Stress & Anxiety
A 4-year-old child being admitted for surgery arrives on the ambulatory surgical unit crying and pulling at the hospital gown while clutching a teddy bear. What is the best response by the nurse? "Please stop crying. Nobody will hurt you." "Hello, I'm your nurse. Let's go and see your room." "I know you feel scared. This must be your special teddy bear." "We want you to be happy here. Let's go to the playroom and play."
"I know you feel scared. This must be your special teddy bear." Acknowledging that the child is scared and referring to the teddy bear focuses on the child's feelings and a familiar object of security. The child may experience pain as part of the treatment, so the statement that no one will hurt the child is untruthful. Diverting the child's attention will not alleviate fear and anxiety.
A client with multiple sclerosis is admitted to the hospital. The client's exacerbations have become more frequent and more severe. One day, the client's partner confides to the nurse, "Life is getting very hard and depressing, and I am upset with myself for thinking about a nursing home." After listening to the partner's concerns, which is the best response by the nurse? "You may be able to lessen your feelings of guilt by seeking counseling." "It would be helpful if you become involved in volunteer work at this time." "I recognize it's hard to deal with this, but try to remember that this too shall pass." "Joining a support group of people who are coping with this problem may be helpful."
"Joining a support group of people who are coping with this problem may be helpful." Talking with others in similar circumstances provides support and allows for sharing of experiences. The response "You may be able to lessen your feelings of guilt by seeking counseling" is inappropriate because the feeling of guilt was not expressed directly and is too early for this intervention. The response "It would be helpful if you become involved in volunteer work at this time" avoids the partner's concerns and makes a recommendation for which the partner may not have the energy. Also, it cuts off communication. Although the response "I recognize it's hard to deal with this, but try to remember that this too shall pass" identifies feelings, it offers false reassurance.
A nursing team holds a conference to develop goals for the care of a withdrawn, shy male client with low self-esteem who is afraid to talk to members of the opposite sex. Which objective should be given priority and documented in the client's plan of care? "The client will increase his self-esteem." "The client will understand his sexual disorder." "The client will examine his feelings toward women." "The client will increase his knowledge of sexual function.
"The client will increase his self-esteem." If the goal to increase the client's self-esteem is met, the client's relationship with others should improve in all aspects, including sexual. Increasing insight may be helpful but should not receive priority. The client may or may not have a sexual disorder. Examining his feelings toward women is not appropriate at this time; examining these feelings is nonproductive until the client's self-esteem improves. Increasing the client's knowledge of sexual function may be done, but improvement of self-esteem should receive priority.
What type of healthcare does a person who is "worried well" require? Select all that apply. Evaluation Reassurance Hospitalization Diagnostic tests Preventive treatment
A person who is "worried well" wants evaluation, reassurance, and preventive treatment. This person does not ask for hospitalization or diagnostic tests.
Which statement about primary anxiolytic drugs requires correction? Benzodiazepines are indicated for ethanol withdrawal. Benzodiazepines block gamma-aminobutyric acid receptors. Benzodiazepines are first-line drugs used in chronic anxiety disorders. Benzodiazepines act by depressing activity in the region of the brainstem
Benzodiazepines block gamma-aminobutyric acid receptors. Benzodiazepines stimulate gamma-aminobutyric acid receptors, which reduces neuron excitability and produces an overall inhibitory effect. Apart from its indication in the treatment of depression, benzodiazepines are also prescribed for ethanol withdrawal, insomnia, and muscle spasms. Benzodiazepines are the drug of choice in acute and chronic anxiety disorders. Benzodiazepines act by depressing activity in the brainstem and limbic system.
A nurse in a hospice program cares for clients and family members who are coping with imminent loss. What is the most important factor in predicting a person's potential reaction to grief? Family interactions Social support system Emotional relationships Earlier experiences with grief
Earlier experiences with grief How a person has handled grief in the past provides clues to how he or she will cope with grief in the present. Although family interactions, social support system, and emotional relationships are all important, none is the paramount predictor of a client's reaction to grief.
