Chapter 41: Stress, Coping and Adaptation

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." Explanation:Each developmental stage includes tasks that must be achieved so that normal growth and development can occur, but change can be stressful. In a school-age child, starting school and being around strangers can be challenging. One way to counteract the anxiety is to introduce them to others in social situations, and teach acceptable social behaviors, before they start school.

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 Explanation:This is an example of magical thinking. Magical thinking is a common reaction to stress in a school-aged child.

The nurse teaches a client about the use of yoga as a stress management intervention. Which client statement indicates to the nurse that learning has taken place?

"It reduces physical and emotional tension through postural changes and focused concentration." Explanation:Stating that yoga reduces physical and emotional tension through postural changes and focused concentration is correct, because yoga reduces stress, increases relaxation, and promotes greater flexibility. Stating that yoga eases tense muscles by clearing the mind of stressful thoughts refers to progressive relaxation, not yoga. Stating that yoga alters a negative physiologic response through the power of suggestion is incorrect, as this is referring to the placebo effect. Using the mind to visualize calming, pleasurable, and positive experiences is called imagery, not yoga.

An adolescent client is brought to the clinic by the parents, who inform the nurse that they are concerned that the adolescent is using maladaptive coping mechanisms to deal with a bullying issue at school. Which statement(s) by the parents should the nurse report to the health care provider as correlating with the use of maladaptive coping mechanisms? Select all that apply.

"Our adolescent is sleeping a lot more than usual." "We have tried to discuss the issues so we can find a solution but are met with anger and hostility." "We have found evidence of drug use, which is very unlike our adolescent." Explanation: Indications that the adolescent is using maladaptive coping mechanisms to deal with the bullying situation at school would be: excessive sleeping which prevents facing the conflict, not wanting to discuss the issue or using hostility and aggression when confronted, the use of drugs or mind and mood-altering substances to prevent having to face reality and create a solution. The negative coping mechanisms may provide a brief relief from the stressor, but eventually create problems when used for an extended period. When interacting with friends in social situations or seeing the school counselor, the adolescent is using positive coping strategies to deal with the present issues

A nurse is educating a client about how the general adaptation syndrome (GAS) theory works in the human body. What statement(s) made by the client indicates to the nurse that further education is required? Select all that apply.

"The alarm reaction alerts my family that I need to slow down." "I often get exhausted when I do too much yardwork." "The fight-or-flight reaction is initiated by growth hormone released in my brain." "The alarm reaction may last for days." Selye's general adaptation syndrome (GAS) theory identifies the stages of stress the human body goes through when challenged physiologically or psychologically. Physical activity is a good coping mechanism for stress relief and decreasing this response. The alarm reaction is within the client, not the family. Physical exertion fatigue is not internal physiologic exhaustion. Fight-or-flight utilizes epinephrine and cortisol, not growth hormone. The alarm reaction is short term and may last from minutes to hours.

The nurse is caring for a client after a stressful and prolonged abdominal surgery. The client's blood glucose level is elevated, yet the client has not been diagnosed with diabetes. Which statement by the nurse addresses the client's concern about the blood glucose level?

"The surgery stressed your body and this is a normal response." Explanation:During stressful situations, adrenocorticotropic hormone (ACTH) stimulates the release of cortisol from the adrenal gland, which creates protein catabolism, releasing amino acids and stimulating the liver to convert amino acids to glucose, also known as the fight-or-flight reaction. The result is elevated blood glucose levels. A simple way for the nurse to explain this is as a stress response by the body. Telling the client, "This is just something that happens sometimes after surgery" is vague and dismissive. Telling the client he or she needs to be tested for diabetes shows the nurse's lack of understanding and may scare the client unnecessarily. Telling the client, "This does not surprise me with your family history of diabetes" is belittling and demonstrates the nurse's lack of understanding on the topic.

A client, while driving, hits a small child crossing the road. The child survives with some minor bruises and cuts. The client feels very stressed and is depressed when thinking of the child's injury. Which technique should the nurse implement in this case?

