Chapter 32 - Stress and Coping - Adaptive Quiz

A 34-year-old man 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 response by the nurse is best? "Are you thinking of suicide?" "You've been doing a good job raising your children. You can do it!" "Is there someone who can help you?" "You have so much to live for."

-"Are you thinking of suicide?" Although this sounds abrupt, the patient usually is relieved that you've broached this issue. For safety reasons, it is very important to discuss any suicidal thoughts with the patient. The other options do not address the priority issue of suicide. Test-Taking Tip: The correct answer may have surprised you, because the other three choices share a milder approach. This is definitely an answer that places safety as the highest priority. Think "Safety first!" when answering a question.

A nurse is assessing the coping skills of a patient who lost his mother and is depressed. Which response by the patient will show that the patient is coping well? "I always feel better when I paint. I think it would help me relieve depression." "My friend said that she drinks a good red wine when she is depressed. I will try that at home." "My grief will be resolved only when I go to a different world altogether." "I have been going to a support group that I find is very good, and I am resuming my studies."

-"I have been going to a support group that I find is very good, and I am resuming my studies." A patient who is coping well would feel better than before and would try to resume the activities of daily life. Therefore the statement that the patient feels good and is resuming studies indicates that the patient is coping well with the loss. The statement that the patient feels better when painting indicates that the patient has been speculating about various strategies that might help. Drinking alcohol is not a healthy sign of coping and should be discouraged. The statement that the patient wants to go to another world indicates that the patient has suicidal ideation.

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. Which statement by the patient leads the nurse to believe this? "I'm going to learn to drive a car so I can be more independent." "My sister says she feels better when she goes shopping, so I'll go shopping." "I've always felt better when I go for a long walk. I'll do that when I get home." "I'm going to attend a support group to learn more about multiple sclerosis."

-"I'm going to attend a support group to learn more about multiple sclerosis." Support groups often benefit people experiencing stress. Driving a car is not safe for a person with multiple sclerosis and psychomotor impairment. What works for the patient's sister may not work for the patient. Shopping may or may not be effective for the patient. Going for a long walk may be difficult for a person with multiple sclerosis and psychomotor impairment.

In such cases where a patient is suffering from stress and anxiety, which instruction or information does a nurse teach the patient about meditation helping healing? Select all that apply. "Relax the body and quiet the mind by directing your focus on a specific word, sound, or image." "During meditation, breathing is deep, slowed, and relaxed." "I will refer you to a teacher who gives personal meditation classes." "Switch off all the fans in your house." "Meditation can be used to decrease stress and anxiety by adults and by children as young as 10 years of age."

-"Relax the body and quiet the mind by directing your focus on a specific word, sound, or image." -"During meditation, breathing is deep, slowed, and relaxed." -"Meditation can be used to decrease stress and anxiety by adults and by children as young as 10 years of age." Meditation involves relaxing the body and quieting the mind by directing one's focus on a specific word, sound, or image. During meditation, breathing is deep, slowed, and relaxed. Meditation can be used to decrease stress and anxiety by adults and by children as young as 10 years of age. Meditation affects the sympathetic nervous system by creating a state of relaxation, thereby lowering blood pressure, heart rate, breathing, metabolism, and blood flow to the muscles. Meditation classes are not always required. Playing peaceful music and turning the fans on may block out distractions, which may help the patient concentrate during meditation.

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. The nurse would make which statement during the first assessment for stress? "Tell me who I can call to help you." "Tell me what bothers you the most about this experience." "I'll contact someone who can help get you temporary housing." "I'll sit with you until other family members can come help you get settled."

-"Tell me what bothers you the most about this experience." The patient's appraisal of the crisis is the most important area to address first. The other statements are appropriate to make after the patient's appraisal of the crisis has been assessed.

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

-"What is bothering you most right now?" -"Have you started drinking and smoking?" -"Has your caffeine intake increased?" 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 distance of the clinic from home does not help assess coping skills.

After the 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 response by the nurse is appropriate? "Don't be sad. People live with cancer every day." "Have you thought about how you are going to tell your family?" "Would you like for me to sit down with you for a few minutes so you can talk about this?" "I know another patient whose colon cancer was cured by surgery."

