Chapters 3, 32-Caring, Comfort, Communication, Stress and Coping-Final Exam Adaptive Quiz

A patient in hospice says, "I am feeling alone and lost today." Which responses by the nurse are therapeutic? Select all that apply. -"Can you tell me more about this?" -"Did you have a good night's sleep?" -"Why are you feeling that way today?" -"Let me spend some time with you." -"You should really stop thinking that."

-"Can you tell me more about this?" -"Let me spend some time with you." The nurse should use therapeutic communication while communicating with the patient. If the nurse asks the patient to elaborate on his or her concerns ("Can you tell me more?"), this allows the patient to develop a trusting relationship with the nurse. If the nurse conveys the wish to spend some more time with the patient, this ensures the patient that the nurse is caring and compassionate. Asking the patient about last night's sleep indicates that the nurse is trying to change the topic. Asking the patient directly about the reason for feeling alone may make the patient defensive. It is also not therapeutic to use "why" questions with patients. The nurse should not directly advise the patient to stop thinking that way. This may discourage the patient and is nontherapeutic.

Which actions would the nurse perform to practice active listening skills when taking the patient's medical history? Select all that apply. -Be relaxed -Sit beside the patient -Avoid sitting with hands crossed -Avoid leaning toward the patient -Maintain intermittent eye contact

-Be relaxed -Avoid sitting with hands crossed -Maintain intermittent eye contact Being comfortable and relaxed is important; restlessness shows that the nurse is not listening. Avoid sitting with hands crossed as this exhibits a defensive attitude; instead sit in an open posture. Maintaining intermittent eye contact shows that the nurse is interested and actively listening. The nurse should not sit beside the patient but should sit facing the patient. The nurse should slightly lean in toward the patient as it shows that the nurse is interested and actively listening.

A nurse is caring for a 16-year-old patient who is under immense stress. He is depressed because his mother has had a stroke and he is the only caregiver. The nurse has prepared a care plan and has asked the patient to follow the same at home. The patient comes back to the nurse 1 month after the initial appointment for reevaluation. Which questions would the nurse ask in order to find out the effectiveness of the interventions? Select all that apply. -"How is your mother?" -"Has your fatigue level decreased?" -"Which music do you prefer listening to?" -"What changes have you brought about in your day-to-day life?" -"How will you perform progressive relaxation?"

-"Has your fatigue level decreased?" -"What changes have you brought about in your day-to-day life?" During reevaluation, the nurse should ask questions that would reflect upon the effectiveness of the care plan made for the patient. The nurse should ask whether the stress and fatigue levels have decreased and what change have the interventions brought in his daily life. Asking about his mother's recovery is irrelevant for assessing the effectiveness of the care plan. Asking about the type of music the patient prefers listening to should be done during the initial assessment, because listening to music could be an effective intervention to induce relaxation. Understanding of the progressive relaxation technique should be assessed during evaluation in the first session itself.

A nurse is assessing a patient who is demonstrating symptoms of severe stress. The nurse interviews the patient to learn whether the patient is using any maladaptive coping skills to reduce stress. Which questions would the nurse ask? Select all that apply. -"What do you think of when you are awake?" -"Have you started sleeping excessively?" -"Do you have high blood pressure?" -"Have you started smoking or drinking?" -"Do you live alone or with family?"

-"Have you started sleeping excessively?" -"Have you started smoking or drinking?" -"Do you live alone or with family?" Use of maladaptive coping skills could be assessed by finding out whether the patient has started sleeping, eating, or drinking excessively or has started staying alone. These behaviors indicate that the patient is not coping well. Asking about what the patient is thinking when awake could be helpful to find out the patient's appraisal of stress. Asking questions like whether one has high blood pressure or about medications gives the nurse an idea about the patient's adherence to healthy practices.

You ask another nurse how to collect a laboratory specimen. The nurse raises her eyebrows and asks, "Why don't you figure it out?" Which response by you would be appropriate? -"Why do you always put me down like that?" -"I guess I just enjoy having you make fun of me." -Say nothing and walk away. Find a different nurse to help you. -"When you brush me off like that, it takes me even longer to do my job."

-"When you brush me off like that, it takes me even longer to do my job." Lateral violence can be dealt with by using assertive communication. Simple assertive statements include referencing the person you are addressing, the behavior that is a problem, and its effect. Becoming defensive, making a sarcastic remark, or avoiding the situation does not help resolve the problem.

A patient says to a nurse, "I have been drinking four glasses of whiskey daily for the past 20 years, and I never had any problems. I don't know why my primary health care provider has asked me to stop drinking." How would the nurse paraphrase this statement? -"You do not want to stop drinking." -"You think drinking is not harming you." -"You want to continue drinking for the rest of your life." -"You are not convinced that you need to stop drinking."

