PSYCH - Chapter 10: Understanding and Managing Responses to Stress

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator identified as A. social support. B. cultural support. C. life satisfaction. D. cognitive reframing.

A 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. REF: Page 170-171

Which of the following are believed to help individual mediate, or lessen, the effects of stress? SELECT ALL THAT APPLY. a. Spirituality and/or religious beliefs b. Wealth c. Higher education level d. Social support e. Culture

A, D, E

A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse, "Do you think saying a prayer would help?" Select the nurse's best answer. a."It could be that prayer is your only hope." b."You may find prayer gives comfort and lowers your stress." c."I can help you feel calmer by teaching you meditation exercises." d."We do not have evidence that prayer helps, but it wouldn't hurt."

ANS:B Many patients find that spiritual measures, including prayer, are helpful in mediating stress. Studies have shown that spiritual practices can enhance the sense of well-being. When a patient suggests a viable means of reducing stress, it should be supported by the nurse. Indicating that prayer is the patient's only hope is pessimistic and would cause further distress. Suggesting meditation or other alternatives to prayer implies that the nurse does not think prayer would be effective. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 170-171 TOP:Nursing Process: Implementation MSC:Client Needs: Psychosocial Integrity

A patient newly diagnosed as HIV-positive seeks the nurse's advice on how to reduce the risk of infections. The patient says, "I used to go to church and I was in my best health then. Maybe I should start going to church again." Which response will the nurse offer? a."Religion does not usually affect health, but you were younger and stronger then." b."Contact with supportive people at church might help, but religion itself is not especially helpful." c."Studies show that spiritual practices can enhance immune system function and coping abilities." d."Going to church would expose you to many potential infections. Let's think about some other options."

ANS:C Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being. The other options wrongly suggest that spiritual practices have little effect on the immune system or reject the patient's preferences regarding health management. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 170-171 TOP:Nursing Process: Implementation MSC:Client Needs: Psychosocial Integrity

If it is determined that a patient will benefit from guided imagery, what teaching should you provide? a. Focus on a visual object or sound. b. Become acutely aware of your breathing pattern. c. Envision an image of a place that is peaceful. d. Develop deep abdominal breathing.

C

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? A. Meditation B. Breathing exercises C. Journal keeping D. Biofeedback

D Biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability. For people with hypnotic ability, meditation, progressive muscle relaxation, and other cognitive-behavioral therapy techniques produce the most rapid reduction in clinical symptoms. REF: Page 177

A nurse leads a psychoeducational group for depressed patients. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise: a.has an antidepressant effect comparable to selective serotonin reuptake inhibitors. b.prevents damage from overstimulation of the sympathetic nervous system. c.detoxifies the body by removing metabolic wastes and other toxins. d.improves mood stability for patients with bipolar disorders.

ANS:A -Endorphins produced during exercise result in improvement in mood and lowered anxiety. The other options are not accurate. PTS:1 DIF:Cognitive Level: Understand (Comprehension) REF:Page 177-178 TOP:Nursing Process: Implementation MSC:Client Needs: Physiological Integrity

Which changes reflect short-term physiological responses to stress? Select all that apply. a.Muscular tension, blood pressure, and triglycerides increase. b.Epinephrine is released, increasing heart and respiratory rates. c.Corticosteroid release increases stamina and impedes digestion. d.Cortisol is released, increasing glucogenesis and reducing fluid loss. e.Immune system functioning decreases, and risk of cancer increases. f.Risk of depression, autoimmune disorders, and heart disease increases.

ANS:A, B, C, D The correct answers are all short-term physiological responses to stress. Increased risk of immune system dysfunction, cancer, cardiovascular disease, depression, and autoimmune disease are all long-term (chronic) effects of stress. PTS:1 DIF:Cognitive Level: Understand (Comprehension) REF:Page 167-169 TOP:Nursing Process: Assessment MSC:Client Needs: Physiological Integrity

Neal, age 30, will be undergoing biofeedback. Which statement b Neal indicates a need for further teaching? a. "This will measure m muscle activity, heart rate, and blood pressure. b. "It will help me recognize how my body responds to stress." c. "I will feel a small shock of electricity if I tell a lie." d. "The instruments will know if my skin temperature changes."

