Chapter 32 Combined

A client who has been diagnosed with a sexually transmitted disease (STD) asks that this information not be shared with her family members. Which of the following responses from the nurse would be appropriate?

" ""Your health information is confidential, and I can't talk to anyone about it without your permission.""

(SELECT ALL THAT APPLY) After being examined by the forensic nurse in the emergency department, a rape victim is prepared for discharge. Due to the nature of the attack, this client is at risk for posttraumatic stress disorder (PTSD). Which symptoms are associated with PTSD?

" 1. Recurrent, intrusive recollections or nightmares 3. Sleep disturbances 6. Difficulty concentrating "

(SELECT ALL THAT APPLY) A physician prescribes clomipramine (Anafranil) for a client diagnosed with obsessive-compulsive disorder (OCD). What instructions should the nurse include when teaching the client about this medication?

"1. Avoid hazardous activities that require alertness or good coordination until adverse central nervous system (CNS) effects are known. 2. Avoid alcohol and other depressants. 3. Use saliva substitutes or sugarless candy or gum to relieve dry mouth. "

The nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior?

"1. By designating times during which the client can focus on the behavior

The nurse in a psychiatric inpatient unit is caring for a client with obsessive-compulsive disorder. As part of the client's treatment, the psychiatrist orders lorazepam (Ativan), 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to:

"1. avoid caffeine.

A nurse notices that a client who came to the clinic for treatment of anxiety disorder has a strong body odor. What can the nurse do or say to help this client?

"2. Ask the client basic hygiene questions to determine how frequently he bathes.

The nurse is caring for a client with panic disorder who has difficulty sleeping. Which nursing intervention would best help the client achieve healthy long-term sleeping habits?

"2. Encouraging the use of relaxation exercises

A nurse on the psychiatric unit realizes that she typically fails to administer medications according to schedule. What's the best way for the nurse to improve her medication administration practice?

"2. Evaluate her current practice and devise an improvement plan.

The nurse is formulating a short-term goal for a client suffering from a severe obsessive-compulsive disorder (OCD). An appropriately stated short-term goal is that after 1 week, the client will:

"2. participate in a daily exercise group.

Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?

"3. Fluvoxamine (Luvox) and clomipramine (Anafranil)

A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time?

"3. Risk for injury

Which nursing intervention would be most helpful for a client experiencing a panic attack?

"3. Staying with the client and remaining calm, confident, and reassuring

A client admitted to the psychiatric unit for treatment of repeated panic attacks comes to the nurses' station in obvious distress. After observing that the client is short of breath, dizzy, trembling, and nauseated, the nurse should first:

"3. escort the client to a quiet area and suggest using a relaxation exercise that he's been taught.

A client who lost her home and dog in an earthquake tells the admitting nurse at the community health center that she finds it harder and harder to "feel anything." She says she can't concentrate on the simplest tasks, fears losing control, and thinks about the earthquake incessantly. She becomes extremely anxious whenever the earthquake is mentioned and must leave the room if people talk about it. The nurse suspects that she has:

"3. posttraumatic stress disorder (PTSD).

While being escorted to an operating room, a client is extremely anxious and says, "I really don't know what they're going to do to me today. The physician said I have a lump in my breast and that's all I know." Which action is appropriate for the nurse to take?

"4. Notify the physician upon arrival at the operating room.

While administering medications to a group of clients admitted with anxiety, a nurse hears someone call for help. The nurse should respond by:

"4. locking the medication cart and responding to the call for help.

A 59-year-old client is scheduled for cardiac catheterization the next morning. His physician prescribed secobarbital sodium (Seconal), 100 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:

"4. sedatives reduce excitement; hypnotics induce sleep.

The physician orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse would be most appropriate?

"Do you have any concerns about taking the medication?"

A client, age 40, is admitted for a surgical biopsy of a suspicious lump in her left breast. When the nurse comes to take her to surgery, she is tearfully finishing a letter to her two children. She tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic?

"In case anything goes wrong? What are your thoughts and feelings right now?"

During the client-teaching session, which instruction should the nurse give to a client receiving alprazolam (Xanax)?

"Inform the physician if you become pregnant or intend to do so."

Before eating a meal, a client with obsessive-compulsive disorder (OCD) must wash his hands for 18 minutes, comb his hair 444 strokes, and switch the bathroom light on and off 44 times. What is the most appropriate goal of care for this client?

"Systematically decrease the number of repetitions of rituals and the amount of time spent performing them.

A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with:

"repetitive thoughts and recurring, irresistible impulses.

Which of the following is an example of the general adaptation syndrome? A. Alarm reaction B. Inflammatory response C. Fight-or-flight response D. Ego-defense mechanisms

A

The nurse is caring for a Vietnam War veteran with a history of explosive anger, unemployment, and depression since being discharged from the service. The client reports feeling ashamed of being "weak" and of letting past experiences control thoughts and actions in the present. What is the nurse's best response?

1. "Many people who have been in your situation experience similar emotions and behaviors."

A client with a history of drug and alcohol abuse is concerned that the hospital will divulge her history to her employer without her knowledge. What response by the nurse would be appropriate?

1. "Your personal health information can't be disclosed to your employer without your permission."

During a panic attack, a client runs to the nurse and reports breathing difficulty, chest pain, and palpitations. The client is pale with his mouth wide open and eyebrows raised. What should the nurse do first?

1. Assist the client to breathe deeply into a paper bag

During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction?

1. Ataxia

Because antianxiety agents such as lorazepam (Ativan) can potentiate the effects of other drugs, the nurse should incorporate which instruction in her teaching plan?

1. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants

(SELECT AL THAT APPLY) A 54-year-old client diagnosed with generalized anxiety disorder is admitted to the facility. Which therapeutic modalities are typically used to treat this disorder?

1. Biofeedback 2. Buspirone 3. Relaxtion technique

The nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to prescribe which psychotropic drug regimen for this client?

1. Buspirone (BuSpar), 5 mg orally three times per day "

After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client?

1. Exploring the meaning of the traumatic event with the client

The nurse notices that a client with obsessive-compulsive disorder dresses and undresses numerous times each day. Which comment by the nurse would be therapeutic?

1. I saw you change clothes several times today. That must be very tiring.

A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction formation?

1. The client assumes an attitude that is the opposite of an impulse that the client harbors.

While in the facility, a client with obsessive-compulsive disorder saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures from them. Which outcome would indicate successful treatment for this client?

1. The client throws away all disposable cups

Lorazepam (Ativan) is often given along with a neuroleptic agent, such as haloperidol (Haldol). What is the purpose of administering the drugs together?

1. To reduce anxiety and potentiate the sedative action of the neuroleptic

A client is admitted to the psychiatric unit with a diagnosis of conversion disorder. Since witnessing the beating of his wife at gunpoint, he has been unable to move his arms, complaining that they are paralyzed. When planning the client's care, the nurse should focus on:

1. helping the client identify and verbalize feelings about the incident.

A client with borderline personality disorder tells the nurse, "You're the only nurse who really understands me. The others are mean." The client then asks the nurse for an extra dose of antianxiety medication because of increased anxiety. How should the nurse respond?

2. ""I'll have to discuss your request with the team. Can we talk about how you're feeling right now?""

A physician's order states to administer lorazepam (Ativan), 20 mg by mouth twice per day, to treat anxiety. How should the nurse proceed?

2. Clarify the order with the prescribing physician because the amount prescribed exceeds the recommended dose.

A client in a psychiatric facility is prescribed escitalopram (Lexapro) for anxiety. She tells the nurse that she has been having "weird dreams" and feelings of wanting to "end it all." What action should the nurse take?

2. Consult a pharmacist to see if these symptoms are adverse effects of the drug.

"After months of coaxing by her husband, a client comes to the mental health clinic. She reports that she suffers from an overwhelming fear of leaving her house. This overwhelming fear has caused the client to lose her job and is beginning to take a toll on her marriage. The physician diagnoses the client with agoraphobia. Which treatment options are effective in treating this disorder?

2. Desensitization 3. Alprazolam (Xanax) therapy 4. Paroxetine (Paxil) therapy

A client is diagnosed with obsessive-compulsive disorder. Which intervention should the nurse include when assisting with development of the plan of care?

2. Giving the client adequate time to perform rituals

A client tells the nurse that she has an overwhelming fear of having a heart attack. This client is most likely suffering from which disorder?

2. Panic disorder

(SELECT ALL THAT APPLY) After receiving a referral from the occupational health nurse, a client comes to the mental health clinic with a suspected diagnosis of obsessive-compulsive disorder. The client explains that his compulsion to wash his hands is interfering with his job. Which interventions are appropriate when caring for a client with this disorder?

2. Support the use of appropriate defense mechanisms. 4. Explore the patterns leading to the compulsive behavior. 6. Encourage activities, such as listening to music."

A client diagnosed as having panic disorder with agoraphobia is admitted to the inpatient psychiatric unit. Until her admission, she had been a virtual prisoner in her home for 5 weeks, afraid to go outside even to buy food. When planning care for this client, what is the nurse's overall goal?

2. To help the client function effectively in her environment

A nurse has been providing care to the same group of clients for 4 consecutive days. On day 5, she sees that her assignment has changed, and she is concerned about the continuity of care for these clients. What should the nurse do?

2. Voice her concerns about continuity of care with the charge nurse.

During a shift report, the nurse learns that she will be providing care for a client who's vulnerable to panic attacks. Treatment for panic attacks includes behavioral therapy, supportive psychotherapy, and medication such as

2. antianxiety drugs.

The nurse is collecting data on a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:

2. diarrhea

Initial interventions for the client with acute anxiety include:

2. encouraging the client to verbalize feelings and concerns.

A client with a conversion disorder reports blindness, and ophthalmologic examinations reveal that no physiologic disorder is causing progressive vision loss. The most likely source of this client's reported blindness is:

2. having been forced to watch a loved one's torture.

While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client may expect the resident to prescribe:

2. lorazepam (Ativan).

A client with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:

2. severe anxiety and fear.