-"You are not convinced that you need to stop drinking." Paraphrasing is defined as restating another person's message briefly using one's own words. The nurse stating the patient is not convinced about the need to stop drinking is an example of paraphrasing. It is important that while paraphrasing a statement, the meaning of it should not be distorted and the message should not be changed. The nurse should not misconstrue that the patient does not want to stop drinking or does not feel that drinking is harmless. The nurse should also not convey that the patient wants to drink for the rest of the life.

You are caring for a patient who is facing amputation of a leg. During the orientation phase of the relationship, which nursing action is appropriate? -Explore the patient's feelings about losing a leg. -Ask the patient about favorite hobbies. -Summarize what you have talked about in the previous sessions. -Review the patient's medical record and talk to other nurses about how the patient is reacting.

-Ask the patient about favorite hobbies. Socializing is used during the orientation phase of a relationship to get acquainted and help establish trust. Exploring feelings about losing a leg, talking with the patient about his hobbies, and reviewing the patient's medical records and talking with other nurses occurs in the working phase.

The nurse states that the ability to express ideas and concerns clearly while respecting the thoughts of others is essential for good communication. Which element of communication is the nurse referring to? -Empathy -Courtesy -Advocacy -Assertiveness

-Assertiveness Assertiveness is the ability to express ideas and concerns clearly while respecting the thoughts of others. Empathy is the ability to understand a person's reality. Saying hello or goodbye to the patient or knocking on the door before entering a patient's room are gestures of courtesy. Advocacy involves defending the rights of others, especially those who are vulnerable or unable to make decisions independently.

The nurse is interviewing a patient to collect health-related data. Which actions would the nurse perform to maintain good interpersonal communication? Select all that apply. -Be authentic. -Respond appropriately to others. -Take initiative in communicating. -Avoid talking to colleagues or other patients. -Discourage expression of negative feelings.

-Be authentic. -Respond appropriately to others. -Take initiative in communicating. Communication is essential when caring for a patient, and nurses should help communication by being authentic or the real self. Doing so maintains transparent communication. When the patient initiates communication, the nurse should respond appropriately to encourage further conversation. The nurse should take initiative in communicating with the patient as the patient may be hesitant or have impaired senses due to the illness. Avoiding talking to others and discouraging expression of negative feelings limits communication and may have adverse effects on patient care.

The nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which reaction while assessing the patient? -Posttraumatic stress disorder -Rising hormone levels -Chronic illness -Return of vital signs to normal

-Chronic illness An increased allostatic load can result in long-term physiologic problems and chronic illness. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.

A nurse attends to a patient with Alzheimer's disease. The patient says to the nurse "Can you get me some wat?" The nurse replies, "I'm not sure I understand what you mean by wat? Perhaps you mean water? Did you mean water but mistakenly said wat?" The patient snaps, "Yes! Water. That's what I meant. The right word wouldn't come." The nurse replies, "I can understand. My mother had Alzheimer's too; she had difficulty getting some of her words out also." Which therapeutic communication techniques is the nurse using for this patient? Select all that apply. -Clarifying -Confrontation -Summarizing -Self-disclosure -Sharing hope

-Clarifying -Self-disclosure Alzheimer's patients typically confuse words. Clarifying by giving an example of what the patient means helps resolve any confusion and improves communication between the nurse and patient. Providing reassurance by disclosing one's personal experiences is self-disclosure, as is evident from the nurse's reply. The nurse has not confronted the patient for using the wrong word and has not summarized the patient's actions. The nurse is also not sharing hope through the response.

Which techniques would the nurse use during the orientation phase of a helping relationship with a patient with hypertension? Select all that apply. -Reviewing the patient's medical history -Closely observing the patient's behavior -Working to understand the patient's behavior -Beginning the conversation with warmth and empathy -Prioritizing the patient's problems and identifying the goals -Choosing a quiet and private location for the interaction

-Closely observing the patient's behavior -Working to understand the patient's behavior -Beginning the conversation with warmth and empathy -Prioritizing the patient's problems and identifying the goals In the orientation phase of building a helping relationship, the nurse should closely observe the patient's behavior and work to understand it. The nurse should create a warm and empathetic conversation and prioritize the patient's problems. Reviewing the patient's medical history and choosing a quiet setting for the conversation are techniques used in the preinteraction phase.

During the assessment of a patient with stress, the nurse also assesses the patient's nutritional pattern. Which recommendations may be given to the patient to overcome the impact of stress? Select all that apply. 1Avoid herbal supplements. -Consult a registered dietitian. -Include whole grains in the diet. -Consume fruits and vegetables. -Include a multivitamin in the daily diet.