A client, while driving, hits a small child crossing the road. The child survives with some minor bruises and cuts. The client feels very stressed and is depressed when thinking of the child's injury. Which technique should the nurse implement in this case?

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." Explanation:Displacement is described as transferring (displacing) an emotional reaction from one object or person to another object or person, as with the mother who is angry at her husband and shouts at the kids to "keep quiet." The athlete who doesn't make a team and instead concentrates on body-building represents the defense mechanism of compensation. A man with symptoms of prostate cancer refusing to see a doctor is displaying the defense mechanism of denial. A man who forgets his medication and blames his wife for putting it way is demonstrating the defense mechanism of projection.

The nurse is caring for a client diagnosed with terminal cancer who wishes to use meditation and prayer to be cured. What is the appropriate nursing action?

Advocate for the client's choice. Explanation:Nurses are accountable to act as a client's advocate, even if the client's choices are not in alignment with the nurse's personal choices. The nurse should not assume that a chaplain is desired, nor administer chemotherapy without further dialoguing with the client. Explaining that meditation and prayer are not curative is not helpful in supporting the client's wishes.

Prior to the client's scheduled bone marrow biopsy, the nurse has devoted time to educating him about the rationale and the specific details of the procedure. The nurse's actions constitute what stress management technique?

Anticipatory guidance Explanation:Anticipatory guidance involves preparing a client psychologically for an event in the knowledge that familiarity reduces anxiety. Guided imagery involves the creation of mental image, not education. Relaxation focuses on the control of the body's responses to stress. Normalization is not a specific stress management technique.

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 Explanation:Anticipatory guidance is the technique wherein the nurse uses teaching about a procedure to prepare the client for what is to come. This can help foster trust, diminish fear of the unknown, and lessen the chance of a negative response to necessary treatments. Guided imagery, biofeedback, and meditation would take time to learn and would not be effective in this current situation.

A nurse hears a client yelling for help from the room. Upon arriving the nurse notes tachypnea and a sense of panic. On further evaluation, the client's heart rate is increased as well as oxygen needs. Which step would the nurse take first to address this client's needs?

Attempt to calm the client and administer oxygen Explanation:The alarm reaction is initiated when a person perceives a specific stressor and the person experiences an increase in energy level, oxygen intake, cardiac output, blood pressure, and mental alertness. The best way to address this is to attempt to calm the client and administer oxygen as needed to maintain oxygen levels and optimal breathing and cardiovascular function. Semi-Fowler position may help with breathing as well as taking deep breaths but is not the immediate need.

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. Explanation:Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the client needs to adopt coping mechanisms that are effective for dealing with stress, such as relaxation techniques. It is unrealistic to expect a client to be stress free. Avoiding stressful situations and starting an antianxiety agent are not the best answers as outcomes for ineffective coping.

Which outcome(s) will the nurse include in the plan of care for a client experiencing caregiver role strain? Select all that apply.

Client will demonstrate appropriate coping strategies. Client will identify support mechanisms to help with stress. Client will identify one or two stressors to eliminate. Demonstrating, not only naming, coping strategies is essential for caregivers who are experiencing role strain. Identifying support mechanisms (family, friends, community resources) is helpful in decreasing stress for the caregiver trying to do everything oneself. Identifying one or two stressors to eliminate is realistic, helpful, and can assist the client with feeling some control over the situation. Blaming and confronting others is not a healthy coping mechanism and will likely add to the caregiver's stress. Expecting the caregiver to eliminate all stress is an unrealistic goal that, when unmet, can cause additional stress due to a feeling of failure.

A nurse has accepted numerous overtime shifts over the past several months. Which behavior indicates the nurse is experiencing burnout?

Dozing at the desk during downtime Explanation:Burnout can manifest as increased fatigue, anger, disorganization, or other behavior changes related to an increased amount of stress. Dozing at the nurse's station indicates fatigue and is unsafe. Taking smoke breaks, while unhealthy, does not necessarily indicate burnout unless it is a new behavior. Implementing an exercise program is a healthy coping mechanism to help combat stress and burnout. Telling the manager staffing numbers are unsafe is assertive, which can be considered a healthy coping mechanism for stress.

