2101 Test 3 - Conflict Resolution & Psychosocial

A nurse is caring for a client who has left-sided hemiplegia resulting from a cerebrovascular accident. The client works as a carpenter and is now experiencing a situational role change based on physical limitations. The client is the primary wage earner in the family. Which of the following describes the client's role problem? 1. Role conflict 2. Role overload 3. Role ambiguity 4. Rose strain

1

A nurse is an ambulatory care clinic is caring for a client who had a mastectomy 6 months ago. The client tells the nurse that there has been a decreased desire for sexual relations since the surgery, stating, "My body is so different now." Which of the following responses should the nurse make? 1. "Really, you look just fine to me. There's no need to feel undesirable." 2. "I'm interested in finding out more about how your body feels to you." 3. "Consider an afternoon at a spa. A facial will make you feel more attractive." 4. "It's still too soon to expect to feel normal. Give it a little more time."

2

A nurse is caring for a client who is recovering from a myocardial infarction and a cardiac catherization. The client states, "I am concerned that things might be a little, you 'different' with my partner when I get home." Which of the following statements should the nurse make? 1. "Sounds like something you should discuss with them when you get home." 2. "It sounds like you are concerned about sexual functioning. Let's discuss your concerns." 3. "Oh, I wouldn't be too concerned. Things will be fine as soon as we get you home." 4. "Just make sure you take your medication as directed, and you should be fine."

2

A nurse is caring for a client whose partner passed away 4 months ago. The client has a recent diagnosis of diabetes mellitus. The client is tearful and state, "How could you possibly understand what I am going through?" Which of the following responses should the nurse make? 1. "It takes time to get over the loss of a loved one." 2. "You are right. I cannot really understand. Perhaps you'd like to tell me more about what you're feeling" 3. "Why don't you try something to take your mind off your troubles, like watching a funny movie." 4. "I might not share your exact situation, but I do know what people go through when they deal with a loss."

2

A nurse is teaching a group of clients how to care for colostomies. Which of the following statements indicated an issue with self-concept? 1. "I was having difficulty with attaching the appliance at first, but my partner was able to help." 2. "I'll never be able to care for this at home. Can you just send a nurse to the house?" 3. "I met a neighbor who also has a colostomy and they taught me a few things." 4. "It can take me a while to get the hang of this. I have to admit, I am pretty nervous."

2

A nurse is caring for a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following nursing interventions for stress, coping, and adherence to the treatment plan should the nurse initiate at this time? (Select all that apply.) 1. Suggest coping skills for the client to use in this situation 2. Allow the client to provide input in the treatment plan 3. Assist the client with time management, and address the client's priorities 4. Provide extensive instructions on the client's treatment regimen 5. Encourage the client in the expression of feelings and concerns

2, 3, 5

A nurse is caring for a group of clients on a medical-surgical unit. Which of the following clients are at increased risk for body-image disturbances? (Select all that apply). 1. A client who had a laparoscopic appendectomy 2. A client who had a mastectomy 3. A client who had a left above-the-knee amputation 4. A client who had a cardiac catherization 5. A client who had a stroke with right-sided hemiplegia

2, 3, 5

A nurse is caring for a client awaiting transport to the surgical suite for a coronary artery bypass graft. Just as the transport team arrives, the nurse takes the client's vital signs and notes an elevation in blood pressure and heart rate. The nurse should recognize this response as which part of the general adaptation syndrome (GAS)? 1. Exhaustion stage 2. Resistance stage 3. Alarm stage 4. Recovery stage

3

A nurse is caring for a client who is 3 days postoperative following a below-the-knee amputation as a result of a motor-vehicle crash. Which of the following statements indicated that the client has a distorted body image? 1. "I'll be able to function exactly as I did before the accident." 2. "I just can't stop crying." 3. "I am so mad at that guy who hit us. I wish he lost a leg." 4. "I don't even want to look at my leg. You can check the dressing."

4

A nurse is caring for a family who is experiencing a crisis. Which of the following approaches should the nurse use when working with a family using an open structure for coping and crisis? 1. Prescribing tasks unilaterally 2. Delegating care to one member 3. Speaking to the primary client privately 4. Convening a family meeting

4

The nursing student has severe test anxiety. When he receives a test in class, his heart rate increases, he feels more mentally alert, and his pupils dilate. According to the general adaptation theory, the nursing student should identify this response as what stage of the body's reaction to stress? a. Alarm b. Resistance c. Adaptation d. Exhaustion

ANS: A During the alarm reaction, rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine levels, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field. During the resistance stage the body stabilizes and responds in an opposite manner to the alarm reaction. In the adaptation stage, antiinflammatory adrenocortical hormones are released, and healing occurs. However, if the stressor remains and adaptation does not happen, the person enters the third stage, exhaustion. The exhaustion stage occurs when the body is no longer able to resist the effects of the stressor and the struggle to maintain adaptation drains all available energy.