-Consult a registered dietitian. -Include whole grains in the diet. -Consume fruits and vegetables. -Include a multivitamin in the daily diet. Stress often causes an individual to indulge in unhealthy food choices. The nurse refers the patient to a registered dietitian to formulate a diet plan. A nutritious diet reduces the risk of infection and promotes wound healing. The patient must increase the consumption of whole grains, legumes, fruits, and vegetables in the diet to enhance the psychological and physical responses to stress. A daily multivitamin may also help facilitate stress reduction. The patient may need to take herbal supplements to reduce stress.

Which interventions by the nurse are consistent with the working phase of the nurse-patient helping relationship? Select all that apply. -Interviewing and assessing the patient -Developing a care plan for the patient -Enhancing the rapport with the patient -Implementing the patient's plan of care -Evaluating the outcomes of the patient

-Developing a care plan for the patient -Enhancing the rapport with the patient -Implementing the patient's plan of care Orientation, working, and termination are the phases of the nurse─patient helping relationship. The nurse develops the plan of care for the patient in the working phase. The nurse should enhance rapport with the patient for better communication in the working phase. In the working phase, the nurse will also implement the care plan. The introductory phase includes interviewing and patient assessment. The termination phase evaluates patient outcomes.

A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The mother's facial expressions and mannerisms demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The patient states that she feels worthless and is overburdened with her responsibilities caring for her son. Which nursing diagnoses are appropriate for this patient? Select all that apply. -Lack of knowledge -Impaired cognition -Decisional conflict -Difficulty coping -Caregiver stress

-Difficulty coping -Caregiver stress The appropriate nursing diagnoses for this patient are difficulty coping (ICNP) and caregiver stress (ICNP). There is no evidence that this patient lacks knowledge about something; therefore lack of knowledge (ICNP) is not an appropriate nursing diagnosis. The patient's cognitive abilities do not appear to be impaired; therefore impaired cognition is not an appropriate nursing diagnosis. The patient does not report feeling conflicted about a decision; therefore decisional conflict (ICNP) is not an appropriate nursing diagnosis.

The nurse is assessing a patient for stress and asks about sleep patterns. Which findings are indicative of stress-related sleep disturbances? Select all that apply. -Difficulty falling asleep -Difficulty awakening -Frequent awakening during the night -Long periods of time spent sleeping -Inability to sleep during the day

-Difficulty falling asleep -Difficulty awakening -Frequent awakening during the night -Long periods of time spent sleeping An individual may experience sleep disturbances from stress and worry. The individual may experience difficulty falling asleep. The individual may find it difficult to wake up from sleep due to tiredness following high stress levels. The individual may wake frequently during the night. Tiredness from stress can cause a patient to sleep for an extended period of time. Sleep is a restful state that is essential for an individual to engage in daily activities. Inability to sleep during the day is not indicative of stress-related sleep disturbances; rather, an individual with sleep disturbances may experience tiredness during the day.

During which phase of the nursing process would the nurse identify factors that influenced the outcome of patient treatment? -Planning -Evaluation -Assessment -Implementation

-Evaluation The nursing process consists of five phases: assessment, diagnosis, planning, implementation, and evaluation. In the evaluation phase, the nurse compares the actual and expected outcomes and identifies the factors that influenced the patient outcomes. Based on these, the nursing care plan is modified. In the planning stage, the expected outcomes are documented. Assessment involves assessing the patient and history taking. The implementation stage includes implementation of nursing interventions and delegation of the work.

A patient who is suffering from chronic stress reports sleep deprivation, chronic fatigue, and depression. On examination the blood pressure is 160/98 mm Hg and the heart rate is 78 beats/min. Which factor would be the probable reason for this presentation? -Inability to sleep -Polymyalgia rheumatica -Increased venous return to the heart -Excessive wear and tear by hormones

-Excessive wear and tear by hormones The symptoms indicate that the patient is in a state of allostatic load. Chronic stress response and excessive wear and tear of hormones results in this state. Persistence of allostatic load can cause problems such as chronic hypertension, depression, insomnia, and autoimmune disorders. Insomnia is one of the symptoms and not the cause. Polymyalgia rheumatica does not present in this way. Increased venous return to the heart does not lead to all these symptoms.

A patient becomes aggressive when he is not allowed to be ambulatory due to a fractured leg. He tries to get out of the bed unattended and falls. The nurse tries to explain that walking and putting weight on the fractured leg may cause more injury and worsen his condition. Which nontherapeutic techniques would the nurse avoid while communicating with the patient? Select all that apply. -Clarification -Listening actively -False reassurance -Asking for explanation -Responding aggressively -Sharing hopes and feelings

-False reassurance -Asking for explanation -Responding aggressively Giving false reassurance to the patient about his situation is unethical and may cause the patient to lose trust in the nurse. Asking for explanation from the patient might be interpreted by the patient as accusatory and may interfere with communication. Responding with aggression, such as by exhibiting anger and frustration, is unprofessional behavior. Clarifying, listening actively, and sharing hopes and feelings are therapeutic communication techniques.

