Chapter 12 Stress and Adaptation(Davis)

One day while you are at work in the hospital, you hear news that a tornado is coming through the area. Everyone on staff must participate in disaster preparedness drills in addition to managing the normal workload. You feel ill prepared for the event and greatly stressed. This situation involves which type of stressor? 1) Situational 2) Developmental 3) Physiological 4) Psychosocial

1) Situational stressors are unpredictable. For example, you cannot predict if you will experience an automobile accident, a natural disaster, or an illness.

You are home alone one night when you hear the sound of glass shattering in the next room. It's a window, and it sounds like someone is trying to break in. You are frightened, and your body enters the alarm stage of the general adaptation syndrome. Which of the following physiological changes should you expect to occur at this time?SELECT ALL THAT APPLY. 1) Your adrenal cortex produces and secretes cortisol. 2) Endorphins are secreted to act as opiates. 3) Release of adrenaline increases mental alertness. 4) Heart rate and contraction force increase. 5) Depth of respiration decreases. 6) Blood vessels constrict, decreasing flow of blood to skeletal muscles.

1,2,3,4 Feedback 1: In response to a perceived stressor, adrenocorticotropic hormone stimulates the adrenal cortex to produce and secrete glucocorticoids (especially cortisol) and mineralocorticoids (especially aldosterone).Feedback 2: Endorphins, secreted by the hypothalamus and posterior pituitary, act like opiates to produce a sense of well-being and reduce pain.Feedback 3: The sympathetic nervous system stimulates the adrenal glands to secrete adrenaline and norepinephrine, which increase mental alertness.Feedback 4: The heart rate and contraction force increase.Feedback 5: The bronchioles dilate, thereby increasing, not decreasing, the depth of respiration and tidal volume.Feedback 6: Blood vessels dilate (not constrict), increasing flow of blood (and thus oxygen and energy) to skeletal muscles.

You are performing a thorough assessment of a client to determine all responses to stress. Which of the following are examples of cognitive responses to stress?SELECT ALL THAT APPLY. 1) Difficulty concentrating 2) Poor judgment 3) Depression 4) Forgetfulness 5) Lethargy 6) Aggressiveness

1,2,4 Feedback 1: Difficulty concentrating is a cognitive response to stress.Feedback 2: Poor judgment is a cognitive response to stress.Feedback 3: Depression is an emotional response to stress.Feedback 4: Forgetfulness is a cognitive response to stress.Feedback 5: Lethargy is an emotional response to stress.Feedback 6: Aggressiveness is a behavioral response to stress.

You are counseling a patient who has a highly stressful job about the long-term effects of stress on the body. Which of the following should you mention as organic disorders brought about by such stress?SELECT ALL THAT APPLY. 1) Myocardial infarction 2) Diabetes 3) Sickle cell anemia 4) Gastroesophageal reflux 5) Headaches 6) Blindness

1,2,4,5 Feedback 1: Continued secretion of epinephrine in response to stress may cause cardiovascular disorders including angina, myocardial infarction, cardiomegaly, and congestive heart failure, all of which lead to decreased cardiac output.Feedback 2: Continuing high levels of blood glucose and insulin in response to stress can cause diabetes.Feedback 3: Sickle cell anemia is an inherited disease and is not caused by stress.Feedback 4: The gastrointestinal system may respond to central nervous system stimulation in response to prolonged stress with constipation or diarrhea, gastroesophageal reflux, colitis, or irritable bowel syndrome.Feedback 5: Constant readiness for fight or flight produces muscle tension and pain in various body sites. Tension headache and temporomandibular joint pain result from prolonged muscle tension in the head, neck, and spine.

You have a new supervisor who is demanding and difficult to work with. Which of the following are adaptive coping strategies for managing this stressful situation?SELECT ALL THAT APPLY. 1) Consult an experienced nurse about how to manage the relationship. 2) Sign up for a kick-boxing course at your local gym. 3) Eat a box of chocolates whenever you feel stressed. 4) Have lunch with your supervisor and respectfully explain your concerns. 5) Drink a bottle of wine each night when you get home. 6) Take your dog for a walk in the park to clear your mind.

1,2,4,6 Feedback 1: Adaptive (effective) coping consists of making healthy choices that reduce the negative effects of stress (e.g., exercising to relieve tension, engaging in a favorite hobby, consulting others for support or advice).Feedback 2: Exercising to relieve tension is a healthy, adaptive coping strategy.Feedback 3: Maladaptive (ineffective) coping does not promote adaptation. Unhealthful coping choices include overeating, working too much, excessive sleeping, and substance abuse.Feedback 4: Communicating with your supervisor to express your concerns is an excellent coping strategy, because it addresses the source of the stress directly.Feedback 5: Substance abuse, such as drinking a bottle of wine each night, is an example of maladaptive coping.Feedback 6: Taking your dog for a walk in the park is a great coping strategy.

You are teaching a client who will be hospitalized next week how to minimize the stress of being in the hospital. Which of the following should you mention?SELECT ALL THAT APPLY. 1) Bring a computer or book to help prevent boredom and depression. 2) Bring cash or credit cards to purchase items at the gift shop. 3) Bring a notepad and pencils to take notes about what your providers tell you. 4) Ask family or friends to leave the room when the physician is making rounds. 5) Invite family members to visit you even if they have a minor illness. 6) Learn the name of your primary nurse on each shift.

1,3,6 Feedback 1: If you will feel well enough, bring your computer, reading material, crossword puzzles, or whatever you like to do that can help prevent boredom and depression.Feedback 2: Do not bring jewelry, cash, credit cards, or other valuables.Feedback 3: Bring a notepad and pencils so that you can take notes about what your primary care providers tell you (e.g., about diagnostic tests and instructions for care).Feedback 4: It helps to ask family or friends to stay at the bedside, particularly when the physician is "making rounds." They can advocate for you and help you feel confident that everything will go well.Feedback 5: Do not allow family or friends to visit if they are ill.Feedback 6: Know the name of your primary nurse (or nurses) on each shift, and ask as many questions as you need to.