-"Would you like for me to sit down with you for a few minutes so you can talk about this?" Ask the patient if he would like you to sit down for a few minutes so he can talk. Providing an open-ended question and an opportunity for the patient to talk allows the nurse to assess the patient's perception of the situation, which is of utmost importance. The other options are not appropriate and do not assist the nurse in providing therapeutic communication.

Posttraumatic stress disorder (PTSD) is one of the common disorders seen in cancer survivors. What is the probable reason for this disorder? Chemicals released from cancerous cells affecting the endocrine system Chemicals released from cancerous cells affecting the central nervous system Acute emotional response to a distressing event or situation Metastasis of cancer to adrenal glands which control the emotions

-Acute emotional response to a distressing event or situation Posttraumatic stress disorder is one of the most common psychological problems seen in cancer survivors. It is characterized by an acute emotional response to a traumatic event or situation. It is not caused by the chemicals released from cancerous cells or by metastasis of cancer to other organs.

The nurse must identify internal and external strategies for managing stress. Which qualities are the features of internal strategies? Select all that apply. Addresses individual feelings associated with stress Seeks to provide relief through family and friends Involves the support of a social networking system Involves techniques to relax the mind and body Focuses on optimal nutrition for body functioning

-Addresses individual feelings associated with stress -Involves techniques to relax the mind and body -Focuses on optimal nutrition for body functioning The nurse assists the patient in managing stress by developing coping skills. Internal strategies address the individual's feelings associated with stress. These therapies address the negative and psychological effects of stress. Exercise, yoga, and guided imagery are some techniques that help the individual relax the mind and body. The nurse must also focus on balance, relaxation, and nutrition to manage stress. The patient must receive optimal nutrition for proper functioning of the body. Stress management also involves the help of family, friends, and support from a social networking system. However, a social network, family, and friends are all considered external strategies for managing stress.

Which term describes the body's response to stress? Distress Eustress Allostasis Homeostasis

-Allostasis McEwan proposed the term allostasis to describe the stress response. Allostasis helps the body to maintain stability and reestablish homeostasis. The fight-or-flight response to stress is an allostatic response. Distress is the stress that is beyond the ability of an individual to cope or adapt effectively. It can cause physical illness or emotional dysfunction. Hans Selye referred to positive or motivational stress as eustress. Eustress is associated with effective coping and adaptation. Eustress is essential for normal growth and development. Selye referred to negative stress as distress. Walter Cannon described homeostasis as the regulation of the body's system to maintain a steady state.

A patient who is diagnosed with terminal colon cancer says, "It's just a stomach infection. I don't have any cancer. It's a wrong diagnosis." Which action should the nurse perform? Refer the patient to a psychiatrist immediately. Show the laboratory reports to the patient. Explain the similarity between stomach infections and colon cancer. Allow the patient to use denial as a coping mechanism.

-Allow the patient to use denial as a coping mechanism. The patient is using denial as a coping mechanism to deal with the stress. Therefore the nurse should allow some time for the patient to cope with the stress before giving more information about the cancer or further process. The patient is overwhelmed by the diagnosis of cancer and does not need a consultation with a psychiatrist. The nurse should not offend the patient by showing the laboratory reports. Telling the patient that stomach infection and colon cancer manifest with similar symptoms indicates giving false assurance.

The nurse is assessing a 47-year-old female patient who was recently diagnosed with carcinoma of the right breast. Her left breast was removed 2 years ago for the same reason. Which symptoms in the patient may indicate difficulty coping (ICNP)? Select all that apply. Appearing poorly groomed Weight gain Laughing inappropriately Ability to meet her basic needs Responding accurately to questions

-Appearing poorly groomed -Weight gain -Laughing inappropriately The nurse should be aware of characteristics that define difficulty coping (ICNP). 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 adequate coping.

The nurse asks a patient with depression, "What is on your mind?" The patient responds, "I have had enough in this world. I wish to leave this planet and enter the world of peace." Which action is the most appropriate immediate intervention of the nurse? Ask if the patient has made any plan for suicide. Inform the health care provider immediately. Inform the police by telephone or fax. Tell the patient that suicide is not a solution for the problems.