The student nurse is discussing her 4-year-old patient with her nursing instructor. The instructor asks her about how Erikson's Developmental Tasks have an impact on a 4-year-old child's self-concept and sexuality. What is the best response? a. "Mike identifies with his father." b. "Mike likes to help dress himself." c. "Mike is aware that he is too small to play football." d. "Mike is looking forward to going to college when he gets bigger."

ANS: A Identifying with his father shows that the patient is in the proper stage for his age. In the Initiative Versus Guilt (3 to 6 years) the individual takes initiative, identifies with a gender, enhances self-awareness, and increases language skills, including identification of feelings. In the Autonomy Versus Shame and Doubt (1 to 3 years) the individual begins to communicate likes and dislikes, becomes increasingly independent in thoughts and actions, and appreciates body appearance and function (including dressing, feeding, talking, and walking). In the Industry Versus Inferiority stage (6 to 12 years) the individual incorporates feedback from peers and teachers, increases self-esteem with new skill mastery (e.g., reading, math, sports, music), strengthens sexual identity, and becomes aware of strengths and limitations. In the Identity Versus Role Confusion stage (12 to 20 years) the individual accepts body changes/maturation, examines attitudes, values, and beliefs; establishes goals for the future, and feels positive about expanded sense of self.

A middle-age single woman has breast cancer and needs a mastectomy. She is concerned with future male relationships. She is crying and indicates that her life is over. According to Erikson, she occupies which stage? a. Intimacy versus Isolation b. Autonomy versus Shame and Doubt c. Identity versus Role Confusion d. Ego Integrity versus Despair

ANS: A Intimacy versus Isolation (mid-20s to mid-40s): Intimate relationships with family and significant others; has stable, positive feelings about self; experiences successful role transitions and increased responsibilities. Autonomy versus Same and Doubt is usually found in children (1 year old to 3 years old) and involves increasing independence in thoughts and actions. In the Identity versus Role Confusion stage (usually in people 12 to 20 years of age) the individual accepts body changes/maturation, examines attitudes, values and beliefs, and feels positive about an expanded sense of self. In the late 60s until death, the person is usually in the Ego Integrity versus Despair stage and is interested in providing a legacy for the next generation.

A male patient shares that, although he has a satisfying relationship with his wife, he is also attracted to men. He is confused and does not know how to deal with this issue. The nurse should do which of the following? a. Explain that the patient's problem is one of orientation and high risk. b. Tell the patient that he has a sexual dysfunction and needs medication. c. Inform the patient that having relationships with other men is normal and risk free. d. Teach that STIs are fewer with men because most STIs are spread vaginally.

ANS: A Lesbian, gay, bisexual, or transgender (LGBT) individuals have unique stressors related to their sexual orientation. Peer, family, and social support is often lacking for this population that is at high risk for health issues such as STIs, HIV, depression, and victimization. Sexual dysfunction interferes with sexual health and is a problem with desire, arousal, or orgasm. Sexually transmitted infections (STI) are infections spread through oral, anal, or vaginal activity. The use of latex condoms can reduce the risk of STIs via any route of transmission.

A nurse is caring for an adult patient who retired last year. While rendering care, the nurse identifies that the patient is struggling emotionally with this change. This situation is most likely associated with what self-concept component? a. Role performance b. Identity stressors c. Self-esteem d. Body image stressors

ANS: A Role performance is the way in which a person views his or her ability to carry out significant roles. Common roles include mother or father, wife or husband, daughter or son, sister or brother, employee or employer, and nurse or patient. Identity stressors affect an individual's identity, but identity is particularly vulnerable during adolescence. Self-esteem stressors vary with developmental stages. Potential self-esteem stressors in older adults include health problems, declining socioeconomic status, spousal loss or bereavement, loss of social support. Body image stressors involve attitudes related to the body, including appearance, femininity and masculinity, youthfulness, health, and strength.

The mother of a 7-year-old boy asked the nurse what factors tended to increase self-esteem in boys. Which of the following is the nurse's best response? a. Positive family communication supporting the child's self-worth. b. It does not really matter because self-esteem varies widely throughout life. c. Avoid situational crises because they lead to permanent changes in self-esteem. d. Let the child know that it is OK to be incompetent.

