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5. The nurse knows that the coping strategies that are more frequently seen in older adults are: (Select all that apply.) a. anger. b. withdrawal. c. information gathering. d. avoidance. e. problem focused.

ANS: A, B Cognitive changes may affect an older adult's ability to cope. Anger or withdrawal as coping strategies may be used more frequently than in the past.

7. The nurse manager of the unit is implementing a program to assist the nursing staff in managing compassion fatigue. Which intervention will be the most successful? (Select all that apply.) a. Support group that nurses can participate in that meets on the unit b. Exercise completion to encourage nurse to exercise and log their time c. Organized break times so nurses can get off the unit for breaks and lunches d. Quiet area on the unit where the nurses can go during break e. Promotion of work-life balance

ANS: A, B, C, D, E To care most effectively for others, nurses must first take time to care for themselves. Many of the stress reduction interventions incorporated into patient care plans can be effective in addressing the stressors faced by nurses. Exercise, balanced nutrition, and mindfulness therapy have been shown to help health care professionals in coping with the demands of patient care. Interventions designed specifically to prevent nurse burnout and address compassion fatigue include mentoring programs, quiet areas on a nursing unit for relaxation, availability of pastoral care, the sharing of feelings with trusted colleagues, and promotion of work-life balance.

6. The nurse manager of a busy oncology unit is concerned about compassion fatigue among her nursing staff. Which of the following signs and symptoms would alter her to this problem? (Select all that apply.) a. Nurses become very emotionally upset without an apparent cause. b. Nurses start to avoid caring for certain patients. c. Nurses start to call in sick more often. d. Nurses begin working more overtime. e. Nurses have difficulty showing empathy for patients.

ANS: A, B, C, E Compassion fatigue occurs when deeply caring and empathetic nurses become overwhelmed by the constant needs of patients and families. Symptoms include mood swings, avoidance of working with some patients, frequent sick days, irritability, reduced memory, poor concentration, and a decreased ability to show empathy.

3. The nurse knows that certain personality factors have been shown to buffer the impact of stress. These factors are: (Select all that apply.) a. resilience. b. sense of coherence. c. gender. d. hardiness. e. coping style.

ANS: A, B, D Personality factors such as resilience, hardiness, and sense of coherence can buffer the impact of stress, reducing the negative consequences. Gender is not a personality factor. Coping style refers to a pattern of measures taken to relieve stress but is not a personality factor.

1. The nurse knows that when patients are experiencing stress, the following change can be seen in their signs and symptoms: (Select all that apply.) a. Increase in heart rate b. Increase in gastric motility c. Pupil dilation d. Decrease in blood pressure e. Increase in respiratory rate

ANS: A, C, E The physiologic response to stress, whether physical or psychological, is 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.

4. The nurse knows that childhood stress related to the school experience centers on: (Select all that apply.) a. goal achievement. b. family dissolution. c. life changes. d. test anxiety. e. competition.

ANS: A, D, E Childhood stress related to the school experience centers on competition, goal achievement, and test anxiety. Family dissolution and life changes are not related to the school experience.

16. The nurse is educating the patient about alternative therapies. Which statement by the patient indicates a need for more information? a. Alternative therapies can include relaxation techniques. b. Alternative therapies are used in conjunction with medical therapies. c. Alternative therapies can be used when patients are experiencing stress. d. Some alternative therapists require certification.

ANS: B Alternative therapies are used in place of medical treatment. These types of interventions are useful when patients are experiencing physiologic and psychological responses to stress. Some complementary and alternative therapies such as therapeutic touch, Reiki, biofeedback, and massage therapy require additional certification and training, whereas muscle relaxation and guided imagery do not.

6. The nurse is providing discharge instructions for a patient with multiple sclerosis (an autoimmune disease). Which discharge instruction is aimed at preventing a future exacerbation? a. Engage in some form of exercise as tolerated. b. Avoid highly stressful situations. c. Check your skin regularly for pressure sores. d. Eat a diet with lots of fiber.

ANS: B High stress levels are known to exacerbate multiple sclerosis and other autoimmune diseases. Exercise helps keep muscles loose and helps with balance, and assessing skin for pressure sores and eating a diet with high fiber prevents complications from multiple sclerosis.

14. The nurse knows that when coordination between multiple health care disciplines is needed, the following role is used: a. Pastoral care b. Case manager c. Social worker d. Dietitian

ANS: B If coordination of care between multiple health care disciplines is needed, a case manager is used. Pastoral care plays a significant role in addressing stress and anxiety issues when the patient has a preferred religion or strong faith background. A social worker identifies appropriate services and resources. A dietician can provide education regarding dietary needs and food choices.

1. The nurse knows that one theory explaining the variation in response to stress among individuals is called: a. stress appraisal. b. sense of coherence. c. allostasis. d. homeostasis.