A 35-year-old woman comes to the local health center with a large mass is her right breast. She has felt the lump for about a year but was afraid come to the clinic because she was sure it was cancer. What is the most appropriate nursing diagnosis for this client?

Ineffective Individual Coping Explanation:Ineffective individual coping is the inability to assess our own stressors and then make choices to access appropriate resources. In this case the client was unable to access health care even when she was aware the disorder could be life threatening. Self-Esteem Disturbance and Altered Family Process are nursing diagnoses that are often associated with breast cancer, but her ineffective individual coping has created a significant safety risk and is therefore the most appropriate nursing diagnosis. The client's behavior was motivated by fear, not confusion.

The nurse is caring for a client who is experiencing stress while weighing two good job offers. The nurse suggests that the client use therapeutic coping strategies. What does the suggestion of the nurse imply?

It means that the client is asked to seek professional assistance. Explanation: When a client seeks professional assistance in a crisis, it means that the client is using therapeutic coping strategies. Other coping strategies include using problem-solving techniques, demonstrating assertive behavior, practicing progressive relaxation, and turning to a comforting other or higher power. Nontherapeutic coping strategies refers to when a client is using mind- and mood-altering substances, hostility and aggression, excessive sleep, avoidance of conflict, and abandonment of social activities.

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. Explanation:The nurse should keep down the conversational noise in the hallway to decrease sensory overload on the client. Nurses should be aware of environmental stressors and make adjustments whenever possible to reduce sensory overload, and to assist clients with coping and adaptation. Turning off all the lights in the unit, keeping the procedures distributed throughout the day, and restricting family visits may increase the client's stress related to hospitalization.

A school nurse is talking with teen related to school and home situations. The teen states, "I can't focus when I study, can't eat or sleep, and I feel like I'm going to pass out sometimes." The nurse believes the teen is experiencing which disorder?

Moderate anxiety response Explanation:Inability to concentrate, nausea, insomnia, dizziness, and hyperventilation are all symptoms of moderate-level anxiety. Alarm reaction is the initial physiologic response to a stressor described in Selye's general adaptation syndrome theory. OCD is a psychiatric pathology. Panic attacks go a step further in the anxiety cascade; the client is unable to function at this level.

An individual steps into a tub of very hot water and immediately jumps out again. What mechanism caused this response?

Reflex pain response Explanation:The reflex pain response is a rapid and automatic response of the central nervous system to pain that serves as a protective mechanism to prevent injury. GAS is the three-stage process that describes the physiological changes the body goes through when under stress as alarm, resistance, and exhaustion. Fight-or-flight response is a component of the autonomic nervous system utilizes and activates the release of norepinephrine in the reaction. The inflammatory response (inflammation) occurs when tissues are injured by bacteria, trauma, toxins, heat, or any other cause which release histamine, bradykinin, and prostaglandins which cause inflammation.

A client who has been working with an organization for several years did not get a promotion. As a result, the client has gone into depression. Which suggestion should the nurse make in order to help the client with his stress?

Seek professional help. Explanation:The client should seek professional help, where he can talk freely about his anger and sense of betrayal. The client should then explore other options in a calmer frame of mind. Changing jobs, compromising, or taking a break from the job will not help the client solve the problem.

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

Situational Explanation:Crises may be maturational, situational, or adventitious. Situational crises occur when a life event, such as the loss of a job, disrupts a person's psychological equilibrium. Maturational crisis or developmental crisis is a life crisis in which usual coping mechanisms are inadequate in dealing with a stress common to a particular stage in the life cycle or with stress caused by a transition from one stage to another. Adventitious crisis is a rare accidental and unexpected tragedy that may affect an entire community or population, such as an earthquake, flood, or airplane crash. In addition to injuries, loss of life, and property damage, an adventitious crisis often results in long-term psychological effects.

The nurse is facilitating an evening meditation and deep breathing class for breast cancer survivors. Which outcome will the nurse anticipate occurring after performing deep breathing with the clients?

