Fundamentals Nursing Prep U Chapter 41 Stress and Adaptation

A client asks the nurse how cortisol works. What is the appropriate nursing response?

"It suppresses the immune response."

Which client statement, after a presentation about drug abuse, indicates to the nurse a correct understanding of the information presented?

"Mixing alcohol and tranquilizers may cause physical impairment and drug dependency."

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

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

A nurse is working with a 67-year-old Asian American woman on diet changes to help with weight loss. She is explaining her role in the family as the one who prepares the meats for the family, while her daughter is responsible for preparing vegetables. Based on the nurse's knowledge of traditional Asian cultures, the nurse knows what to be true?

Families operate in a collectivistic manner.

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 client has been diagnosed with breast cancer. An example of adaptation to this physiologic stressor would be:

participating in a cancer survivors 5K walk/run.

A nurse is assessing a client for anxiety. Which questions should the nurse ask to elicit subjective data related to anxiety? (Select all that apply.)

• "Have there been any changes in your appetite?" • "Has your heart felt like it was racing or skipping a beat?" • "Do you feel like you get angry or upset easily?"

A client newly diagnosed with type 2 diabetes mellitus states, "I just can't seem to win. Every time I turn around, I am being thrown a curve ball." Which questions should the nurse ask to determine the client's current ability to adapt to this new diagnosis? (Select all that apply.)

• "How long have you felt like this?" • "Do you have any other health problems?" • "How do you usually cope with life problems?" • "Have you told your doctor how you are feeling?"

The nurse is explaining to a group of high school students how the nervous system helps regulate homeostasis. Which statements by the nurse are correct? (Select all that apply.)

• "The sympathetic nervous system is responsible for the flight-or-fight response." • "The parasympathetic nervous system increases peristalsis."

The client is experiencing stress due to family issues and the nurse is teaching meditation to relieve stress. Which suggestions will the nurse make to the client? Select all that apply.

• "You will need a quiet place to meditate." • "Place yourself in a comfortable sitting position." • "Focus on a word that has meaning to you."

The nurse is evaluating anxiety levels in the assigned client group. What should the nurse identify related to the four levels of anxiety that occur in people's lives? Select all that apply

• Although mild anxiety may interfere with sleep, it also facilitates problem solving. • Severe anxiety creates a very narrow focus on specific detail, causing all behavior to be geared toward getting relief. • During the panic stage, the person cannot learn, concentrates only on the present situation, and often experiences feelings of impending doom.

A 2-day-old, 28-week gestation preterm infant is being cared for in the neonatal intensive care unit. The mother is recovering from a cesarean section and comes in to visit for the first time today. Determining that stress can affect infant development., what situation does the nurse identify can develop? Select all that apply.

• Mother's increased cortisol levels lead to increased anxiety and decreased attachment. • The inability to hold and touch can lead to delay in bonding between mother and infant. • Excessive noise and lights can increase cortisol levels in the neonate.

The nurse provides education about physiological stressors. The nurse recognizes the education to be effective when the client identifies which physiological stressors? (Select all that apply.)

• Outside temperature of 100 degrees • Upper respiratory infection • Excessive protein in the diet • Rheumatoid arthritis

The client asks the nurse to explain stress and its effect on the body. Which information will the nurse include? Select all that apply.

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

A client was at home alone when a tornado struck and damaged the structure. What type of crisis does the nurse address in the care of this client?

Adventitious

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 abuse

A client responds to an approaching diagnostic test with a rapidly beating heart and hands that are shaking. This is the result of what type of response?

Coping responses

An adolescent entering high school voices anxiety over changing schools. Stating anxiety is an act of:

adaptation

A client asks the nurse, "Why do I get so excited when I drink caffeine?" Which nursing response is most appropriate?

"Caffeine increases activity in the reticular activating system."

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 client is adapting to physiological stressors?

A 62-year-old with breast cancer who researches breast reconstruction websites

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 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 teen is worried that her boyfriend is under "a lot of stress" with his home life, classes, clubs, community service, and part-time work. She asks the nurse what medication he should take to "calm down." Which response would be best?

"Do you think he would be willing to sit down and talk with me? I'd like to get to know him better so I can suggest some healthy alternatives."

