NUR 120 Taylor Chapter 41 - Stress and Adaptation

A client is admitted to the oncology unit with a diagnosis of leukemia. Her sister comes to visit. The healthy sibling tells the nurse that her sister is sick because "I got mad at her and wished she would go away." Based on this information, the nurse would estimate the sister's age to be: 3 years 21 years 15 years 7 years

7 years This is an example of magical thinking. Magical thinking is a common reaction to stress in a school-aged child.

Upon arrival to the emergency room, the mother of a client 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? Mild anxiety A panic attack Moderate anxiety Severe anxiety

A panic attack 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.

A 56-year-old construction worker is in for his annual physical. As the nurse takes his vital signs, he tells her that his blood pressure may be a little off this morning. He tells the nurse that he is recently unemployed, is quite stressed, and is having a hard time coping. He feels like he needs to numb the pain. What is the nurse most concerned about regarding this client? Projection Exercise Cocaine use Alcohol abuse

Alcohol abuse Alcohol abuse is a common altered coping pattern for individuals with poor coping skills. It is legal and easily accessible. Phrases such as "I just cannot cope" and "I need to numb the pain" are common among those who abuse alcohol.

Prior to the client's scheduled bone marrow biopsy, the nurse has devoted time to educating him about the rationale and the specific details of the procedure. The nurse's actions constitute what stress management technique? Relaxation Normalization Guided imagery Anticipatory guidance

Anticipatory guidance Anticipatory guidance involves preparing a client psychologically for an event in the knowledge that familiarity reduces anxiety. Guided imagery involves the creation of mental image, not education. Relaxation focuses on the control of the body's responses to stress. Normalization is not a specific stress management technique.

A nurse assesses patients in a long-term care facility for diseases that are exacerbated by stressors. What is an autoimmune disease that is related to stress? Esophageal reflux Asthma Grave's disease Hypertension

Grave's disease The cumulative negative effects of stress on the body can cause the exacerbation of autoimmune disorders, including Grave's disease. Asthma, hypertension, and esophageal reflux are diseases associated with stress but are not autoimmune in nature.

A group of nursing students is learning about the body's response to stress. Which system is responsible for initiating the fight-or-flight response to stress? Endocrine system Parasympathetic nervous system Sympathetic nervous system Respiratory system

Sympathetic nervous system Functions of the sympathetic nervous system under stressful conditions bring about the fight-or-flight response.

A Spanish-speaking client is admitted to the Emergency Department with a urinary tract infection and is experiencing a stress response from hospitalization. What is the priority nursing intervention? Collect a urine specimen. Begin taking a client history. Contact a translator. Administer broad-spectrum antibiotic.

Contact a translator. In order to decrease the stress response, it is important to provide explanations in understandable language. Contacting a translator to facilitate communication is the priority nursing intervention. While taking a history, collecting urine, and starting antibiotics is important, they are not emergent and effective communication takes precedence especially when a stress response is present.

Upon assessment of a client being evaluated at the headache clinic, the client informs the nurse that her headaches started when she started experiencing marital problems. The client reports that each time she and her husband have a fight, she develops a headache and loses her appetite for several days. What best defines the physiologic symptoms? fear anxiety a coping mechanism a psychosomatic disorder

a psychosomatic disorder A psychosomatic disorder is a real illness caused by psychological influences. The client's fight with her husband causes emotions that lead to physical symptoms. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by an autonomic response. Fear is a cognitive response to a known threat. Anxiety is often managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety.

A client who responds to bad news concerning his lab reports by crying uncontrollably is handling stress by using: adaptation technique. defense mechanism. coping mechanism. withdrawal behavior.

coping mechanism. Anxiety often is managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. Coping mechanisms are immediate responses and are often involuntary. Crying is considered a coping mechanism. The change that takes place as a result of the response to a stressor is adaptation. Withdrawal is a type of coping mechanism. Defense mechanisms protect one's self-esteem and are useful in mild to moderate anxiety; if they used to an extreme, however, they distort reality and create problems with relationships.

A client who responds to bad news concerning his lab reports by crying uncontrollably is handling stress by using: coping mechanism. adaptation technique. defense mechanism. withdrawal behavior.

coping mechanism. Anxiety often is managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. Coping mechanisms are immediate responses and are often involuntary. Crying is considered a coping mechanism. The change that takes place as a result of the response to a stressor is adaptation. Withdrawal is a type of coping mechanism. Defense mechanisms protect one's self-esteem and are useful in mild to moderate anxiety; if they used to an extreme, however, they distort reality and create problems with relationships.

A client asks the nurse, "Why do I get so excited when I drink caffeine?" Which nursing response is most appropriate? "Caffeine increases activity in the reticular activating system." "Caffeine slows processing between the cortex and the subcortex." "Caffeine can slow down brain activity." "Caffeine only causes excitement when combined with sugar."