B

You are caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm? a. Constricted pupils b. Dry mouth c. Decreased heart rate d. Sudden drop in blood pressure

B

High-quality social support relationships have attributes that include A. constructive criticism. B. minor conflict. C. continuous feedback. D. reciprocal closeness.

D High-quality social support relationships are relatively conflict free, close, confiding, and reciprocal. REF: 170-171

A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes A. biofeedback. B. guided imagery. C. therapeutic touch. D. assertiveness training.

A Biofeedback is a technique for gaining conscious control over unconscious processes. The scenario describes one method that might accomplish this. REF: Page 177

The physiologic basis for the success of guided imagery is A. β-endorphin release raises the pain threshold. B. imagery raises the body level of cortisol and epinephrine. C. the sympathetic nervous system is stimulated to produce a quiet state. D. brain catecholamines are less available to transmit pain impulses.

A Guided imagery stimulates release of β-endorphins, a brain chemical that raises the individual's pain threshold. In so doing, the guided imagery is responsible for making the client more comfortable. REF: Page 176

What would a client experience during a progressive relaxation session? A. Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed B. Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter C. Having a nurse enter the client's energy field to rebalance it and bring harmony D. Being led into a positive imaginary sensory experience

A Instruction on sequential tensing and relaxing muscles provides a description of Benson's method of progressive relaxation. Being attached to a machine that uses sound describes biofeedback. Rebalancing an energy field describes therapeutic touch. Positive imaging describes a component of guided imagery. REF: Page 175

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex, and over the long term it can result in A. insulin resistance. B. a high resting heart rate. C. digestive problems. D. chronic muscle tension.

A Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress. REF: 169-170

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? A. The individual's perception of the event B. The individual's degree of spirituality C. The effect of the individual's health-sustaining behaviors D. The amount of social support available to the individual

A 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. REF: 170-171

Myla, a 29-year-old patient admitted with anxiety, states, "my counselor keeps talking about my stressors. What exactly are stressors?" Your best response to the patient would be: A. "Stressors are events that happen that threaten your current functioning and require you to adapt." B. "Stressors are complicated neuro stimuli that cause mental illness." C. "It's best if you ask questions like that of your provider for a complete answer." D. "Instead of focusing on what stressors are, let's explore your coping skills."

A This is the best explanation of stressors. Stressors are not complicated neuro stimuli; telling the patient to address these questions to her provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject. Cognitive Level: Understand (Comprehension) Nursing Process: Implementation NCLEX: Psychosocial Integrity Text page: 167

The adult child of a patient diagnosed with major depression asks, "Do you think depression and physical illness are connected? Since my father's death, my mother has had shingles and the flu, but she's usually not one who gets sick." Which answer by the nurse best reflects current knowledge about psychoneuroimmunology? a."It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system." b."You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses." c."So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link." d."Negative emotions and stress may interfere with the body's ability to protect itself and can increase the likelihood of infection."

ANS: D The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to infections. Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother's baseline. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 169-170 TOP:Nursing Process: Implementation MSC:Client Needs: Physiological Integrity

A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress? a.The patient's systolic blood pressure has changed from the 140s to the 120s mm Hg. b.The patient reports, "I feel better, and that things are not bothering me as much." c.The patient reports, "I spend more time napping or sitting quietly at home." d.The patient's weight decreased by 3 pounds.

ANS:A Objective measures tend to be the most reliable means of gauging progress. In this case, the patient's elevated blood pressure, an indication of the body's physiological response to stress, has diminished. The patient's report regarding activity level is subjective; sitting quietly could reflect depression rather than improvement. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress. The patient's weight change could be a positive or negative indicator; the blood pressure change is the best answer. PTS:1 DIF:Cognitive Level: Analyze (Analysis) REF:Page 174-175 TOP:Nursing Process: Evaluation MSC:Client Needs: Psychosocial Integrity

An individual says to the nurse, "I feel so stressed out lately. I think the stress is affecting my body also." Which somatic complaints are most likely to accompany this feeling? Select all that apply. a.Headache b.Neck pain c.Insomnia d.Anorexia e.Myopia