The parents of an 11-year-old child with a terminal illness appear overwhelmed and anxious. What is the best response by the nurse? Explaining the diagnosis in a variety of ways Encouraging the parents to express their feelings Recommending that the parents talk with other parents Offering assurance that surgery will probably correct the problem
Encouraging the parents to express their feelings The parents need to express and work through their feelings before they can move forward with other coping strategies. Explanation of the diagnosis is not focused on the needs of the parents at this time. Participation in a support group may eventually be suggested; however, this is not the priority at this time. Assuring the parents that surgery will correct the problem is false reassurance; there is no guarantee that the surgery will be successful.
An 18-year-old adolescent who was diagnosed with new-onset type 1 diabetes mellitus has stress and reports not having a menstrual cycle for a long time. Which condition is the adolescent experiencing? Amenorrhea Primary amenorrhea Female athlete triad Hypogonadotropic amenorrhea
Hypogonadotropic amenorrhea Hypogonadotropic amenorrhea may occur in type 1 diabetic adolescents experiencing stress. This condition can also result from sudden and severe weight loss, eating disorders, strenuous exercise, and mental illness.
A college student is brought to the mental health clinic by parents with a diagnosis of borderline personality disorder. Which factors in the client's history support this diagnosis? Impulsiveness Lability of mood Ritualistic behavior Psychomotor retardation Self-destructive behavior
Impulsiveness Lability of mood Self-destructive behavior Clients with borderline personality disorder often lead complex, chaotic lives because of their inability to control or limit impulses. Extremes of emotions, ranging from apathy and boredom to anger, may be displayed within short periods. Impulsive self-destructive acts such as reckless driving, spending money, and engaging in unsafe sex often result in negative consequences. Ritualistic behavior is associated with obsessive-compulsive disorders. Psychomotor retardation is associated with mood disorders such as depression.
A client with a personality disorder is playing cards with another person in the lounge. When the other person cheats at cards, the client responds by aggressively scattering the cards around the room. What does the nurse conclude about the client's personality? Poor reality testing A violent personality An antisocial personality Inadequate impulse control
Inadequate impulse control The client is angry and reacts impulsively; the action is unplanned and is not under the client's control. No data are provided to suggest that the client is out of contact with reality; the client is reacting to a real situation with anger. There is no identifiable cluster of behaviors to suggest that the client has a violent personality. There is no pattern of behavior to suggest an antisocial personality, which may or may not involve impulse control.
A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience? Dizziness Breathlessness Abdominal cramps Increased alertness
Increased alertness Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious. Dizziness, breathlessness, and abdominal cramps are all common signs of moderate to severe anxiety.
Which psychosocial nursing actions are appropriate when providing client care after a community disaster? Select all that apply. Performing triage of injuries Administering first aid to wounds Offering choices whenever possible Establishing rapport through active listening Requesting assistance from crisis counselors
Offering choices whenever possible Establishing rapport through active listening Requesting assistance from crisis counselors Psychosocial nursing actions appropriate when providing care after a community disaster include offering choices whenever possible, establishing rapport through active listening, and requesting assistance from crisis counselors. Performing triage of injuries and administering first aid to wounds are not psychosocial nursing actions.
Which reactions does a nurse expect of a 4-year-old child in response to illness and hospitalization? Anger, resentment over depersonalization, and loss of peer support Boredom, depression over separation from family, and fear of death Out-of-control behavior, regression to overdependency, and fear of bodily mutilation Intense panic, loss of security over separation from parents, and low frustration tolerance
Out-of-control behavior, regression to overdependency, and fear of bodily mutilation Preschoolers experience loss of control caused by physical restriction, loss of routines, and enforced dependency, which may make them feel out of control. Preschoolers are also likely to experience feelings of regression or overdependency and fear of bodily mutilation. Anger, resentment over depersonalization, and loss of peer support are typical feelings expressed in adolescence. Boredom, depression over separation from family, and fear of death are typical feelings expressed by school-age children. Intense panic, loss of security over separation from parents, and low frustration tolerance are feelings usually experienced by toddlers.