ANS: B Sense of coherence (SOC) is a characteristic of personality that references one's perception of the world as comprehensible, meaningful, and manageable. Stress appraisal is the automatic, often unconscious assessment of a demand or stressor. Allostasis is an alternative term for the stress response. Homeostasis is the tendency of the body to seek and maintain a condition of balance or equilibrium.

4. The nurse is measuring her patient's blood glucose levels after an acute myocardial infarction (MI). She knows the rationale for doing this is: a. damaged muscle tissue releases glucose. b. corticosteroids increase glucose. c. myocardial infarctions are often seen in diabetics. d. all patients should have their blood glucose checked.

ANS: B The endocrine system responds to stress on the body such as what happens during an acute MI. Corticosteroids are important in the stress response because they increase serum glucose levels and inhibit the inflammatory response. Although MIs can be seen in diabetics, there is nothing to indicate this patient is diabetic. All patients do not routinely have their blood glucose checked regularly.

2. The nurse knows that the body's response to the release of hormones in the "fight or flight" response is which of the following? (Select all that apply.) a. Decreased respiratory rate b. Slowing of the digestive process c. Glucose being mobilized from the liver d. Pupils dilating e. Smooth muscles in the bronchi constricting

ANS: B, C, D The release of hormones increases the heart rate, resulting in increased cardiac output and elevated blood pressure. There is an increase in the flow of blood to muscles at the expense of the digestive and other systems not immediately needed in the fight-or-flight response. Smooth muscles in the bronchi relax and dilate the bronchi and smaller airways, and the respiratory rate increases, allowing for an enhanced flow of well-oxygenated blood to muscles and other organs. The motility of the digestive tract is decreased, slowing digestive processes, but glucose and fatty acids are mobilized from the liver and other stores to support increased mental activities (alertness) and skeletal muscle function. Pupillary dilation produces a larger visual field.

11. The nurse knows an appropriate goal for the nursing diagnosis of Ineffective coping would be: a. The patient will report an ability to remember discharge instructions. b. The patient's family will understand how to access respite care services. c. The patient will discuss possible coping strategies during weekly counseling sessions. d. The patient will attend an online support group weekly.

ANS: C An appropriate goal for Ineffective coping would be to discuss coping strategies. Remembering discharge instructions is an appropriate goal for Anxiety. Understanding how to access respite care services is an appropriate goal for Caregiver role strain, and attending a support group is an appropriate goal for Readiness for enhanced coping.

3. The nurse is caring for a patient who is undergoing a major cardiac procedure. The patient tells you her heart is racing and she feels nauseated. You know this is part of hormone response known as: a. sense of coherence. b. stress appraisal. c. fight or flight. d. sympathoadrenal response.

ANS: C In the "fight or flight" response, the corticotropin-releasing hormone (CRH) released by the hypothalamus stimulates the pituitary to release adrenocorticotropic hormone (ACTH). These hormones increase the heart rate, resulting in increased cardiac output, and the motility of the digestive tract is decreased, slowing digestive processes that could result in abdominal distress. Sense of coherence (SOC) is a characteristic of personality that references one's perception of the world as comprehensible, meaningful, and manageable. Stress appraisal is the automatic, often unconscious, assessment of a demand or stressor. The sympathoadrenal response is a consequence of hypothalamic activation in sympathetic stimulation, which triggers epinephrine and norepinephrine release from the adrenal medulla.

18. The nurse is seeing a patient during a follow-up visit after discharge in which the patient had a nursing diagnosis of Ineffective coping. Which statement by the patient would be a cause for concern? a. "I am sleeping better most nights." b. "I feel less anxious." c. "I do not need to do the relaxation exercises anymore." d. "I am continuing my exercises every day."

ANS: C Patients should continue using the stress-reduction techniques to maintain a feeling of well-being. Once stress decreases, patients typically report feeling better, sleeping more soundly, and feeling less anxious. Continuing their positive activities such as exercising is good.

12. The nurse knows an appropriate goal for Stress overload is: a. The patient will attend a weekly support group. b. The patient will discuss possible coping strategies during weekly office visits. c. The patient will discuss strategies for coping with relationship violence within 24 hours. d. The patient's family will use respite care once a week for the next month.

ANS: C Strategies for coping with relationship violence within 24 hours (short timeframe) is an appropriate goal for Stress overload. Attending a weekly support group is an appropriate goal for Readiness for enhanced coping. An appropriate goal for Ineffective coping would be to discuss possible coping strategies during weekly visits. Using respite care once a week for the next month is an appropriate goal for Caregiver role strain.

15. The nurse is providing education to a patient around anger management strategies. Which statement indicates a need for further education by the patient? a. "Exercise can help me deal with the anger." b. "I can use humor." c. "I can punch things." d. "I can take a time out."