Which signs and symptoms indicate difficulty coping with stress? Select all that apply. -Fatigue and lack of sleep -Expressing a need for social support -Increased feelings of anxiety -Exhibiting a negative attitude toward recovery -Difficulty making decisions

-Fatigue and lack of sleep -Increased feelings of anxiety -Exhibiting a negative attitude toward recovery -Difficulty making decisions A patient with difficulty coping (ICNP) is not able to relax and reports fatigue and sleeplessness. Increased feelings of anxiety indicate that patient person is probably using defense mechanisms instead of coping methods. The patient who feels that recovery is difficult has a negative attitude and has not been able to accept and take control of the situation, making coping difficult. Difficulty making decisions is associated with difficulty coping with stress. Expressing a need for social support indicates effective coping.

At 0700, the nurse delegates a task to the nursing assistant. At 1300 the nurse tells the nursing assistant that he would like to talk to her about the task that was delegated, which was walking a particular patient earlier that morning. The nurse says, "You did a good job walking the patient by 0930. I saw that you recorded her pulse before and after the walk. I saw that the patient walked in the hallway barefoot. For safety, the next time you walk a patient, make sure the patient wears slippers or shoes. Please walk the patient again by 1500." Which characteristics of good feedback did the nurse use when talking to the nursing assistant? Select all that apply. -Given immediately -Focused on one issue -Offered concrete details -Identified ways to improve -Focused on changeable things -Was specific about what is done incorrectly only

-Focused on one issue -Offered concrete details -Identified ways to improve -Focused on changeable things These are characteristics of good feedback: focuses on one issue, offers concrete details, identifies ways to improve, and focuses on changeable things. The RN did not provide feedback immediately. The nursing assistant performed the task in the morning, but the feedback was not given until the afternoon. Feedback is both positive and negative feedback to improve the incorrectly done tasks.

The nurse is learning about using focused questions as a therapeutic means of communication. Which characteristics are advantages of this means of communication? Select all that apply. -Focuses on the immediate needs of the patient -Asks the patient to provide details regarding various concerns -Uses focusing when the patient provides valuable information -Uses focusing to distract the patient from her illness and give suggestions -Encourages the patient to share specific data necessary for completing a thorough assessment

-Focuses on the immediate needs of the patient -Asks the patient to provide details regarding various concerns -Encourages the patient to share specific data necessary for completing a thorough assessment Focusing is used to concentrate on one area. Guiding the direction of the conversation to important areas will help gather the required information. When the patient begins a vague conversation, the important information is missed. In this case focusing helps gather the missed data. When the patient provides valuable information, it should be carefully considered instead of using the technique of focusing. Focusing is used to direct the conversation to important areas and not to distract the patient or give suggestions.

The community nurse is leading a group of health care professionals involved in a vaccination program and concludes that the group is in the norming phase of development. Which characteristics of the group enabled the nurse to arrive at such a conclusion? Select all that apply. -Relying heavily on the group leader -Having increased trust among themselves -Having increasing conflicts among themselves -Readily sharing information with each other -Helping each other in solving any problems

-Having increased trust among themselves -Readily sharing information with each other There are five phases in group development: forming, storming, norming, performing, and adjourning. Increased trust and openness of sharing information among the group members are the prime characteristics of the norming phase. This phase results in increased productivity among the group members. Group members relying heavily on the group leader indicates the forming phase. Conflicts occur at the individual level or group level during the storming phase of group development. Problem solving activity among group members indicates the performing phase.

The nurse is caring for a patient who is quadriplegic and on a ventilator. Which technique would the patient employ to facilitate communication with the nurse? Select all that apply. -Head gestures -An interpreter -Sign language -Eye movement -Electronic devices

-Head gestures -Eye movement -Electronic devices Quadriplegic patients may have complete paralysis of the body from the neck down. They may use gestures such as head nods to communicate. They may also use eye movements or electronic devices to communicate with others. An interpreter may be helpful for deaf patients or if the patient uses sign language or speaks a language different from that used in the health care center.

Which actions should the nurse perform during the working phase of a helping relationship? Select all that apply. -Help the patient express feelings. -Review medical data of the patient. -Assess patient for health status. -Work with the patient to set goals. -Take actions to help the patient meet the goals.

-Help the patient express feelings. -Work with the patient to set goals. -Take actions to help the patient meet the goals. The working phase of a helping relationship involves nurses working together with patients to express their feelings, to set their goals, and encourage them to solve their problems. This phase also involves helping the patients take actions to meet their goals. Reviewing the medical data of the patients is a part of the preinteraction phase of the helping relationship. Assessing patients for their health status is a part of the orientation phase in which the nurse and the patients get to know each other.