A nurse is working in the orientation phase of a therapeutic relationship with a client who has borderline personality disorder. What will be most difficult for the client at this stage of the relationship? Controlling anxiety Terminating the session on time Accepting the psychiatric diagnosis Setting mutual goals for the relationship
Setting mutual goals for the relationship Clients with borderline personality disorder frequently demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals. Although the client with a borderline personality disorder may have difficulty in the areas of controlling anxiety, ending sessions on time, and accepting the diagnosis, none is the most significant issue.
A client has been diagnosed with generalized anxiety disorder (GAD). Which behavior supports this diagnosis? Making huge efforts to avoid "any kind of bug or spider" Experiencing flashbacks to an event that involved a sexual attack Spending hours each day worrying about something "bad happening" Becoming suddenly tachycardic and diaphoretic for no apparent reason
Spending hours each day worrying about something "bad happening" Using worrying as a coping mechanism is a behavior characteristic of GAD. Experiencing an accelerated heart rate and perfuse sweating for no apparent reason is consistent with a panic attack. Avoiding bugs and spiders would indicate a phobia. Flashbacks to traumatic events are characteristic of posttraumatic stress disorder (PTSD).
A client who lives with the parents is diagnosed with stage III Hodgkin disease with a grossly involved spleen and is scheduled for a splenectomy. After the nurse performs preoperative teaching, the client appears anxious. What is the best approach for the nurse to use at this time? Allow the client to regress at this time and rest quietly. State that that the client seems anxious and ask whether the client would like to talk for a while. Consider the reaction an unconscious response and inquire about the client's relationship with the parents. Understand that anxiety prevented the client from comprehending and repeat the information in simpler terms.
State that that the client seems anxious and ask whether the client would like to talk for a while. Stating that the client seems anxious and asking whether the client would like to talk for a while provides an opportunity for the client to explore concerns with the nurse. The data do not indicate regression; the client is anxious, not regressed. If the nurse considers the response an unconscious response relating to the client's relationship with the parents, this is based on an incorrect interpretation of the data. The data do not indicate that the client does not understand; the nurse should attempt to provide for consensual validation before coming to this conclusion.
A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms? Partial thromboplastin time (PTT) and prothrombin time (PT) T3, T4, and thyroid-stimulating hormone (TSH) Venereal disease research laboratory (VDRL) test and complete blood count (CBC) Adrenocorticotropic hormone (ACTH), antidiuretic hormone (ADH), and corticotropin-releasing factor (CRF)
T3, T4, and thyroid-stimulating hormone (TSH) T3, T4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client's signs and symptoms. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.
A client exhibits blurred and double vision and muscular weakness, and diagnostic tests are prescribed. The client is informed that a diagnosis of multiple sclerosis (MS) has been made. The client becomes visibly upset. How should the nurse respond? "That must have really shocked you. Tell me what the healthcare provider told you about it." "You should see a psychiatrist who will help you cope with this overwhelming news." "Don't worry; early treatment often alleviates symptoms of the disease." "You should be glad that we caught it early so it can be cured."
The response "That must have really shocked you. Tell me what the healthcare provider told you about it" acknowledges the effect of the diagnosis on the client and explores what is known. There is no evidence of ineffective coping, so a referral to a psychiatrist is not necessary. The statement "Don't worry; early treatment often alleviates symptoms of the disease" provides false reassurance. The statement "You should be glad we caught it early so it can be cured" does not address the client's current emotional state, and it is inaccurate; MS is a chronic autoimmune disease.
A client is newly diagnosed with multiple sclerosis. The client is obviously upset with the diagnosis and asks, "Am I going to die?" Which is the nurse's best response? "Most individuals with your disease live a normal life span." "Is your family here? I would like to explain your disease to all of you." "The prognosis is variable; most individuals experience remissions and exacerbations." "Why don't you speak with your healthcare provider? You probably can get more details about your disease."
