Psych Exam 2 - Ch. 10 (Stress Responses and Stress Management)

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful?

"I can be successful if I do all the things required to learn the job." Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. "I do not have the ability to handle that job," "I may be fired from the job but eventually I will find something else to do with my life," and "I can never learn all there is to know for the job" are all negative cognitive distortions that would prevent the individual from succeeding. p. 167

A patient is extremely depressed after ending a relationship with a partner. The nurse is teaching cognitive reframing techniques to this patient as a means to counteract depression. Which response given by the patient indicates effective teaching by the nurse?

"I have many friends who love and care for me." The nurse should teach cognitive reframing to patients who are depressed and suffer from self-blame. It helps the patients develop positive insight towards life and real-life situations. In this regard, the patient's response, "I have many friends who love and care for me," is appropriate because it is a positive statement. The response, "I will never think about my partner again in my life," is not appropriate. It indicates that the patient is not accepting the reality and avoids thoughts related to the incident. The response, "My destiny is responsible for the breakup," is not appropriate either. It indicates that the patient is compromising with the situation. The response, "My partner will realize that I was not wrong," is not appropriate. The patient is reflecting anger and distress in this response. p. 167

A nurse is planning mind-body therapies for patients in the medical unit. Which patients are likely to benefit most from the therapies? (SATA)

-A patient with insomnia. -A patient with high blood pressure. -A patient with asthma. -A patient with fibromyalgia. Mind-body therapies are used for disease conditions that are likely to benefit from reduction of stress and anxiety. These disease conditions are caused not only by the pathological changes in the body, but also have a psychological cause to them. These conditions include insomnia, high blood pressure, asthma and fibromyalgia. Reduction of stress and anxiety in these patients may help to relieve the symptoms. A patient with fracture may experience a reduced anxiety with mind-body therapy but will not have a therapeutic effect on the fracture. pp. 159-160

Which factor is most likely to affect how a person reacts to stress and anxiety? (SATA)

-Age -Gender -Culture -Life experiences Responses to stress and anxiety are affected by factors such as age, gender, culture, life experience, and lifestyle, all of which may work to either lessen or increase the degree of emotional or physical influence and the sequelae (consequence or result) of stress. Chronic illness generally is not recognized as an influence on coping abilities. p. 160

A diagnosis of chronic stress is supported by which assessment finding? (SATA)

-Amenorrhea -History of panic attacks -Insulin-resistant diabetes Prolonged or chronic stress is more likely to result in chronic or long-term health issues like panic attacks, amenorrhea, and insulin-resistant diabetes. Recent blood clots and a loss of appetite are generally a result of acute stress. p. 160, Table 10.1

After reviewing the following information, identify which life events were perceived as increasing in stressfulness over a 40-year period? (Table 10-2 Perception of Life Stressors in 1967 & 2007) (SATA)

-Birth of a child -Becoming unemployed -Children leaving the home Over the last 40 years, there has been an increase in the perceived stress associated with employment issues, birth of a child, and children leaving their birth homes. The stress associated with the death of a friend has remained constant, whereas the death of a spouse is now perceived as less stressful. p. 163, Table 10.2

The nurse provides care to a patient who presents with uneasiness and reports feeling stressed. What does the nurse recognize as psychological stressors? (SATA)

-Divorce -Job loss -Retirement -Birth of a new baby Retirement, job loss, divorce, and the birth of a new baby are psychological stressors, or events that stimulate emotional arousal, fatigue, fear, and other similar sensations. Trauma and pain are examples of physiological stressors, which are physical conditions. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 160

Which statement regarding stress is correct? (SATA)