Which advantages would the nurse teach about using the technique of summarizing in therapeutic communication? Select all that apply. -Helps recall previous discussions -Helps participants to focus on key issues -Helps reveal true personal experiences -Allows the patient to agree or add additional concerns -Brings a sense of caring and human connection

-Helps recall previous discussions -Helps participants to focus on key issues -Allows the patient to agree or add additional concerns Summarizing is a short review of the key areas of interaction, so it helps in recalling previous discussions and makes further discussions easier. It is a short review of the key areas of interaction. It helps the participants focus on key issues, offers a revision, and makes the interaction more productive. Using this technique, any points that are misunderstood can be clarified. Self-disclosure involves revealing true personal experiences. Using touch, not summarizing, brings a sense of caring and human connection.

A nurse attends to an 80-year-old patient with early-onset Alzheimer's disease. The patient expresses worry for the future as her condition is deteriorating day by day. The nurse replies, "You look so tense. You are a courageous lady and have the ability to tackle anything and everything." Which communication technique is the nurse using? Select all that apply. -Hope -Humor -Empathy -Feelings -Observation

-Hope -Observation The nurse is sharing hope by saying that the patient has the ability to cope with everything and observation by commenting on the patient's tensed look. The nurse's reply does not show humor, empathy, or feelings.

A nurse is explaining the physiologic mechanism underlying the fight-or-flight mechanism to a patient. The nurse says that "the medulla oblongata plays a major role in controlling the response of the body to a stressor." Which functions does the medulla oblongata perform when the body is stressed? Select all that apply. -Constrict pupils -Increase respiratory rate -Increase mental alertness -Increase blood pressure -Increase blood glucose levels

-Increase respiratory rate -Increase blood pressure Through its connection via the autonomic nervous system, the medulla oblongata is responsible for increasing respiratory rate, heart rate, and blood pressure as a response to stress. Dilated, not constricted, pupils are a response to stress. Increased alertness is due to the action of the reticular formation. Increased blood glucose levels occur due to the action of the pituitary.

Which statements are true about the General Adaptation Syndrome (GAS)? Select all that apply. -It is a physical response to stress. -It consists of four stages of reaction to stress. -The GAS is initially evoked when the stimulation or stressor is strong enough to activate a parasympathetic response. -The GAS is evoked when the stimulation or stressor is strong enough to activate the autonomic nervous branch of the central nervous system. -Chronic, prolonged, unrelieved stress, such as that which is common at the exhaustion stage, may cause disease in and of itself.

-It is a physical response to stress. -The GAS is evoked when the stimulation or stressor is strong enough to activate the autonomic nervous branch of the central nervous system. -Chronic, prolonged, unrelieved stress, such as that which is common at the exhaustion stage, may cause disease in and of itself. Hans Selye (1976) named the physical response to stress the general adaptation syndrome (GAS). He noted that the body responds in the same way to any demand, whether it be physical, emotional, pleasant, or unpleasant. The GAS is evoked when the stimulation or stressor is strong enough to activate the autonomic nervous branch of the central nervous system, eliciting an adaptive response. The GAS consists of three stages: alarm reaction, resistance, and exhaustion. Most stressful events involve only the first two, but some ongoing demands can exceed the body's resources and lead to the final stage of exhaustion. When a stressor reaches a threshold that threatens homeostasis, it is strong enough to activate the alarm stage of the stress response. In the alarm stage, the hypothalamic-pituitary-adrenal and autonomic nervous systems are activated, successively triggering responses in the sympathetic nervous system and the endocrine and immune systems. In the resistance stage, the body attempts to adapt to the stressor, and some of the initial responses are attenuated as the parasympathetic nervous system reverses the sympathetic stimulation and stabilization occurs. The body begins to repair damage and restore resources. When resources are depleted and the body is unable to continue the efforts of adaptation, the body cannot maintain physical function and death may result at a cellular or systemic level. This stage may be reversed by the augmentation of the body's resources from the outside, such as through medication, nutritional support, or other therapies. Chronic, prolonged, unrelieved stress, such as that which is common at the exhaustion stage, may cause disease in and of itself. Such illnesses are recognized as stress-related diseases.

The advanced practice nurse who is assessing a patient wearing two hearing aids uses which approaches when conducting the interview? Select all that apply. -Limits direct eye contact -Involves a sign language interpreter -Maintains a neutral facial expression -Leans forward when interacting with the patient -Acknowledge the patient's answers through head nodding

-Leans forward when interacting with the patient -Acknowledge the patient's answers through head nodding Leaning forward shows that the nurse is aware and attending to what the patient is saying. The use of head nodding regulates the interaction and makes it easier for the patient to know the nurse's responses to his comments. Good eye contact communicates the nurse's interest in what the patient has to say. Involving a sign language interpreter is not needed, as the patient is not deaf and there is no indication that the patient's hearing aids are malfunctioning. A neutral expression does not express warmth or immediacy, which is needed to establish a positive relationship.