"The prognosis is variable; most individuals experience remissions and exacerbations." "The prognosis is variable; most individuals experience remissions and exacerbations" is a truthful answer that provides some realistic hope. The response "Most individuals with your disease live a normal life span" provides false reassurance; repeated exacerbations may reduce the life span. The response "Is your family here? I would like to explain your disease to all of you" avoids the client's question; the family did not ask the question. The response "Why don't you speak with your healthcare provider? You probably can get more details about your disease" avoids the client's question and transfers responsibility to the practitioner.
How should a nurse respond to parents who are concerned about separation anxiety in their 15-month-old toddler? "This is an expected developmental reaction." "You may be spending too much time with your child." "It might be helpful to leave your child with someone once in a while." "Toddlers who have separation anxiety may have difficulty when they start school."
"This is an expected developmental reaction." Understanding that separation anxiety is an expected developmental occurrence will be reassuring to the parents. Commenting that the parents may be spending too much time with their child is a value judgment and does not address this expected stage of development. Giving advice is not therapeutic and does not address the child's separation anxiety. There is no connection between separation anxiety in a 15-month-old child and difficulty starting school.
A child is admitted to the pediatric intensive care unit after an accident at school. The mother, at the child's bedside, is visibly upset. What is the most therapeutic statement the nurse can make? "You must be full of emotions right now." "Let me give you a referral for social services." "Your child will get excellent care at this hospital." "It's a shame that your child has become ill so suddenly."
"You must be full of emotions right now." Noting that the mother must be racked with emotion reflects the mother's feelings. Offering a referral does not address the mother's feelings. Although assuring the mother that the child will receive excellent care, this statement gives false hope for recovery. "It's a shame that your child has become ill so suddenly" does not address the mother's feelings.
During admission a client appears anxious and says to the nurse, "The doctor told me I have lung cancer. My father died from cancer. I wish I had never smoked." What is the nurse's best response? "You seem concerned about your diagnosis." "You are feeling guilty about your smoking." "There have been advances in lung cancer therapy." "Trust your healthcare provider, who is very competent in treating cancer."
"You seem concerned about your diagnosis." The correct response acknowledges the client's concerns and allows them to set the framework for discussion and express self-identified feelings. The client's statement is not specific enough to come to the conclusion that the client feels guilty; this is an assumption by the nurse. Talking about advances in lung cancer therapy or trust for the healthcare provider avoids the client's concerns and cuts off communication.
A client with chronic renal failure has been on hemodialysis for 2 years. The client communicates with the nurse in the dialysis unit in an angry, critical manner and is frequently noncompliant with medications and diet. The nurse can best intervene by first considering that the client's behavior is most likely for which reason? An attempt to punish the nursing staff A constructive method of accepting reality A defense against underlying depression and fear An effort to maintain life and to live it as fully as possible
A defense against underlying depression and fear Both hostility and noncompliance are forms of anger that are associated with grieving. The client's behavior is not a conscious attempt to hurt others but a way to relieve and reduce anxiety within the self. The client's behavior is a self-destructive method of coping, which can result in death. The client's behavior is an effort to maintain control over a situation that is really controlling the client; it is an unconscious method of coping, and noncompliance may be a form of denial.
A nurse is assessing a client for the use of defense mechanisms. In the presence of which defense mechanism does the client express emotional conflicts through motor, sensory, or somatic disabilities? Projection Conversion Dissociation Compensation
Conversion The defense mechanism is called conversion because the individual reduces emotional anxiety to a physical disability. Projection occurs when people assign their own unacceptable thoughts and feelings to others. With dissociation there is separation of certain mental processes from consciousness as though they belonged to another; a dissociative reaction is expressed as amnesia, fugue, multiple personality, aimless running, depersonalization, sleepwalking, and other behaviors. Compensation is a mechanism used to make up for a lack in one area by emphasizing capabilities in another.
A 68-year-old client who has metastatic carcinoma is told by the practitioner that death will occur within a month or two. Later the nurse enters the client's room and finds the client crying. Before responding, which factor should the nurse consider? Crying relieves depression and helps the client face reality. Crying releases tension and frees psychic energy for coping. Nurses should not interfere with a client's behavior and defenses. Accepting a client's tears maintains and strengthens the nurse-client bond.
