chapter 42- stress and adaptation

A client who is recently divorced reports sleeping during the day and an inability to adapt to the life change. Which teaching by the nurse would promote healthy adaptation?

"Try making a list to prioritize what needs to be done."

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 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? a. elevated glucose levels b. depression c. cardiac dysrhythmias d. elevated potassium levels

a. elevated glucose levels

An example of a long-term coping strategy is: a. walking briskly three times a week for 20 minutes. b. indulging in a rich desert after a stressful day. c. taking a stick and banging it on a tree. d. crying to release tension after a stressful event.

a. walking briskly three times a week for 20 minutes.

The nurse is caring for a client who is a teacher in a high school and states that there have been several issues with violence. What clinical manifestations during the client assessment would indicate that the client is experiencing physical manifestations of stress? Select all that apply.

an extra heart sound every fourth to sixth beat report of frequent evening headaches relieved by sleep reports of nausea

Which emotional clinical manifestations of stress should the nurse anticipate when providing care to an adolescent client? a. anxiety disorders, flare of acne, and headaches b. withdrawal, depression, and angry outbursts c. constipation, dry mouth, and excessive sleep d. forgetfulness, impaired concentration, and preoccupation

b. withdrawal, depression, and angry outbursts

A nursing student is engaging in a conversation with a nursing instructor whom the student intensely dislikes. Which nursing student behavior is consistent with reaction formation? a. accusing the nursing instructor of being prejudiced b. imitating the speech of the nursing instructor c. being extremely nice to the nursing instructor d. developing stomach pain during each conversation with the nursing instructor

c. being extremely nice to the nursing instructor

Which response to long-term stress may present itself in clients? Select all that apply. a. peritonitis b. diplopia c. bulimia d. alcoholism e. hypertension

c. bulimia d. alcoholism e. hypertension

A client is using prayer to assist in relieving stress. The use of prayer allows the client to: a. plan. b. understand. c. recover. d. cope.

d. cope

A nurse is providing a seminar about stress. Which information should the nurse include? Select all that apply.

Stress can be physical and psychological. People can have a positive or negative reaction to stress. Adaptation occurs to maintain balance from stress.

The client is a parent who has just been notified their son was in a motor vehicle accident. The nurse assesses the following reactions of the client over time. Place the reactions in the order of the stages of the general adaptation syndrome (GAS). The client reports a feeling of exhaustion. The client's pupils are measured at 5 mm from original 3 mm. The client's heart rate decreases from 116 to 84 beats/min. The client states she feels rested after sleeping.

The client's pupils are measured at 5 mm from original 3 mm. The client's heart rate decreases from 116 to 84 beats/min. The client reports a feeling of exhaustion. The client states she feels rested after sleeping.

A client informs the nurse that headaches started when marital problems began. The client reports that each time they have a fight, a headache develops and loss of appetite occurs for several days. What does the nurse identify as the physiologic symptoms?

a somatic disorder

The client tells the nurse she has never "gotten over" the loss of her husband 2 years ago. The client states she is drinking alcohol to excess every day and has started smoking, saying both help her cope. What is the best response by the nurse? a. "It may be time for you to consider a comprehensive treatment program." b. "As you learn to better cope, you will see a decrease in your need for these substances." c. "You need to decrease your alcohol consumption and stop smoking for your overall health." d. "This is the way you are coping with the stress. Everyone copes in their own way."

a. "It may be time for you to consider a comprehensive treatment program."

Which client is handling stress by using the defense mechanism termed displacement? a. A mother who is angry at her husband shouts at the kids to "keep quiet." b. A man who forgets his medication blames his wife for putting it away. c. An athlete who doesn't make the team concentrates on body-building instead. d. A man with symptoms of prostate cancer refuses to see a doctor.

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

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? a. Anticipatory guidance b. Normalization c. Relaxation d. Guided imagery

a. Anticipatory guidance

A client tells the nurse about feeling depressed and low. Further assessment reveals that the client has difficulty verbalizing his feelings and needs, often feeling manipulated by others. Which action would the nurse suggest to the client to help relieve stress? a. Enroll in a class or workshop in assertiveness training. b. Practice rephrasing thoughts that are negative or irrational. c. Be realistic about how much you can accomplish. d. Gain control over self-defeating thoughts.

a. Enroll in a class or workshop in assertiveness training.