Which findings would the nurse expect to observe in a patient with prolonged periods of stress? Select all that apply. -Loss of potassium and calcium -Increased sodium reabsorption -Increased extracellular volume -Reduced gastrointestinal motility -Reactivation of herpes infections

-Loss of potassium and calcium -Increased sodium reabsorption -Increased extracellular volume Unrelieved stress causes increased secretion of stress hormones such as aldosterone and antidiuretic hormone. Increases in these hormonal levels cause loss of potassium and calcium from the body. Aldosterone causes the kidneys to reabsorb large amounts of sodium, resulting in sodium retention. Both hormones affect the kidneys and contribute to increased extracellular volume. Prolonged stress is known to cause increased gastrointestinal motility, leading to irritable bowel syndrome. Herpes simplex and zoster viruses can remain latent within an infected cell and show an affinity for neurons. Periodic reactivation of herpes infections commonly occurs with acute stress, not prolonged stress.

A postmenopausal patient with high blood pressure suffers from flushing and irritability. This patient refuses to take medications to relieve the postmenopausal symptoms. The nurse suggests the patient use relaxation therapy. Which health benefits of relaxation therapy would the nurse emphasize? Select all that apply. -May be used to treat nausea -Promotes sleep -Improve scores on anxiety and stress scales -Increases depression -Reduces pain and anxiety

-May be used to treat nausea -Promotes sleep -Improve scores on anxiety and stress scales -Reduces pain and anxiety Progressive relaxation and guided imagery have been shown to significantly treat nausea, promote sleep, improve scores on anxiety and stress scales, and reduce pain as reported by patients. Many studies have indicated that progressive relaxation is effectively used to treat nausea and vomiting, pain, depression and anxiety, and sleep disturbance.

The nurse is assessing a patient who has posttraumatic stress disorder (PTSD) after witnessing a plane crash. Which subjective data would be the findings in this patient? Select all that apply. -Nightmares of the air crash -Flashbacks of the air crash -Significant weight loss -Hearing strange voices at night -Seeing strange faces at night

-Nightmares of the air crash -Flashbacks of the air crash Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs when a person witnesses or experiences a traumatic event—in this case, the plane crash. It may manifest as nightmares, flashbacks, and intrusive recollections of the event. Patients may also respond by attempting suicide or by substance abuse. Loss of significant weight is usually seen in patients with depression. Auditory and visual hallucinations are present in patients with schizophrenia.

A patient mentions to the nurse that she recently lost her husband in a car accident. Which behaviors would the nurse identify as denial defense mechanisms? Select all that apply. -Not accepting the death of her spouse -Not sleeping and eating -Not disclosing her feelings to any other people -Being speechless and totally numb -Shouting and blaming God for her loss

-Not accepting the death of her spouse -Not disclosing her feelings to any other people A denial defense mechanism is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Not discussing the loss and not accepting the loss are both denial defense mechanism behaviors. Cessation of sleeping and eating is a conversion defense mechanism. Being speechless and totally numb are examples of dissociative defense mechanisms. Shouting and blaming God for the loss is an example of displacement defense mechanism.

The nurse is training a nursing student on the professional approach in communication. The nurse explains that the way a nurse responds to a question or a situation indicates his or her state of mind. Which statements are true about this explanation? Select all that apply. -Passive responses reflect helplessness. -Aggressive responses provoke confrontation. -Passive responses reflect anger and frustration. -Aggressive responses help avoid issues. -Assertive responses are a more professional approach.

-Passive responses reflect helplessness. -Aggressive responses provoke confrontation. -Assertive responses are a more professional approach. Passive responses by nurses show that they are helpless in the given situation and are used to avoid conflicts. Aggressive responses may indicate a background of anger, frustration, and stress, and may provoke others. Assertive responses are a more professional approach, as the nurse needs to remain calm but face the problem with assertive communication. Aggressive responses reflect anger and frustration, and passive responses reflect helplessness. Aggressive responses provoke confrontation, and passive responses are used to avoid or sidestep issues.

Which practices may be recommended for a patient who becomes violent when angry? Select all that apply. -Practice guided imagery. -Perform deep breathing. -Accept one's own feelings. -Increase concentration skills. -Seek professional counseling.

-Perform deep breathing. -Accept one's own feelings. -Seek professional counseling. Some individuals become violent and indulge in abusive behavior when angry. The patient may be encouraged to use deep-breathing techniques in situations that cause anger. Deep breathing helps the patient relax. The patient must be able to accept responsibility for his or her feelings and use a nonconfrontational attitude when expressing feelings. If the individual is severely stressed by feelings of anger, then the patient may be referred for professional counseling. Guided imagery is generally practiced to reduce pain and promote sleep. An individual with stress caused by a lack of time management needs to practice concentration skills to reduce work stress.

