Chapter 12
A client visits the clinic and tells the nurse about being under a great deal of stress on the job for the past month. Applying the factors that determine the stress response, which question would be most appropriate for the nurse to ask? A) "What effect is the stress having on your job performance?" B) "How would you describe the social network within your family?" C) "What is the specific event that you find most stressful?" D) "When did you first become aware of experiencing this stress?"
Ans: A Feedback: A given event or situation may be extremely stressful to one person but not to another. The more important or meaningful the outcome, the more vulnerable the person is to stress. Appraisal is the process in which all aspects are considered-demands, constraints, and resources are balanced with personal goals and beliefs. Asking about the social network, the specific event, or first becoming aware reflects the person-environment relationship, which is determined by the significance of the event.
A nurse is caring for a client who has been under severe stress while caring for her elderly mother, who is in the advanced stages of Alzheimer's disease. The nurse explains that the client is adapting to the stress that she is experiencing because of which of the following? A) Ability to survive in the midst of severe stress B) Acceptance of others' help in caring for her mother C) Success at being able to solve problems D) Capability in setting reasonable personal goals
Ans: A Feedback: Adaptation can be conceptualized as a person's capacity to survive and flourish. Adaptation, or lack of it, affects three important areas: health, psychological well-being, and social functioning. A period of stress may compromise any or all of these areas. If a person copes successfully with stress, he or she returns to a previous level of adaptation. Successful coping results in an improvement in health, well-being, and social functioning. Accepting help, solving problems, and setting reasonable goals are means for achieving adaptation.
After interviewing a client about social supports, a nurse determines that the client is experiencing emotional support from these social supports based on which statement? A) "I'm glad I have someone that I can talk to." B) "The person who cut my lawn was great!" C) "I received a small community grant for groceries." D) "The senior center gave me a booklet about my medications."
Ans: A Feedback: Emotional support from social support is evidenced by attachment, reassurance, and being able to rely on and confide in a person. The statement about having someone to talk to reflects this. The statements about cutting the lawn and the grant for groceries reflect tangible support. The statement about the medication booklet reflects informational support.
During an interview, the client states, "I feel so guilty, and I'm so ashamed of what I did." The nurse interprets this as which of the following? A) Negative emotion B) Positive emotion C) Borderline emotion D) Nonemotion
Ans: A Feedback: Negative emotions occur when there is a threat to, delay in, or thwarting of a goal or a conflict between goals; these emotions include anger, fright, anxiety, guilt, shame, sadness, envy, jealousy, and disgust. Positive emotions occur when there is movement toward, or attainment of, a goal; examples include happiness, pride, relief, and love. Borderline emotions are somewhat ambiguous and include hope, compassion, empathy, sympathy, and contentment. Nonemotions connote emotional reactions but are too ambiguous to fit into any of the preceding categories; these include confidence, awe, confusion, and excitement.
The nurse is caring for a client with chronic stress because of job loss and financial difficulties. When evaluating the client's assessment findings, the nurse would anticipate finding an elevated antibody titer to which of the following? A) Herpes simplex viruses B) Herpes zoster viruses C) Acquired immune deficiency viruses D) Influenza viruses
Ans: A Feedback: Research has shown that antibody titers to Epstein-Barr and herpes simplex viruses are elevated in stressed populations.
The nurse is preparing to care for a client under severe stress, caused by her caregiver duties for her elderly aunt diagnosed with leukemia. When assessing the client's psychological domain, which question would the nurse ask first? A) "Let's talk about what you have been feeling." B) "Tell me about your depressed moods." C) "How long have you been caring for your aunt?" D) "Are you feeling overwhelmed by caring for your aunt?"
Ans: A Feedback: Using therapeutic communication techniques, a person's emotional state is assessed in a nurse-client interview. By beginning the interview with a statement such as, "Let's talk about what you have been feeling," the nurse can elicit the feelings that the person has been experiencing. Identifying the person's emotions can be helpful in assessing the intensity of the stress being experienced. Asking about depressed moods or feeling overwhelmed does not allow the client to verbalize her feelings. Asking how long the client has been caring for her aunt provides no information about what the client is feeling.
A nurse is conducting an assessment of a client's social network. Which of the following would the nurse assess? Select all that apply. A) "How big is your network of contacts?" B) "Who gives you the best advice?" C) "Who is responsible for providing support?" D) "Do any of the members know one another?" E) "What services do you think might be helpful?"