-Ask if the patient has made any plan for suicide. A trusting nurse—patient relationship is required to make an assessment of a patient's stress level and coping mechanisms. A nurse should start with an open-ended question first to build a rapport. It is important to ask directly about suicidal or homicidal thoughts. If a patient has these thoughts, then the nurse should immediately ask if the patient has any plans of harming him- or herself or others. The nurse should also inquire the means by which the patient plans to commit suicide. Thereafter, the nurse can inform the health care provider or police. The nurse can then try to counsel the patient by saying that suicide is not a solution for the problems.

Which therapy would the nurse suggest to a patient with hypertension to reduce the need for antihypertensive drugs? Meditation Simple touch Acupuncture Therapeutic touch

-Meditation Prolonged practice of meditation techniques is helpful for the patient to reduce the need for antihypertensive drugs. Meditation is self-directed, and it involves relaxed, deep, slow, abdominal breathing that evokes a restful state. It reduces the respiratory rate, lowers oxygen consumption, and decreases heart rate. Simple touch, acupuncture, and therapeutic touch have not been shown conclusively to reduce blood pressure. The patient may enjoy these therapies, but they are not necessarily helpful in reducing the need for antihypertensive drugs.

A 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, which actions should the nurse perform? Select all that apply. Ask open-ended questions. Ask questions that the patient can answer with yes or no. Take the patient's medical history and make an assessment through the patient's view. Consult with the patient's partner on the patient's medical history to make the assessment. Learn about the patient by asking questions as well as by observing his nonverbal behavior.

-Ask open-ended questions. -Take the patient's medical history and make an assessment through the patient's view. -Learn about the patient by asking questions as well as by observing his nonverbal behavior. Always ask the patient open-ended questions because it encourages the patient to express his feelings and give more information. The nurse should take the patient's medical history and make an assessment through the patient's view. It is essential that the nurse assess the patient by asking questions as well as by observing his nonverbal behavior. Do not ask the patient questions that can be answered with just yes or no. The nurse should consult with the patient directly, rather than with the patient's partner, to make the most accurate assessment.

Which interventions does the nurse teach a patient about time management to reduce work-related stress? Select all that apply. Shift from one task to another frequently. Avoid procrastination and set limits for tasks. Ensure goals for tasks and prioritize them. Practice techniques to increase concentration. Use technology to execute many tasks at the same time.

-Avoid procrastination and set limits for tasks. -Ensure goals for tasks and prioritize them. -Practice techniques to increase concentration. The nurse must teach the patient to avoid procrastination and set limits for tasks. This can be accomplished by setting clear goals for the tasks at hand and prioritizing them. Important tasks must be completed within a set time limit. This helps the individual complete the most important tasks first. The individual must practice techniques such as meditation or yoga to increase concentration. The nurse does not teach the patient to shift from one task to another, as this reduces cognitive ability and productivity. Likewise, the nurse does not encourage the use of technology for multitasking. It has been observed that multitasking causes significant stress and actually increases the time needed to complete tasks by 25 percent.

The nurse is assessing a family in which a wife is providing care for her husband, who is bedridden due to a chronic ailment. Which observations made by the nurse confirm that the wife is experiencing caregiver stress? Select all that apply. Changes in mood Tension in the relationship Changes in wife's level of health Changes in the patient's treatment Improvement in patient's health

-Changes in mood -Tension in the relationship -Changes in wife's level of health A caregiver experiencing role stress may have mood changes due to stress. The relationship between the patient and his wife may become tense due to the demands of caregiving. A change in the caregiver's health indicates that the caregiver is stressed by the responsibilities. A change in the patient's treatment may be due to the improvement or aggravation in hea

The nurse is caring for a patient who is partially paralyzed on the right side following a stroke. The patient is learning to write with the left hand. Which defense mechanism is the patient using? Sublimation Displacement Compensation Rationalization

-Compensation The patient prefers to focus on strengths rather than weaknesses which is characteristic of using compensation. Sublimation is the channeling of unacceptable emotions into acceptable actions or responses. For example, an individual may vent frustration through acceptable channels such as poetry, painting, or aggressive sports. Displacement is a defense mechanism in which the patient redirects negative emotions to a safer focus. Individuals who may be unable to express anger toward their bosses may use displacement and demonstrate anger to people at home. The patient uses rationalization to explain personal actions in a way that enhances self-image. For example, a person may indulge in an extramarital affair and justify the action by blaming the spouse for lack of affection.