-Humans have a capacity to respond to both internal and external stress. -Stress results in predictable biochemical, physiological, and behavioral changes. -Reaction to stress is central to many human mental health disorders. Stress is natural, and humans have evolved with a capacity to respond to internal and external situations. A classic definition of stress is that it is a negative emotional experience that results in predictable biochemical, physiologic, cognitive, and behavioral changes directed at adjusting to the effects of the stress or altering the stress itself. Stress and the responses to it are central to psychiatric disorders and the provision of mental health care. Early exposure to stressful events actually sensitizes people to stress in later life. In other words, people who are exposed to high levels of stress as children, especially during stress-sensitive developmental periods, have a greater incidence of all mental illnesses as adults. It is not known, however, if severe stress causes a vulnerability to mental illness or if vulnerability to mental illness influences the likelihood of adverse stress responses. pp. 156-157

A nurse on a home visit finds that the patient is stressed. What psychological stressors does the nurse consider when interviewing the patient? (SATA)

-Loss of job -Divorce from spouse -Unmanageable debt The psychological stressors that cause a stress response can include divorce from spouse, loss of job, and unmanageable debt. These stressors do not have a direct impact on the body; these stressors cause a stress response by causing an emotional response to the stress. Infection and excessive cold are physical stressors. p. 160

A nurse is caring for a chronically stressed patient. What are suggestions that would help the patient relieve stress? (SATA)

-Talk to a therapist to process stress -Going to sleep 30 to 60 minutes earlier each night for a few weeks -Exercising at least 30 minutes three or more times a week Exercise can dissipate chronic and acute stress and may decrease levels of anxiety, depression, and sensitivity to stress. Fatigue occurs more often in chronically stressed people and can be reduced by getting sufficient sleep early in the night. Sleeping later in the morning can disrupt body rhythms and so is not particularly helpful in reducing stress. Caffeine intake leads to more energy consumption and increased muscle pain. Talking to a therapist may be useful for a patient with a stress disorder but may not be necessary for all patients who experience stress. p. 160, Box 10.1

Which fact concerning meditation would a nurse include in a discussion with a patient experiencing moderate anxiety and stress? (SATA)

-The practice quiets the sympathetic nervous system. -Meditation can be practiced anyplace and at anytime. -The strategy helps a person to create personal calmness. -A visual object, a sound, or even one's own breathing can be the focus. Meditation follows the basic guidelines described for the relaxation response. Meditation can be used to help people reach their deep inner resources for healing and calm their minds. Meditation elicits a relaxation response by creating a hypometabolic state of quieting the sympathetic nervous system. Some people meditate using a visual object or a sound to help them focus. Others may find it useful to concentrate on their breathing while meditating. Meditation is easy to practice anywhere at anytime. Keep in mind that meditation, like most other skills, must be practiced to produce the relaxation responses. p. 166

When identifying coping strategies for a patient who is experiencing stress, the nurse will include which intervention regarding deep breathing? (SATA)

-Use abdominal breathing. -Inhale slowly through the nose. -Exhale slowly through the mouth. -Repeat the exercise for 2 to 5 minutes. This technique incorporates abdominal breathing with inhalation through the nose and exhalation through the mouth that is repeated for 2 to 5 minutes. Muscle relaxation is a factor, but this technique does not include muscle tension. pp. 164-165, Box 10.2

Which patient is illustrating eustress?

A bride who is planning for her wedding Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. Failing an exam, getting laid off from a job, and getting into a fight at school all describe distress, or a negative energy. p. 159

The nurse is caring for four patients. Which patient is experiencing distress?

A patient whose uncle recently passed away A death in the family is an example of an event that causes distress, a negative draining energy that results in anxiety, confusion, depression, helplessness, and hopelessness. It can also cause physiological responses, such as fatigue and appetite loss, or even difficulty sleeping. Feeling motivated because of a vacation, excited for the birth of a baby, or the challenge of a new job are examples of eustress, which is a positive and beneficial energy that causes people to feel happy and hopeful. p. 159

Which scenario presents an example of eustress?

A senior nursing student addresses invitations to graduation. Eustress is a positive, beneficial energy that motivates and results in feelings of happiness, hopefulness, and purposeful movement. Eustress is the result of a positive perception toward a stressor. A senior nursing student would happily look forward to graduation and the activities associated with that accomplishment. Questioning a marriage, anticipating a CABG, or listening to medical bad news offer situations that depict distress. p. 159

When assessing an individual who has had several infections in a short period, it is important to ask which question initially?

