Chapter 5: Homeostasis, Adaptation, and Stress

Which statement, made by a senior citizen who has taken a class on stress reduction, would indicate to the nurse the need for further instruction?

"As one grows older, their stress decreases."

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 recently divorced client presents to the emergency department with chest pain, nausea, headaches, palpitations, and diaphoresis. An electrocardiogram (ECG) and lab work do not demonstrate an ischemic cardiovascular event. What question during the data collection might lead the nurse to a nursing diagnosis of Anxiety?

"Can you tell me what has been going on in your life recently?"

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."

Which question would be helpful in eliciting data about the effects of stress during a health history?

"How does your body feel when you are upset?"

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?'

A client informs the nurse that they have a well paying job but that it is demanding and causes a great deal of anxiety. What statement made by the client indicates that the client has a coping mechanism to deal with anxiety produced by this situation?

"I am actively seeking job opportunities in a less stressful environment."

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 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."

Which statement made by the client indicates a need for further teaching regarding stress management?

"I manage my stress with occasional alcohol and alprazolam."

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?"

The client tells the nurse she has never "gotten over" the loss of her husband 2 years ago. The client states she is drinking alcohol to excess every day and has started smoking, saying both help her cope. What is the best response by the nurse?

"It may be time for you to consider a comprehensive treatment program."

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."

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."

A nurse is educating a client about how the general adaptation syndrome (GAS) theory works in the human body. What statement(s) made by the client indicates to the nurse that further education is required? Select all that apply.

"The alarm reaction alerts my family that I need to slow down." "I often get exhausted when I do too much yard work." "The fight-or-flight reaction is initiated by growth hormone released in my brain."

A client who is recently divorced reports sleeping during the day and an inability to adapt to the life change. Which teaching by the nurse would promote healthy adaptation?

"Try making a list to prioritize what needs to be done."

A group of nursing students is reviewing information about stress and coping. The students demonstrate an understanding of the information when they identify what as the outcome of coping?

Adaptation

What is the term for the change that takes place in response to a stressor?

Adaptation

A student nurse has learned about the role of endorphins in stress management and their potential to foster a sense of well-being. A client with a history of depression has initiated a discussion with the student about non-pharmacologic stress management techniques. What activity should the nurse recommend that may result in the release of endorphins?

Aerobic exercise

A nurse hears a client yelling for help from his room. The nurse runs to the client's room, and upon arriving in the room, the nurse's heart rate and oxygen demands have increased. What phase of the general adaptation syndrome (GAS) is best described by the nurse's physiologic changes?

Alarm reaction

While conducting the physical assessment of a client, the nurse notes an increase in the blood glucose levels. Upon inquiry, the client discloses that lately he has been under a lot of stress at work. Which stage of stress is the client experiencing?

Alarm stage

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

Which response to long-term stress may present itself in clients? Select all that apply.

Alcoholism Hypertension Bulimia

The client is a single mother of two children who attends college and works full time. She is seeing the college nurse due to a crying outburst in class. The first step of crisis intervention that the nurse employs is:

Assisting the client to identify the reason for her outburst

A nurse is sent to care for a client who recently had a stroke and is unable to perform activities of daily living. How should the nurse assist the client to get back to performing normal activities?

By exercising the client regularly

A client has been prescribed a medication that affects their levels of the neurotransmitter serotonin. Serotonin may contribute to adaptation in what way?

By stabilizing the client's mood

The nurse walks into the client's room and finds her sobbing uncontrollably. When the nurse asks what the problem is, the client responds "I am so scared. I have never known anyone who goes into a hospital and comes out alive." On this client's care plan the nurse notes a nursing diagnosis of Ineffective Coping related to stress. What is the best outcome the nurse can expect for this client?

Client will adapt relaxation techniques to reduce stress.

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

A community health nurse is discussing coping strategies with a group of clients who are all experiencing significant transitions in their lives. What coping strategy should the nurse identify as being potentially nontherapeutic?