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 which defense mechanism? Denial Conversion Dissociation Displacement

-Denial 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 sugar. Conversion, dissociation, and displacement do not involve ignoring aspects of reality.

The nurse could not get through the licensing exam. After seeing the results, the nurse said, "No! I do not believe this. I prepared for the exam for 2 years. I should have made it through the test. There must be some error in this." What kind of response does this describe? Denial Illusion Primary appraisal Posttraumatic stress disorder

-Denial Denial is one of the types of defense mechanisms used to cope with stressors. In such a case a person consciously refuses to acknowledge anything that causes intolerable emotional pain. Illusion is a false belief. Evaluating a situation for its personal meaning is called primary appraisal. Posttraumatic stress disorder does not present in this way. 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.

During a stress response, which criterion does a secondary appraisal focus on? Factors triggering stress in a person Factors hindering coping for a person with stress Effects of stress for a person with stress Different coping strategies available to a person with stress

-Different coping strategies available to a person with stress Appraisal is the process of evaluation of stressors in a patient's life and how the person can deal with them. There are two types of appraisals: primary and secondary. Secondary appraisal focuses on the coping strategies available to a person. Primary appraisal includes identification of factors that trigger stress or factors that interfere with coping with stress. It also includes the patient's evaluating the meaning of stress on himself or herself.

Which actions by a patient does the nurse relate to possible indications of depression? Select all that apply. Experiencing sleeplessness Having difficulty getting out of bed Engaging in ritualistic behaviors Being chronically tired and withdrawn Experiencing horrific flashbacks

-Experiencing sleeplessness -Having difficulty getting out of bed -Being chronically tired and withdrawn The patient experiencing depression has a feeling of worthlessness or hopelessness. The patient has insomnia and is unable to sleep. This results in lethargy, and the patient has difficulty getting out of bed. The patient is tired all the time from lack of sleep and energy. The patient also tends to withdraw and avoid socializing. Repeating ritualized behaviors is characteristic of obsessive-compulsive disorder, while horrific flashbacks are characteristic of posttraumatic stress disorder.

A single mother lives with her 10-year-old son who has Down syndrome. The mother's facial expressions demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The nurse understands that the mother is experiencing caregiver role stress. Which findings noted by the nurse indicate caregiver role stress? Select all that apply. Fatigue and malaise Unkempt appearance Lack of interest in socializing The disease condition of the patient's son Single motherhood

-Fatigue and malaise -Unkempt appearance -Lack of interest in socializing Physical symptoms like fatigue and malaise indicate caregiver role strain. Lack of interest in grooming and socializing also indicates that the patient is overburdened with caregiving responsibilities. The disease condition of the patient's son and single motherhood are causes of, not indicators of, caregiver role strain in the patient.

The nurse expects that a patient with muscle tension in the head, neck, and back may benefit from progressive relaxation therapy. Which patient actions are expected during this therapy? Select all that apply. Focus on the tense muscles Relax the muscle group intentionally Relax muscle groups from head to toe Visualize an image of relaxed muscles Perform therapy three times a week

-Focus on the tense muscles -Relax the muscle group intentionally -Relax muscle groups from head to toe -Visualize an image of relaxed muscles Progressive relaxation therapy is a nonpharmacologic technique to reduce psychological and physiologic distress. The patient must develop awareness of muscle tension and focus on the muscles that are tense. The patient must then intentionally relax those muscles. Progressive relaxation involves relaxation of the muscles from head to toe. Gradually, the patient will practice to visualize an image of the relaxed muscles. This helps the patient relax the muscles. The patient should practice this technique daily, not just three times a week, for effectiveness.