A client is having a stress response related to a recent accident while boating. What does the nurse identify will be excreted from the adrenal cortex in response to this reaction? a. cortisol b. epinephrine c. insulin d. thyroxine

a. cortisol

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. a. preventing additional stressors b. ignoring the stressors c. implementing stress management techniques d. assisting in maintain a network of social support e. assessing the client's response to stress

a. preventing additional stressors c. implementing stress management techniques d. assisting in maintain a network of social support e. assessing the client's response to stress

A client informs the nurse that they have a well-paying job but that it is demanding and causes a great deal of anxiety. What statement made by the client indicates that the client has a coping mechanism to deal with anxiety produced by this situation? a. " Everyone feels sorry for me, and I find comfort in that." b. "I am actively seeking job opportunities in a less stressful environment." c. "I am going to have to start taking medication for this anxiety." d. "I am going to tell my manager that I just can't deal with the stress."

b. "I am actively seeking job opportunities in a less stressful environment."

An emergency department nurse is caring for four clients. Which client would the nurse suspect as using displacement as a defense mechanism? a. An adult client crying and stating, "I want my mommy." b. A client with a fractured hand after punching a wall c. A client on dialysis who missed two appointments in one week. d. A client with a traumatic amputation refusing to look at the extremity

b. A client with a fractured hand after punching a wall

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? a. Explain that meditation and prayer are not curative. b. Advocate for the client's choice. c. Prepare to administer chemotherapy as ordered. d. Arrange for a chaplain to visit with the client.

b. Advocate for the client's choice.

The client asks the nurse to explain stress and its effect on the body. Which information will the nurse include? Select all that apply. a. Stress begins in children at about age 2. b. Some forms of stress are positive events. c. Stress is ever-present. d. Stress begins in utero. e. All stress has a negative effect on the human body in some form.

b. Some forms of stress are positive events. c. Stress is ever-present. d. Stress begins in utero.

A client asks about general adaptation syndrome (GAS). Which details provided by the nurse are correct? Select all that apply. a. The resistance stage usually lasts for less than a day. b. The alarm stage of GAS can last from minutes to hours. c. GAS requires psychological hospitalization for treatment. d. There are three stages to GAS. e. It can be a response to physiologic or psychological stress.

b. The alarm stage of GAS can last from minutes to hours. d. There are three stages to GAS. e. It can be a response to physiologic or psychological stress.

A nurse is making a follow-up phone call to a client who reported being raped. The client answers the phone and states, "I don't know what you are talking about. I have never been raped." What action should the nurse take? a. Provide a detailed account of what the client stated when reporting the event. b. Apologize and end the phone call. c. Offer support, recognizing that the client may be using repression as a defense mechanism. d. Report the statements to the police department.

c. Offer support, recognizing that the client may be using repression as a defense mechanism.

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. a. As the duration, intensity, or number of stressors increases, a person's ability to adapt is lessened. b. The health-illness continuum is affected by stress. c. Stress has a negative impact on a person as he strives to meet basic human needs at each level. d. Recovery from illness and return to normal function are compromised by prolonged stress. e. The effects of stress on a sick or injured person are usually positive. f. People react to stress in a consistent and predictable manner.

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

An adolescent entering high school voices anxiety over changing schools. Stating anxiety is an act of: a.reaction. b. adaptation. c. evaluation. d. valuation.

b. adaptation

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? a. transmits sensation of pain b. heightens arousal and increases energy c. stabilizes mood and regulates temperature d. promotes coordinated movement

b. heightens arousal and increases energy

A nurse is assessing a client with stress-related problems. Which factor influences responses to stressors? a. personal hygiene b. social support c. eating habits d. economic status

b. social support

The nurse determines that a client understands instruction regarding progressive relaxation when the client states that the technique requires: a. using a mantra in a relaxed position. b. tensing and relaxing various muscle groups. c. using a biofeedback machine. d. focusing on pleasant images.

b. tensing and relaxing various muscle groups.