"Caffeine increases activity in the reticular activating system." Drugs, like caffeine, increase activity in the reticular activating system, producing alertness and the "thinking activity" of the cortex by stimulating receptors for norepinephrine. Drugs, like alcohol, narcotic analgesics, and tranquilizers, decrease brain activity and induce sleep by simulating or increasing GABA. Caffeine does not slow processing between the cortex and the subcortex. Caffeine can stimulate the RAS alone, or in conjunction with sugar.

A Red Cross volunteer has recently returned from assisting families in the Northwest who survived a devastating forest fire. She is having trouble sleeping and has taken up smoking again. Which statement by her leads the nurse to suspect a nursing diagnosis of Caregiver Role Strain related to stress from disaster volunteer activities? "I get so tired from working long hours at the site." "I need to get back to work here at home. That will get me back into a routine." "I guess the smoke in the air brought out my mental addiction to cigarettes." "I can't seem to calm down. I keep seeing those faces and hearing their words every time I close my eyes."

"I can't seem to calm down. I keep seeing those faces and hearing their words every time I close my eyes." This person is exhibiting a physiologic response to stress, while also taking up a negative coping solution to diminish the symptoms. Reliving the events that were stressful is a common complaint when under anxiety. The other statements do not demonstrate the burden of role strain.

A mother tells the school nurse that her 5-year-old is refusing to go to school and won't accept a "school night" bedtime. The school nurse knows the mother will need more instruction when the mother makes which statement? "I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." "We've all been talking to him about what school will be like; his brother had the same teacher and really liked her." "It's so hard to get them into a routine after summer break. I go through this every year with all my kids." "I am bringing him to the orientation so he can meet his teacher and some classmates."

"I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." Each developmental stage includes tasks that must be achieved so that normal growth and development can occur, but change can be stressful. In a school-age child, starting school and being around strangers can be challenging. One way to counteract the anxiety is to introduce them to others in social situations, and teach acceptable social behaviors, before they start school.

A client presents with a flare of lupus. Which statement made by the client would cause the nurse to suspect a stress reaction? "My lupus typically flares twice a year." "I have a fever with this flare." "My joints hurt more with this flare." "I just had a baby 3 weeks ago."

"I just had a baby 3 weeks ago." The brain-immune connection suggests that changes in body chemistry during periods of stress may trigger an autoimmune (self-attacking) response like those associated with lupus. While having a baby can be positive it is stress both physically and emotionally and could be a stress trigger for the lupus flare. The other options present differences in lupus flare presentation, which is not specific to a stress response.

Four daughters of a client diagnosed with brain death after a myocardial infarction are trying to come to terms with this stressor. Which statement from one of the daughters shows the nurse that they are coping effectively with their mother's situation? "Is it okay if I ask our pastor to come and say a prayer with us in Mom's room?" "You people have no idea how to care for someone this sick." "Her doctor changed her blood pressure medication last month and I think that caused this." "I know she will get better because she has always been a strong person."

"Is it okay if I ask our pastor to come and say a prayer with us in Mom's room?" Family coping can be influenced by shared values and culture, economics, environment, past events, and religion. Blaming, projection, and denial can be unhealthy ways to defend against a stressor. An effective way to help these daughters cope with grieving and loss might be seeking out the support of a respected member of their religious community.

The nurse teaches a client about the use of yoga as a stress management intervention. Which client statement indicates to the nurse that learning has taken place? "It alters a negative physiologic response through the power of suggestion." "It eases tense muscles by clearing the mind of stressful thoughts." "It uses the mind to visualize calming, pleasurable, and positive experiences." "It reduces physical and emotional tension through postural changes and focused concentration."

"It reduces physical and emotional tension through postural changes and focused concentration." Stating that yoga reduces physical and emotional tension through postural changes and focused concentration is correct because yoga reduces stress, increases relaxation, and promotes greater flexibility. Stating that yoga eases tense muscles by clearing the mind of stressful thoughts refers to progressive relaxation, not yoga. Stating that yoga alters a negative physiologic response through the power of suggestion is incorrect, as this is referring to the placebo effect. Using the mind to visualize calming, pleasurable, and positive experiences is called imagery, not yoga.

A 22-year-old college student recently engaged in sexual intercourse with a new partner. When a nurse tells her that she is pregnant, she tells the nurse "that's not possible, I got my period last week". This is an example of what defense mechanism? Regression Denial Rationalization Suppression

Denial The client is exhibiting denial by refusing to accept something as is.

The children of a woman 60 years of age are distraught at her apparent lack of recovery following a stroke several weeks earlier. The client'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 client's daughter be exhibiting? Sublimation Displacement Regression Denial

Displacement 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.