Which phase of a helping relationship involves activities such as reviewing available medical and nursing history? -Working -Orientation -Termination -Preinteraction

-Preinteraction There are four phases in a helping relationship. These phases are preinteraction, orientation, working, and termination. In the preinteraction phase, a nurse reviews the available medical and nursing history of a patient and collects information from caregivers before meeting the patient. In the working phase, the nurse and patient work with each other to solve the problems. The orientation phase is when the nurse and patient meet each other. The termination phase occurs during the end of the relationship process where evaluation occurs. STUDY TIP: If you recall Peplau's phases of a working relationship, she had put forth the orientation, working, and termination phases. Now you can just add preinteraction and you'll know the four phases in a helping relationship.

A patient suffering from a stomachache was diagnosed with stomach cancer. The patient became anxious after knowing the diagnosis. Which nursing interventions would be helpful to this patient? Select all that apply. -Promote measures to reduce anxiety. -Encourage use of effective coping skills. -Assess the potential for committing suicide. -Assess the potential for psychosis. -Encourage the patient to listen to music.

-Promote measures to reduce anxiety. -Encourage use of effective coping skills. -Encourage the patient to listen to music. The nurse should promote measures to reduce anxiety, because anxiety further deteriorates health. Encouraging coping skills boosts emotional support for the patient. Listening to music decreases anxiety and helps the patient relax. Suicidal tendencies should be evaluated only if the patient shows signs of depression. Psychosis is usually due to neurotransmitter disturbance and is not secondary to malignancies.

Which actions should the nurse perform to practice therapeutic communication techniques? Select all that apply. -Provide personal opinion. -Provide hope to the patients. -Listen actively to the patients. -Understand the patient's feelings. -Provide sympathy to the patient.

-Provide hope to the patients. -Listen actively to the patients. -Understand the patient's feelings. Therapeutic communication techniques include specific responses to encourage expressions while respecting the patients. The nurse should provide hope and encouragement to the patient. Active listening helps improve communication with patients. Understanding the feelings helps the nurse empathize with them. Providing personal opinions is nontherapeutic. Providing sympathy to the patient is a nontherapeutic approach of communication and shows pity instead of respect to the patient.

During a school health screening, the nurse observes a distinctive, intentional gait in a child while communicating. Based on this, which behaviors would the nurse expect from this child? Select all that apply. -Self-confidence -Deep thoughtful reflection -Feelings of hopelessness -Readiness for immediate action -Potentially negative cues

-Self-confidence -Readiness for immediate action -Potentially negative cues A person's manner of walking and standing can provide insight into his or her behavior. An intentional gait may represent self-confidence, and it may indicate the need for immediate action, such as going to the school office. A distinctive gait may communicate potentially negative cues that can be harmful to the child. A child who is walking slowly with a bowed head may be in deep thought or feeling hopeless.

A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." Which response by the nurse is appropriate? -"Let's talk about something cheerful." -"Do other members of your family have diabetes?" -"I can tell that you feel stressed to learn that you have diabetes." -Silence

-Silence The nurse understands that denial is a defense mechanism that assists in coping with a shock. Therapeutic use of silence gives patients time to process their thoughts. The other options are not correct, as the nurse should use silence and not make any comments or ask any questions. STUDY TIP: Did you catch that? Silence can be an appropriate response to a patient in denial about his or her diagnosis. Think of silence as the audio equivalent of presence. Both are powerful tools. Try "silence" as a response the next time you hear someone make a statement that communicates denial.

A patient is diagnosed with breast cancer. Which patient behaviors suggest difficulty coping with the diagnosis? Select all that apply. -Giving appropriate answers to the questions asked -Sleeping excessively -Laughing inappropriately -Showing lack of interest in food -Losing 5 kg of weight in 2 weeks

-Sleeping excessively -Laughing inappropriately -Showing lack of interest in food -Losing 5 kg of weight in 2 weeks Sleeping excessively is an ineffective coping mechanism often used to escape reality. Laughing inappropriately may indicate difficulty coping with distressing topics. A lack of interest in food may indicate depression and difficulty coping. Weight loss may be a sign that the patient is not coping well. Giving appropriate answers to questions indicates ability to concentrate and suggests that the patient is coping adequately with the diagnosis.

While interviewing a patient with a hearing impairment, the nurse speaks in a normal volume and asks the patient to reduce carbohydrate intake. The patient does not understand what the nurse says, so the nurse restates the direction. Which part of the communication would be avoided? -Raising voice level slightly -Staying within 2 feet of the patient -Reducing the environmental noise -Gaining the patient's attention before the interview

-Staying within 2 feet of the patient A nurse should use some special communication skills when talking to hearing-impaired patients. Stay within 3 to 6 feet of patients with hearing problems when conversing and avoid turning or walking away while talking. Speaking in a slightly higher volume facilitates better understanding. Other techniques to improve the communication include reducing the environmental noise and getting the attention of the patient before starting the interview.