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

"It reduces physical and emotional tension through postural changes and focused concentration."

Four daughters of a client diagnosed with brain death after a myocardial infarction are trying to come to terms with this stressor. Which statement from one of the daughters shows the nurse that they are coping effectively with their mother's situation?

"Is it okay if I ask our pastor to come and say a prayer with us in Mom's room?"

Aleah is a 22-year-old college student who recently engaged in sexual intercourse with a new partner. When the nurse tells her that she is pregnant, she states, "That's not possible, I got my period last week." This is an example of what defense mechanism?

Denial

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 withdrawn and isolated patient is most likely suffering from what type of stressors on basic human needs?

Love and belonging needs

A nurse is providing care for client who experienced a stroke. Which nursing intervention reflects tertiary level of prevention?

Provide care transition at discharge for speech therapy.

The nurse is caring for a 72-year-old female who is recovering from abdominal surgery on the medical-surgical unit. The surgery was very stressful and prolonged. The nurse notes on the chart that the client's blood sugars are elevated, yet she has not been diagnosed with diabetes. To what does the nurse attribute this elevation in blood sugars?

The blood sugars are probably a result of the "fight-or-flight" reaction.

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 experienced a fight or flight response immediately following a car accident. What clinical symptoms would the nurse expect to assess? (Select all that apply.)

• increased heart rate • decreased digestion • heightened awareness • pallor

Which situations are threats to psychological homeostasis in a client? Select all that apply.

• loss of job • a parent being diagnosed with dementia

What are examples of psychosocial stressors? Select all that apply.

• news reports on television about a war • fearing a terrorist attack • Being involved in an accident

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

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

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

• setting limits with family members who upset you • learning relaxation techniques • taking a vacation

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."

A client has just been diagnosed with a brain tumor after recurring headaches prompted his physician to order a CT scan. The client may be experiencing the nursing diagnosis of Ineffective Denial if he states:

"I really need to get back to my job because I'm falling behind on a lot of tasks."

An emergency department nurse is caring for four clients. Which client would the nurse suspect as using displacement as a defense mechanism?

A client with a fractured hand after punching a wall

When nurses become overwhelmed in their jobs and develop symptoms of anxiety and stress, they are experiencing what condition?

Burnout

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?

Enroll in a class or workshop in assertiveness training.

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?

Environmental stress

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

Ineffective Individual Coping

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

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 is caring for a 65-year-old widow whose wife died 4 months ago. He tells the nurse that he is not doing well and that no one will talk with him about his wife. What could the nurse do to help the client?

Refer him 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 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?

Resistance

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

Social support

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.

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

The client asks the nurse what she should do about a skin lesion she is very worried about. The nurse suggests the client should notify her physician for a diagnosis. The client is relieved and states she will make an appointment. This type of activity is considered:

buffering

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 is using prayer to assist in relieving stress. The use of prayer allows the client to:

cope

A client who responds to bad news concerning his lab reports by crying uncontrollably is handling stress by using:

coping mechanism

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

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

Which stressor collected during the assessment process for an adult client requires priority intervention by the nurse?

experiencing the death of a loved one

To assess the coping abilities of a first-time mother who expresses to the nurse that she is feeling overwhelmed by the needs of her newborn, the nurse should ask the client about her:

interpretation of events.

The nurse assesses a client's stressors using the Social Readjustment Rate Scale. The client's current score is 145. Which terminology should the nurse use when documenting this data in the medical record?

low risk

In evaluating the therapeutic outcome of using biofeedback to help a client work through a stressful situation, the nurse would expect the client to:

maintain vital signs within normal limits.

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

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

reframing

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

repression

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 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

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 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 which allows oneself to be distracted and temporarily escape from stressful situations

The parents of an infant who requires cardiac surgery inform the nurse that they are not anxious about the surgery and "will leave the outcome in God's hands." The nurse notes that the parents are likely anxious when she observes:

the parents pacing around the child's hospital room.

The nurse is caring for a postoperative Asian client who speaks minimal English. The nurse notes the client has not requested medication for pain. Considering the client's culture, the nurse would:

understand that, culturally, Asians may see pain as weakness.