ANS:A, B, C, D When individuals feel "stressed-out," they often have accompanying somatic complaints, especially associated with sleep, eating, and headache or back pain. Changes in vision, such as myopia, would not be expected. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 169-170 (Table 10-1) | Page 172-173 TOP:Nursing Process: Assessment MSC:Client Needs: Psychosocial Integrity

Which nursing comments are likely to help a patient to cope by addressing the mediators of stress? Select all that apply. a."A divorce, while stressful, can be the beginning of a new, better phase of life." b."You said you used to jog; getting back to aerobic exercise could be helpful." c."Journaling often promotes awareness of how experiences have affected people." d."Slowing your breathing by counting to three between breaths will calm you." e."Would a short-term loan make your finances less stressful?" f."There is a support group for newly divorced persons in your neighborhood."

ANS:A, C, E, F Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how we perceive and respond to stress (or how our personality affects how we respond to stressors). A loan could help the patient by reducing the financial pressures. Participation in support groups is an excellent way to expand one's support network relative to specific issues. However, neither aerobic exercise nor breathing-control exercises, while helpful in other ways, affect stress mediators. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 170-173 TOP:Nursing Process: Implementation MSC:Client Needs: Psychosocial Integrity

Which scenario best demonstrates an example of eustress? An individual: a.loses a beloved family pet. b.prepares to take a one-week vacation to a tropical island with a group of close friends. c.receives a bank notice there were insufficient funds in their account for a recent rent payment. d.receives notification their current employer is experiencing financial problems and some workers will be terminated.

ANS:B Eustress is beneficial stress; it motivates people to develop skills they need to solve problems and meet personal goals. Positive life experiences produce eustress. Going on a tropical vacation is an exciting, relaxing experience and is an example of eustress. Losing the family pet, worrying about employment security, and having financial problems are examples of distress, a negative experience that drains energy and can lead to significant emotional problems. See related audience response question. PTS:1 DIF:Cognitive Level: Understand (Comprehension) REF:Page 167-169 TOP:Nursing Process: Assessment MSC:Client Needs: Psychosocial Integrity

A patient tells the nurse, "I will never be happy until I'm as successful as my older sister." Thenurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping? a."People should treat me as well as they treat my sister." b."I can find contentment in succeeding at my own job level." c."I won't be happy until I make as much money as my sister." d."Being as smart or clever as my sister isn't really important."

ANS:B Finding contentment within one's own work, even when it does not involve success as others might define it, is likely to lead to a reduced sense of distress about achievement level. It speaks to finding satisfaction and happiness without measuring the self against another person. Focusing on salary is simply a more specific way of being as successful as the sister, which would not promote coping. Expecting others to treat her as they do her sister is beyond her control. Dismissing the sister's cleverness as unimportant indicates that the patient continues to feel inferior to the sibling. PTS:1 DIF:Cognitive Level: Analyze (Analysis) REF:Page 175 (Table 10-4) | Page 177-178 TOP:Nursing Process: Evaluation MSC:Client Needs: Psychosocial Integrity

A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, "The immigration to America has been very difficult." Considering cultural background, which expression of stress by this patient would the nurse expect? a.Motor restlessness c.Memory deficiencies b.Somatic complaints d.Sensory perceptual alterations

ANS:B Honduras is in Central America. Many people from Central American cultures express distress in somatic terms. The other options are not specific to this patient's cultural background and are less likely to be observed in persons from Central America. PTS:1 DIF:Cognitive Level: Understand (Comprehension) REF:Page 170-171 TOP:Nursing Process: Assessment MSC:Client Needs: Psychosocial Integrity

A patient says, "One result of my chronic stress is that I feel so tired. I usually sleep from 11:00 PM to 6:30 AM. I started setting my alarm to give me an extra 30 minutes of sleep each morning, but I don't feel any better and I'm rushed for work." Which nursing response would best address the patient's concerns? a."You may need to speak to your doctor about taking a sedative to help you sleep." b."Perhaps going to bed a half-hour earlier would work better than sleeping later." c."A glass of wine in the evening might take the edge off and help you to rest." d."Exercising just before retiring for the night may help you to sleep better."