A woman, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. The client asks the nurse, "Why has this happened to me?" What is the most appropriate response?

3. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."

A client is undergoing treatment for an anxiety disorder. Such a disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least:

3. 6 months

A client enters the crisis unit complaining of increased stress from her studies as a medical student. She states that she has been increasingly anxious for the past month. Her physician prescribes alprazolam (Xanax), 25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when given concomitantly with alprazolam?

3. Diphenhydramine (Benadryl)

A nurse observes a medical student walk into a client's room and begin questioning her about her current health status. The client appears reluctant to respond. How should the nurse intervene?

3. Explain to the client that she has the right to refuse to answer questions asked by the medical student.

A client admitted to the unit is visibly anxious. When collecting data on the client, the nurse would expect to see which cardiovascular effect produced by the sympathetic nervous system?

3. Increased heart rate

A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. The nurse notices that the client's hair is thinning and the skin on the forehead is irritated — possible effects of this ritual. When planning the client's care, the nurse should assign highest priority to:

3. setting consistent limits on the ritualistic behavior if it harms the client or others.

The nurse is caring for a client experiencing an anxiety attack. Appropriate nursing interventions include:

3. staying with the client and speaking in short sentences.

During the admission data collection, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What is the nurse's best response?

4. ""You're having a panic attack. I'll stay here with you

During a panic attack, a client hyperventilates, becomes unable to speak, and reports symptoms that mimic those of a heart attack. Which nursing intervention would be best?

4. Accompany the client to his room; remain there and provide instructions in short, simple statements.

Victims of sexual assault can experience posttraumatic stress reactions after the attack. Which of the following statements best describes symptoms associated with posttraumatic stress disorder (PTSD)?

4. Flashbacks, recurring dreams, and numbness

(SELECT ALL THAT APPLY) A registered nurse caring for a client with generalized anxiety disorder identifies a nursing diagnosis of Anxiety. The short-term goal identified is: The client will identify his physical, emotional, and behavioral responses to anxiety. Which nursing interventions will help the client achieve this goal?

4. Observe the client for overt signs of anxiety. 5. Help the client connect anxiety with uncomfortable physical, emotional, or behavioral responses. 6. Introduce the client to new strategies for coping with anxiety, such as relaxation techniques and exercise.

While driving home from work, a nurse realizes that she failed to communicate to the oncoming nurse that a client asked for more information about advance directives. Which action would be appropriate for the nurse to take?

4. Phone the nurse caring for the client and inform her of the client's request.

The nurse discovers that a client with obsessive-compulsive disorder (OCD) is attempting to resist the compulsion. Based on this finding, the nurse should look for signs of:

4. increased anxiety.

A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. Your best response would be which of the following? A. "Are you thinking of suicide?" B. "You've been doing a good job raising your children. You can do it!" C. "Is there someone who can help you?" D. "You have so much to live for."

A

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." The patient is using the defense mechanism: A. Denial. B. Conversion. C. Dissociation. D. Displacement.

A

A trauma occurs, and its effects sometimes last well after the event ends: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

A

An experience a person is exposed to through a stimulus or stressor: A. Stress B. Allostatic load C. Appraisal D. Stressors

A

Arousal of the sympathetic nervous system: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

A

Body stabilizes and responds in the opposite manner to the alarm reaction: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

A

Major homeostatic mechanisms are controlled by all of the following except: A. Thymus gland B. Pituitary gland C. Medulla Oblongata D. Reticular Formation

A

Person's effort to manage psychological stress: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

A

When teaching a patient about the negative feedback response to stress, the nurse includes which of the following to describe the benefits of this stress response? A. Results in neurophysiological response. B. Reduces body temperature C. Causes a person to be hypervigilant D. Reduces level of consciousness to conserve energy.

A

Which definition does not characterize stress? A. Efforts to maintain relative constancy within the internal environment. B. A condition eliciting an intellectual, behavioral, or metabolic response. C. Any situation in which a nonspecific demand requires an individual to respond or take action. D. A phenomenon affecting social, psychological, developmental, spiritual, and physiological dimensions.

A

A First and most important the parents need to know the immediate status of their daughter. Letting them know the situation will help to relieve their immediate stress. Second, helping the parents calm down and reduce their stress will allow them to see their daughter without increasing the 10-year-old's anxiety. Third, let the parents know you recognize their need to talk to the doctor as soon as possible and you will act as their advocate to get that accomplished. Last, but important, you want to ask if there is anyone you can call to help. There may be children who need to be picked up from camp/day care, and a neighbor or grandparent may be able to assist.

A 10-year-old girl was playing on a slide at a playground during a summer camp. She fell and broke her arm. The camp notified the parents and took the child to the emergency department according to the camp protocol for injuries. The parents arrive at the emergency department and are stressed and frantic. The 10-year-old is happy in the treatment room, eating a Popsicle and picking out the color of her cast. What is the correct order for the nurse's discussion with the parents? 1. "Can I contact someone to help you?" 2. "Your daughter is happy in the treatment room, eating a Popsicle and picking out the color of her cast." 3. "I'll have the doctor come out and talk to you as soon as possible." 4. "Let me help you two calm down a bit so I can take you to your daughter." A. 2, 4, 3, 1 B. 4, 2, 1, 3 C. 3, 1, 4, 2 D. 2, 3, 4, 1

1, 4 Crisis occurs when a person encounters a major change in his or her life and tries to cope with it. External sources such as a change in job, a car accident, a death, or severe illness provoke situational crisis. A new life developmental stage such as a marriage, the birth of a child, or retirement, requires coping with developmental crisis. A major disaster or crime of violence is example of adventitious crisis.

A 34-year-old man is getting married. He is waiting in the church for the bride to arrive. On the way to the church, the bride's father is in a motor vehicle accident and dies at the scene. The bride is grieving the loss of her father. However, the groom is not aware of what has happened. What type of crisis are the bride and the groom experiencing? Select all that apply. 1 The bride is in situational crisis. 2 The groom is in adventitious crisis. 3 The bride is in developmental crisis. 4 The groom is in developmental crisis. 5 The bride is in adventitious crisis.

1 Although this sounds abrupt, the patient usually is relieved that you've broached this issue. For safety reasons it is very important to discuss the patient's suicidal thoughts.

A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. What is your best response? 1 "Are you thinking of suicide?" 2 "You've been doing a good job raising your children. You can do it!" 3 "Is there someone who can help you?" 4 "You have so much to live for.

D You need to get information about what the gentleman means when he says he can't go on any longer. He might be thinking of turning his children over to a grandparent or seeking other child-care arrangements. Asking about suicide initially might be premature. Asking, "Are you thinking of suicide?" prematurely might shut the patient down entirely. If the patient talks about suicide, for safety reasons it is very important to further discuss his suicidal thoughts and refer to the appropriate health care professional. Asking the open-ended question provides an opportunity to understand what the person is thinking and open lines of communication.

A 34-year-old single father who is anxious, tearful, and tired from caring for his three young children tells the nurse that he feels depressed and doesn't see how he can go on much longer. Which of the following would be the nurse's best response? A. "Are you thinking of suicide?" B. "You've been doing a good job raising your children. You can do it!" C. "Is there someone who can help you during the evenings and weekends?" D. "What do you mean when you say you can't go on any longer?"

1, 5 Regression is a defense mechanism that happens unconsciously to cope with a stressor. It includes actions and behaviors related to an earlier developmental period in life. Defense mechanisms, as a rule, do not result in psychiatric disorders but are very helpful in coping with the stress. The use of defense mechanisms does not predict the development of a psychiatric disorder in the future. Drinking milk from the younger brother's cup is an example of regression; it is not an example of displacement. The use of defense mechanisms does not predict the development of an intellectual disability in the future.

A 35-year-old patient approaches the nurse for advice about her children, who are ages 8 and 3 years. The patient informs the nurse that the older son likes drinking milk from his brother's sippy cup. What should the nurse explain to the woman? Select all that apply. 1 The elder son is using a regression defense mechanism. 2 The elder son will develop psychiatric disorders in future. 3 The elder son is using a displacement defense mechanism. 4 The elder son will develop intellectual disability in the future. 5 The elder son obtains psychological protection from stress with this behavior.

1, 2, 5 The priority nursing intervention should be the son, who has Down syndrome. The son can participate in respite care. This would reduce the caregiver burden much more successfully than in-home services. Other measures that can reduce stress in the mother include referring her to support groups to seek help. These groups help to lower stress related to caregiving. The patient can also do yoga and meditation to manage stress. Prescribing antidepressants to the mother is not required as she is not depressed. The patient does not suffer from a psychiatric illness; therefore, admission to a psychiatric ward is not required

A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The patient's facial expressions and mannerisms demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The nurse understands that the patient is experiencing caregiver role strain. What interventions should the nurse plan for the mother and son? Select all that apply. 1 Refer the son to respite care. 2 Refer the patient to support groups. 3 Prescribe antidepressants to the patient. 4 Admit the patient to the psychiatric ward. 5 Advise the patient to do yoga and meditation.

4, 5 The patient feels worthless and is unable to cope with stressful events in her life; therefore, the diagnosis should be ineffective coping. The patient is feeling overburdened with the caregiving responsibilities of her son. Therefore, an additional diagnosis should be caregiver role strain. Anemia and depression are medical diagnoses and are not indicated in this case

A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The patient's facial expressions and manners demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The patient states that she feels worthless and is overburdened with her responsibilities. What are the differential nursing diagnoses for this patient? Select all that apply. 1 Anemia 2 Psychosis 3 Depression 4 Ineffective coping 5 Caregiver role strain

A young adult's chief complaint is "seizure fits." A chart review shows a negative EEG report and a normal neurological consultation report. A psychosocial history reveals increased family stress, bankruptcy, and a recent divorce. The nurse recognizes that this young man's pseudo-seizures most likely are an example of which unconscious coping mechanism? Conversion

A conversion reaction is an ego defense mechanism that involves repressing an anxiety-producing conflict and transforming it into a nonorganic symptom such as difficulty sleeping, loss of appetite, or sudden blindness without medical cause. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Dissociation involves experiencing a subjective sense of numbing and a reduced awareness of one's surroundings. Denial is seen as avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain.