Crying releases tension and frees psychic energy for coping. Crying is an expression of an emotion that, if not expressed, increases anxiety and tension; the increased anxiety and tension use additional psychic energy and hinder coping. Crying does not relieve depression, nor does it help a client face reality. It is not universally true that nurses should not interfere with a client's behavior and defenses. In most instances the client's defenses should not be taken away until they can be replaced by more healthy defenses. The nurse must interfere with behavior and defenses that may place the client in danger, but the client's current behavior poses no threat to the client. It is not always true that accepting a client's crying maintains and strengthens the nurse-client bond. Many clients are embarrassed by what they consider a "show of weakness" and have difficulty relating to the individual who witnessed it. The nurse must do more than just accept the crying to strengthen the nurse-client relationship.
Which psychosocial change is least likely to be seen in preschoolers?
Preschoolers feel happy if there is a newborn in the family. Sources of stress for preschoolers can include changes in caregiving arrangements, the birth of a sibling, and parental marital distress. Hence, preschoolers are less likely to feel happy with the birth of a new baby in the family. Preschoolers may revert to bedwetting or thumb sucking during times of stress. Guilt arises in children when they believe that they have not behaved correctly. Preschoolers tend to be curious about their environment.
The wife of a client who is dying tells the nurse that although she wants to visit her husband daily, she can visit only twice a week because she works and has to take care of the house and their cat and dog. What defense mechanism does the nurse conclude that the client's wife is using? Projection Sublimation Compensation Rationalization
Rationalization Rationalization is offering a socially acceptable or logical explanation to justify an unacceptable feeling or behavior. Projection is the denial of emotionally unacceptable feelings and the attribution of the traits to another person. Sublimation is the substitution of a socially acceptable behavior for an unacceptable feeling or drive. Compensation is making up for a perceived deficiency by emphasizing another feature perceived as an asset.
A school nurse knows that school-aged children often use defense mechanisms to cope with situations that might negatively affect their self-esteem. The nurse hears a child who was not invited to a sleepover say, "I don't have time to go to that sleepover. I have better things to do." The nurse concludes that the student is using which defense mechanism? Denial Projection Regression Rationalization
Rationalization Rationalization is the offering of an explanation to one's self or others to allay anxiety. Denial involves avoiding the reality of a situation. Projection is blaming others for one's shortcomings. Regression is returning to an earlier more familiar mode of behavior.
A client is found to have generalized anxiety disorder. For what behavior should the nurse assess the client to determine the effectiveness of therapy?
Recognition of anxiety or symptoms of increasing anxiety is an indication that the client is improving. Avoidance of anxiety is not a good indication of improvement; there is no guarantee that anxiety can always be avoided. Participating in activities and taking medications as prescribed do not indicate improvement or recognition of feelings; the client may be doing what others expect.
A client with newly diagnosed multiple myeloma asks, "How long do you think I have to live?" What is the most appropriate response by the nurse? "Let me ask your primary healthcare provider for you." "I can understand why you are worried." "Tell me about your concerns as of the moment." "It depends on whether the tumor has spread."
The response, "Tell me about your concerns as of the moment," encourages the client to review facts and provides an opportunity to talk about feelings. While clients are waiting for the results of diagnostic studies, be available to actively listen to their concerns. Their anxiety may arise from myths and misconceptions about cancer. Correcting those misconceptions can help to minimize their anxiety. Avoid communication patterns that may hinder exploration of feelings and meaning, such as providing false reassurances, redirecting the discussion, generalizing, and using overly technical language as a means of distancing yourself from the client. These self-protective strategies deny clients the opportunity to share the meaning of their experience. In addition, they can jeopardize your ability to build a trusting relationship with your clients. The response, "Let me ask your primary healthcare provider for you," suggests the nurse does not want to discuss the subject; it abdicates the nurse's responsibility to explore the issue with the client. Although it is an empathic answer, the response, "I can understand why you are worried," does not encourage the client to explore feelings; it may increase anxiety. Although the statement, "It depends on whether the tumor has spread," is true, the response does not encourage the client to examine feelings.