Conflict avoidance

A middle-age adult discusses with the nurse the loss of his job due to frequent illness. The nurse recognizes the client's loss of his income as which of the following?

A stressor

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

Denial

A man has noticed bright red blood in his bowel movements for over a month. He says to himself, "Oh, it's just my hemorrhoids." What defense mechanism is the man using?

Denial

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

The children of a woman 60 years of age are distraught at her apparent lack of recovery following a stroke several weeks earlier. The client's daughter has frequently directed harsh criticism toward the nurses, accusing them of a substandard effort in rehabilitating her mother despite their best efforts. What defense mechanism may the client's daughter be exhibiting?

Displacement

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 nurse has been forced to accept numerous overtime shifts over the past several months in an effort to meet her personal financial obligations. The nurse now describes herself as "burned out," a condition that is comparable to what stage of anxiety?

Exhaustion

A nurse working on an oncology floor often sits with her clients in a calm, quiet, dimly lit environment and describes a walk along the ocean's shore. The nurse provides details of the walk and verbally paints a picture for the client. What best defines this form of stress management?

Guided imagery

The client is under immediate stress. The nurse assesses which sign as an effect of the sympathetic system?

Heart rate of 102 beats/min.

If a nurse assessed the vital signs of a person who was in the initial alarm reaction stage (shock phase) of the GAS, what would be the expected findings?

Hypertension

Which are considered internal stressors? Select all that apply.

Illness Hormonal change Fear

Which physiologic events may happen in the alarm phase of the General Adaptation Syndrome?

Increased sympathetic nervous system stimulation

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

The mission statement of a large health care organization states the objective of providing holistic care for clients. A nurse should be aware that holism is important for which reason?

Interplay between the mind and the body can have a profound influence on health

The nurse is caring for a client who is experiencing stress while weighing two good job offers. The nurse suggests that the client use therapeutic coping strategies. What does the suggestion of the nurse imply?

It means the client is asked to seek professional assistance.

Which factor increases an older adult's vulnerability and reaction to stressors?

Loss of a network for support

An older adult client assumed care of a parent with dementia and had to decrease work hours to stay and home and care for the parent. Due to the decrease in hours, it is difficult to meet financial obligations. What actions by the nurse would be appropriate for this client? Select all that apply.

Make a referral to the case manager to determine available resources Have the client make an appointment with social services to assist with financial resources Suggest that the client join a support group for caregivers of parents with dementia

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

An occupational health nurse at an oil refinery on the gulf coast of Texas performs client education with an adult client. The client is being seen after having suffering a chemical burn in an accident at the refinery. Which type of stressor has this client been exposed to?

Physiologic

A physician, while treating a client, asks the nurse to use the social readjustment rating scale tool. What does this tool predict?

Potential for developing a stress-related disorder

A new graduate is having difficulty coping with the role transition from student to registered nurse (RN). Which defense mechanism is being exhibitied when stating, "I hate going in to work on weekends. The aides are lazy, the clients are all complaining, and the families are all crazy!"

Reaction formation

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 nurse teaches a client deep-breathing exercises to help control his anxiety. This is considered what type of stress management technique?

Relaxation

A nurse has been caring for a client who experienced a physical assault a year ago. The client now describes being "totally recovered from it." Which stage of stress is the client currently experiencing?

Resistance stage

Which neurotransmitter induces sleep and stabilizes mood?

Serotonin

A nurse is meeting with a young woman who has recently lost her mother, lost her job, and moved with her husband to a new city. She is reporting acute anxiety and depression. What does the nurse know about stress that would be helpful with this client's situation?

Sometimes too many stressors disrupt homeostasis and if adaptation fails, the result is disease.

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 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 nurse is caring for a client with decreased secretory immunoglobulin A (sIgA). Which health problem can the client face because of this condition?

The client is at a risk for severe infections or cancer.

