Chapter 42: Stress and Adaptation
A teenage girl is discussing her recent breakup with her boyfriend. She tells the nurse she just stays in bed all day and cannot seem to feel any better. She says she is only relieved of the pain while sleeping. The nurse identifies this coping strategy as:
avoidance coping.
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.
A Spanish-speaking client is admitted to the emergency department with a urinary tract infection and is experiencing a stress response from hospitalization. What is the prioritynursing intervention?
contact a translator
A client who responds to bad news concerning his lab reports by crying uncontrollably is handling stress by using:
coping mechanism.
The client is a single mother of two children who attends college and works full time. She is seeing the college nurse due to a crying outburst in class. The last step of crisis intervention that the nurse employs is:
determining if the outcome has been achieved.
A client with diabetes mellitus is experiencing acute stress. The nurse identifies that the client will be secreting excess levels of cortisol. What should the nurse monitor the client for related to the increased levels of cortisol?
elevated glucose levels
The nurse is performing an admission intake on a client with dehydration and diarrhea. The client states, "Every time I get stressed, I get diarrhea! Why does this happen?" Which explanation does the nurse share with the client?
"During stress, chemical messengers send signals between the brain and gut causing a variety of gastrointestinal symptoms."
Which client statement, after a presentation about drug use, indicates to the nurse a correct understanding of the information presented?
"Mixing alcohol and tranquilizers may cause physical impairment and drug dependency."
The emergency department nurse suspects that an older adult client who fell and broke her hip is using a defense mechanism when the client states:
"They must have given me the wrong medication at the drug store. I don't have trouble with my eyesight."
Which are considered internal stressors? Select all that apply.
- illness - hormonal change - fear
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.
A client asks about general adaptation syndrome (GAS). Which details provided by the nurse are correct? Select all that apply.
-The alarm stage of GAS can last from minutes to hours. -It can be a response to physiologic or psychological stress. -There are three stages to GAS.
Which behaviors represent effective coping mechanisms? Select all that apply.
-setting limits with family members who upset you -learning relaxation techniques -taking a vacation
An adolescent entering high school voices anxiety over changing schools. Stating anxiety is an act of:
Adaptation
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.
When nurses become overwhelmed in their jobs and develop symptoms of anxiety and stress, they are experiencing what condition?
Burnout
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
A client's body uses physiologic mechanisms from within to respond to internal changes and maintain an essential balance. This process is known as:
Homeostasis.
A 15-year-old student is on the high school soccer team. She tells a nurse how she has really started to take a leadership role on the team. When the nurse talks with the client's mother, the mother tells the nurse that her daughter's best friend is a natural leader and may be voted team captain next year. The client's behavior is an example of what defense mechanism?
Introjection
A withdrawn and isolated client is most likely suffering from what type of stressors on basic human needs?
Love and belonging needs
The nurse is caring for a 65-year-old widower whose spouse died 4 months ago. The client tells the nurse about not doing well and that no one will talk with him about his spouse. Which is the nurse's priority intervention for this client?
Refer the client to a support group
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
The nurse is discussing methods of relaxation for a client diagnosed with anxiety and panic attacks. When informing the client about the benefits of meditation, what conditions does the nurse include that must be present to be effective for a state of relaxation? Select all that apply.
The client should have a passive attitude. -The client should identify a word or mental image on which to focus. -The client should be in a quiet area. -The client should be in a comfortable position that can be maintained.
A toilet trained toddler was admitted to the hospital for dehydration. Upon returning home, the toddler becomes incontinent of urine and stool. The parent is concerned regarding this return to previous behavior and calls the pediatric clinic. What is the nurse's best response to the parent?
This behavior is called regression.
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.
A client is discussing stressors with the nurse and is describing how she feels better when she takes a brisk walk. The client's action is an example of:
adaptation
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
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
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
A 65-year-old client has experienced the death of a parent and a family pet in the span of 1 month. Which action is a coping mechanism that demonstrates adaptation?
joining the local garden club
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
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 - praying
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
A nurse is providing care for client who experienced a stroke. Which nursing intervention reflects the tertiary level of prevention?
provide care transition at discharge for speech therapy
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
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
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 nurse is assessing a client with stress-related problems. Which factor influences responses to stressors?
social support
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
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 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.
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.
A dancer has suffered a fall injury, which will prevent participation in a much-anticipated event. The fall is classified as what?
Stressor
In contrast to anxiety, fear is characterized by:
a cognitive response to a known threat.
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.
Which stressor collected during the assessment process for an adult client requires priority intervention by the nurse?
experiencing the death of a friend
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 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 -praying
Upon arrival at the emergency room, the mother of a client involved in a motor vehicle accident becomes upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breathe. What is the mother likely experiencing?
A panic attack
A young woman, who has recently suffered acute stress, asks the nurse why she seems to be more sensitive to stress than her husband. The nurse explains that a contributor to this phenomenon is:
estrogen levels.
An adolescent describes a dysfunctional home life to the nurse and reports smoking marijuana to help cope with the situation. How will the nurse identify this form of coping?
maladaptive
Which emotional clinical manifestations of stress should the nurse anticipate when providing care to an adolescent client?
withdrawal, depression, and angry outbursts
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 presents with a flare of lupus. Which statement made by the client would cause the nurse to suspect a stress reaction?
"I just had a baby 3 weeks ago."
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.".
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."
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 nurse is caring for a pregnant client in labor. Which intervention will the nurse initiate to assist the client in managing her stress?
Deep breathing
The nurse is caring for a client with chronic pain. Which long-term coping strategies may be helpful in this situation?
Deep breathing and meditation
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
A high school student comes to the nurse's office to discuss her anxiety regarding an upcoming test. Her test-taking anxiety is a (an):
Stressor
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
A client with persistent nausea is diagnosed with somatization. What is the appropriate nursing action when the client reports nausea?
Sit with the client and ask them about their feelings
A middle-age woman's father has passed away, and her mother requires physical and emotional help due to disabilities. The woman is married and raising two children, along with working full time. All of the factors described are:
stressors.
The nurse determines that a client understands instruction regarding progressive relaxation when the client states that the technique requires:
tensing and relaxing various muscle groups.
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
The nurse is caring for four clients. Which client does the nurse identify as the highest risk for social readjustment concerns?
77-year-old whose spouse just died
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 nurse is most likely to experience the greatest amount of stress related to his or her position as a nurse?
A graduate nurse working on a telemetry unit
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
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
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
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
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?
The alarm stage
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
In human beings, the physiologic response to a stressor includes the:
epinephrine increasing the blood-glucose level.
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
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 learning about the body's response to stress. Which system is responsible for initiating the fight-or-flight response to stress
sympathetic nervous system