A mother brings her 10-year-old daughter to your clinic because the girl has exhibited a limp in one leg for the past week. On examining her, you can find no cause for the condition. She does not complain of any pain, and when you ask why she is limping and what caused it, she just shrugs. You suspect a somatoform disorder. Which one of the following is it most likely to be? 1) Hypochondriasis 2) Somatization 3) Pain disorder 4) Malingering

2) In somatization, anxiety and emotional turmoil are expressed in physical symptoms, loss of physical function, pain that changes location often, and depression. The patient is unable to control the symptoms and behaviors, and complaints are vague or exaggerated.

A client arrives 15 minutes late for his appointment. He appears to be angry and impatient and says, "If you people would provide closer parking, I could be here on time." When you ask him whether he has fasted in preparation for his blood draw today, he looks surprised and says, "Nobody told me I needed to fast. Somebody here dropped the ball on that." What psychological defense mechanism is this client using? 1) Rationalization 2) Projection 3) Sublimation 4) Intellectualization

2) Projection is blaming others, attributing one's own personality traits, mistakes, emotions, motives, and thoughts to another; it is "finger pointing."

Which of the following is the correct definition of stress? 1) A stimulus that the person perceives as a challenge or threat 2) Any disturbance in a person's normal balanced state 3) A change that takes place as a result of disturbances and coping 4) A state of external and internal equilibrium

2) Stress is any disturbance in a person's normal balanced state.

You are caring for a client who claims to have frequent anxiety attacks. As you talk with her, however, you find that some of the client's responses are fear rather than anxiety, both of which are psychological responses to stress. Which of the following are true of anxiety?SELECT ALL THAT APPLY. 1) It is a cognitive response. 2) It is related to a future or anticipated event. 3) Its source is often not identifiable. 4) It results from physical threat. 5) It initiates the release of epinephrine. 6) It can be beneficial when mild to moderate.

2,3,5,6 Feedback 1: Fear is a cognitive response, whereas anxiety is an emotional response.Feedback 2: Fear is related to a present event, whereas anxiety is related to a future (or anticipated) event.Feedback 3: The source of fear is easily identifiable, whereas the source of anxiety may not be identifiable.Feedback 4: Fear can result from either a physical or a psychological event; anxiety results from psychological conflict rather than physical threat.Feedback 5: Anxiety and fear initiate the release of epinephrine, which stimulates the sympathetic nervous system and prepares the person for fight or flight.Feedback 6: Mild to moderate anxiety may be adaptive because it motivates and mobilizes the person to action. However, severe anxiety consumes energy and interferes with the person's ability to focus on and respond to what is really happening.

Which of the following are examples of the local adaptation syndrome (LAS), as opposed to the general adaptation syndrome (GAS)?SELECT ALL THAT APPLY. 1) Heart rate increasing after you almost crash on a motorcycle going 70 miles per hour 2) Your pupils contracting after you walk out of a dark movie theater into the bright sunlight 3) Muscles in the arms and legs tensing as you see a small child fall off a dock into the water 4) Your hand jerking back reflexively when you touch a pot handle that is very hot 5) Your skin becoming red and inflamed after you cut your foot on a piece of sharp metal 6) Respirations becoming deeper when a stranger approaches you on a dark street

2,4,5 Feedback 1: Heart rate increasing after a sudden scare is an example of the GAS, not the LAS.Feedback 2: Pupils contracting in response to light is an example of the LAS.Feedback 3: Muscles tensing in response to a child being in danger is an example of the GAS, not the LAS.Feedback 4: Your hand jerking back reflexively from a hot surface is an example of the reflex pain response, which is a common LAS response.Feedback 5: Your foot becoming red and inflamed after being cut is an example of the inflammatory response, which is a common LAS response.Feedback 6: Respiratory depth increasing when a threat is perceived is an example of the GAS, not the LAS.

You are seeing a 12-year-old client who has been severely bullied at his school. His mother explains that he often feigns being sick in the mornings and begs to stay home from school. When he does go to school, he intentionally delays and goes to class late, after the halls are clear. Which psychological defense mechanism is this client using? 1) Denial 2) Displacement 3) Avoidance 4) Minimization

3) Avoidance involves unconsciously staying away from events or situations that might open feelings of aggression or anxiety.

You are caring for a patient who is recovering from open heart surgery. For the first 24 hours following the surgery, you notice a pinkish fluid oozing from the incision site. Which phase of the inflammatory response does this represent? 1) Vascular response 2) Cellular response 3) Exudate formation 4) Healing

3) The fluid and white blood cells that move from the circulation to the site of injury are called exudate. The nature and quantity of exudate depend on the severity of injury and the tissues involved. For example, a surgical incision may ooze clear or pinkish exudate for a day or two.

A client has recently learned that she will have to have her foot amputated because of severe necrosis as a complication of her diabetes. She is devastated because of how this will affect her mobility. She also has hypertension and is concerned about how she will continue to exercise to manage her blood pressure and general health. She is a member of a local church, though, and many of her friends have already expressed a desire to help her remain active and mobile after the amputation. Still, the client tells you, "I don't know how I'm going to live with this." Which of the following personal factors is most likely to contribute to successful adaptation to this stressor? 1) Perception of the stressor 2) Overall health status 3) Hardiness 4) Support system

4) The client's strong support system of church members and friends is the personal factor that is most likely to contribute to successful adaptation.