A, C, D The stressors for this parent are her child's illness, missing school, and loss of disability payments. Obtaining resources to resolve these stressors will reduce the mother's stress load and allow her to focus on helping her child improve and preventing another respiratory tract infection. Discharging the child in 72 hours with a return to school may not be best for the child's physical condition and may make the situation worse. Giving the mom a 6-week time frame is unrealistic because everyone's time frame is different. The mom may also need to adjust to a "new normal."

A crisis intervention nurse is working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her child's disability payment while the child is hospitalized. The mother worries that her daughter will fall behind in special-school classes during hospitalization. Which strategies are effective in helping this mother cope with these stressors? (Select all that apply.) A. Referral to social service process reestablishing the child's disability payment B. Sending the child home in 72 hours and having the child return to school C. Coordinating hospital-based and home-based schooling with the child's teacher D. Teaching the mother signs and symptoms of a respiratory tract infection E. Telling the mother that the stress will decrease in 6 weeks when everything is back to normal

1 A situational crisis occurs when external sources such as a job change, motor vehicle crash, death, or severe illness trigger stress. Therefore, all the people who survived the accident may have a situational crisis. A developmental crisis occurs when there is a change in the developmental stage of a person such as a marriage, the birth of a child, or retirement that requires new coping styles. Therefore, the husband and wife will not have a developmental crisis. An adventitious crisis occurs in situations of a major natural disaster, man-made disaster, or a crime of violence. Therefore, none of the survivors will have an adventitious crisis.

A family of three consisting of a husband, wife, and son were involved in a motor vehicle accident. The husband and wife did not sustain any major injuries, but the child died. What could be the possible outcome of this accident? 1 The husband may have a situational crisis. 2 The wife may have a developmental crisis. 3 The husband may have a developmental crisis. 4 The husband and wife may have an adventitious crisis.

Which of the following nurses is most likely to experience the greatest amount of stress related to his or her position as a nurse? a) A graduate nurse working on a telemetry unit b) A nurse with 1 year of experience working on an oncology unit c) A nurse who is an editor of a nursing journal d) A nurse with 10 years of experience working as a nurse educator

A graduate nurse working on a telemetry unit Explanation: Stress is often greater for new graduate nurses and nurses who work in settings such as an intensive care unit and emergency care.

C An adventitious crisis is a type of crisis resulting from a natural disaster such as a tsunami.

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of: A. A situational crisis. B. A maturational crisis. C. An adventitious crisis. D. A developmental crisis.

3 An adventitious crisis is a type of crisis resulting from a natural disaster such as a tsunami.

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. What is this is an example of? 1 A situational crisis 2 A maturational crisis 3 An adventitious crisis 4 A developmental crisis

A senior college student contacts the college health clinic about a freshman student living on the same dormitory floor. The senior student reports that the freshman is crying and is not adjusting to college life. The clinic nurse recognizes this as a combination of situational and maturational stress factors. The best comment to the senior student would be "Give her this list of university and community resources."

A health care provider can help to reduce situational stress factors for individuals. Providing the student with a list of resources is one way to begin this process, as part of secondary prevention strategies. This is not a medical or psychiatric emergency, so calling 911 is not necessary. Not everyone who has sadness needs medications; some need counseling only. Not enough information is given to know whether the student would be best suited to leave college.

An assessment finding example for caregiver strain would be which of the following? Caregiver has not received medical care when ill.

A nurse will identify a caregiver's lack of self-care as a potential example of caregiver role strain. Sacrificing their own health to care for the identified patient places caregivers at risk for becoming ill themselves. If caregivers jeopardize their own health, they may not be able to care for the actual patient. In all of the other options, the caregiver is handling caregiver stress appropriately.

Upon arrival to the emergency room, the mother of a patient involved in a motor vehicle accident becomes upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breathe. What is the mother likely experiencing? a) Severe anxiety b) A panic attack c) Mild anxiety d) Moderate anxiety

A panic attack Explanation: Panic causes the person to lose control and experience dread and terror. Panic is characterized by a disorganized state, increased physical activity, difficulty communicating, agitation, trembling, dyspnea, palpitations, a choking sensation, and sensations of chest pressure or pain. Severe anxiety creates a narrow focus on specific detail; moderate anxiety leads to a focus on immediate concerns; and mild anxiety is often present in day-to-day living, and it increases alertness and perceptual fields.

2, 3, 4, 5 Sleeping excessively is an ineffective coping mechanism to escape reality. Laughing inappropriately is an inappropriate behavior and indicates ineffective coping. A lack of interest in food may indicate depression and ineffective coping. Similarly, weight loss may be a sign the patient is not coping well. Giving appropriate answers to questions indicates the patient is able to concentrate and implies that the patient is coping well with the illness.

A patient is diagnosed with breast cancer. She is upset about the diagnosis. What assessment findings indicate ineffective coping related to the stress of her illness? Select all that apply. 1 The patient gives appropriate answers to the questions asked. 2 The patient sleeps excessively. 3 The patient laughs inappropriately. 4 The patient shows lack of interest in food. 5 The patient has lost 11 lbs (5 kg) of weight in 2 weeks.

1 The patient is experiencing a situational crisis due to the diagnosis. Situational crises are responses to various situations in life, including a job change, chronic illness, or a motor vehicle accident. An adventitious crisis arises from a major natural disaster or a man-made disaster. A developmental or maturation crisis occurs due to a new developmental stage, such as marriage or the birth of a child.

A patient is diagnosed with breast cancer. She is upset about the diagnosis. What is the type of crisis the patient is experiencing? 1 Situational crisis 2 Adventitious crisis 3 Developmental crisis 4 Maturation crisis

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

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

1, 2, 3 Asking the patient about the issues bothering her helps the nurse understand the patient's concerns. Asking whether the patient has started drinking and smoking or has increased her caffeine intake checks the patient's maladaptive skills. Information about monthly income and the distance of the clinic from the patient's home does not help assess coping skills.

A patient is diagnosed with breast cancer. She is upset about the diagnosis. What questions should the nurse ask to assess the coping skills of the patient? Select all that apply. 1 "What is bothering you most right now?" 2 "Have you started drinking and smoking?" 3 "Has your caffeine intake increased?" 4 "What is your monthly income?" 5 "How far is the health care clinic from your house?"

2 The general adaptation syndrome is a three-stage reaction that describes how the body responds to stressors through different stages. When the body encounters a physical demand such as an injury, the pituitary gland initiates the GAS. The parotid gland secrets saliva and is not related to the GAS. The pineal and adrenal glands do not initiate the GAS.

A patient is experiencing chronic stress. Which gland in the patient's body will initiate the general adaptation syndrome (GAS)? 1 Parotid gland 2 Pituitary gland 3 Pineal gland 4 Adrenal gland

1, 3 A denial defense mechanism is a reaction to emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Not discussing the loss and not accepting the loss are both denial defense mechanism behaviors. Cessation of eating and sleeping is a conversion defense mechanism. Being speechless and numb are examples of dissociative defense mechanisms. Shouting and blaming God for the loss is an example of the displacement defense mechanism.

A patient mentions to the nurse that she recently lost her husband in a car accident. Which behaviors could the nurse identify as denial defense mechanisms? Select all that apply. 1 Not accepting the death of her spouse 2 Not sleeping and eating 3 Not disclosing her feelings to anyone 4 Being speechless and numb 5 Shouting and blaming God for her loss

A Denial is avoiding emotional stress by refusing to consciously acknowledge anything that causes intolerable anxiety. This patient's statements reflect denial about poorly controlled blood sugars.

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." Which defense mechanism is the patient using? A. Denial. B. Conversion. C. Dissociation. D. Displacement.

B, D, E With stress the general adaptation syndrome is present. Glucose levels rise because ACTH stimulates cortisol, and gluconeogenesis occurs; the body creates new glucose from nonglucose sources (proteins and fats); cortisol alone increases gluconeogenesis; the sympathetic nervous system causes increased epinephrine, which elevates blood glucose. In the person with diabetes, these physiological responses can cause blood glucose levels to elevate beyond normal. ADH and aldosterone affect sodium and/or water balance and do not affect blood glucose.

A patient with type 2 diabetes is experiencing a lot of work-related stress and is fearful of losing his job. In addition, his wife is threatening divorce. His blood sugar is elevating, and his doctors want him to attend some stress-management classes. He says, "My blood sugar can't be high because of my work stress." What causes blood glucose to rise during stress? (Select all that apply.) A. Increases in antidiuretic hormone (ADH) B. Increases in cortisol C. Increases in aldosterone D. Increases in adrenocorticotropic hormone (ACTH) E. Increases in epinephrine

A, B, D Nurses frequently experience stress with the rapid changes in health care and when the situation seems out of their personal control. When job stress remains unresolved, patient care and clinical decision making can be affected because the stress is perceived as uncontrolled and all consuming.

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. Which of the following are true about work-related stress? (Select all that apply.) A. Job-related stress can affect the quality of patient care. B. Stress can affect nurses' efficiency and decision making. C. Nurses who talk about feeling stress are unprofessional and should calm down. D. Nurses frequently experience stress with the rapid changes in health care technology. E. Nurses cannot resolve job-related stress.

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

ANS: A The GAS consists of three stages: alarm reaction, resistance, and exhaustion. Most stressful events involve only the first two, but some ongoing demands can exceed the body's resources and lead to the final stage of exhaustion.

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

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

A client is admitted to the psychiatric unit with a diagnosis of major depression. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client's plan of care? A. A simple, structured daily schedule with limited choices of activities B. A daily schedule filled with activities to promote socialization C. A flexible schedule that allows the client opportunities for decision making D. A schedule that includes mandatory activities to decrease social isolation

ANS: A A client diagnosed with depression has difficulty concentrating and may be overwhelmed by activity overload or the expectation of independent decision making. A simple, structured daily schedule with limited choices of activities is more appropriate.

