Chapter 37: Stress and Coping

A trauma survivor is requesting sleep medication because of ―bad dreams.‖ The nurse is concerned that the patient may be experiencing posttraumatic stress disorder (PTSD). Which question is a priority for the nurse to ask the patient? a. ―Are you reliving your trauma? b. ―Are you having chest pain? c. ―Can you describe your phobias? d. ―Can you tell me when you wake up?

a. ―Are you reliving your trauma? People who have PTSD often have flashbacks, recurrent and intrusive recollections of the event. The other answers involve assessment of problems not specific to PTSD.

A nurse is planning care for a client who is recently divorced with two young children. The client reports difficulty sleeping, feeling hopeless, and being estranged from family. The nurse should plan to monitor the client for which of the following potential manifestations of chronic stress? a. Systemic infection b. Exaggerated startle response c. Recurring nightmares d. Suicide

d. Suicide Chronic stress can cause or exacerbate serious health problems such as depression, anxiety, cancer, and suicide.

A nurse is teaching the staff about the general adaptation syndrome. In which order will the nurse list the stages, beginning with the first stage? 1-Resistance 2-Exhaustion 3-Alarm a. 3, 1, 2 b. 3, 2, 1 c. 1, 3, 2 d. 1, 2, 3

a. 3, 1, 2 Alarm Resistance Exhaustion The general adaptation syndrome (GAS), a three-stage reaction to stress, describes how the body responds physiologically to stressors through stages of alarm, resistance, and exhaustion.

A nurse in a community clinic is interviewing a client who is distressed and reports being unable to sleep following a neighborhood fire several days ago. The client has hypertension, tachycardia, and is diaphoretic. The nurse should identify that the client is experiencing which of the following types of stress? a. Acute stress b. Post-traumatic stress disorder (PTSD) c. Episodic acute stress d. Chronic stress

a. Acute stress The nurse should identify that the client is experiencing acute stress. Most episodes of acute stress do not have lingering health effects; however, if an individual experiences severe or prolonged stress levels, this condition could lead to mental health issues.

A nurse is caring for an older adult client who reports being stressed about their health status due to problems with short-term memory, slower reaction times when driving, and urinary frequency. The nurse should recognize that the client is experiencing which of the following types of stressors? a. Developmental stressors b. Situational stressors c. Adventitious stressors d. Socioeconomic stressors

a. Developmental stressors Developmental, or maturational, stressors vary throughout the lifespan and occur as individuals move through the stages of life. Older adults may experience stressors related to health problems and changes in mobility and cognition.

A nurse is assessing a client who is working at home due to COVID-19 restrictions. The client reports abdominal cramping and bloating with diarrhea and states, "I am completely stressed out from working at home." The nurse should identify that the client is experiencing manifestations of which of the following stress-related conditions? a. Irritable bowel syndrome b. Food poisoning c. Panic disorder d. Major depressive disorder

a. Irritable bowel syndrome Irritable bowel syndrome is a condition often triggered by stress and characterized by abdominal discomfort, cramping, bloating, and diarrhea.

A nurse is talking about implementing self-care strategies to cope with the stress of caregiving with the partner of a client who has dementia. Which of the following strategies reported by the partner should the nurse identify as an example of effective coping? a. Practicing deep breathing while sitting outside b. Sitting by the client's bedside and drinking coffee c. Going out onto the patio to smoke a cigarette when feeling stressed d. Drinking a glass of wine every night before falling asleep

a. Practicing deep breathing while sitting outside Eating nutritious meals, participating in active exercise, and engaging in mindfulness activities such as deep breathing are examples of healthy coping.

A nurse in a health clinic is interviewing a client who is upset and reports that their stress "is too much to handle." The client is unemployed, a single guardian to young children, and has periodic asthma attacks. Which of the following stress-related conditions is the client experiencing? a. Post-traumatic stress disorder (PTSD) b. Allostatic load c. Chronic illness d. Alarm stage

b. Allostatic load Chronic exposure to elevated or fluctuating endocrine or neural responses causes excessive wear and tear on the body organs, resulting in allostatic load. The nurse should identify that the client's constant stress may be manifesting itself in physical ailments such as periodic asthma attacks.

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. What is the nurse's best response? a. ―Many times, disasters can create mental health problems, so you really should participate with your family. b. ―Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique. c. ―Don't worry now. The psychiatrists are well trained to help. d. ―This will help your family communicate better.

b. ―Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique. Crisis intervention is a type of brief therapy that is more directive than traditional psychotherapy or counseling. It focuses on problem solving and involves only the problem created by the crisis.

A nurse is caring for a client who is in crisis following the breakup of a long-term relationship. The client tells the nurse, "I might as well just die. My life is over." Which of the following actions should the nurse take first? a. Explore past positive coping strategies. b. Establish a follow-up plan of care. c. Conduct a suicidal risk evaluation. d. Display a neutral attitude.

c. Conduct a suicidal risk evaluation. The greatest risk to this client is injury to self or others; therefore, the first action the nurse should take is to conduct a suicidal and homicidal risk evaluation.

A nurse is conducting an educational session for clients who report experiencing stress-related disorders. A client asks the nurse which part of the body activates the stress response. Which of the following responses should the nurse provide? a. Sympathetic nervous system (SNS) b. Adrenal glands c. Hypothalamus d. Adrenocorticotropic hormone

c. Hypothalamus The hypothalamus activates the stress response. When a stress response is triggered, the hypothalamus sends signals to the pituitary and adrenal glands.

Which sociocultural finding in the history of a patient will alert the nurse to a possible developmental problem? a. Family relocation b. Childhood obesity c. Prolonged poverty d. Loss of stamina

c. Prolonged poverty Environmental and social stressors often lead to developmental problems. Sociocultural refers to societal or cultural factors; poverty is a sociocultural factor.

The nurse teaches stress-reduction and relaxation training to a health education group of patients after cardiac bypass surgery. Which level of intervention is the nurse using? a. Primary b. Secondary c. Tertiary d. Quad

c. Tertiary Tertiary-level interventions assist the patient in readapting and can include relaxation training and time-management training. At the primary level of prevention, you direct nursing activities to identifying individuals and populations who are possibly at risk for stress. Nursing interventions at the secondary level include actions directed at symptoms such as protecting the patient from self-harm. Quad level does not exist.

A nurse is planning care for a patient that uses displacement as a defense mechanism. Which information should the nurse consider when planning interventions? a. This copes with stress directly. b. This evaluates an event for its personal meaning. c. This protects against feelings of worthlessness and anxiety. d. This triggers the stress control functions of the medulla oblongata.

c. This protects against feelings of worthlessness and anxiety. Ego defense mechanisms, like displacement, regulate emotional distress and thus give a person protection from anxiety and stress. Everyone uses them unconsciously to protect against worthlessness and feelings of anxiety. Ego-defense mechanisms help a person cope with stress indirectly and offer psychological protection from a stressful event. 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.

A female teen diagnosed with celiac disease continues to eat food she knows will make her ill several hours after ingestion. While planning care, the nurse considers maturational and tertiary-level interventions. Which intervention will the nurse add to the care plan? a. Teach the teen about the food pyramid. b. Administer antidiarrheal medications with meals. c. Gently admonish the teen and her parents regarding the consistently poor diet choices. d. Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends.

d. Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends. Tertiary-level interventions assist the patient in readapting to life with an illness. By adjusting the diet to meet dietary guidelines and also addressing adolescent maturational needs, the nurse will help the teen to eat an appropriate diet without health complications and see herself as a ―typical and normal‖ teenager.