The nurse evaluates the goals of nursing care with a patient who underwent surgery. Which phase of the helping relationship does this nursing action represent? -Working -Orientation -Termination -Preinteraction

-Termination A helping relationship with the patient involves four phases: preinteraction phase, orientation phase, working phase, and termination phase. During the termination phase, the nurse evaluates the outcomes of the interventions performed and the goals achieved. The nurse plans and performs the interventions during the working phase of developing a human relationship. The orientation and preinteraction phases involve gathering the patient's assessment data.

The nurse is assessing a young school-age child who has recently started bedwetting. Which factors are the likely causes for the child's regressive behavior? Select all that apply. -The child has a poor self-concept. -The child is being bullied in school. -The mother-child relationship is lacking. -The mother is caring for a younger sibling. -The child feels a lack of situational control.

-The child is being bullied in school. -The mother-child relationship is lacking. -The mother is caring for a younger sibling. Regression is a defense mechanism that causes the child to revert to an earlier stage of development when challenged by stress. The child may not be able to cope with the bullying and may be reluctant to attend school. The child's social support network outside the family must be considered during the assessment. The nurse must assess the mother-child relationship, which is an important factor that helps the child cope better. The arrival of a sibling can lead to a temporary diversion of attention from the child and may cause stress to the older child. The young school-age child may not have a strong self-concept. Poor self-concept is a stress factor often observed in young adults. Feeling a lack of situational control is also a stress factor for younger adults rather than school-age children.

In the general adaptation syndrome, which adaptations occur in the body as a result of increased epinephrine? Select all that apply. -The heart rate increases. -Blood glucose levels increase. -Oxygen intake increases. -Gluconeogenesis increases. -Water reabsorption increases.

-The heart rate increases. -Blood glucose levels increase. -Oxygen intake increases. When a stressor occurs, the pituitary gland, adrenal medulla, and sympathetic nervous system are activated. These in turn produce hormones that bring about changes in the body. Epinephrine is one of the hormones produced as a result of the arousal of the sympathetic nervous system and adrenal medulla. Increased epinephrine results in increased heart rate, blood glucose levels, and oxygen intake. Increased epinephrine does not affect gluconeogenesis or water reabsorption. Gluconeogenesis increases as a result of increased cortisol, and increased water reabsorption occurs due to increased aldosterone.

Arrange the steps of communication between two people in the order in which they occur. -The information is interpreted by another individual. -An individual encodes the information by translating thoughts and feelings. -The information is verified to ensure successful communication. -The encoded information is transmitted to another individual. -The presence of a referent or event initiates communication.

-The presence of a referent or event initiates communication. -An individual encodes the information by translating thoughts and feelings. -The encoded information is transmitted to another individual. -The information is interpreted by another individual. -The information is verified to ensure successful communication. The first key element is a referent or an event, which is necessary to initiate communication. The referent can be a thought or a sensation that leads one individual to interact with another. The second key element is the sender who initiates the communication. The sender encodes the message or information by translating thoughts and feelings. The third key element is the message. This is encoded information that is transmitted to another individual. The message may be spoken, written, or nonverbal. Communication occurs only if the message is received by another individual or the receiver. The receiver, who is the next key element in the process, must actively listen, observe, and engage in a conversation to decode or interpret the meaning of the message. The last key element is the feedback provided by the receiver to avoid misinterpretation and ensure successful communication.

The nurse is teaching a group of students about different coping mechanisms. Which statements are true about defense mechanisms? Select all that apply. -They can lead to mania in a person. -They are used by people unconsciously. -They can lead to major depression in a person. -They do not lead to psychiatric disorders. -They offer psychological protection from a stressful event.

-They are used by people unconsciously. -They can lead to major depression in a person. -They do not lead to psychiatric disorders. Defense mechanisms are some of the coping mechanisms used unconsciously by people. Psychiatric disorders do not occur as a result of defense mechanisms. The defense mechanisms regulate emotional distress and help a person cope with stress indirectly. They offer psychological protection from a stressful event. They do not result in mania or depression in the patient.

Which measures would the nurse take when communicating with a patient who is visually impaired? Select all that apply. -Use large print -Use audio or e-books for patient education -Enter the room without addressing the patient -Follow the patient's gestures and nonverbal communication -Use the position of numbers on an analog clock as a reference when communicating locations

-Use large print -Use audio or e-books for patient education -Use the position of numbers on an analog clock as a reference when communicating locations Using large print makes it easy for the patient to see and read. Audio or e-books may be helpful in communicating effectively with visually impaired or blind patients. Font size is often scalable on e-books. The position of numbers on an analog clock is often used as a reference when communicating the location of food on the plate of a blind patient. The nurse should identify him or herself and address the patient when entering the patient's room. The nurse should not rely on the patient's gestures and nonverbal communication.