Which relaxation technique involves a verbal form of instruction by the nurse to direct the patient away from stressful thoughts? Energy therapy Mindfulness Biofeedback Guided imagery

-Guided imagery Guided imagery is a verbal form of instruction that guides the patient away from upsetting thoughts to focus on positive external images such as the patient's favorite place. This technique helps create a relaxed state and boosts the patient's immune system, decreases pain, and develops positive feelings. Energy therapy involves a practitioner's hands manipulating a patient's negative energy fields. Mindfulness-based stress reduction has become increasingly popular in recent years, especially within the medical community. It is a form of therapy that helps people become more aware of their thoughts, emotions, and motivating behaviors; this awareness has been shown to reduce levels of anxiety, pain, insomnia, and depression. Biofeedback is the use of electronic devices to help the patient develop a learned awareness of the body's physiologic responses to unconscious, involuntary stressors.

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

-He is using regression defense mechanism. -He gets psychological protection from stress with this behavior. 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 development of psychiatric disorders 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 development of intellectual disability in the future.

Which benefits does exercise provide? Select all that apply. Improves tone of muscles Increases levels of cortisol Decreases risk of depression Increases score on stress scale Increases pulmonary function

-Improves tone of muscles -Decreases risk of depression -Increases pulmonary function Exercise increases muscle tone and helps manage weight. Exercise decreases the risk of physiologic and psychological issues such as depression. Exercise helps improve cardiovascular and pulmonary function. Exercise decreases stress levels and cortisol levels to increase a sense of well-being in individuals. It helps reduce stress; therefore the patient will have a lower score on the stress scale.

The nurse is providing patient teaching about the stress response. What is the best explanation of the stress appraisal? Demonstration of a physiologic reaction Activation of the autonomic nervous system Activation of the immune system in the tissues Interpretation of an event that upsets equilibrium

-Interpretation of an event that upsets equilibrium Stress appraisal is the process by which an individual interprets a stressor or an event that upsets the sense of equilibrium. It is a two-step process, which may occur simultaneously, to determine whether the stressor is a threat or a challenge. The stress response is the activation of the autonomic nervous system to assist the body in maintaining homeostasis. The activation of the autonomic nervous system results in increased heart rate, blood pressure, and respiration. This fight-or-flight response is a physiologic response to excitement or threat. The autonomic nervous system triggers a response in the immune system, leading to local adaptation syndrome. This appears as inflammation, reflexive response to pain, or hypoxia in the tissues of the body directly affected by the stress.

A patient is diagnosed with end-stage prostate cancer. The patient is depressed and approaches the nurse to seek advice regarding nonpharmacologic therapies to manage depression. Which information would the nurse provide to the patient about meditation? Select all that apply. It improves the life span. It creates a state of relaxation. It requires the patient to be receptive and be able to focus attention. It helps reduce the dose of chemotherapeutic agents. It lowers blood pressure, heart rate, and metabolism.

-It creates a state of relaxation. -It requires the patient to be receptive and be able to focus attention. -It lowers blood pressure, heart rate, and metabolism. Meditation involves relaxing the body and quieting the mind by directing one's focus on a specific word, sound, or image. During meditation, breathing is deep, slowed, and relaxed. Meditation can be used to decrease stress and anxiety in adults and by children as young as 10 years of age. Meditation affects the sympathetic nervous system by creating a state of relaxation, thereby lowering blood pressure, heart rate, breathing, metabolism, and blood flow to the muscles. It helps improve the quality of life, not the quantity. It does not reduce the dose of chemotherapeutic agents.

The nurse understands that an individual with a strong sense of coherence (SOC) is likely to recognize and utilize resources, even in a stressful situation. Which qualities describe an individual's perception of the world according to the concept of SOC? Select all that apply. Manageable Comprehensible Unpredictable Overwhelming Meaningful

-Manageable -Comprehensible -Meaningful An individual with a strong SOC is able to access the necessary resources to make a stressful situation manageable. The individual comprehends the situation and understands the demands of the stressor. The individual who finds the stressor unpredictable is unable to comprehend the demands of the stressor and would be assessed as having low SOC. An individual who perceives the world as overwhelming will have low SOC and have difficulty in coping with the stressor.

