Chapter 32: Stress and Coping

The patient has just been told that he has cancer. When the nurse assesses the patient at shift change, his heart rate and respirations are elevated. What type of response is this to stress? a. Physiologic b. Psychological c. Somatic d. Neurologic

ANS: A Increases in heart rate and respirations are physiologic in nature.

The stages of Selye's General Adaptation Response are a. alarm, resistance, and exhaustion. b. excitement, adaptation, and coping. c. activation, coping, and adaptation. d. appraisal, reaction, and resolution.

ANS: A 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.

The physiologic response to stress is a. activation of the autonomic nervous system with increased heart rate and respirations. b. activation of the parasympathetic nervous system with relaxation of smooth muscle and decreased secretions. c. activation of the autonomic nervous system with peripheral vasodilation, decreased blood pressure, and pupil constriction. d. activation of the parasympathetic nervous system with increased gastric emptying, dry mouth, and adrenal suppression.

ANS: A The physiologic response to stress is the activation of the autonomic nervous system, resulting in an increase in heart rate, blood pressure, and respirations along with pupil dilation and a decrease in gastric motility and blood flow to the skin.

There is great variation among individual responses to the same stressor. In addition to age, nutritional status, and genetic inheritance, which additional factor influences the expression of stress response and reflects the complex psychological processing involved? a. The amount of stress b. The individual's appraisal of the stressor c. The context of the stressful event d. The type of stressor

ANS: B Stress appraisal, the affected person's attribution of meaning to a stressful event, influences the expression of this stress response and reflects the complex psychological processing involved.

George is a junior college student. Recently he has felt anxious and jittery. He decides that he will swim during his lunch hour. After several days he notices a decrease in feeling anxious. What type of stress management did George use? a. Guided imagery b. Biofeedback c. Exercise d. Progressive muscle relaxation

ANS: C George used exercise. Exercise has been found to decrease stress level and cortisol levels and increase a sense of well-being in patients of all ages.

The hormone used as a physiologic marker for stress is a. ACTH. b. ADH. c. cortisol. d. Aldactone.

ANS: C Measurement of cortisol, found in the blood, urine, and saliva, is the standard for laboratory assessment of physiologic stress.

Successful coping is thought to involve a. problem-focused efforts. b. emotion-focused efforts. c. both problem-focused efforts and emotion-focused efforts. d. physiologic efforts.

ANS: C Studies have shown that successful coping usually involves both problem-focused and emotion-focused efforts. Problem-focused coping techniques are aimed at altering or removing the stressor. In circumstances in which the problem may not have a solution, emotion-focused coping strategies work to ease the emotional distress associated with a stressful condition.

The term McEwan used to describe the burden of prolonged stress is a. homeostasis. b. distress. c. "fight or flight." d. allostatic load.

ANS: D McEwan and Lasley proposed allostasis as an alternate term for the stress response. Allostatic load describes the burden of prolonged stress on the body. A sustained stress response is potentially damaging. Allostatic responses (such as the fight-or-flight response) should terminate when no longer needed, reducing the allostatic load.

TRUE or FALSE: Stress may be referred to as positive or negative.

ANS: True This is true. Selye referred to the demands that produce the adaptive response as stressors and noted that stress is unavoidable. He labeled negative stress as distress (stress that is beyond the ability of the affected person to cope with or adapt to effectively), which can cause physical illness or emotional dysfunction. He identified positive stress as eustress (motivational stress), which is associated with effective coping and adaptation. Eustress is thought to be essential for normal growth and development.

Which short-term goal would be most appropriate for a patient with the nursing diagnosis Anxiety related to upcoming diagnostic tests, as evidenced by expressions of concern and pacing around the room? a. Patient will discuss specific aspects of concern. b. Nurse will administer prescribed antianxiety medication. c. Patient will understand diagnostic test procedures. d. Nurse will describe test procedures in detail to allay concerns.

Answer: a Having the patient discuss specific aspects of concern allows the nurse the opportunity to assess the patient's level of anxiety and what interventions might be most appropriate to help allay the stated concerns. Goals must be patient-centered, measurable, and realistic. None of the other three goals meet these criteria. Two of the goals are nurse-focused. The action "understand" is not measurable.

A male patient is told that he may have colon cancer. Which response by the patient best indicates that his initial appraisal of the situation is primarily a challenge to be met? a. Requesting information on various treatment options b. Demanding to see another physician immediately c. Storming out of the gastroenterologist's office d. Yelling at the nurse who is scheduling his colonoscopy

Answer: a Requesting further information regarding treatment indicates that the patient is viewing the situation primarily as a challenge to be faced. Primary and secondary appraisals determine whether the stressful situation or transaction is a threat or a challenge. A threat invokes the possibility of harm or loss, whereas a challenge holds forth the possibility of benefit. Demanding, angry behavior indicates that the patient feels threatened rather than challenged.