Which emotional clinical manifestations of stress should the nurse anticipate when providing care to an adolescent client? a. constipation, dry mouth, and excessive sleep b. withdrawal, depression, and angry outbursts c. anxiety disorders, flare of acne, and headaches d. forgetfulness, impaired concentration, and preoccupation

b. withdrawal, depression, and angry outbursts

A client asks the nurse how cortisol works. What is the appropriate nursing response? a. "It causes release of proinflammatory mediators." b. "It strengthens lymphoid tissue." c. "It suppresses the immune response." d. "It increases capillary permeability to prevent tissue swelling."

c. "It suppresses the immune response."

A freshman college student comes to the health clinic reporting insomnia and difficulty concentrating in class. The student has three red, scaly patches of skin on his arms and chest. The nurse believes the primary nursing diagnosis for this client is: a. Disturbed Thought Processes related to increased scholastic workload. b. Sleep Deprivation related to change in living arrangements. c. Anxiety related to stress of achievement in school. d. Impaired Skin Integrity related to psoriasis.

c. Anxiety related to stress of achievement in school.

Which client would the nurse expect to have negative coping skills? a. a 37-year-old factory worker who is laid off for the summer b. a 72-year-old retiree who needs to take an expensive new chemotherapeutic agent c. a 19-year-old diagnosed with schizophrenia who is heading off to college d. a 13-year-old diabetic who joins a softball league

c. a 19-year-old diagnosed with schizophrenia who is heading off to college

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? a. sociocultural stress b. psychological stress c. environmental stress d. physiologic stress

c. environmental stress

In human beings, the physiologic response to a stressor includes the: a. hypothalamus secreting thyroid-stimulating hormone. b. sympathetic nervous system slowing the heart rate. c. epinephrine increasing the blood-glucose level. d. hypothalamus secreting adrenocorticotropic hormone.

c. epinephrine increasing the blood-glucose level.

A nurse working on an oncology floor often sits with her clients in a calm, quiet, dimly lit environment and describes a walk along the ocean's shore. The nurse provides details of the walk and verbally paints a picture for the client. What best defines this form of stress management? a. anticipatory guidance b. biofeedback c. guided imagery d. meditation

c. guided imagery

A client who has a history of sexual abuse is demonstrating repression. What client behavior does the nurse expect? a. blaming others for the sexual abuse b. behaving like a young child c. having no memory of the sexual abuse d. refusing to believe that the sexual abuse occurred

c. having no memory of the sexual abuse

What is a general task for a client adapting to acute and chronic illness? a. Handle pain b. Confront family problems c. Maintain self-esteem d. Carry out medical treatment

c. maintain self-esteem

In evaluating the therapeutic outcome of using biofeedback to help a client work through a stressful situation, the nurse would expect the client to: a. redemonstrate a home care procedure properly. b. identify support personnel and services. c. maintain vital signs within normal limits. d. verbalize the actions and side effects of his medications.

c. maintain vital signs within normal limits.

The nurse is assessing a client who was involved in a neighborhood shooting. The client's vital signs show that his body is attempting to adapt to the stressor. What stage of the general adaptation syndrome is this client experiencing? a. Exhaustion b. Homeostasis c. Resistance d. Alarm reaction

c. resistance

The young adult client is awaiting diagnostic test results for cancer. The client will not sit in the chair and is pacing in the room. The client's heart rate is 112 bpm and respirations are 32 breaths/min. The client's speech is rapid and makes little sense. The nurse assesses the client level of anxiety as: a. panic. b. mild. c. severe. d. moderate.

c. severe

A nurse is assessing a client with stress-related problems. Which factor influences responses to stressors? a. eating habits b. personal hygiene c. social support d. economic status

c. social support

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? a. Take a break from the job. b. Accept the changes. c. Change the job. d. Seek professional help.

d. seek professional help

A client is dealing with the death of a spouse 10 days ago. The client tells the nurse about not feeling like eating and struggling to get food in. What does the nurse identify is occurring with the client? a. This is a personal coping style. b. This is a form of maladaptive coping. c. This is an example of the resolution of loss. d. This is part of the normal sympathetic stress response.

d. This is part of the normal sympathetic stress response.

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? a. resistance stage b. exhaustion stage c. tertiary stage d. alarm stage

d. alarm stage

Which data is most appropriate for the nurse to include when assessing an older adult client's capacity to adapt to current stressors? a. level of education, religious belief, and social losses b. expectations of life, attitudes, and advanced age c. advanced age, number of children, and network of social factors d. social losses, network of social factors, and advanced age

d. social losses, network of social factors, and advanced age