A client diagnosed with major depressive disorder was raised in an excessively religiously based household. Which nursing intervention would be most appropriate to address this client's underlying problem? A. Encourage the client to bring into awareness underlying sources of guilt. B. Teach the client that religious beliefs should be put into perspective throughout the life span. C. Confront the client with the irrational nature of the belief system. D. Assist the client to modify his or her belief system in order to improve coping skills.

ANS: A A client raised in an excessively religiously based household maybe at risk for experiencing guilt to the point of accepting liability in situations for which one is not responsible. The client may view himself or herself as evil and deserving of punishment leading to depression. Assisting the client to bring these feelings into awareness allows the client to realistically appraise distorted responsibility and dysfunctional guilt.

A nurse reviews the laboratory data of a client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL B. Potassium (K+) level of 4.2 mEq/L C. Sodium (Na+) level of 140 mEq/L D. Calcium (Ca2+) level of 9.5 mg/dL

ANS: A According to the DSM-IV-TR, symptoms of major depressive disorder cannot be due to the direct physiological effects of a general medical condition (e.g., hypothyroidism). The diagnosis of major depressive disorder may be ruled out if the client's laboratory results indicate a high TSH level which results from a low thyroid function or hypothyroidism. In hypothyroidism, metabolic processes are slowed leading to depressive symptoms.

A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola

ANS: A The nurse should instruct the client to avoid pepperoni pizza and red wine. Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

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.

A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply.) A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." D. "I'm going to miss my caffeinated coffee in the morning." E. "I'll be sure not to stop this medication abruptly."

ANS: A, B, C, E The nurse should evaluate that teaching has been successful when the client states that phenelzine (Nardil) should not be taken in conjunction with the use of alcohol or foods high in tyramine and should not be stopped abruptly. Phenelzine is a monoamine oxidase inhibitor (MAOI) that can have negative interactions with other medications. The client needs to tell other physicians about taking MAOIs due to the risk of drug interactions.

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.

A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) A. Sad mood on most days B. Mood rating of 2/10 for the past 6 months C. Labile mood D. Sad mood for the past 3 years after spouse's death E. Pressured speech when communicating

ANS: A, D The nurse should anticipate that a client with a diagnosis of dysthymic disorder would experience a sad mood on most days for more than 2 years. The essential feature of dysthymia is a chronically depressed mood which can have an early or late onset.

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.

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

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

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.

An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. "We'll go to the day room when you are ready for group." B. "I'll walk with you to the day room. Group is about to start." C. "It must be difficult for you to attend group when you feel so bad." D. "Let me tell you about the benefits of attending this group."

ANS: B A client diagnosed with major depressive disorder exhibits little to no motivation and must be firmly directed by staff to participate in therapy. It is difficult for a severely depressed client to make decisions, and this function must be temporarily assumed by the staff.

A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder? A. Altered communication R/T feelings of worthlessness AEB anhedonia B. Social isolation R/T poor self-esteem AEB secluding self in room C. Altered thought processes R/T hopelessness AEB persecutory delusions D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

ANS: B A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive disorder. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, maintaining a fetal position, and no personal hygiene and/or grooming.

A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. "I cannot drink any alcohol with this medication." B. "It is going to take 2 to 3 weeks in order for me to begin to feel better." C. "This drug causes physical dependence and I need to strictly follow doctor's orders." D. "I can't take this medication with food. It needs to be taken on an empty stomach."

ANS: B Buspar takes at least 2 to 3 weeks to be effective in controlling symptoms of depression. This is important to teach clients in order to prevent potential noncompliance due to the perception that the medication is ineffective.

A newly admitted client diagnosed with major depressive disorder states, "I have never considered suicide." Later the client confides to the nurse about plans to end it all by medication overdose. What is the most helpful nursing reply? A. "I'm glad you shared this. There is nothing to worry about. We will handle it together." B. "Bringing this up is a very positive action on your part." C. "We need to talk about the things you have to live for." D. "I think you should consider all your options prior to taking this action."

ANS: B By admitting to the staff a suicide plan, this client has taken responsibility for possible personal actions and expresses trust in the nurse. Therefore, the client may be receptive to continuing a safety plan. Recognition of this achievement reinforces this adaptive behavior.

A client admitted to the psychiatric unit following a suicide attempt is diagnosed with major depressive disorder. Which behavioral symptoms should the nurse expect to assess? A. Anxiety and unconscious anger B. Lack of attention to grooming and hygiene C. Guilt and indecisiveness D. Expressions of poor self-esteem

ANS: B Lack of attention to grooming and hygiene is the only behavioral symptom presented. Depressed clients do not care enough about themselves to participate in grooming and hygiene.

A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, "I'm feeling a lot better so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply? A. "I really appreciate your concern but I have been ordered to continue to watch you." B. "Because we are concerned about your safety, we will continue to observe you." C. "I am glad you are feeling better. The treatment team will consider your request." D. "I will forward you request to your psychiatrist because it is his decision."

ANS: B Often suicidal clients resist personal monitoring which impedes the implementation of a suicide plan. A nurse should continually observe a client when risk for suicide is suspected.

A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client? A. Teach about the effective of suicide on family dynamics. B. Carefully and unobtrusively observe based on assessed data, at varied intervals around the clock. C. Encourage the client to spend a portion of each day interacting within the milieu. D. Set realistic achievable goals to increase self esteem.

ANS: B The most effective way to interrupt a suicide attempt is to carefully, unobtrusively observe based on assessed data at varied intervals around the clock. If a nurse observes behavior that indicates self-harm, the nurse can intervene to stop the behavior and keep the client safe.

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder? A. The attention during the assessment is beneficial in decreasing social isolation. B. Depression can generate somatic symptoms that can mask actual physical disorders. C. Physical health complications are likely to arise from antidepressant therapy. D. Depressed clients avoid addressing physical health and ignore medical problems.

ANS: B The nurse should determine that a client with a diagnosis of major depressive disorder needs a full physical health assessment because depression can generate somatic symptoms that can mask actual physical disorders. Somatization is the process by which psychological needs are expressed in the form of physical symptoms.

A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing reply? A. "This combination of drugs can lead to delirium tremens." B. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." C. "That's a good idea. There have been good results with the combination of these two drugs." D. "The only disadvantage would be the exorbitant cost of the MAOI."

ANS: B The nurse should explain to the client that combining an MAOI and Luvox can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

A client is admitted with a diagnosis of depression NOS (not otherwise specified). Which client statement would describe a somatic symptom that can occur with this diagnosis? A. "I am extremely sad, but I don't know why." B. "Sometimes I just don't want to eat because I ache all over." C. "I feel like I can't ever make the right decision." D. "I can't seem to leave the house without someone with me."

ANS: B When a client diagnosed with depression expresses physical complaints, the client is experiencing somatic symptoms. Somatic symptoms occur with depression because of a general slowdown of the entire body reflected in sluggish digestion, constipation, impotence, anorexia, difficulty falling asleep, and a wide variety of other symptoms.

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.

An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) A. Gender differences in social opportunities that occur with age B. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioning E. Inaccessibility of resources for dealing with life stressors

ANS: B, C, D The nurse should identify drastic temperature and barometric pressure changes, increased levels of melatonin, and/or variations in serotonergic functioning as contributing to the etiology of the client's symptoms. A number of studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November).

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.

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

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

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.

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

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

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.

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

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

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.

A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out senile dementia D. To rule out a personality disorder

ANS: C A mini-mental status exam should be performed to rule out senile dementia. The elderly are often misdiagnosed with senile dementia when depression is their actual diagnosis. Memory loss, confused thinking, or apathy symptomatic of dementia actually may be the result of depression.

A 75-year-old client diagnosed with a long history of depression is currently on doxepin (Sinequan) 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? A. Risk for ineffective thermoregulation R/T anhidrosis B. Risk for constipation R/T excessive fluid loss C. Risk for injury R/T orthostatic hypotension D. Risk for infection R/T suppressed white blood cell count

ANS: C A side effect of Sinequan is orthostatic hypotension. Dehydration due to fluid loss from a combination of diuretic medication and flu symptoms can also contribute to this problem, putting this client at risk for injury R/T orthostatic hypotension.

A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? A. According to psychoanalytic theory, depression is a result of anger turned inward. B. According to object-loss theory, depression is a result of abandonment. C. According to learning theory, depression is a result of repeated failures. D. According to cognitive theory, depression is a result of negative perceptions.

ANS: C The nurse should assess that this client's depressive symptoms may have resulted from repeated failures. This assessment was based on the principles of learning theory. Learning theory describes a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed.

What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The client's understanding of the need for regular blood work B. The client's mood and affect score, using the facility's mood scale C. The client's cognitive ability to understand information about the medication D. The client's access to a support network willing to participate in treatment

ANS: C There are many dietary and medication restrictions when taking Nardil. A client must have the cognitive ability to understand information about the medication and which foods, beverages, and medications to eliminate when taking Nardil.

The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to assess and attempt to modify the negative thought patterns of these clients. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theory

ANS: C When a nurse assesses and attempts to modify negative thought patterns related to depressive symptoms, the nurse is using a cognitive theory framework.

Sertraline (Zoloft) has been prescribed for a client complaining of poor appetite, fatigue, and anhedonia. Which consideration should the nurse recognize as influencing this prescriptive choice? A. Zoloft is less expensive for the client. B. Zoloft is extremely sedating and will help with sleep disturbances. C. Zoloft has less adverse side effects than other antidepressants. D. Zoloft begins to improve depressive symptoms quickly.

ANS: C Zoloft is a selective serotonin reuptake inhibitor (SSRI) that has a relatively benign side effect profile as compared with other antidepressants.

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

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

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

A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)

ANS: D Fluoxetine (Prozac) is FDA approved for the treatment of depression in children and adolescents. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.

Which client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder? A. "It's just a matter of time and I will be well." B. "If I ignore these feelings, they will go away." C. "I can fight these feelings and overcome this disorder." D. "I deserve to feel this way."

ANS: D Hopelessness and helplessness are typical symptoms of clients diagnosed with major depressive disorder. Depressive symptoms are often described as anger turned inward.