ANS: C Strategies should focus on non-violent methods. Some anger management interventions include expressing feelings in a calm, non-confrontational manner; exercising; identifying potential solutions; taking a time out; forgiving; diffusing the situation with humor; owning one's feelings; and breathing deeply.

7. The nurse is assessing level of stress in a patient from another culture. Which question is the most appropriate in helping the nurse understand the impact of the patient's belief system? a. "Do you engage in prayer to help you during times of stress?" b. "Do you go to church or other form of organized worship?" c. "Do you have certain beliefs that are helpful during times of stress?" d. "Do you want spiritual counseling while you are here?"

ANS: C The nurse needs to obtain a knowledge base of the patient's culture as well as identify health beliefs and cultural values from the patient's worldview. Asking the patient specific questions about prayer or church or spiritual counseling is inappropriate until the nurse first understands what the patient's own beliefs and practices are.

13. The nurse knows that an appropriate goal for Readiness for enhanced coping would be: a. The patient will report an ability to focus on discharge instructions. b. The patient will attend a coping skills class on a weekly basis. c. The patient will discuss possible coping strategies during weekly office visits. d. The patient will discuss strategies for coping with relationship violence within 24 hours.

ANS: C The patient will discuss possible coping strategies during weekly office visits is an appropriate goal for Readiness for enhanced coping. The patient will report an ability to focus on discharge instructions is an appropriate goal for Anxiety. An appropriate goal for Ineffective coping would be to discuss possible coping strategies during weekly visits. Strategies for coping with relationship violence within 24 hours (short timeframe) is an appropriate goal for Stress overload.

8. The nurse is performing a physical assessment of patient who is undergoing a bone marrow biopsy. What finding by the nurse indicates the patient is experiencing stress? a. Blood pressure of 120/84 b. Temperature of 37.5° C c. Heart rate of 110 beats/min d. Respiratory rate of 10 breaths/min

ANS: C The release of hormones increase the heart rate, resulting in increased cardiac output and elevated blood pressure. A reading of 120/84 is a normal blood pressure, and temperature is elevated is indicative of an infection. The respiratory rate increases in stress not decreases.

9. The nurse is assessing the patient's use of coping skills in response to stressful situations. Which of the following questions is the most useful? a. "Have you been evaluated for stress?" b. "Do you have someone you can go to for help when you are stressed?" c. "How have you managed stressful situations in the past?" d. "Does stress cause you to experience muscle tension or headaches?"

ANS: C The use of open-ended questions assists in obtaining accurate information regarding the patient's stressors and coping skills. Questions that elicit yes/no answers will not allow the patient to provide as much information. Asking the patient about headaches and tension is asking about physical symptoms, not coping skills.

17. The nurse is educating the patient on the use of relaxing therapy. Which statement by the patient indicates a need for further education? a. "I should relax my muscles from head to toe." b. "I visual the relaxed muscle." c. "I should do this three times a week." d. "I focus on muscles that are tense."

ANS: C This technique should be done daily. Typically, relaxation progresses from head to toe. With practice, the patient visualizes an image of the relaxed muscles and will be able to relax muscles from the mental image. Progressive relaxation is implemented by having patients focus on muscles that are tensed and then intentionally relax those muscle groups.

10. The nurse is caring for a patient on a medical-surgical inpatient unit. The patient tells the nurse he is very sad and is considering suicide. What is the first thing the nurse should do? a. Notify the health care provider. b. Make a referral to psychiatric services. c. Implement one-on-one observations. d. Document in the electronic medical record.

ANS: C Verbalization of suicidal ideation or a suicide plan must be taken seriously. In the case of a hospitalized patient, one-on-one observation should be implemented to ensure patient safety. Once the patient is under observation, the health care provider is notified to put in the referral; nurses generally do not put in the referral. Documentation is always done after the patient's safety is ensured.

2. The nurse is caring for a patient with a new diagnosis of diabetes type 2. Which of the following statements indicates a negative coping response? a. "I will look up information on the Internet about diabetes." b. "I will join a support group." c. "I will only focus on learning to manage my medication first." d. "I will make changes slowly so I can adapt to each change."

ANS: C When the patient puts limits on learning by stating he/she will only learn about medication, he/she is using avoidance strategies to alleviate stress. Using strategies such as information gathering (seeking information about diabetes) is positive. Joining support groups and making changes slowly to adapt is also taking direct action by moving forward.

5. The nurse is teaching her patient about the difference between mild anxiety and moderate anxiety. Which statement by the patient indicates a need for further education? a. "Mild anxiety can help me remember things." b. "Moderate anxiety will narrow my focus." c. "Mild anxiety will help me be creative." d. "Moderate anxiety will increase my perception."

ANS: D Moderate anxiety narrows a person's focus, dulls perception, and may challenge a person to pay attention or use appropriate problem-solving skills. Mild anxiety can be motivational, foster creativity, and actually increase a person's ability to think clearly.