ANS:B Sleeping later in the morning may disturb circadian rhythms and in this case is adding, rather than reducing, stress. Going to bed earlier and arising at the usual time alleviates fatigue more effectively. Sedatives may offer some benefit but are a short-term intervention with potential side effects, and other nonpharmacological interventions might work as well or better. Exercise earlier in the evening could induce tiredness and ease the process of falling asleep, but doing so right before bedtime would stimulate and interfere with sleep. Alcohol is sedating but potentially addictive; encouraging its use could increase the risk of using alcohol maladaptively as a response to stress in general. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 171 (Box 10-1) TOP:Nursing Process: Implementation MSC:Client Needs: Health Promotion and Maintenance

A patient nervously says, "Financial problems are stressing my marriage. I've heard rumors about cutbacks at work; I am afraid I might get laid off." The patient's pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement? a.Advise the patient, "Go to sleep 30 to 60 minutes earlier each night to increase rest." b.Direct the patient in slow and deep breathing via use of a positive, repeated word. c.Suggest the patient consider that a new job might be better than the present one. d.Tell the patient, "Relax by spending more time playing with your pet."

ANS:B The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident by elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system will counter the sympathetic nervous system's arousal, normalizing these vital-sign changes and reducing the physiological demands stress is placing on his body. Other options do not address his physiological response pattern as directly or immediately. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 174-176 (Box 10-4) TOP:Nursing Process: Planning MSC:Client Needs: Physiological Integrity

The nurse wishes to use guided imagery to help a patient relax. Which comments would be appropriate to include in the guided imagery script? Select all that apply. a."Imagine others treating you the way they should, the way you want to be treated ..." b."With each breath, you feel calmer, more relaxed, almost as if you are floating ..." c."You are alone on a beach, the sun is warm, and you hear only the sound of the surf ..." d."You have taken control, nothing can hurt you now. Everything is going your way..." e."You have grown calm, your mind is still, there is nothing to disturb your well-being ..." f."You will feel better as work calms down, as your boss becomes more understanding ..."

ANS:B, C, E The intent of guided imagery to assist patients manage stress is to lead the patient to envision images that are calming and health-enhancing. Statements that involve the patient calming progressively with breathing, feeling increasingly relaxed, being in a calm and pleasant location, being away from stressors, and having a peaceful and calm mind are therapeutic and should be included in the script. However, items that raise stressful images or memories or that involve unrealistic expectations or elements beyond the patient's control (e.g., that others will treat the patient as he desires, that everything is going the patient's way, that bosses are understanding) interfere with relaxation and/or do not promote effective coping. Thus these are not health-promoting and should not be included in the script. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 176-177 (Box 10-6) TOP:Nursing Process: Planning MSC:Client Needs: Psychosocial Integrity

According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a person's stress status and coping abilities? a.A person who has been assigned more responsibility at work b.A parent whose job required relocation to a different city c.A person returning to college after an employer ceased operations d.A man who recently separated from his wife because of marital problems

ANS:C A person returning to college after losing a job is dealing with two significant stressors simultaneously. Together, these stressors total more life change units than any of the single stressors cited in the other options. PTS:1 DIF:Cognitive Level: Analyze (Analysis) REF:Page 171-173 (Table 10-3) TOP:Nursing Process: Assessment MSC:Client Needs: Psychosocial Integrity

A patient tells the nurse, "My doctor thinks my problems with stress relate to the negative wayI think about things and suggested I learn new ways of thinking." Which response by the nurse would support the recommendation? a.Encourage the patient to imagine being in calm circumstances. b.Provide the patient with a blank journal and guidance about journaling. c.Teach the patient to recognize, reconsider, and reframe irrational thoughts. d.Teach the patient to use instruments that give feedback about bodily functions.

ANS:C Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient's manner of thinking. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 177-178 (Table 10-4) TOP:Nursing Process: Planning MSC:Client Needs: Psychosocial Integrity

A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience? a.Limbic system c.Sympathetic nervous system b.Peripheral nervous system d.Parasympathetic nervous system

ANS:C The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system. PTS:1 DIF:Cognitive Level: Understand (Comprehension) REF:Page 167-169 TOP:Nursing Process: Assessment MSC:Client Needs: Physiological Integrity

A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system? a.Thalamus c.Hypothalamus b.Parietal lobe d.Pituitary gland