A nurse is caring for four clients taking various medications including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? A. Tofranil B. Senequan C. Geodon D. Parnate

ANS: D Hypertensive crisis occurs in clients receiving monoamine oxidase inhibitor (MAOI) who consume foods or drugs high in tyramine content.

A client diagnosed with seasonal affective disorder (SAD) states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which reply by the nurse will best assess this client's symptoms. A. "Have you been diagnosed with any physical disorder within the last 3 months?" B. "Have you experienced any traumatic events that triggered this mood change?" C. "People who have seasonal mood changes often feel better when spring comes." D. "Help me understand what you mean when you say, 'feeling down'?"

ANS: D The nurse is using a clarifying statement in order to gather more details related to this client's mood. The diagnosis of SAD is not associated with a traumatic event.

A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis? A. The client is disheveled and malodorous. B. The client refuses to interact with others. C. The client is unable to feel any pleasure. D. The client has maxed-out charge cards and exhibits promiscuous behaviors.

ANS: D The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior would be exhibiting manic symptoms. According to the DSM-IV-TR, these symptoms would rule out the diagnosis of major depressive disorder.

A client is diagnosed with dysthymic disorder. Which should a nurse classify as an affective symptom of this disorder? A. Social isolation with a focus on self B. Low energy level C. Difficulty concentrating D. Gloomy and pessimistic outlook on life

ANS: D The nurse should classify a gloomy and pessimistic outlook on life as an affective symptom of dysthymic disorder. Symptoms of depression can be described as alterations in four areas of human functions: affective, behavioral, cognitive, and physiological.

A confused client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect and what could be its possible cause? A. Neuroleptic malignant syndrome caused by ingestion of two different seratonin reuptake inhibitors (SSRIs) B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI D. Serotonin syndrome caused by ingestion of two different SSRIs

ANS: D The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

TRUE/FALSE 1. Stress may be referred to as positive or negative.

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

An adolescent entering high school voices anxiety over changing schools. Stating anxiety is an act of a) Valuation b) Adaptation c) Evaluation d) Reaction

Adaptation Explanation: Adaptation is generally considered a person's capacity to flourish and survive, even with diversity.

A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client has been sleeping poorly, has lost 8 lb (3.6 kg), is poorly groomed, exhibits hyperactivity, and loudly denies the need for hospitalization. Which nursing intervention takes priority for this client?

Administering a sedative as prescribed

A nurse is caring for a client who is an investment banker. The client is stressed because of the sudden fall of share prices in the stock exchange. Which of the following stress-reduction techniques should the nurse use with this client? a) Discourage family from interacting with the client. b) Advocate on behalf of the client to others. c) Avoid referring the client to other organizations. d) Avoid discussing the client's condition with client's family.

Advocate on behalf of the client to others. Explanation: The nurse should advocate on behalf of the client to others. If need be, the nurse should refer the client and his family to organizations or people who provide post-discharge assistance. The nurse should keep the client and the client's family informed about the client's condition and encourage the family members to interact with the client.

3 Ask the patient if he would like you to sit down for a few minutes so he can talk. Asking an open-ended question and providing an opportunity for the patient to talk allow the nurse to assess the patient's perception of the situation, which is of utmost importance.

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. What is the nurse's first response? 1 "Don't be sad. People live with cancer every day." 2 "Have you thought about how you are going to tell your family?" 3 "I can sit with you for a while, if you would like to talk." 4 "I know another patient whose colon cancer was cured by surgery."

D, E Sitting quietly or asking the patient if he would like you to sit down for a few minutes so he can talk are both effective. This provides the patient some quiet time, knowing that someone is there. Allowing the patient to talk allows the nurse to assess the patient's fears, knowledge, and perception of the situation, which is of utmost importance. The other responses are telling the patient what to do or giving reassurance, and the situation does not call for either of these.

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. Which of the following are appropriate responses or actions of the nurse? (Select all that apply.) A. "I know another patient whose colon cancer was cured by surgery." B. Straighten the patient's bed and room C. "Have you thought about how you are going to tell your family?" D. "Would you like for me to sit down with you for a few minutes so you can talk about this?" E. Sit quietly with the patient

Symptoms of stress persist beyond the duration of a stressor: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

C

Despite working in a highly stressful nursing unit and accepting additional shifts, a new nursing graduate has a strategy to prevent burnout. The best strategy would be for the new nurse to Identify limits and scope of work responsibilities.

An important step in preventing burnout is acknowledging one's own limitations, as well as what one's scope of work is while on the job. By doing this, the person will help to prevent emotional exhaustion and will limit the effects of chronic stress. Journaling and muscle relaxation are good stress-relieving techniques but are not directed at the cause of the workplace stress. Delegating if not applicable is an inappropriate coping mechanism.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress the nurse says: A. "Tell me who I can call to help you." B. "Tell me what bothers you the most about this experience." C. "I'll contact someone who can help get you temporary housing." D. "I'll sit with you until other family members can come help you get settled."

B

A crisis intervention nurse working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her entitlement check while the child is hospitalized can expect the mother to regain stability after how long? A. After 2 weeks when the child's pneumonia begins to improve B. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks C. After 1 month when the child goes home and the mother gets help from a food pantry D. After 6 months when the child is back in school

B

A three-stage reaction to stress: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

B

Allows a person to cope with stress indirectly: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

B

Chronic arousal that causes excessive wear and tear on the person: A. Stress B. Allostatic load C. Appraisal D. Stressors

B

During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions? A. How is this flood affecting your life? B. Since your husband has died, what have you been doing in the evening when you feel lonely? C. How is having diabetes affecting your life? D. I know this must be hard for you. Let me tell you what might help.

B

Occurs in stable conditions and from stressful roles: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

B

Occurs when the body is no longer able to resist the effects of the stressor: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

B

When doing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. The nurse recognizes this as: A. Conversion. B. Post Traumatic Stress Disorder (PTSD). C. Dissociation. D. Displacement.

B

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of: A. A situational crisis. B. A maturational crisis. C. An adventitious crisis. D. A developmental crisis.

C

A nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which of the following while assessing the patient? A. Posttraumatic stress disorder B. Rising hormone levels C. Chronic illness D. Return of vital signs to normal

C

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. The nurse's first response is which of the following? A. "Don't be sad. People live with cancer every day." B. "Have you thought about how you are going to tell your family?" C. "Would you like for me to sit down with you for a few minutes so you can talk about this?" D. "I know another patient whose colon cancer was cured by surgery."

C

Controls heart rate, blood pressure and respirations: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

C

Crisis intervention is a specific measure used for helping a patient resolve a particular, immediate stress problem. This approach is based on: A. An in-depth analysis of a patient's situation B. The ability of the nurse to solve the patient's problems C. Effective communication between the nurse and patient D. Teaching the patient how to use ego-defense mechanisms.

C

How people interpret the impact of the stressor on themselves: A. Stress B. Allostatic load C. Appraisal D. Stressors

C

Monitors the physiological status of the body through connections with sensory and motor tracts: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

C

Recurrent or intrusive recollections of the event: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

C

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following? A. The amount of family support B. A 3-day diet recall C. A thorough physical assessment D. Threats to safety in her home

C

After a natural disaster occurred, an emergency worker referred a family for crisis intervention services. One family member refused to attend the services, stating "No way, I'm not crazy." The best response the nurse can give is which of the following? "Crisis intervention is a short-term problem-solving type of help, and seeking this help does not mean that you have a mental illness."

Crisis intervention is a type of brief therapy that is more directive than typical psychotherapy or counseling. It focuses on problem solving and involves only the problem created by the crisis. The goal of crisis intervention is to create stability for the person involved in the crisis while promoting self-reliance. The other options do not properly reassure the patient and build trust.

A patient newly diagnosed with type 2 diabetes says, "My blood sugar was just a little high. I don't have diabetes." The nurse responds: A. "Let's talk about something cheerful." B. "Do other members of your family have diabetes?" C. "I can tell that you feel stressed to learn that you have diabetes." D. With silence.

D

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. The supervising nurse recognizes that: A. Nurses who feel stress usually pass the stress along to their patients. B. A nurse who feels stress is ineffective as a nurse and should not be working. C. Nurses who talk about feeling stress are unprofessional and should calm down. D. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

D

Are tension-producing stimuli operating within or on any system: A. Stress B. Allostatic load C. Appraisal D. Stressors

D

Identifying the event or circumstance as a threat: A. Coping B. Ego-defense mechanisms C. Reticular formation D. Primary appraisal

D

Occurs as the person moves through life's stages: A. Post Traumatic Stress Disorder (PTSD) B. Chronic stress C. Flashbacks D. Developmental crisis

D

Produces hormones necessary for adaptation to stress: A. Resistance Stage B. Exhaustion Stage C. Medulla Oblongata D. Pituitary Gland

D

Rising hormone levels result in increased blood volume: A. Fight-or-flight response B. General adaptation syndrome C. Crisis D. Alarm reaction

D

The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says: A. "I'm going to learn to drive a car so I can be more independent." B. "My sister says she feels better when she goes shopping, so I'll go shopping." C. "I've always felt better when I go for a long walk. I'll do that when I get home." D. "I' m going to attend a support group to learn more about multiple sclerosis."

D

The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following? A. Loss of autonomy caused by health problems B. Physical appearance, family, friends, and school C. Self-esteem issues, changing family structure D. Search for identity with peer groups and separating from family

D

Which of the following is a physiological response experienced during the exhaustion stage of general adaptation syndrome? a) Increased mental alertness b) Vasoconstriction c) The initiation of neuroendocrine activity d) Decreased blood pressure

Decreased blood pressure Explanation: The stage of exhaustion is often accompanied by decreased blood pressure and vasodilation. Increased mental alertness and the initiation of neuroendocrine activity are associated with the alarm reaction of the GAS.

A person states that he was not shoplifting from the store despite very clear evidence on the store surveillance tape. This person is demonstrating which ego defense mechanism? Denial

Denial consists of avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Dissociation involves creating subjective numbness and less awareness of surroundings. Conversion involves repressing anxiety and manifesting it into a physiological problem. Compensation occurs when an individual makes up for a deficit by strongly emphasizing another feature.