Ans: A, B, C, D Feedback: When assessing a client's social network, questions should address the following: the size and extent of the client's social network, both relatives and nonrelatives, professional and nonprofessional, and how long known; functions that the network serves (e.g., intimacy, social integration, nurturance, reassurance of worth, guidance and advice, access to new contacts); degree of reciprocity between the client and other network members (i.e., who provides support to the client and who the client supports); and the degree of interconnectedness (i.e., how many of the network members know one another and are in contact).
When describing the concept of allostatic load to a group of students, which of the following would the instructor identify as abnormal, indicative of the overall changes of the biologic regulatory system? A) Nuclear imaging studies B) Laboratory test results C) Bone radiographs D) Cardiac studies
Ans: B Feedback: As wear and tear on the brain and body occurs, there is a corresponding increase in the number of abnormal biologic parameters called allostatic load (AL) (Fig. 12.2). AL is measured by the cumulative changes of the biologic regulatory systems as indicated by abnormal laboratory values. Nuclear imaging studies, bone radiographs, and cardiac studies are not used to measure AL.
A nurse is performing an assessment interview with a client. The client tells the nurse that he has a type A personality. Based on the nurse's interpretation, the nurse would expect which behavior by the client? A) Appearing relaxed and easygoing throughout the interview B) Wanting the interview to be over as quickly as possible C) Being pleased with the overall pace of the interview D) Speaking slowly, requiring time to consider his answers
Ans: B Feedback: The nurse can anticipate that the client will be competitive, aggressive, and impatient because these characteristics signify the type A personality. People with type B personalities do not exhibit these behaviors and generally are more relaxed, easygoing, and easily satisfied. They have an accepting attitude about trivial mistakes and use a problem-solving approach to major problems. People with type C personalities are described as having difficulty expressing emotion; being introverted, respectful, conforming, compliant, and eager to please; and avoiding conflict. They respond to stress with depression and hopelessness. A person with a type D (distressed) personality is indicated when he or she experiences increased negative emotions (depression) and pessimism, and does not share emotions.
A client is talking to a nurse about her friendship with another person. She comments, "That person is always there for me, and I am always there for her. We help each other out; sometimes she's helping me, and sometimes I am helping her." The nurse interprets the client's statements about her social network as reflecting which of the following? A) Denseness B) Reciprocity C) Social support D) Constraints
Ans: B Feedback: The patient is describing reciprocity, opportunities for give and take. Network members both provide and receive support, aid, services, and information. Reciprocity is particularly important because most friendships do not last without the give and take of support and services. Denseness is the size of the network and the interconnectedness of the individuals in that network. Social support refers to the positive interpersonal interactions that occur as part of a dynamic process that is in constant flux. Constraints are personal and environmental limitations.
A group of students is reviewing the events associated with the fight-or-flight response. They demonstrate understanding of the information when they identify that which of the following results from sympathetic nervous stimulation? A) Hypoglycemia B) Tachycardia C) Hypotension D) Hypercoagulability
Ans: B Feedback: With the "fight-or-flight" response, the sympathetic nervous system is activated, leading to an increase in heart rate, blood pressure, and blood sugar. Hyperactivation of the hemostatic and coagulation systems, leading to hypercoagulability to prevent excessive bleeding from wounds, also occurs, but it is not related to sympathetic nervous system activation.
A nurse is providing an in-service presentation on coping and adaptation. Which of the following would the nurse most likely include? Select all that apply. A) Most coping strategies are similar in their approach. B) Coping, when effective, leads to adaptation. C) Reappraisal occurs simultaneously with coping. D) The same coping strategy is used in each situation. E) Coping is a deliberate and planned effort to manage stress.
Ans: B, E Feedback: Coping is a deliberate, planned, and psychological effort to manage stressful demands. Positive coping leads to adaptation. No singular coping strategy is best for all situations. Coping strategies work best in particular situations. Over time, these strategies become automatic and develop into patterns for each person. Hopefully, the strategies are effective.
A group of nursing students is reviewing information about emotional responses to stress and the themes associated with them. The students demonstrate understanding of the information when they identify which emotion as associated with being moved by another's suffering and wanting to help? A) Relief B) Hope C) Compassion D) Love
Ans: C Feedback: Compassion reflects being moved by another's suffering and wanting to help. Relief is reflected as a distressing goal-incongruent condition that has changed for the better or gone away. Hope reflects fearing the worst but yearning for better. Love reflects desiring or participating in affection, usually (but not necessarily) reciprocated.