ANS:C The individual will find this experience stressful. The hypothalamus functions as the command-and-control center when receiving stressful signals. The hypothalamus responds to signals of stress by engaging the autonomic nervous system. The parietal lobe is responsible for interpretation of other sensations. The thalamus processes messages associated with pain and wakefulness. The pituitary gland may be involved in other aspects of the person's response but would not stimulate the autonomic nervous system. PTS:1 DIF:Cognitive Level: Understand (Comprehension) REF:Page 167-169 TOP:Nursing Process: Assessment MSC:Client Needs: Physiological Integrity

A patient reports, "I am overwhelmed by stress." Which question by the nurse would be most important to use in the initial assessment of this the patient? a."Tell me about your family history. Do you have any relatives who have problems with stress?" b."Tell me about your exercise. How much activity do you typically get in a day?" c."Tell me about the kinds of things you do to reduce or cope with your stress." d."Stress can interfere with sleep. How much did you sleep last night?"

ANS:C The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether or not his distress is placing him in danger (e.g., by elevating his blood pressure dangerously or via maladaptive responses, such as drinking) and would help the nurse understand how he copes and how well his coping strategies and resources serve him. Of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful but seek data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general). PTS:1 DIF:Cognitive Level: Analyze (Analysis) REF:Page 172-173 TOP:Nursing Process: Assessment MSC:Client Needs: Psychosocial Integrity

A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize? a.Engaging in activity without using any supplemental oxygen b.Sleeping comfortably and soundly, without respiratory distress c.Feeling relaxed and taking regular deep breaths when leaving home d.Having a younger, healthier body that knows no exercise limitations

ANS:C The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen-carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 176-177 (Box 10-6) TOP:Nursing Process: Planning MSC:Client Needs: Psychosocial Integrity

When a nurse asks a newly admitted patient to describe social supports, the patient says, "My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I don't have many friends because most people my age just want to go out drinking." Which action will the nurse apply? a.Advise the patient that being so particular about potential friends reduces social contact. b.Suggest using the Internet as a way to find supportive others with similar values. c.Encourage the patient to begin dating again, perhaps with members of the church. d.Discuss how divorce support groups could increase coping and social support.

ANS:D High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships affect a person's coping negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than helping her cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable persons. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 170-171 TOP:Nursing Process: Implementation MSC:Client Needs: Psychosocial Integrity

A patient tells the nurse, "I know that I should reduce the stress in my life, but I have no idea where to start." What would be the best initial nursing response? a."Physical exercise works to elevate mood and reduce anxiety." b."Reading about stress and how to manage it might be a good place to start." c."Why not start by learning to meditate? That technique will cover everything." d."Let's talk about what is going on in your life and then look at possible options."

ANS:D In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. Further assessment is indicated before potential solutions can be explored. Suggesting exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention. PTS:1 DIF:Cognitive Level: Apply (Application) REF:Page 172-173 TOP:Nursing Process: Assessment MSC:Client Needs: Psychosocial Integrity

A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient's vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected? a.P 64, R 14 c.P 72, R 16 b.P 68, R 12 d.P 80, R 20

ANS:D The patient would experience stress associated with anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight or flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs. PTS:1 DIF:Cognitive Level: Analyze (Analysis) REF:Page 167-168 TOP:Nursing Process: Assessment MSC:Client Needs: Physiological Integrity

A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. This technique is called A. guided imagery. B. cognitive reframing. C. wishful thinking. D. confrontational assertion.

B Cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative. REF: Page 177-178

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? A. "I do not have the ability to handle that job." B. "I can be successful if I do all the things required to learn the job." C. "I may be fired from the job but eventually I will find something else to do with my life." D. "I can never learn all there is to know for the job."

B Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success. Cognitive Level: Analyze (Analysis) Nursing Process: Evaluation NCLEX: Psychosocial Integrity Text page: 177

Which of the following examples illustrates eustress? A. A college student fails an exam. B. A bride is planning for her wedding. C. A man is laid off from his job. D. An adolescent gets into a fight at school.

B Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy. Cognitive Level: Understand (Comprehension) Nursing Process: Assessment NCLEX: Psychosocial Integrity Text page: 169

The relaxation response calls upon A. sympathetic activation. B. parasympathetic activation. C. brainstem deactivation. D. increased cortisol production by the adrenals.