Slowed heart rate Explanation:Breathing is an important element of the relaxation response. When a person is relaxed, breathing slows and deepens and the heart rate returns to normal. As stress and tension mount during the day, breathing becomes shallow and irregular and the heart rate accelerates. Poorly oxygenated blood contributes to lethargy, tension, restlessness, and depression.

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. Explanation:Four concepts—constancy, homeostasis, stress, and adaptation—are key to the understanding of steady state. Homeostasis is maintained through emotional, neurologic, and hormonal measures; stressors create pressure for adaptation. Sometimes too many stressors disrupt homeostasis, and if adaptation fails, the result is disease. If a person is overwhelmed by stress, that person may never adapt. Acute anxiety and depression are frequently associated with stress.

A client has been brought to the health care facility with accident-related injuries. During the initial interview, the client becomes agitated and 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. Explanation:The client is currently in the alarm stage, where the stimulating neurotransmitters and neurohormones are released, which prepare the client for a fight-or-flight response. The brain, at this time, receives more oxygen to sharpen the senses and coordination. The brain also sends more chemicals to the bloodstream, which helps the client to keep alert for an extended period of time.

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. Explanation:Some general interventions appropriate during the care of the client who is suffering from stress include remaining calm during the discussions with the client, being available to the client, responding promptly to the client's signal for assistance, and encouraging family interaction. However, taking the help of a senior physician or giving the client a sedative would not help in assessing the client. The nurse has to assess the client's type of stress.

The nurse is caring for two clients on the same unit. One client states that cold temperatures and loud noises are stressors. The other client says the temperature is fine and the noises do not bother him. What is the difference between the two clients related to these stressors?

The perception and effects of stressors are highly individualized. Explanation:A stressor is anything that is perceived as challenging, threatening, or demanding. Stressors may be internal or external. The perception and effects of the stressors are highly individualized.

In contrast to anxiety, fear is characterized by:

a cognitive response to a known threat. Explanation:Fear is a cognitive response to a known threat, while anxiety is the emotional response to that threat. Fear does not necessarily resolve in the short term, and an action plan may or may not be formulated by the individual. The fact that fear involves the identification of a known threat does not necessarily mean that the object of fear is objectively real.

Which of the following best describes stress?

a response to changes in the normal balanced state Explanation:Stress is a condition in which the human system responds to changes in its normal balanced state or homeostasis. Stress results from a change in the environment that is perceived as a challenge, a threat, or a danger, and can have both positive and negative effects. Stress can cause general adaptation syndrome, which is the three-stage process (alarm, resistance, and exhaustion) that describes the physiological changes the body goes through, to occur.

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. Explanation:Disasters are considered adventitious crises. Those who are affected will utilize coping skills, good or bad, to maintain homeostasis. Positive coping might involve supporting loved ones and helping others adapt. Negative coping might include denial, anger, withdrawal, and panic.

A group of nursing students is reviewing information about stress and coping. The students demonstrate an understanding of the information when they identify what as the outcome of coping?

adaptation Explanation:The outcome of coping is adaptation. Allostasis refers to the process of re-establishing or maintaining homeostasis, which is the body's maintenance of physiologic balance within a certain range or "set point". Compensation, a defense mechanism, is the attempt to achieve respect or recognition in one activity as a substitute for the inability to achieve them in another endeavor.

What is the term for the change that takes place in response to a stressor?

adaptation Explanation:When a person is in a threatening situation, immediate and often involuntary responses occur. The change that takes place in response to a stressor is adaptation. Rehabilitation is the action of restoring someone to health or normal life through training and therapy after imprisonment, addiction, or illness. Positive or negative movement is the reactions of the response to the stressor in regards the nature of the actions.

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 Explanation:The nurse should advocate on behalf of the client to others. If need be, the nurse should refer the client and his family to organizations or people who provide post-discharge assistance. The nurse should keep the client and the client's family informed about the client's condition and encourage the family members to interact with the client.

The nurse is preparing to administer an injection to an adult client and states, "Try to stay as still as possible." Which stage of the General Adaptation Syndrome (GAS) is the nurse addressing by making this statement?

alarm Explanation:The alarm stage is correct, because this stage prepares the client for a "fight-or-flight" response to overcome the perceived danger, such as the injection of a needle. Stage of resistance is designed to restore homeostasis and is therefore incorrect. Stage of exhaustion occurs when more adaptive or resistive mechanisms are no longer to protect the patient experiencing a stressor. Pathological response is not a phase of GAS.