A client has come to the clinic to discuss the stress she is experiencing because of failing two exams at school. Initially, she described her failures as "the worst thing that has ever happened to me," and she stated, ìThere is absolutely nothing I can do to pass this course now." Based on the client's responses to questions, the nurse finds out there are three more equally weighted exams scheduled for this course. The nurse and client collaborate and decide to use interventions to facilitate emotion-focused coping. Which additional comment from the client would the nurse identify as providing support for this decision? A) "You've got to figure out something for me to do to get me out of this situation!" B) "This is a waste of time because absolutely nothing you or I can do will make it any better." C) "I overreacted; surely together we can figure out something for me to do." D) "This is the worst thing that could ever happen to me. I'm nothing but a failure."
Ans: C Feedback: In an assessment interview, a nurse can determine whether a person uses problem-focused or emotion-focused coping strategies effectively. Emotion-focused coping is effective when the person has inaccurately assessed the situation. Coping corrects the false interpretation. Deciding she overreacted indicates that the client is capable of more accurately assessing her situation and is able to begin viewing her predicament as a challenge, which will lessen the impact of the stress on her mental health. The statements about figuring out something, that this is a waste of time, and that this is the worst thing that could ever happen do not reflect emotion-focused coping.
A nurse is assessing a client and the client's social networks. When evaluating this area, the nurse integrates knowledge that which of the following is an important component? A) Blood relationships B) Bonding with one another C) Reciprocity D) Emotional support
Ans: C Feedback: Social networks provide opportunities for give and take. Network members both provide and receive support, aid, services, and information. Reciprocity is particularly important because most friendships do not last without the give and take of support and services. A person who is always on the receiving end eventually becomes isolated from others. Emotional support and bonding may occur in a social network, but this is not a key component. Blood relationships are unrelated to social networks.
A nurse is assessing a client and uses the Recent Life Changes Questionnaire as part of an assessment. The nurse determines that the client has experienced a major life crisis when which score is attained? A) 150 B) 250 C) 350 D) 450
Ans: D Feedback: A score of over 400 on the Recent Life Changes Questionnaire indicates major life crisis. A minor life crisis is indicated by a score between 250 and 400.
While leading a student class presentation about general adaptation syndrome and its stages, which of the following would the student describe as the final stage? A) Perception of a threat B) Use of coping mechanisms C) Physiologic response D) Exhaustion
Ans: D Feedback: Hans Seyle described this process as general adaptation syndrome (GAS), which he defined as consisting of three stages: the alarm reaction (a threat is perceived and the body responds physiologically), stage of resistance (coping mechanisms are used to try to reestablish homeostasis), and stage of exhaustion (occurs if homeostasis is not achieved).
After educating a group of students on appraisal and the stress response, the instructor determines that additional education is needed when the students identify which of the following as part of the primary appraisal? A) Relevance of the goal B) Consistency of the goal with values C) Personal commitment D) Outcome explanation
Ans: D Feedback: In a secondary appraisal, the person explains the outcome of events. During the primary appraisal of a goal, the person determines whether (1) the goal is relevant, (2) the goal is consistent with his or her values and beliefs, and (3) a personal commitment is present.
A nurse is reviewing the assessment findings of several clients. Which patient would the nurse identify as having a type D personality? A) A man who threatens the receptionist in the emergency department with bodily harm if a doctor does not see him right away B) A woman who sits quietly reading in a waiting room before seeing her doctor for her annual physical C) A quiet teen who drinks a six pack of beer against his better judgment because of peer pressure D) A man who reacts negatively to almost everything but never discusses his feelings with anyone
Ans: D Feedback: Persons with type D or distressed personalities experience increased negative emotions, but do not share their emotions. People with type A personalities are characterized as competitive, aggressive, ambitious, impatient, alert, tense, and restless. Persons with type B personalities do not exhibit these behaviors and generally are more relaxed, easygoing, and easily satisfied. They have an accepting attitude about trivial mistakes and use a problem-solving approach to major problems. People with type C personalities are described as having difficulty expressing emotion; being introverted, respectful, conforming, compliant, and eager to please; and avoiding conflict. They respond to stress with depression and hopelessness.
A nurse has completed an assessment of a client who is experiencing significant stress. The assessment revealed intense anger and acting-out behaviors, along with statements of negative emotions. Which nursing diagnosis would be most appropriate? A) Disturbed Thought Processes B) Low Self-esteem C) Hopelessness D) Ineffective Coping
Ans: D Feedback: The assessment information supports the nursing diagnosis of Ineffective Coping. There is no information related to problems with thought processes. Low self-esteem may be a problem, but there is no information to support this diagnosis. The client also may be experiencing hopelessness, but the situation does not support this.