Time management skills are helpful in managing stress. Which principles are included in time management? Select all that apply. Prioritizing tasks Setting goals Decreasing distractions Avoiding procrastination Clinical decision making

-Prioritizing tasks -Setting goals -Decreasing distractions -Avoiding procrastination Strategies such as prioritizing tasks, setting goals, increasing concentration skills, decreasing distractions, avoiding procrastination, setting boundaries, and maintaining self-discipline are time management interventions that individuals may employ to address certain types of stressors. Clinical decision making is part of clinical care coordination.

The nurse is aware that some forms of stress are essential for the normal growth and development of an individual. Hans Selye described this as which type of stress? Physiologic Motivational Sociocultural Psychological

-Motivational Hans Selye referred to positive stress as eustress or motivational stress. Motivational stress is essential for normal growth and development. It is associated with effective coping and adaptation. Hans Selye referred to physiologic stress as the body's potentially harmful reaction to a stimulus. The physiologic stress response is activated when an individual identifies an event as a threat. Sociocultural stress occurs when social systems are challenged by racism, economic hardship, or political upheaval. Psychological stress includes the emotional and cognitive factors involved in the appraisal of a threat.

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. Which factor would the nursing supervisor be aware of? Nurses who feel stress usually pass the stress along to their patients. A nurse who feels stress is ineffective as a nurse and should not be working. Nurses who talk about feeling stress are unprofessional and should calm down. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

-Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring. Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring and when the situation seems out of their personal control.

A nurse is interviewing a 37-year-old patient who is not coping well with a recent loss of employment. Which activities should the nurse perform to assess coping in the patient? Select all that apply. Observe the patient's appearance. Ask the patient about changes in eating patterns. Ask the patient about changes in sleeping pattern. Ask the patient about his ability to remember a recent event. Observe the patient's response to questions asked.

-Observe the patient's appearance. -Ask the patient about changes in eating patterns. -Ask the patient about changes in sleeping pattern. -Observe the patient's response to questions asked. A disheveled appearance and poor grooming indicate difficulty coping (ICNP). Changes in eating pattern and lack of interest in food may indicate the patient is not coping well. Difficulty coping can also alter sleeping patterns. The patient may sleep excessively. Inaccurate responses to questions asked and inability to concentrate indicate difficulty concentrating and coping.

The nurse is with a patient who has just been informed of the need for surgery to extract a cancerous tumor. The patient is agitated, with difficulty breathing and complaints of chest pain. Which reaction is the patient experiencing? Mild anxiety Panic attack Moderate anxiety Severe anxiety

-Panic attack The patient is experiencing a panic attack. Panic is accompanied by feelings of dread and terror that may immobilize the patient. Panic attacks may manifest in physical signs such as chest pain and difficulty in breathing. Mild anxiety can be motivational and enable a patient to think clearly. Moderate anxiety narrows a person's focus and may challenge the person to use appropriate problem-solving skills. Severe anxiety is associated with the inability to make decisions or solve problems.

A child performs poorly in mathematics and finds it difficult to improve even after spending more time on it. Which behavior shows that the child is using compensation as a defense mechanism? Taking lessons from an experienced math tutor Performing well in music, as she is good at music Taking herbal supplements to improve the memory Eating nutritious food and practicing yoga

-Performing well in music, as she is good at music In compensation, a person makes up for a deficiency by strongly emphasizing a feature considered to be an asset. The child uses musical skill as compensation for poor performance in math. Taking math lessons is not a defense mechanism; it is a corrective action to improve competency in math. Taking herbal supplements, eating nutritious food, or practicing yoga are emotion-focused coping skills.

A patient is suffering from chronic stress. Which gland in the patient's body will initiate general adaptation syndrome (GAS)? Parotid Pituitary Pineal Adrenal

-Pituitary GAS 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 GAS. Pineal and adrenal glands do not initiate GAS. STUDY TIP: Remember that the pituitary gland is also called the master gland because it controls so many functions. It is vital in the process of homeostasis, and adapting to chronic stress is definitely part of homeostasis.