While conducting the physical assessment of a client, the nurse notes an increase in the blood glucose level. Upon inquiry, the client discloses that lately he has been under a lot of stress at work. Which stage of stress is the client experiencing?

alarm stage Explanation:The client is most likely in the alarm stage of stress if the blood glucose level is increasing rapidly. This occurs when the body is responding to a stressor by raising the blood glucose as a reserve for meeting increased energy requirements. The stage of resistance is characterized by restoration of normalcy. Physiologic exhaustion occurs when one or more adaptive/resistive mechanisms can no longer protect the person experiencing a stressor. There is no tertiary stage; however, tertiary prevention minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease.

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 use Explanation:Alcohol use is a common altered coping pattern for individuals with poor coping skills. It is legal and easily accessible. Phrases such as "I just cannot cope" and "I need to numb the pain" are common among those who misuse alcohol.

A client who tends to volunteer to complete major assignments but forgets to complete his own work is stressed because of this. The nurse suggests that the client prioritize the work, complete the difficult part of the work first, and delegate the rest of the work to colleagues. In this case, what technique is the nurse asking the client to follow?

alternative behaviors Explanation:Alternative behaviors means behavioral approaches that help to reduce stress, including prioritizing what needs to be accomplished and initially attending to that which is most important or difficult. Less important activities may be postponed or delegated to others. A negative technique may provide immediate temporary relief from a stressor, but it will eventually cause problems

An intensive care unit (ICU) nurse with 11 years of experience has been frequently absent or late for shifts, has been verbally abusive with coworkers she feels are unskilled at the technological tasks of the job, and cursed under her breath at a distraught family member today. The nurse manager is threatening to suspend her if it happens again. The ICU nurse may be experiencing:

burnout. Explanation:Burnout is the term used to describe behaviors that occur when a person is overwhelmed with the demands of a situation and is similar to the exhaustion stage of anxiety. This is commonly seen in nurses who work in high-stress environments. The individual in this scenario may have a great allostatic load and/or sleep deprivation, but there is no evidence of this in the given scenario. Repression is when a person copes by unconsciously denying the occurrence of a stressful event.

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. Explanation:Crisis intervention is a problem-solving technique that begins with the identification of the problem. This precedes the identification of options and assessment of proposed solutions. Once the problem is identified by the client and the crisis team is way, interventions should be then be developed by the team members. The crisis intervention is very individualized and should not be compared to other families. Analysis is the last step of the process.

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

coping mechanism Explanation:When a person is in a threatening situation, immediate responses occur. Those responses, which are often involuntary, are called coping responses. The change that takes place as a result of the response to a stressor is adaptation. Homeostasis is remaining steady in the present condition. A defense mechanism is an unconscious psychological mechanism that reduces anxiety arising from unacceptable or potentially harmful stimuli.

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 Explanation:When using denial as a defense mechanism, an individual is refusing to acknowledge the presence of a condition that is disturbing. Rationalization is the action of attempting to explain or justify behavior or an attitude with logical reasons, even if these are not appropriate. Repression is the psychological attempt to direct one's own desires and impulses toward pleasurable instincts by excluding them from one's consciousness and holding or subduing them in the unconscious. Compensation is the action or process of awarding someone money as a recompense for loss, injury, or suffering.

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 Explanation:The client is in the exhaustion stage, when one or more adaptive/resistive mechanisms can no longer protect the person experiencing a stressor; this results in exhaustion. The effects of stress-related neurohormones suppress the immune system, and the body is open to various ailments. In the alarm stage, the person is prepared for a fight-or-flight response. In the resistance stage, the client's body is returned to the homeostasis state. Consequently, one or more organs or physiologic processes may eventually lead to increased vulnerability to stress-related disorders, or progression to the stage of exhaustion. The secondary stage is not a stage related to stress.