The children of a 60-year-old woman are distraught at her apparent lack of recovery following a stroke several weeks earlier. The patient'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 patient's daughter be exhibiting? a) Sublimation b) Regression c) Displacement d) Denial

Displacement Explanation: The daughter may be transferring her feelings about her mother's health status to the care providers, an act that involves the displacement of the emotional reaction to another person. Denial about her mother's potential for recovery may underlie her response, but this is not demonstrated as clearly as displacement.

The nurse would recognize that short-term pharmacological treatment may be appropriate if an anxious patient's nursing diagnoses includes which of the following? a) Social isolation b) Decisional conflict c) Disturbed sleep pattern d) Defensive coping

Disturbed sleep pattern Explanation: The nurse should recognize that diagnoses relating to conflict, coping, and decisional conflict are less amenable to pharmacologic treatment. Disturbances in sleep patterns, however, are often addressed by the appropriate use of hypnotic medications.

A, B, E A developmental crisis occurs as a person moves through the stages of life, including widowhood. It is important to gather information about how this crisis affects her interactions, coping with loneliness, and any changes in lifestyle habits. Although stress can affect diabetes, there is nothing in this situation that states that the woman has diabetes. Saying, "I know this must be hard for you. Let me tell you what might help" is unacceptable, because the whole purpose of assessment is to gather data and let the patient tell his or her story.

During the assessment interview of an older woman who is recently widowed, the nurse suspects that this woman is experiencing a developmental crisis. Which of the following questions provide information about the impact of this crisis? (Select all that apply.) A. With whom do you talk on a routine basis? B. What do you do when you feel lonely? C. How is having diabetes affecting your life? D. I know this must be hard for you. Let me tell you what might help. E. Do you have any changes in lifestyle habits: sleeping, eating, smoking, and drinking?

During the evaluation stage of the critical thinking model applied to a patient coping with stress, the nurse will a. Select nursing interventions to promote the patient's adaptation to stress. Reassess patient's stress-related symptoms and compare with expected outcomes.

During the evaluation stage, the nurse compares current stress-related symptoms against established measurable outcomes to evaluate the effectiveness of the intervention. Selecting appropriate interventions and establishing goals are part of the planning process.

The purpose of unconscious ego defense mechanisms is to do which of the following for the individual? Protect against feelings of worthlessness and anxiety.

Ego defense mechanisms offer the individual psychological protection from emotional stress. They are used unconsciously to protect against worthlessness and feelings of anxiety. Problem-focused coping is a coping strategy rather than an ego defense mechanism. Evaluation of an event for its personal meaning is primary appraisal. The medulla oblongata controls heart rate, blood pressure, and respirations and is not triggered by ego defense mechanisms.

Identify a sociocultural factor that can lead to developmental problems. Prolonged poverty

Environmental and social stressors are believed to lead to developmental problems. Sociocultural refers to societal or cultural factors; poverty is a sociocultural factor. Stamina loss and obesity are health problems, and family relocation is a situational factor.

An adult who was in a motor vehicle accident is brought into the emergency department by paramedics, who report the following in-transit vital signs: Oral temperature: 99.0° F Pulse: 102 beats per minute Respiratory rate: 26 breaths per minute Blood pressure: 140/106 The nurse can identify that which hormones are the likely causes of the abnormal vital signs? Epinephrine and norepinephrine

Epinephrine and norepinephrine are catecholamine hormones secreted by the adrenal medulla that rapidly elevate heart rate and blood pressure. ACTH originates from the anterior pituitary gland and stimulates cortisol release; ADH originates from the posterior pituitary and increases renal reabsorption of water. ACTH, cortisol, and ADH do not increase heart rate

A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the plan of care?

Exercising the client's arms regularly

The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. At what stage of stress is the client? a) Secondary stage b) Exhaustion stage c) Alarm stage d) Resistance stage

Exhaustion stage Explanation: The client is in the exhaustion stage when one or more adaptive/resistive mechanisms can no longer protect the person experiencing a stressor; this results in exhaustion. The effects of stress-related neurohormones suppress the immune system and the body is open to various ailments. In the alarm stage, the person is prepared for a fight-or-flight response. In the resistance stage, the client's body is returned to the homeostasis state. Consequently, one or more organs or physiologic processes may eventually lead to increased vulnerability to stress-related disorders or progression to the stage of exhaustion. The secondary stage is not a stage related to stress.

The nurse is interviewing a client with complaints of chronic fatigue. The nurse understands that the client has a sedentary lifestyle and suggests that the client start low-intensity exercise. Which of the following exercises would be appropriate for the nurse to suggest the client engage in initially? a) Brisk walking b) Running c) Cycling d) Gardening

Gardening Explanation: The nurse should suggest that the client start with gardening, which is a low-intensity exercise and is particularly good preparation for sedentary persons before they progress to more vigorous aerobic exercise. Running, cycling, and brisk walking are vigorous aerobic exercises.

A nurse is teaching guided imagery to a prenatal class. Identify an example of guided imagery from the options below. Sensory peaceful words

Guided imagery is used as a means to create a relaxed state through the person's imagination, often using sensory words. Imagination allows the person to create a soothing and peaceful environment. Singing, back massage, and listening to music are other types of stress management techniques.

A nurse is assessing an obese teenager who is unhappy and stressed out because she has not lost weight despite working out at the gym. The physician asks the nurse to try the modeling intervention for stress management for the client. Which of the following actions should the nurse perform when adhering to the modeling intervention? a) Ask the client to undergo liposuction surgery. b) Ask the client to change her exercise regimen. c) Ask the client to cut down on her food intake. d) Introduce the client to someone with a positive attitude.

Introduce the client to someone with a positive attitude. Explanation: The nurse should introduce the client to a person who demonstrates a positive attitude or behavior as this promotes the ability to learn an adaptive response. The nurse should not ask the client to change her exercise regime, cut down on her food intake, or undergo liposuction surgery as that could lead to further medical complications.

In a natural disaster relief facility, the nurse observes that an elderly man has a recovery plan, while a 25-year-old man is still overwhelmed by the disaster situation. These different reactions to the same situation would be explained best by which of the following? Maturational and sociocultural factors

Maturational factors and sociocultural factors can affect people differently depending on their life experiences. An older individual would have more life experiences to draw from and to analyze on why he was successful, whereas a younger individual would have fewer life experiences based on chronological age to analyze for patterns of previous success. Nothing in the scenario implies that either man is in restorative care, has strong financial resources, or is immature or intelligent.

A 49-year-old painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician prescribes buspirone (BuSpar), 5 mg by mouth three times per day. During buspirone therapy, the client should avoid which of the following drugs?

Monoamine oxidase (MAO) inhibitors

A client who is a drug addict visits a health care facility for treatment. During counseling, he discloses that he took to drugs because it helped him deal with stressful situations. The nurse explains that he is not using the correct coping strategy to overcome his stress-related problems. What kind of strategy has the client used in this case? a) Stress-reduction strategy b) Therapeutic coping strategy c) Antidepressant strategy d) Non-therapeutic coping strategy

Non-therapeutic coping strategy Explanation: The client has used non-therapeutic coping strategies such as mind- and mood-altering substances to cope with stress. Negative coping strategies may provide immediate temporary relief from a stressor, but they eventually cause problems. Therapeutic coping strategies usually help the person to acquire insight, gain confidence to confront reality, and develop emotional maturity. Also, the client has not used an antidepressant strategy.

You walk into your patients' room and find her sobbing uncontrollably. When you ask what the problem is your patient responds "I am so scared. I have never known anyone who goes into a hospital and comes out alive." On this patient's care plan you note a nursing diagnosis of "Ineffective coping related to stress". What is the best outcome you can expect for this patient? a) Patient will avoid stressful situations. b) Patient will start anti-anxiety agent. c) Patient will adapt relaxation techniques to reduce stress. d) Patient will be stress free.

Patient will adapt relaxation techniques to reduce stress. Explanation: Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the patient needs to adopt coping mechanisms that are effective for dealing with stress, such as relaxation techniques. The other options are incorrect because it is unrealistic to expect a patient to be stress free; avoiding stressful situations and starting an anti-anxiety agent are not the best answers as outcomes for ineffective coping.

A trauma survivor is requesting sleep medication because of "bad dreams." Concerned about posttraumatic stress disorder, the nurse asks "Are you reliving your trauma?"

People who have PTSD often have flashbacks, reexperiencing the trauma. The other answers involve assessment of problems not specific to PTSD.

As an occupational health nurse at an oil refinery on the Gulf coast of Texas you are doing patient education with a man in his mid-forties. The patient is being seen after having been exposed to a chemical spill at the refinery. What type of stressor has this patient been exposed to? a) Psychiatric b) Psychosocial c) Physiologic d) Physical

Physical Explanation: Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. These facts make the other options incorrect.

A woman who was sexually assaulted a month ago presents to the emergency department with complaints of recurrent nightmares, fear of going to sleep, repeated vivid memories of the sexual assault, and inability to feel much emotion. The nurse recognizes the signs and symptoms of which medical problem?

Posttraumatic stress disorder is characterized by vivid recollections of the traumatic event and emotional numbing and often is accompanied by nightmares. General adaptation syndrome is the expected reaction to a major stressor. Developmental crisis occurs as a person moves through life stages rather than in response to a trauma. Alarm reaction involves physiological events such as increased activation of the sympathetic nervous system that would have occurred at the time of the sexual assault.

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) a) Adjustment b) Concern c) Threat d) Stressor

Stressor Explanation: Stress, coping, and adaptation are interrelated. Survival depends upon successful coping responses to ordinary and sometimes extraordinary circumstances and challenges.

A middle-aged 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 a) Stressors b) Demands c) Illnesses d) Stimuli

Stressors Explanation: Stress is defined as any event or set of events, a stressor, that causes a response. Everyday triggers associated with work or social relationships, and uncommon events such as natural disasters, physical trauma, injuries, illnesses, divorce, death of a loved one, or loss of a job are commonly recognized stressors.

