information about the client's stress history. What would the nurse collect as subjective data?

Structured interview

When discussing his problem, a client tells the nurse that he is always doing small, petty jobs for everyone and he is not happy about it. Because of this, he is feeling stressed and has been getting into fights with his wife. What should the nurse suggest to help the client overcome this problem?

Take control of the situation.

A client has been brought to the health care facility with accident-related injuries. During the initial interview, the client becomes agitated, upset and is unable to answer any more of the nurse's questions. What does the nurse conclude about the condition of the client?

The client's mind is preparing for a fight-or-flight response as he relates the incident.

A nurse is trying to assess a client's stress type; however, the client is very depressed and quiet and does not reply to the nurse's questions. The nurse is unable to maintain her calm while repeating the questions. Where is the nurse going wrong in assessing the client?

The nurse should demonstrate confidence and expertise.

Cold temperatures and loud noises are stressors to one person but not another. Why does this occur?

The perception and effects of stressors are highly individualized.

In contrast to anxiety, fear is characterized by:

a cognitive response to a known threat.

Which of the following best describes stress?

a response to changes in the normal balanced state

Many families are sheltering in the local middle school gymnasium during a severe tornado outbreak. Many homes have been destroyed and lives lost. The community health nurse expects to see negative stress reactions to the crisis, such as:

a young wife asking everyone repeatedly if they know where her husband is.

Family conflict around the care of a recently hospitalized woman has escalated to the point that crisis intervention may be required. This process should begin with:

clear identification of the relevant problem.

A young mother tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior?

coping mechanism

A client who responds to bad news concerning his lab reports by crying uncontrollably is handling stress by using:

coping mechanism.

The nurse is providing care to the following clients. The nurse assesses the client exhibiting maladaptive behavior as the client who is:

experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live."

A group of nursing students is reviewing information about the various stresses affecting individuals across the lifespan. The students demonstrate understanding of the information when they identify what as a stressor affecting the infant?

need for attachment

The wife of a client on hospice at home is diagnosed with "caregiver burden." Which of the following best describes this syndrome?

prolonged stress from caring for a family member at home

The client is a child age 5 years hospitalized for a surgical procedure. The client is bedwetting. The parents report this is a new behavior and their child is toilet trained. The nurse assesses the client is exhibiting the defense mechanism of:

regression.

A client is on a stress management program. She states that she is open to trying a guided meditation class. When helping her get started, a nurse tells her that which of the following is not important?

soft music

Which group of terms best describes anxiety?

unknown cause, emotional, apprehensive

Which response to long-term stress may present itself in clients? Select all that apply.

• Alcoholism • Hypertension • Bulimia

Which are considered internal stressors? Select all that apply.

• Illness • Fear • Hormonal change

The nurse is describing the effect of stress on the body to a group of health practitioners. Which statements accurately describe the role of stress on the health and illness of clients? Select all that apply.

• The health-illness continuum is affected by stress. • As the duration, intensity, or number of stressors increases, a person's ability to adapt is lessened. • Recovery from illness and return to normal function are compromised by prolonged stress.

Which behaviors represent effective coping mechanisms? Select all that apply.

• learning relaxation techniques • taking a vacation • setting limits with family members who upset you

What philosophy for handling stress can nurses encourage clients to adopt?

"Accept what can't be changed, change what can't be accepted."

Which question would be helpful in eliciting data about the effects of stress during a health history?

"How does your body feel when you are upset?"

A nursing instructor is discussing burnout with a group of graduating nursing students. Which statement might lead the instructor to believe that the particular student is prone to poor coping skills?

"I can handle absolutely any situation now. You teachers have trained us well."

A Red Cross volunteer has recently returned from assisting families in the Northwest who survived a devastating forest fire. She is having trouble sleeping and has taken up smoking again. Which statement by her leads the nurse to suspect a nursing diagnosis of Caregiver Role Strain related to stress from disaster volunteer activities?

"I can't seem to calm down. I keep seeing those faces and hearing their words every time I close my eyes."

A mother tells the school nurse that her 5-year-old is refusing to go to school and won't accept a "school night" bedtime. The school nurse knows the mother will need more instruction when the mother makes which statement?

"I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer."

A client is admitted to the oncology unit with a diagnosis of leukemia. Her sister comes to visit. The healthy sibling tells the nurse that her sister is sick because "I got mad at her and wished she would go away." Based on this information, the nurse would estimate the sister's age to be:

7 years

Which response to stressors results from the activation of the local adaptation syndrome (LAS)?

A girl quickly withdraws her hand from a stream of hot tap water.

Which client is handling stress by using the defense mechanism termed displacement?

A mother who is angry at her husband shouts at the kids to "keep quiet."

A middle-age adult discusses with the nurse the loss of his job due to frequent illness. The nurse recognizes the client's loss of his income as which of the following?

A stressor

A nurse is caring for a client who is an investment banker. The client is stressed because of the sudden fall of share prices in the stock exchange. Which stress-reduction technique should the nurse use with this client?

Advocate on behalf of the client to others.

A 56-year-old construction worker is in for his annual physical. As the nurse takes his vital signs, he tells her that his blood pressure may be a little off this morning. He tells the nurse that he is recently unemployed, is quite stressed, and is having a hard time coping. He feels like he needs to numb the pain. What is the nurse most concerned about regarding this client?

Alcohol abuse