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." Explanation:The client who has a terminal illness and makes the above statement is in denial. The other clients exhibit appropriate behaviors for their situations.

A client who has a history of sexual abuse is demonstrating repression. What client behavior does the nurse expect?

having no memory of the sexual abuse Explanation:Repression is forgetting about the stressor or removing the experience from the subconscious. Blaming others is a sign of displacing anger. Refusal to believe is a sign of denial. Childish behavior is demonstrative of regression.

A nurse is assisting a neurologist, who is assessing the norepinephrine (noradrenaline) level of a client who is reporting stress. Which function does norepinephrine (noradrenaline) perform?

heightens arousal and increases energy Explanation:Norepinephrine (noradrenaline) heightens arousal and increases energy. Acetylcholine and dopamine promote coordinated movement. Serotonin stabilizes mood, induces sleep, and regulates the temperature of a person. Substance P transmits the sensation of pain, whereas endorphins and enkephalins interrupt the transmission of substance P and promote a sense of well-being.

The nurse is reviewing the care of a client who is experiencing the exhaustion stage. Which sign or symptom does the nurse expect to find?

higher-than-normal blood glucose levels Explanation:The higher-than-normal blood glucose level occurs in a response to the prolong level of cortisol, which is produced to inhibit insulin in order to meet the increased need for energy when a person is stressed. Lower-than-normal blood glucose levels would suggest that the pancreas is overproducing insulin in response to stress, which is incorrect. Experiencing stress does not affect the iron levels in the body; therefore the iron level is not expected to increase or decrease.

Which are considered internal stressors? Select all that apply.

illness hormonal change fear Explanation: A stressor is anything that is perceived as challenging, threatening, or demanding. Stressors may be internal (e.g., an illness, a hormonal change, or fear) or external (e.g., loud noise or cold temperature).

A nurse is preparing an inservice presentation about stress. When describing the neuroendocrine regulation of stress, what would the nurse be least likely to include?

limbic system Explanation:The limbic system receives and integrates information about the stressor and sets off the neurological cascade of responding events. It is not part of the neuroendocrine response, which involves the hypothalamus and the pituitary and adrenal glands.

A client is experiencing a stress response each time the family visits the room. What nursing intervention is most appropriate?

limit the family visits to once daily Explanation:When a person is experiencing a stressor, it is important for the nurse to reduce or eliminate the stress. In this case, it is appropriate to limit the family visiting time to allow the client to recover without experiencing a stress response. Telling the family they are causing the stress is not therapeutic. Telling the client that the family should be there invalidates the client's feelings. Doing nothing is not an appropriate response to decrease or remove the stressor.

A nurse is reviewing coping methods with a client who is a new teacher and who is struggling to meet the demands of her job. What would the nurse include as an example of a problem-focused coping method?

making a schedule and sticking to it Explanation:Making a schedule and sticking to it is an example of problem-focused coping. Meditating, crying, taking a walk, or accepting understanding from a friend are examples of solution-focused coping.

A nurse is teaching a client regarding effective coping strategies. Which teaching will the nurse include? Select all that apply.

making an appointment with a counselor writing a list of pros and cons practicing yoga and relaxation turning to a higher power Making an appointment with a counselor is an appropriate step in positive coping. Writing a list of pros and cons is a problem-solving technique used in positive coping. Practicing yoga and relaxation is similar to progressive relaxation, which is a positive coping strategy. Turning to a higher power can also be a sign of positive coping. Excessive sleeping and social avoidance are signs of maladaptive coping.

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 Explanation:This client may have increased anxiety from adjusting to retirement, a significant life stressor. There are not enough data to identify any of the other disorders as being present.

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 Explanation:The client has used nontherapeutic coping strategies such as mind- and mood-altering substances to cope with stress. Negative coping strategies may provide immediate temporary relief from a stressor, but they eventually cause problems. Therapeutic coping strategies usually help the person to acquire insight, gain confidence to confront reality, and develop emotional maturity. Also, the client has not used an antidepressant strategy.