Does the person have an increase in recent stress in his or her life? Stress is a common factor that can have negative effects on a person's health. A series of stressful events can be contributing factors to illness. Although it is true that persons with an autoimmune disease or a genetic history of a depressed immune system are vulnerable to infections, these are less common reasons. Exposure to multiple children with infections can increase a person's risk for infections as well but again is less likely a cause than stress. p. 157

A nurse is caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm?

Dry mouth Dry mouth indicates that the patient is in the alarm stage. In the alarm stage, the body prepares itself for the fight-or-flight response; this stage is characterized by increased activity of the sympathetic system. Constricted pupils, decreased heart rate, and a drop in blood pressure result from decreased sympathetic system activity. These signs indicate that the body is relaxed. pp. 158-159

The nurse is performing stress assessments in outpatients by using Recent Life Changes Questionnaire. Which important point should the nurse keep in mind for obtaining effective results from the questionnaire?

Every patient has a different threshold beyond which disruption occurs for a given situation. The Recent Life Changes questionnaire is used by the nurse to assess the level of stress in the patients. The nurse should consider certain points before assessing the level of stress in the patient by using the Recent Life Changes questionnaire. Each and every patient has a different threshold with which the patient tries to cope with a stressful situation. Disruption of this threshold level would cause acute and chronic stress in the patients. The patients don't experience the same level of stress in all the situations in their lives. It depends on their perceptions and surroundings. The patients belonging to different cultural groups experience different levels of stress. People with different beliefs and perception react differently to a given situation. The questionnaire has different scoring for each stress level according to life-changing events. pp. 163-164, Table 10.3

One effect of stress can be attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex, causing a short-term increase in

Gluconeogenesis An increase in gluconeogenesis, stimulated by the release of cortisol, ensures that increased amounts of glucose are available to the individual. Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor. p. 158, Figure 10.2

A nursing student learns that corticosteroids are released in response to stress. What are the consequences of increased levels of corticosteroids in the body?

Increase in muscle endurance In response to stress, the hypothalamus stimulates the adrenal cortex to secrete corticosteroids. High levels of corticosteroids increase the muscle endurance and stamina required for the fight-or-flight response. However, body functions, which include digestive process, immunity, and reproductive function, do not help the fight-or-flight response decrease. p. 160

What is the simplest method of reducing stress, anxiety, and mental noise?

Interrupting the thoughts and engaging in abdominal breathing Deep breathing exercises are considered to be the simplest method of reducing stress and anxiety while reducing mental noise. Deep breathing exercises have two components, namely relaxed abdominal breathing and thought-flow interruption. Guided imagery is a technique of relaxation that involves envisioning calming and serene images. In progressive muscle relaxation, anxiety is relieved by tensing muscles and then relaxing them. Mindfulness is a technique that involves being completely present in the current moment. p. 165

Over a 5-year period, an adult experienced liver failure. A liver transplant was performed. During the immediate postoperative period, which intervention could the nurse recommend to enhance healing and reduce the harmful effects of stress?

Listening to music This patient has experienced sustained stress that is both psychological and physiologic. Listening to music increases the sense of relaxation and may lead to increased healing effects. The patient is not ready for aerobic exercise in the immediate postoperative period. Because the patient has received immunosuppressant medications, groups of people should be avoided. Chocolate contains caffeine; lowering or stopping caffeine intake can lead to more energy, fewer muscle aches, and greater relaxation. p. 162, Box 10.1

A nurse is caring for a patient diagnosed with tension headaches. Which technique does the nurse teach the patient to relieve tension headaches?

