Chapter 42- Stress and Adaptation
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 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
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 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 with stress-related problems. Which factor influences responses to stressors?
social support
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
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
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 client's body uses physiologic mechanisms from within to respond to internal changes and maintain an essential balance.This process is known as:
homeostasis.
The nurse is caring for a client who is exhibiting signs of stress. Which cognitive symptom associated with stress does the nurse recognize?
impaired concentration
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 nursing instructor is discussing burnout with a group of graduating nursing students. Which statement might lead the instructor to believe that the particular student has not developed needed coping mechanisms for nursing practice?
"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."
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."
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."
Which response to long-term stress may present itself in clients? Select all that apply.
-alcoholism -hypertension -bulimia
Which behaviors represent effective coping mechanisms? Select all that apply.
-setting limits with family members who upset you -learning relaxation techniques -taking a vacation
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
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.
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
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
In contrast to anxiety, fear is characterized by:
a cognitive response to a known threat.
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 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 dancer has suffered a fall injury, which will prevent participation in a much-anticipated event. The fall is classified as what?
stressor
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.
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
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.
The nurse at the student health center is seeing a group of nursing students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What does guided imagery involve?
the mindful use of a word, phrase, or visual image that allows oneself to be distracted and temporarily escape from stressful situations
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 priority nursing intervention?
contact a translator
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
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 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 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
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 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:
Anxiety related to stress of achievement in school.
A withdrawn and isolated client is most likely suffering from what type of stressors on basic human needs?
Love and belonging needs
A toilet trained toddler was admitted to the hospital for dehydration. Upon returing 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.
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
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.
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 parent has inadvertently locked the keys in her car with the baby strapped in the car seat. In a panic, the parent summons help from a locksmith. What type of reaction is the parent having?
coping
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 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 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