A client is experiencing a stress response each time the family visits the room. What nursing intervention is most appropriate? Do not intervene and allow the client to work out the family issue. Tell the family they are causing too much stress. Explain that family visits and support are important. Limit the family visits to once daily.

Limit the family visits to once daily. When a person is experiencing a stressor, it is important for the nurse to reduce or eliminate the stress. In this case, it is appropriate to limit the family visiting time to allow the client to recover without experiencing a stress response. Telling the family they are causing the stress is not therapeutic. Telling the client that they family should be there invalidates the client's feelings. Doing nothing is not an appropriate response to decrease or remove the stressor.

A nurse is providing care for client who experienced a stroke. Which nursing intervention reflects tertiary level of prevention? Provide care transition at discharge for speech therapy. Conduct mental status assessment every 2 hours. Assess blood pressure every 4 hours. Discuss family history of hypertension.

Provide care transition at discharge for speech therapy. Tertiary prevention minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease. An example is speech therapy to help restore ability. Blood pressure and mental status exams are examples of secondary prevention associated with the acute stroke. Discussing family history is also secondary prevention in terms of assessing for further risk factors.

A client with cancer has recovered from tumor removal surgery and is now stable while undergoing a chemotherapy treatment schedule. She is not having any symptoms at this time and is continuing to work and enjoy social events. What stage of the general adaptation syndrome (GAS) would the nurse place her in? Exhaustion Alarm reaction Resistance Reflex pain response

Resistance This client's situation is an example of the resistance stage of the GAS. Stress is continuing, but the client is maintaining homeostasis. Alarm is the initial stage when major stress is encountered. Exhaustion is when homeostasis can no longer be achieved. The reflex pain response is part of the local adaptation syndrome.

A client with persistent nausea is diagnosed with somatization. What is the appropriate nursing action when the client reports nausea? Sit with the client and ask them about their feelings. Explain that the physical symptoms are all in their head. Immediately administer an antiemetic. Contact the primary care provider.

Sit with the client and ask them about their feelings. Somatization is manifesting an emotional stress through a physical disorder. Treating the nausea with an antiemetic will not get at the root cause of the emotional issue. Contacting the primary care provider is not appropriate, as the diagnosis of somatization is present. Explaining that the physical symptoms are all in the client's head is not therapeutic. Sitting with the client to explore what is really going on is most appropriate nursing response.

Which stressor collected during the assessment process for an adult client requires priority intervention by the nurse? downsizing of a business venture being fired from one's job experiencing the death of a close friend taking early retirement

being fired from one's job Being fired from one's job is information that is collected during the assessment process for adult clients and requires priority intervention. This is because being fired from one's job is a very stressful situation that personally and directly affects the client, and may impact the client's well being. Experiencing the death of a close friend, taking an early retirement, and downsizing a business are all stressors, but they do not take priority.

During a counseling session a client states, "I just try to forget about my spouse hitting me." Which coping mechanism should the nurse document based on this client's statement? repression reaction formation rationalization regression

repression Repression is the coping mechanism that this client is using, in which the client has removed the experience of being abused from conscious memory. Reaction formation is a coping mechanism that sees an individual acting just the opposite of one's feelings. Rationalization is relieving oneself of personal accountability by attributing responsibility to someone or something else. Regression is behaving in a manner that is characteristic of a much younger age.

Which behaviors represent effective coping mechanisms? Select all that apply. setting limits with family members who upset you taking a vacation sleeping 3 hours a night denying responsibility for a DUI conviction learning relaxation techniques sleeping 14 hours a night

setting limits with family members who upset you learning relaxation techniques taking a vacation Coping mechanisms can have positive or negative effects on a client's well-being. All of these examples represent coping, either effective or ineffective.

A client is on a stress management program. She states that she is open to trying a guided meditation class. When helping her get started, a nurse tells her that which of the following is not important? soft music a focus of attention a quiet environment an open attitude

soft music Music may be helpful for some, but is not essential for meditation.

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): stressor. adjustment. concern. threat.

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

A middle-age 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: stimuli. demands. illnesses. stressors.

stressors. 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.

The nurse is caring for an postoperative Asian client who speaks minimal English. The nurse notes the client has not requested medication for pain. Considering the client's culture, the nurse would: understand that the client is not in pain. understand that, culturally, Asians may see pain as weakness. understand that, culturally, Asians often do not take medicine. understand that the client is being difficult.

understand that, culturally, Asians may see pain as weakness. Some cultural beliefs, for example, discourage admitting feeling pain, as it may be thought of as a sign of weakness. A patient experiencing pain may hesitate to ask for pain medication so as not to break the cultural norm.