Progressive muscle relaxation Stress causes muscle contraction, which causes tension headaches. In progressive muscle relaxation, the muscles are trained to become tensed and then relaxed, which reduces the pain. Relaxation response helps to focus and be calm. Cognitive reframing may help the patient to change perception toward illness but it may not help to relieve tension headaches. Deep breathing reduces anxiety but doesn't cause muscle relaxation. p. 166, Box 10.4

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator identified as

Social support Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. p. 161

An Asian patient would be most likely to respond to stress by the subjective experience of

Somatic complaints The overwhelming majority of Asians, Africans, and Central Americans not only express subjective distress in somatic terms, but actually experience this distress somatically, such that psychological interpretations of suffering may not be much use cross-culturally. p. 162

What is the term used to describe the psychological or physical stimuli that are incompatible with the current functioning of an individual and require adaptation in the human body?

Stressors Stressors are the psychological or physical stimuli that are incompatible with current functioning and require adaptation. Endorphins are polypeptides are released to reduce sensitivity to pain and injury. Cytokines are proteins and glycoproteins used for communication between cells when a pathogen is detected. Hormones are the chemical messengers that transport a signal from one cell to another in the body. pp. 157, 160

A nurse is teaching the relaxation response technique to a patient suffering from migraine headaches. How does this technique help in reducing the stress response?

Switches the sympathetic mode to the parasympathetic mode. The relaxation response counteracts the stress response and helps to adopt a calm and passive attitude. It allows the autonomic nervous system to switch to parasympathetic mode from the sympathetic mode. The parasympathetic activation relaxes the body. Deep breathing exercises help to dampen the cognitive processes likely to induce stress reactions. Meditation helps to create a hypometabolic state of quieting the sympathetic nervous system. Guided imagery helps to produce endorphins, which increase pain thresholds. p. 166

What factor exerts the greatest influence on the degree to which various life events upset a specific individual?

The individual's perception of the event Researchers have looked at the degree to which various life events upset specific individuals. They have found that the perception of a recent life event determines the person's emotional and psychological reactions to it. For example, a man in his 40s who has a new baby, has just purchased a home, and is laid off with 6 months' severance pay may feel the stress of a lost job more intensely than a man who is 62 years old, financially secure, and asked to take an early retirement. p. 160

Which is an example of the exhaustion stage of general adaptation syndrome (GAS)?

The patient reports being unable to eat or sleep and wants to remain isolated. Being unable to eat or sleep and wanting to remain isolated is symptomatic of the exhaustion stage of GAS, in which the patient has attempted to resist the stressor, but the attempts proven futile and resources are depleted. The stress becomes chronic at this stage. Becoming energized by the stimulus and having a physiological response to stress is characteristic of the alarm stage of GAS. Getting into a physical altercation due to being threatened is an example of the alarm (fight-or-flight) stage of GAS. Developing a rash on the skin as a result of stress is an example of an immune system stress response, not GAS. p. 159

The nurse teaches short progressive muscle relaxation to patients with antisocial personality disorder. The nurse reports to the primary health care provider that some of the patients are effectively participating in the therapy. Based on which actions did the nurse give the report?

The patients close the mouth by tightly holding the lips in the session. In progressive muscle relaxation technique, the patient is instructed to tighten the body muscles initially in order to increase the tension in the muscles. The patient is then instructed to release the tension. The patient should close the mouth by tightly holding the lips in front of the teeth. It helps to relax the jaw muscles. In the first step, the patient should raise the shoulders up towards the ears, and then drop the shoulders. Progressive muscle relaxation involves alternating contraction and relaxation. A relaxed position throughout the session indicates that the patient is not contracting the muscles effectively, thus it should be avoided. The patient should not raise the eyebrows from a long time, as it creates excessive tension in the facial muscles. The nurse should ask the patient to raise eyebrows to contract the forehead muscles and then release the tension. The patient should feel the tension by raising the eyebrows and then immediately lower them and close the eyes to release the tension. It helps to release the tension created. The patient should also tighten the hands and then shake them, because that helps to release the tension and causes muscle relaxation. p. 166