When discussing his problem, a client tells the nurse that he is always doing small, petty jobs for everyone and he is not happy about it. Because of this, he is feeling stressed and has been getting into fights with his wife. What should the nurse suggest to help the client overcome this problem? a) Avoid doing petty jobs. b) Take control of the situation. c) Change jobs. d) Avoid people who dump tasks on him.

Take control of the situation. Explanation: A behavioral technique for modifying stress is to take control rather than become immobilized. This is also known as alternative behavior. Another behavioral approach to reduce stress is to sometimes say "no," in order to avoid becoming overwhelmed and more stressed. Changing jobs or avoiding the person or the petty jobs would not help.

A teen with celiac disease continues to eat food she knows will make her ill several hours after ingestion. Given appropriate tertiary level interventions, the nursing intervention would be to Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends.

Tertiary level interventions have the purpose of assisting the patient in readapting to life with an illness. By adjusting the diet to meet dietary guidelines and also addressing adolescent emotional needs, the nurse will help the teen to eat an appropriate diet without health complications and see herself as a "typical and normal" teenager. Teaching about the food pyramid will not address the real issue, which is that the teen is still eating what she knows will make her ill. Administering antidiarrheal medications may help but is not a tertiary level intervention. Admonishing the teen and parents is not a tertiary level intervention, and because this approach is nontherapeutic, it may cause communication problems.

The nurse teaches stress reduction and relaxation training to a health education group of patients after cardiac bypass surgery. The nurse is performing which level of intervention? .Tertiary

Tertiary level interventions have the purpose of assisting the patient in readapting to life with an illness. Tertiary prevention focuses on the person who already has the disease and is recovering or rehabilitating. Tertiary prevention goals are to slow down the disease process, prevent further damage or pain from the disease, and prevent the current disease from creating other health problems. Primary level consists of stress prevention, promotion of wellness, and risk factor reduction before illness occurs. Secondary level occurs after symptoms appear and assists the person to develop resources to manage illness and stress. Quad level does not exist.

The nursing student gave a wellness lecture on the importance of accurate assessment and intervention from a personal, family, and community perspective. The other nursing students enjoyed the lecture about which nursing theory? Neuman systems model

The Neuman systems model is based on an individual's/family's/community's relationship to stress and the reaction to stress. This model promotes wellness on primary, secondary, and tertiary levels. The other items listed as models are not nursing theories. Ego defense mechanisms are unconscious coping mechanisms. Situational refers to factors such as relocation or family job changes that are stressors. Evidence-based practice consists of relying on data or other reputable information sources to guide nursing care.

You are the nurse 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 and you note on the chart that her blood sugars are elevated yet she in not been diagnosed with diabetes. To what do you attribute this elevation in blood sugars? a) It is a result of antidiuretic hormone. b) She must have had diabetes prior to surgery. c) She has become a diabetic from the abdominal surgery. d) The blood sugars are probably a result of the "fight-or-flight" reaction.

The blood sugars are probably a result of the "fight-or-flight" reaction. Explanation: During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to glucose, the result is elevated blood sugars. Option A is incorrect, antidiuretic hormone is released during stressful situations and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Option B is incorrect; assuming the patient had diabetes prior to surgery demonstrates a lack of understanding of stress induced hyperglycemia. Option C is incorrect, there is no evidence presented in the question other than are elevated blood sugars that would support a diagnosis of diabetes.

1, 2, 3 The nurse should be aware of the characteristics that define ineffective coping. These include poor grooming, weight gain, and inappropriate laughing or crying. A patient who is able to meet basic needs and responds accurately to the questions asked demonstrates effective coping skills.

The nurse is assessing a 47-year-old, female patient who has been recently diagnosed with carcinoma of the right breast. Her left breast was removed 2 years ago for the same reason. What symptoms in the patient may indicate ineffective coping? Select all that apply. 1 The patient appears poorly groomed. 2 The patient complains of weight gain. 3 The patient laughs inappropriately. 4 The patient is able to meet her basic needs. 5 The patient responds accurately to questions.

2 Crisis occurs when the intensity of stress is beyond the patient's ability to cope. There are three different types of crisis: developmental, situational, and adventitious. A developmental crisis occurs when a new developmental stage occurs in a person's life such as a marriage, the birth of a child, or retirement. A situational crisis occurs when external sources such as a job change or motor vehicle crash provoke stress. Posttraumatic stress disorder occurs when a person experiences a traumatic incident and responds with intense fear and helplessness. The stress in this patient is not due to a traumatic incident. General adaptation syndrome is not a type of crisis. It refers to the process of reaction to stress.

The nurse is assessing a recently married patient who is stressed due to responsibilities towards family and work. The patient tells the nurse that being single was better than being married. What kind of situation or crisis does the patient have? 1 Situational crisis 2 Developmental crisis 3 Posttraumatic stress disorder 4 General adaptation syndrome

1, 3, 5 Always ask the patient open-ended questions because they encourage the patient to express his or her feelings and give more information. It is essential that the nurse assess the patient by asking questions as well as by observing his or her nonverbal behavior. Do not ask the patient questions that can be answered with just yes or no. In order to make the most accurate assessment, the nurse should consult with the patient directly rather than with the patient's partner.

The nurse is attending to a patient with posttraumatic stress disorder (PTSD) following a motor vehicle accident. The patient lost his left leg in the accident. When completing an assessment of this patient, what are the things that the nurse should take care of? Select all that apply. 1 Ask open-ended questions. 2 Ask questions that the patient can answer with a yes or no. 3 Take the patient's medical history and observe the patient's nonverbal behavior. 4 In order to make the assessment, consult with the patient's partner regarding the patient's medical history. 5 Learn about the patient by asking questions as well as by observing his or her nonverbal behavior.

2, 4 During reevaluation, the nurse should ask questions that would reflect upon the effectiveness of the patient's care plan. The nurse should ask whether the stress and fatigue levels have reduced and what changes the interventions have brought to his daily life. Asking about his mother's recovery is irrelevant to assessing the effectiveness of the plan. Asking about the type of music the patient prefers listening to should be done during the initial assessment because, listening to music could be an effective intervention to induce relaxation. Understanding of the progressive relaxation technique should be assessed during evaluation in the first session.

The nurse is caring for a 16-year-old patient who is under immense stress. He is depressed because his mother had a stroke and he is the only caregiver. The nurse previously prepared a care plan and asked the patient to follow the same at home. The patient came back for reevaluation after 1 month of the initial appointment. Which questions should the nurse ask in order to find out the effectiveness of the interventions? Select all that apply. 1 "How is your mother?" 2 "Has your fatigue level decreased?" 3 "Which music do you prefer listening to?" 4 "What changes have you brought about in your day-to-day life?" 5 "How will you perform the progressive relaxation technique?"

2, 3, 4, 5 Ineffective coping manifests as a change in sleep pattern. The patient may not be able to fall asleep at night. The patient may show inappropriate behavior such as laughing without a reason. The patient may have a change in appetite and may lack interest in food. The patient may not answer the questions properly due to an inability to concentrate. An accurate response to questions asked indicates effective coping.

The nurse is caring for a patient who lost his spouse in an accident. Which assessment findings would indicate ineffective coping in the patient? Select all that apply. 1 Accurate response to questions asked 2 Inability to fall asleep at night 3 Inappropriate laughing 4 Lack of interest in food 5 Inability to concentrate

D Stressors that apply to preadolescents are self-esteem issues and a changing family structure. A loss of autonomy caused by health problems applies to the older adult. Stressors that apply to children are physical appearance, family, friends, and school.

The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following? A. Loss of autonomy caused by health problems B. Physical appearance, family, friends, and school C. Self-esteem issues, changing family structure D. Search for identity with peer groups and separation from family

C, E Inviting the occupational therapist into the patient's home and attending support groups are early indicators that the patient is recognizing some of the challenges of the disease and participating in positive realistic activities to cope with the stressors related to changes in physical functioning. The other options relate to independence and other coping strategies but do not address coping with the specific challenges of the disease.

The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. Which of the following statements indicate that the patient is beginning to cope with the diagnosis? (Select all that apply.) A. "I'm going to learn to drive a car so I can be more independent." B. "My sister says she feels better when she goes shopping, so I'll go shopping." C. "I'm going to let the occupational therapist assess my home to improve efficiency." D. "I've always felt better when I go for a long walk. I'll do that when I get home." E. "I'm going to attend a support group to learn more about multiple sclerosis."

2, 4 Through its connection via the autonomic nervous system, the medulla oblongata is responsible for increasing respiratory rate, heart rate, blood pressure, and respirations as a response to stress. Increased alertness is due to the action of the reticular formation. Increased blood glucose levels occur due to the action of the pituitary. Dilated, not constricted, pupils are a response to stress.

The nurse is explaining the physiological mechanism underlying the fight-or-flight mechanism to a patient. The nurse says that the medulla oblongata plays a major role in controlling the response of the body to a stressor. What are the functions of medulla oblongata when the body is stressed? Select all that apply. 1 Constricted pupils 2 Increased respiratory rate 3 Increased mental alertness 4 Increased blood pressure 5 Increased blood glucose levels

C, E An increased allopathic load can result in long-term physiological and psychological problems such as chronic illness and depression. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.

The nurse is interviewing a patient in the community clinic and gathers the following information about her: she is intermittently homeless, a single parent with two children who have developmental delays, and is suffering from chronic asthma. She does not laugh or smile, does not volunteer any information, and at times appears close to tears. She has no support system and does not work. She is experiencing an allostatic load. As a result, which of the following would be present during complete patient assessment? (Select all that apply.) A. Posttraumatic stress disorder B. Rising hormone levels C. Chronic illness D. Return of vital signs to normal E. Depression

1, 2, 4 Objective assessments are the assessments that are done through observation or measurement. Information such as the patient's behavior and appearance can be observed by the nurse. Blood pressure assessment is also done by the nurse. Thus, these are considered objective assessments. As the nurse is assessing the patient for the first time, the nurse cannot observe the patient's change in diet; the nurse has to ask the patient for this information. The nurse would have to ask the patient regarding the social support system (family, co-workers, etc.). Thus, these assessments would come under subjective assessments.