A client has been brought to the health care facility with accident-related injuries. During the initial interview, the client becomes agitated, upset and is unable to answer any more of the nurse's questions. What does the nurse conclude about the condition of the client?

The client's mind is preparing for a fight-or-flight response as he relates the incident.

A nurse is trying to assess a client's stress type; however, the client is very depressed and quiet and does not reply to the nurse's questions. The nurse is unable to maintain her calm while repeating the questions. Where is the nurse going wrong in assessing the client?

The nurse should demonstrate confidence and expertise.

While providing care to a client, the client states, "I can't do anything. I'm just so useless." Which technique would the nurse suggest to help the client gain control over negative thoughts?

Use supportive internal messages.

Which client would the nurse expect to have negative coping skills?

a 19-year-old diagnosed with schizophrenia who is heading off to college

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

adaptation

A client is discussing stressors with the nurse and is describing how she feels better when she takes a brisk walk. The client's action is an example of:

adaptation.

The nurse is caring for a client that is a teacher in a high school and states that there have been several issues with violence. What clinical manifestations during the client assessment would indicate that the client is experiencing physical manifestations of stress? Select all that apply.

an extra heart sound every fourth to sixth beat report of frequent evening headaches relieved by sleep reports of nausea

An adult receives a call from her bank stating her account is overdrawn and a significant fee has been assessed. The adult would have an initial reaction of:

appraisal.

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

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 parent has inadvertently locked the keys in her car with the baby strapped in the car seat. In a panic, the parent summons help from a locksmith. What type of reaction is the parent having?

coping

A young mother tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior?

coping mechanism

A client has experienced the loss of a loved one and is in the grieving process. The grief following this stressful event may be documented as what type of event?

distress.

In human beings, the physiologic response to a stressor includes the:

epinephrine increasing the blood-glucose level.

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.

The nurse is providing care to the following clients. The nurse assesses the client exhibiting maladaptive behavior as the client who is:

experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live."

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

experiencing the death of a loved one

During an interview, the client states, "When my stress is really high, I have diarrhea." The physiologic response affects:

gastrointestinal status.

Various physiologic mechanisms within the body respond to internal changes in order to maintain relative constancy in the internal environment. The state that results is called:

homeostasis.

A young woman who has just started college is 6 weeks into the semester and has several tests and assignments due in approximately 3 days. She has developed a sore throat and fever. The development of illness is related to:

immunosuppression with stress.

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.

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

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 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.

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

After failing a nursing exam, the nursing student states, "That exam written terribly." What coping strategy would the nursing instructor identify?

rationalization

A client that is a single parent of two small children is working two part-time jobs. The client comes into the clinic for an appointment looking disheveled and fatigued. Which health promotion activities would this client benefit from? Select all that apply.

reduction of stressors perfection reduction

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

reframing

The client is a child age 5 years hospitalized for a surgical procedure. The client is bedwetting. The parents report this is a new behavior and their child is toilet trained. The nurse assesses the client is exhibiting the defense mechanism of:

regression.

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

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

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

Which data is most appropriate for the nurse to include when assessing an older adult client's capacity to adapt to current stressors?

social losses, network of social factors, and advanced age

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 is with a young client who has just been informed of his terminal illness. His heart rate increases, his eyes dilate and his blood pressure increases. The nurse recognizes this response as:

sympathetic nervous response.

A 7-year-old boy has been the victim of abuse. He appears stoic and disconnected while being interviewed by the nurse. Although he currently has a painful injury, he does not cry or flinch when the area is touched. The nurse understands that:

the child has learned to cope by shutting off his feelings.

A client is dealing with the death of a spouse 10 days ago. The client tells the nurse about not feeling like eating and struggling to get food in. What does the nurse identify is occurring with the client?

this is part of the normal sympathetic stress response.

The nurse is caring for an 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.

An example of a long-term coping strategy is:

walking briskly three times a week for 20 minutes.