A patient has a history of smoking 10 cigarettes per day for 20 years and drinks alcohol occasionally. The patient was recently diagnosed with lung cancer during a lung cancer screening program. The patient expresses fear of death and has nightmares. The patient is divorced. Which condition is the probable reason for the patient's anxiety and nightmares? Cirrhosis of the liver Posttraumatic stress disorder (PTSD) Metastasis of lung cancer to the brain Malingering to seek medical attention

-Posttraumatic stress disorder (PTSD) PTSD is characterized by an acute emotional response to a traumatic event or situation such as a recent diagnosis of cancer. Symptoms of PTSD include grief, intrusive thoughts about the disease, nightmares, relational difficulties, or fear. Fear of death and nightmares are not caused by cirrhosis of the liver or metastasis of lung cancer to the brain. Malingerers may report fear and nightmares, but this is an unlikely cause in the patient, as the patient is diagnosed with lung cancer.

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. Which condition does this nurse recognize this behavior as? Fight-or-flight response General adaptation syndrome The exhaustion stage Posttraumatic stress disorder (PTSD)

-Posttraumatic stress disorder (PTSD) PTSD originates with a person's experiencing or witnessing a traumatic event and responding with intense fear or helplessness. A car accident is the traumatic event that is causing intense fear or helplessness in this patient.

A single mother lives with her 10-year-old son who has Down syndrome. The mother'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 mother is experiencing caregiver role stress. Which interventions would the nurse plan for the mother and son? Select all that apply. Refer the son to respite care. Refer the patient to support groups. Prescribe antidepressants to the patient. Admit the patient to the psychiatric ward. Advise the patient to do yoga and meditation.

-Refer the son to respite care. -Refer the patient to support groups. -Advise the patient to do yoga and meditation. The priority of 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 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.

Which findings indicate the presence of caregiver stress in a person caring for a terminally ill patient? Select all that apply. Significant change in body weight Support of friends and family Nonverbal expressions of anxiety Use of respite care once a week Recurring gastrointestinal upset

-Significant change in body weight -Nonverbal expressions of anxiety -Recurring gastrointestinal upset Caregivers are likely to experience stress from caring for patients. The nurse must assess the caregiver for changes in weight and expressions of anxiety. Stress can also trigger gastrointestinal problems by decreasing gastric motility. Continuous stress may cause increased gastric motility, resulting in irritable bowel syndrome. The support of friends and family provides relief to the caregiver. The caregiver may be able to utilize respite care at least once a week to reduce stress from caring for the patient.

The nurse is teaching the physiology of fight-or-flight responses to student nurses. Which system is responsible for these phenomena? Renin-angiotensin system Respiratory system Sympathetic nervous system Parasympathetic nervous system

-Sympathetic nervous system People experience stress in day-to-day activities. Stress stimulates thinking processes and helps people be alert. The fight-or-flight response helps a person prepare for action. A consequence of hypothalamic activation is sympathetic stimulation, which triggers epinephrine and norepinephrine release from the adrenal medulla. The renin-angiotensin system helps in maintaining electrolyte and fluid balance. The respiratory system does not initiate fight-or-flight responses. The parasympathetic system counteracts the action of the sympathetic nervous system. STUDY TIP: If you confuse the sympathetic with the parasympathetic nervous system, use this mnemonic: the parasympathetic system can be nicknamed the "rest and digest" system. Notice the r in parasympathetic and in rest. There is no r in sympathetic, so you can recall that sympathetic is the fight-or-flight system.

A 34-year-old single woman looks after her 3-year-old child and her elderly parents. Her mother is diagnosed with throat cancer. Her ex-husband abuses drugs and divorced her 2 years ago. His parents live in an old-age home. Among those listed, which individual belongs to the sandwich generation? The 34-year-old single woman The 3-year-old child The parents of the woman's ex-husband The mother of the 34-year-old woman

-The 34-year-old single woman Caregivers who are 30 to 50 years old and have to care for their own immediate family and parents are considered members of the sandwich generation. In this scenario, the 34-year-old single woman belongs to the sandwich generation. The 3-year-old son is too young to take care of anyone and is not part of the sandwich generation. The parents of the woman do not belong to the sandwich generation. The ex-husband is not a caregiver in this scenario, and thus not a part of the sandwich generation.