The nurse is performing a first-time assessment of a patient who is extremely stressed. Which are the objective assessments documented by the nurse in the assessment sheet? Select all that apply. 1 Patient's behavior 2 Appearance of the patient 3 Changes in diet of the patient 4 Blood pressure of the patient 5 Social support of the patient

1, 4, 5

The nurse is teaching a group of nursing students about the general adaptation syndrome (GAS). What is true about this phenomenon? Select all that apply. 1 It is triggered directly by a physical event. 2 It consists of four stages of reaction to stress. 3 It is triggered directly by a psychological event. 4 It involves the autonomic nervous and endocrine systems. 5 It is initiated by the pituitary gland after a physical injury.

2, 4, 5 Ego-defense mechanisms are one of the coping mechanisms people use unconsciously. Psychiatric disorders usually do not occur because of ego-defense mechanisms. The defense mechanisms regulate emotional distress and help a person cope with stress indirectly. They offer psychological protection from a stressful event. They do not result in mania or depression in the patient.

The nurse is teaching a group of students about different coping mechanisms. What is true about ego-defense mechanisms? Select all that apply. 1 They can lead to mania in a person. 2 They are used by people unconsciously. 3 They can lead to major depression in a person. 4 They usually do not lead to psychiatric disorders. 5 They offer psychological protection from a stressful event.

1, 3, 4 The symptoms indicate that the nurse is experiencing burnout. The nurse should now make behavioral changes to cope with workplace stress. These include identifying the limits and responsibilities at work, which helps to focus the nursing efforts. Strengthening friendships outside of the workplace helps the nurse to obtain some relief from workplace stress. Spending off-duty hours engaged in interesting activities such as sports, music, or painting helps the nurse to de-stress. Spending more time at work to learn new technologies or do research would worsen the burnout.

The nurse is working in a health care unit in which there have been rapid changes in health care technology systems in a short time. The nurse is unable to become comfortable with the new systems and is exhausted. The nurse feels a sense of failure and a lack of identity. What does the nurse do now? Select all that apply. 1 Identify limits and responsibilities at work. 2 Spend more time at work to learn the new technology. 3 Strengthen friendships outside of the workplace. 4 Spend off-duty hours in activities such as sports, music, or painting. 5 Spend on-duty hours researching the new technologies.

3 An increased allostatic load can result in long-term physiological problems and chronic illness. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.

The nurse observes that a patient whose home life is chaotic including intermittent homelessness, a child with spina bifida, and an abusive spouse who appears to be experiencing an allostatic load. As a result, what does the nurse expect to detect while assessing the patient? 1 Posttraumatic stress disorder 2 Rising hormone levels 3 Chronic illness 4 Return of vital signs to normal

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? a) The nurse should demonstrate confidence and expertise. b) The nurse should take help from the senior physician. c) The nurse should not assess the client's stress type. d) The nurse should calm him first by giving him a sedative.

The nurse should demonstrate confidence and expertise. Explanation: Some general interventions appropriate during the care of the client who is suffering from stress include remaining calm during the discussions with the client, being available to the client, responding promptly to the client's signal for assistance, and encouraging family interaction. However, taking the help of a senior physician or giving the client a sedative would not help in assessing the client. The nurse has to assess the client's type of stress.

Pediatric stressors related to self-esteem and changes in family structure reflect which maturational school age category? Preadolescence

The preadolescent age category experiences stress related to self-esteem issues, changing family structure due to divorce or death of a parent, or hospitalization. Adolescent stressors include identity issues with peer groups and separation from parents. Elementary school age stressors include friends, family, and school relations. Adult stressors centralize around life events.

An adult male reports new-onset seizurelike activity. An EEG and a neurology consultant's report rule out a seizure disorder. When considering the ego defense mechanism of conversion, the nurse's next best action would be to Obtain history of any recent life stressors.

The purpose of an ego defense mechanism is to help regulate emotional stress. By regulating emotional stress, the individual gains some protection from anxiety and stress. A conversion reaction involves repressing an anxiety-producing conflict and transforming it into a nonorganic symptom such as difficulty sleeping, appetite loss, or sudden blindness without medical cause. The nurse must assess the patient fully before implementing any nursing interventions. Although the patient may be malingering, confrontation is non therapeutic because the patient is using this type of defense mechanism in response to some type of stressor.

While giving a lecture on attention-deficit/hyperactivity disorder, the nurse encourages which of the following to reduce children's stress regarding homework assignments? Time management skills

Time management skills are most related to homework assignment completion. Anemia prevention will improve energy levels but not stress. Routine health visits are important but do not directly affect ability to complete homework. Speech and other developmental aspects need to be developed if the child is to be successful, but skill development will not directly reduce homework-related stress.

1, 2, 5 The general adaptation syndrome (GAS) is a reaction to stress. It can be triggered directly by physical stress such as an injury or indirectly by psychological stress. It has three stages that describe how the body reacts to different stressors. These stages include the alarm reaction, resistance stage, and exhaustion stage. The alarm stage is characterized by rising hormone levels. The resistance stage is characterized by body reactions in opposition to the alarm reactions. The exhaustion stage occurs when the body has depleted its resources. Appraisal is the continuous process of being aware of the stressors and the coping mechanisms. Crisis occurs in response to the body's stressors.

What are the different stages of the general adaptation syndrome (GAS)? Select all that apply. 1 Alarm reaction 2 Resistance 3 Appraisal 4 Crisis 5 Exhaustion

1, 2 An adventitious crisis can be triggered by a major natural disaster, a man-made disaster, or a crime of violence. Therefore, a tsunami or earthquake can result in an adventitious crisis. Childbirth, the death of a pet, or a leg amputation can cause a situational crisis.

What can cause an adventitious crisis in a person? Select all that apply. 1 Tsunami 2 Earthquake 3 Childbirth 4 Death of a pet 5 Leg amputation

C Stress often causes symptoms similar to physical illnesses. Physical causes for problems need to be investigated and treated before treatment for stress-related symptoms can be initiated.

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following? A. The amount of family support B. A 3-day diet recall C. A thorough physical assessment D. Threats to safety in her home

A Negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as shivering to generate body heat to return the body to hormonal homeostasis.

When teaching a patient about the negative feedback response to stress, the nurse includes which of the following to describe the benefits of this stress response? A. Results in neurophysiological response B. Reduces body temperature C. Causes a person to be hypervigilant D. Reduces level of consciousness to conserve energy

1 The process of negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as shivering to generate body heat to return the body to hormonal homeostasis.

When teaching a patient about the negative feedback response to stress, what does the nurse include to describe the benefits of this stress response? 1 It results in the neurophysiological response. 2 It reduces body temperature. 3 It causes a person to be hypervigilant. 4 It reduces the level of consciousness to conserve energy.

4 Anxiety causes muscle tension and progressive muscle relaxation is a technique used to relax the muscle groups. A person usually achieves a relaxed state after deep chest breathing. Once this is done, the patient is then asked to alternately tighten and relax specific muscle groups. The instructions, "sit in a comfortable position" and "close your eyes," are given before asking the patient to do deep breathing. This helps to relax the body. Not all the muscle groups should be worked on at the same time.

When teaching the patient progressive muscle relaxation techniques, the nurse asks the patient to take deep breaths. What would be the next instruction after breathing deeply? 1 Sit in a comfortable position. 2 Close your eyes and try to relax. 3 Relax all the muscle groups at one time. 4 Alternately tighten and relax specific muscle groups.

4 Displacement is the defense mechanism that occurs when the emotions are transferred from one target to another target that is considered less stressful or neutral. Therefore, the patient is exhibiting the displacement defense mechanism. Denial is the refusal to acknowledge the existence of a real situation or the feelings associated with it. Regression is retreating to an earlier level of development and the comforting measures associated with that level of functioning. Identification is an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual whom one admires.

Which ego defense mechanism does the nurse suspect in the patient who breaks objects when he experiences high levels of stress? 1 Denial 2 Regression 3 Identification 4 Displacement

3 An adventitious crisis is also known as a disaster crisis. It occurs due to a major natural disaster or man-made disaster. A situational crisis occurs due to external sources such as a job change, a motor vehicle crash, or severe illness. A maturational crisis is also known as a developmental crisis. Developmental stages such as marriage, pregnancy, and the birth of a child require new coping styles. Failure to cope with the exposure to stressors during these stages leads to developmental crises.

Which type of crisis is an earthquake that has killed more than 7000 people? 1 A situational crisis 2 A maturational crisis 3 An adventitious crisis 4 A developmental crisis

A client expresses to the nurse that she constantly feels irritated and loses her temper. During the course of the interview, the nurse finds that the client takes care of her mother who was confined to bed following a stroke. The client struggles to balance caring for her family and her mother. Which nrusing diagnosis would the nurse most likely identify for this client? a) Compromised family adjustment b) Caregiver role strain c) Ineffective coping d) Anxiety

b) Caregiver role strain Explanation: The most appropriate nursing diagnosis is caregiver role strain because the client feels tired and fatigued by struggling to care for her mother and fulfilling family needs. Ineffective coping, compromised family adjustment, and anxiety would be inappropriate nursing diagnoses based on the information provided.

A client with obsessive-compulsive disorder tells the nurse that he must check the lock on his apartment door 25 times before leaving for an appointment. The nurse knows that this behavior represents the client's attempt to:

reduce anxiety.

The client is a 5-year-old child 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 a) displacement. b) reaction formation. c) compensation. d) regression.

regression. Explanation: Regression is a maladaptive behavior in which the client returns to an earlier method of behaving as seen in the child who is now bedwetting. Compensation is overcoming a perceived weakness by emphasizing a more desirable trait. Displacement is transferring an emotional reaction from one object or person to another. Reaction formation is exhibiting behaviors that are the opposite of what the client would really like to do.

A client comes to the emergency department while experiencing a panic attack. The nurse should respond to a client having a panic attack by:

staying with the client until the attack subsides