An occupational health nurse at an oil refinery on the Gulf Coast of Texas performs client education with an adult client. The client is being seen after having suffering a chemical burn in an accident at the refinery. Which type of stressor has this client been exposed to?

physiologic Explanation:Physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders. Psychosocial stressors include both real and perceived threats. Environmental stressors are items found in our surroundings, such as noise and crowds. Socioeconomic stressors relate to income and home life (such as low household income and low occupational status of the householder).

An occupational health nurse at an oil refinery on the Gulf Coast of Texas performs client education with an adult client. The client is being seen after having suffering a chemical burn in an accident at the refinery. Which type of stressor has this client been exposed to??

physiologic Explanation:Physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders. Psychosocial stressors include both real and perceived threats. Environmental stressors are items found in our surroundings, such as noise and crowds. Socioeconomic stressors relate to income and home life (such as low household income and low occupational status of the householder).

A middle-aged adult discusses the loss of a job due to frequent illness. Which will the nurse discuss with the client to assist in problem-solving the loss?

practicing meditation or yoga Explanation:Coping is the process of applying thoughts and actions to deal with stressful events. There are various mechanisms to coping. An example of a normal, long-term coping mechanism is learning and practicing meditation or yoga. A short-term and possibly unhealthy coping mechanism is drinking alcohol or "pill popping" (e.g., taking aspirin or tranquilizers). Searching for a job with adequate health insurance does not address the client's current issue and the job search may add more stress.

The nurse is making preparations for a group of clients who have been experiencing some stressful events in their lives. Which nursing strategies should the nurse use to assist these clients? Select all that apply.

preventing additional stressors assessing the client's response to stress implementing stress management techniques assisting in maintaining a network of social support Preventing additional stressors will eliminate the cumulative effects of other stressors. Assessing the client's response to stress will help indicate how well the client is adapting to the stressors. Implementing stress management techniques will provide strategies to assist the clients in mitigating further stressors. Maintaining a network of social support will provide the clients with other individuals to share their concerns with. Ignoring the stressors will just add to the cumulative effect or other stressful life events; it will not remove the stress.

After failing a nursing exam, the nursing student states, "That exam was written terribly." What coping strategy would the nursing instructor identify?

rationalization Explanation:Rationalization is relieving oneself of personal accountability by attributing responsibility to someone or something else. By claiming the exam is written poorly, the student is relieved of the personal responsibility. Denial is simply rejecting information. Repression is forgetting about the stressor. Suppression is purposeful avoidance of the topic or issue causing stress.

Which adaptive activity should the nurse suggest for a client who recently experienced a minor motor vehicle accident?

reframing Explanation:Reframing helps a person analyze a stressful situation and conclude that the situation is not as bad as it once seemed. For example, instead of dwelling on the negative consequences of the accident, the person chooses to focus on the positive aspect of being physically unharmed. Suppression is purposely avoiding thinking about the accident; instead, the person turns the problem over to a higher power. Rationalization is relieving oneself of personal accountability by attributing responsibility to someone else, such as blaming his parents for sending him shopping, which caused him to have the accident. Displacement is taking anger out on something or someone else who is less likely to retaliate, such as kicking the dog after being reprimanded by his mother for crashing the vehicle.

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. Explanation:Regression is a maladaptive behavior in which the client returns to an earlier method of behaving, as seen in the child who is now bedwetting. Compensation is overcoming a perceived weakness by emphasizing a more desirable trait. Displacement is transferring an emotional reaction from one object or person to another. Reaction formation is exhibiting behaviors that are the opposite of what the client would prefer to do.

During a counseling session a client states, "I just try to forget about my spouse hitting me." Which coping mechanism should the nurse document on the basis of this client's statement?

repression Explanation:Repression is the coping mechanism that this client is using, in which the client has removed the experience of being abused from conscious memory. Reaction formation is a coping mechanism that sees an individual acting just the opposite of one's feelings. Rationalization is relieving oneself of personal accountability by attributing responsibility to someone or something else. Regression is behaving in a manner that is characteristic of a much younger age.