The nurse has been assigned the same patients for the past 4 days. Two of the patients demand a great deal of attention, and the nurse feels anxious and angry about being given this assignment again. What action would demonstrate the most effective way for the nurse to cope with the patient care assignment? a. Share complaints about the assignment with the nurse manager. b. Prioritize the patients' needs, and identify a specific time period for care for each patient. c. Talk with the patients, and explain that they cannot expect so much personal attention. d. Trade assignments with another nurse who is unaware of the concerns regarding the patient assignment.

Answer: b Prioritizing care and setting aside time to spend with specific patients constitute the most effective coping strategy for the nurse to use. Sharing concerns with the nurse manager does not demonstrate strong problem-solving skills; it merely shows a desire to complain. Trading assignments diminishes the continuity of care during which patient trust and nurse-patient relationships are developed. Patients are always the focus of nursing care and should not be given the impression that the nurse does not have time to care or listen to their concerns.

A patient is newly diagnosed with diabetes and requires insulin injections. He requests information about classes offered by the diabetes educator. Which type of coping technique is this patient using? a. Emotion-focused b. Problem-focused c. Avoidance d. Denial

Answer: b Problem-focused coping techniques are aimed at altering or removing a stressor. If this patient gains the skills to administer his own injections from the diabetes educator, he will remove a major stressor associated with a new diabetes diagnosis. Emotion-focused coping techniques, avoidance, and denial are all psychological techniques, rather than a psychomotor-based activity, which is required in this situation.

Which intervention would be most appropriate for the nurse to include in the care plan for a patient who is experiencing constipation and increased heart and respiratory rates? a. Time management b. Decreased grain intake c. Relaxation therapy d. Regimented exercise

Answer: c Relaxation therapy typically lowers the person's heart and respiratory rates while increasing gastric motility. Not enough information is provided to indicate the need for time management. Both decreased grain intake and regimented exercise may exacerbate the patient's problems.

In the immediate postoperative period after open-heart surgery, a patient who is not a diabetic has elevated blood glucose levels. What physiologic stress response best describes the rationale for the patient's increased blood sugar? a. Release of epinephrine b. Secretion of CRH c. Circulation of endorphins d. Increase in corticosteroids

Answer: d Corticosteroids increase serum glucose levels and inhibit the inflammatory response. Often patients who have experienced extreme physiologic stress will require short-term insulin therapy until their corticosteroid and blood glucose levels return to normal. Epinephrine, CRH, and endorphins all respond to stress; however, corticosteroids are directly responsible for the increase in this patient's blood sugar.

A 25-year-old female patient demands that her mother or father be present during all blood testing. Which defense mechanism could the nurse document as being used by this patient? a. Sublimation b. Repression c. Projection d. Regression

Answer: d This young adult patient is reverting back to behavior consistent with an earlier stage of development, which is the defense mechanism of regression. Sublimation is channeling unacceptable emotions into acceptable actions. Repression involves blocking unacceptable thoughts from consciousness, and projection attributes one person's desires or traits to another person.

Two adult siblings are caring for their ill mother, who requires 24-hour care. She needs assistance with feeding, bathing, and toileting. One of the siblings takes time to exercise after work, whereas the other goes directly to the mother's home before and after work each day. The nurse recognizes that people may react differently to the same stressors depending on which factors? (Select all that apply.) a. Individual coping skills b. Type of identified stressor c. Amount of perceived stress d. Personal appraisal of the stressor e. Hair color, gender, and skin type

Answers: a, b, c, d The person's coping skills have an impact on how that person perceives and responds to stress. The type and amount of stress as well as the appraisal of stress also affect how the person reacts. Hair color, gender, and skin type are not recognized as factors related to stress reactions.

Which statement by a patient would indicate the use of effective coping strategies? (Select all that apply.) a. "Each month, my wife and I attend a support group for parents of children with autism." b. "Talking with my spiritual adviser may challenge my thinking on how best to handle this situation." c. "I've invited my son to join me for drinks at the bar each night on his way home from work so we can spend more time together." d. "We are looking into joining the new health club facility in our neighborhood." e. "After working all day, I eat dinner in front of the television while my family sits at the kitchen table."

Answers: a, b, d Support groups, spiritual advisors, and health clubs all offer services that can enhance coping skills. The daily use of alcohol is not a healthy coping strategy, even if it involves spending time with family. Eating in front of the television promotes obesity and social isolation.

When using a stress assessment tool with a patient from another culture, what factor(s) must the nurse take into consideration? (Select all that apply.) a. Specific methods of managing stress are revealed in using stress assessment tools. b. Stress assessment tools should be used only for persons living in North America. c. Stress assessment tools may not be appropriate for all people of all ages. d. Resistance resources become evident when stress assessment tools are analyzed. e. Adaptations may need to be made to the assessment tool based on circumstances.

Answers: c, e It is not possible to use stress assessment tools in some situations. Stress assessment tools must be adapted to specific age groups, cultures, and circumstances to be most effective in gathering pertinent data. Stress assessment tools identify only stressors that the person is experiencing and not methods of managing stress or the person's resistance resources.