B Sympathetic activation prepares the individual for the fight-or-flight response. Parasympathetic activation has the opposite effect. REF: 174-175

The first stage of the general adaptation syndrome can be characterized as A. eustress. B. adaptive. C. maladaptive. D. psychological.

B The initial adaptive response of the general adaptation syndrome prepares the individual to fight or flee in the face of acute stress. REF: 167-168

An Asian client would be most likely to respond to stress by the subjective experience of A. anxiety. B. somatic complaints. C. memory deficiencies. D. sensory perceptual alterations.

B 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.

Your 39-year-old patient, Samantha, who was admitted with anxiety, asks you what the stress-relieving technique of mindfulness is. The best response is: a. Mindfulness is focusing on an object and repeating a word or phrase while deep breathing b. Mindfulness is progressively tensing, then relaxing, body muscles c. Mindfulness is focusing on the here and now, that the past or future, and paying attention to what is going on around you d. Mindfulness is a memory system to assist you in short-term memory recall

C

One effect of stress can be attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex, causing a short-term increase in A. the heart rate. B. triglycerides. C. gluconeogenesis. D. brain norepinephrine.

C 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. REF: 169-170

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is A. assertiveness. B. journal keeping. C. diaphragmatic breathing. D. restructuring and setting priorities.

C Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. REF: 172-173

Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friends with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by: A. projection. B. denial. C. perception. D. repression.

C Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress. The perception of a stressor determines the person's emotional and psychological reactions to it. The other options are all defense mechanisms that do not explain the difference in reactions to a stressor. Cognitive Level: Understand (Comprehension) Nursing Process: Assessment NCLEX: Psychosocial Integrity Text page: 170

Stress reduction is not likely to result in A. reduced pain. B. lower blood pressure. C. decreased cognitive functions. D. decreased gastrointestinal problems.

C Stress reduction should benefit the individual by increasing cognitive ability rather than decreasing it.

Meditation is successful in promoting stress reduction because it A. prevents endorphin release. B. changes the client's energy field. C. quiets the sympathetic nervous system. D. activates the parasympathetic nervous system.

C Sympathetic nervous system stimulation prepares the body for fight or flight in response to stress. Meditation reduces this state of alert. REF: Page 167

The individual initially thinks, "I'll never get through this huge assignment," but then amends the thought to "I can get through the assignment by breaking it into small portions and doing them one by one." This thought process is an example of A. rationalization. B. wishful thinking. C. simple assertion. D. cognitive reframing.

D Cognitive reframing involves changing the way one looks at a problem, moving from a negative view to a more positive view. REF: Page 177-178

A client who is experiencing great stress associated with a disturbing new diagnosis asks the nurse, "Do you think saying a prayer would help?" The answer the nurse should give is A. "Of course you may pray if you wish. I'll leave you alone." B. "At the moment we should continue the stress assessment." C. "Shall I call the chaplain for you?" D. "If you find comfort in prayer, I'd encourage you to pray."

D People who include spiritual solutions to physical or mental distress often gain a sense of comfort and support that could aid in healing and lowering stress. Even prayer, by itself, can elicit the relaxation response, which is known to reduce stress physically, emotionally, and immunologically. REF: 170-171

Melissa, whose friend recently committed suicide, asks you some ways she could cope with her stress regarding the event. Which of the following options would be appropriate to discuss with Melissa? A. Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over B. Antianxiety medication to help her relax C. Starting a hobby to keep her mind off the troubling event D. Talking with friends and attending a loss support group

D Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem. Cognitive Level: Analyze (Analysis) Nursing Process: Implementation NCLEX: Psychosocial Integrity Text page: 170-171

An advantage of the Holmes and Rahe updated life event and social readjustment scale is that it A. focuses on the presenting symptoms. B. identifies the client's perception of events. C. considers the client's various mediating factors. D. assesses stress threshold and potential for future illness.

D The scoring of this scale gives nurses the capability of predicting a person's potential for future stress-related illness. REF: Page 172

What tool might be useful in assessing the amount of stress a client has experienced in the past year? A. NANDA Handbook B. DSM-IV-TR C. Quick Mental Status Assessment D. Life-Changing Event Questionnaire

D This questionnaire calls for the client to review events of the past year and score each. This is the only tool listed that assesses stress. REF: Page 1733 (Table 10-3)