A nurse has been caring for a client who experienced a physical assault a year ago. The client now describes being "totally recovered from it." Which stage of stress is the client currently experiencing?

resistance stage Explanation:The client is in the resistance stage, where the body has returned to the homeostasis state. The mind or brain is normal again, so the incident does not affect the client anymore. In the alarm stage, the stimulating neurotransmitters and neurohormones prepare the client for a fight-or-flight response. When one or more adaptive/resistive mechanisms can no longer protect the client experiencing a stressor, exhaustion occurs. The body loses its capability to fight stress. The primary stage is not related to stages of stress and is applicable for stress prevention.

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 Explanation:The nurse should suggest that the client seek assistance from family and friends as a crisis intervention. Adequate support during a crisis and its resolution can help clients realistically perceive the problem and reinstitute coping strategies. Performing meditation, tensing and relaxing muscle groups systematically for progressive relaxation, and keeping the home environment noise free are methods to calm and relax the client that may not necessarily help in crisis intervention.

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

setting limits with family members who upset you learning relaxation techniques taking a vacation Explanation: Coping mechanisms can have positive or negative effects on a client's well-being. All of these examples represent coping, either effective or ineffective.

The nurse is obtaining data for a client experiencing a sympathetic response to a medication. Which symptom(s) will the nurse document that will correlate with the medication effects? Select all that apply.

skin is pale bowel sounds are hypoactive in all quadrants urine output is decreased to less than 30 ml/h Explanation:Pinpoint or constricted pupils and bradycardia indicate a parasympathetic response. In a sympathetic response to a medication, the heart rate will be rapid and the pupils will be dilated. Pale skin is a sympathetic response due to constriction of blood vessels. Digestive motility is decreased which will be indicated in the slowing of peristalsis and hypoactive bowel sounds. The detrusor muscle is inhibited which suppresses urination and limits flow.

A nurse is assessing a client with stress-related problems. Which factor influences responses to stressors?

social support Explanation:A person's response to stressors depends on social support, intensity of the stressor, number of stressors, duration of the stressor, physical health status, life experiences, coping strategies, personal beliefs, attitudes, and values. A person's response to stressors is independent of education, eating habits, economic status, or personal hygiene.

In what phase of the general adaptation syndrome (GAS) is a client who is using all of the physiologic adaptive mechanisms for dealing with stress leaving no defense against the distress?

stage of exhaustion Explanation:GAS is the three-stage process that describes the physiological changes the body goes through when under stress as alarm, resistance, and exhaustion. Alarm is the first stage. Resistance is when the client refuses to accept the change and continues on. Exhaustion results when the adaptive mechanisms are exhausted. Without defense against the stressor, the body may either rest and mobilize its defenses to return to normal or reach total exhaustion and die. The fight-or-flight response is a component of the autonomic nervous system that utilizes and activates the release of norepinephrine in the reaction.

A group of nursing students is learning about the body's response to stress. Which system is responsible for initiating the fight-or-flight response to stress?

sympathetic nervous system Explanation:Functions of the sympathetic nervous system under stressful conditions bring about the fight-or-flight response. Sometimes called the rest-and-digest system, the parasympathetic system conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood. The respiratory system is a series of organs responsible for taking in oxygen and expelling carbon dioxide. The primary organs of the respiratory system are the lungs, which carry out this exchange of gases.

Which group of terms best describes anxiety?

unknown cause, emotional, apprehensive Explanation:The most common human response to stress is anxiety. Anxiety is a vague, uneasy feeling of discomfort or dread, an emotional response to a threat. The source is often nonspecific or unknown. It is a feeling of apprehension caused by anticipating a danger and can be prolonged depending on the client. Long term anxiety can be linked to depression.

While providing care to a client, the client states, "I can't do anything. I'm just so useless." Which technique would the nurse suggest to help the client gain control over negative thoughts?

use supportive internal messages Explanation:The nurse should encourage the client to use supportive internal messages to gain control over negative thoughts. Clients can learn to replace defeating negative internal messages with supportive messages to help cope with difficulties. Clients with a perfectionist attitude may benefit from setting realistic goals about the self. Clients who are unable to express their needs should join assertiveness training classes. Performing high-intensity exercise helps to reduce stress levels in the body but is not specific to gaining control over negative thoughts.