The nurse is helping a patient cope with stress in the exhaustion stage of general adaptation syndrome (GAS). Which effect of stress on the patient presents during this stage? The parasympathetic nervous system reverses sympathetic stimulation. The body's resources need to be augmented through medication and nutrition. The initial responses are attenuated and the body begins to repair itself and stabilize. The autonomic nervous system triggers a response in the sympathetic nervous system.

-The body's resources need to be augmented through medication and nutrition. According to Hans Selye, GAS, or the physical response to stress, has three stages: alarm reaction, resistance, and exhaustion. A patient in the exhaustion stage is unable to continue the efforts of adaptation and needs medication, nutritional support, and other therapies. The first stage of GAS is the alarm reaction, during which the autonomic nervous system is activated by stress. This triggers a response in the sympathetic nervous system, the endocrine system, and the immune system. During the resistance stage, the body attempts to adapt to the stressor and stabilize. During this stage, the body begins to repair the damage and restore resources. If the stress is not relieved during the resistance stage, the body advances to the exhaustion stage. STUDY TIP: When a battery is drained (exhausted), it needs to be recharged; so do we! Nutrition and medication are ways to recharge our batteries in the exhaustion stage.

A nurse explains to the family of a patient how to provide home care and identify caregiver role stress. Which indicators of caregiver role stress would the nurse teach the family about? Select all that apply. The caregiver loses interest in his appearance. The caregiver focuses on the patient completely. The caregiver is fearful of learning new therapies. The caregiver is keen to learn new therapies or techniques. The caregiver loses interest in his social life and becomes irritable.

-The caregiver loses interest in his appearance. -The caregiver is fearful of learning new therapies. -The caregiver loses interest in his social life and becomes irritable. Caregiving can take a toll on the caregiver's physical, emotional, and social well-being. This can be manifested by the caregiver losing interest in his appearance. Role strain is also indicated by the caregiver being afraid of learning new therapies or techniques. If the caregiver loses interest in his social life and gets irritable or withdrawn, it indicates that he is facing role strain. Focusing on the patient completely and showing interest in learning new techniques indicate that the caregiver is interested in his role.

Which situation demands that the nurse provide crisis intervention? The lone survivor of a motor vehicle accident An individual who is worried about losing a job A person who is receiving chemotherapy for cancer The individual with muscle tension in the neck

-The lone survivor of a motor vehicle accident A crisis intervention is short-term assistance to help an individual regain equilibrium during a time of physical or emotional turmoil. The lone survivor of a motor vehicle accident requires the nurse to provide crisis intervention to overcome the stress. The nurse may teach relaxation techniques or time-management methods to an individual worried about losing a job. A person who is receiving chemotherapy for cancer may benefit from guided imagery for pain relief and relaxation. An individual with muscle tension in the neck may benefit from progressive relaxation techniques.

Which information does the nurse teach the patient about the application of Reiki therapy? The practitioner uses hand motions to transfer energy. The practitioner transfers energy through the hands. The hand motions enhance energy to promote healing. The therapy is based on the opposite forces of nature.

-The practitioner transfers energy through the hands. Reiki is a therapy in which the practitioner transfers energy from the practitioner to the patient through the hands. This helps restore balance and harmony to the body during times of health issues. Therapeutic touch is a therapy that uses touch through hand motions to enhance energy fields and promote healing. Traditional Chinese medicine is based on the balance of harmony and equilibrium. According to this therapy, an imbalance in the yin and yang causes illness and disease.

The nurse is caring for a patient with generalized anxiety disorder (GAD). Which behavior is characteristic of GAD? Worrying without valid reason Fearing the judgment of others Performing ritualistic behaviors Having flashbacks of a past event

-Worrying without valid reason An individual with GAD has unrealistic levels of worry and tension with or without a definite cause. Social anxiety disorder is an overwhelming self-consciousness in social situations accompanied by a fear of being judged by others. A patient with obsessive-compulsive disorder (OCD) may engage in ritualistic behaviors such as washing hands over and over. OCD interferes with a person's daily activities. The patient experiencing posttraumatic stress disorder (PTSD) may have flashbacks of a traumatic event long after it occurred.