ANS: A Self-esteem is an individual's overall sense of personal worth or value. Self-esteem is positive when one feels capable, worthwhile, and competent. Once established, basic feelings about the self tend to be constant, even though there is sometimes a little fluctuation. A situational crisis, like a hospitalization, often temporarily affects one's self-esteem.

A 48-year-old nurse is complaining of being continually exhausted because of the workload on her unit. She states that "the patients are getting heavier and the halls are getting longer. Sometimes I just don't think I can get through the day." The nurse is dealing with stress caused by: a. situational factors. b. maturational factors. c. sociocultural factors. d. compassion fatigue.

ANS: A Situational factors include work stress that happens with work overload (patient load, distractions, conflicting priorities), heavy physical work, long hour work shifts, patient concerns (dealing with death and medical treatment), and interpersonal problems with other health care professionals and staff. Coping strategies vary with the individual and the situation. Maturational factors involve stressors and coping strategies that vary with life stage. Sociocultural factors include prolonged poverty, physical handicap, and chronic illness. Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress.

A patient and family attend a counseling session. The patient has become depressed after a job loss. The nurse leading the counseling session informs the patient and his family that this type of crisis is caused by: a. situational factors. b. maturational factors. c. sociocultural factors. d. compassion fatigue.

ANS: A Situational factors include work-related stress. Coping strategies vary with the individual and the situation. Maturational factors involve stressors and coping strategies that vary with life stage. Sociocultural factors include prolonged poverty, physical handicap, and chronic illness. Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress.

The nurse is administering flu vaccines. One of the children who is scheduled to receive the vaccine is afraid of needles and is tearful, and his younger brother is trying to calm him down. The nurse knows that the tearful child has evaluated this event as challenging and therefore is experiencing psychological stress caused by which of the following? a. Primary appraisal b. Coping c. Secondary appraisal d. Dissociation

ANS: A When a person encounters an event, there is an immediate process of primary appraisal or rating of the event. If this appraisal results in the event being identified as a potential harm, loss, threat, or challenge, the person has stress. Coping refers to strategies or practices that help people deal with stress. Following the recognition of stress, secondary appraisal focuses on the resources or coping strategies that can meet the stress. Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one's surroundings.

The nurse is caring for a 65-year-old mother of three who recently underwent abdominal surgery and has a colostomy as a result. The patient has a history of multiple surgeries, including a tracheostomy after lung surgery about 20 years earlier that has since healed over. To determine how to best work with this patient, the nurse should do which of the following? a. Determine how the patient dealt with her previous surgeries. b. Realize that past coping mechanisms are always positive in nature. c. Approach care in a standard method because all patients are the same. d. Avoid using family input in determining the course of care.

ANS: A Your nursing assessment includes consideration of previous coping behaviors. Knowing how a patient has dealt with self-concept stressors in the past provides insight into the patient's style of coping. Not all patients address issues in the same way, but often a person uses a familiar coping pattern for newly encountered stressors. As you identify previous coping patterns, it is useful to determine whether these patterns have contributed to healthy functioning or created more problems. Exploring resources and strengths, such as availability of significant others or prior use of community resources, is important when formulating a realistic and effective plan.

A middle-age female model is admitted for a double mastectomy. On admission the nurse notes that she is depressed and withdrawn. The most appropriate patient-centered nursing intervention(s) might be which of the following? (Select all that apply.) a. Use a positive and matter-of-fact approach to care. b. Include the patient in decision making about her care. c. Be aware of nonverbal behaviors when providing care. d. Focus on the task when an unpleasant task must be done. e. Focus matter-of-fact statements on positive aspects of patient healing.

ANS: A, B, C, E A positive and matter-of-fact approach to care provides a model for the patient and family to follow. General nursing interventions, such as appropriately including the patient in decision making, supports most patients' self-concept. Your nonverbal behavior conveys the level of caring that exists for your patient and affects your patient's self-esteem. For example, when an incontinent patient perceives that you find the situation unpleasant, this threatens the patient's self-concept. Anticipate your own reactions, acknowledge them, and focus on the patient instead of the unpleasant task or situation. Matter-of-fact statements such as, "This wound is healing nicely" or "This looks healthy" enhance the body image of the patient.

The patient has severe injuries. The nurse knows that the general adaptation syndrome (GAS) was viewed as a reaction to stress consisting of: (Select all that apply.) a. a pattern of alarm. b. deleterious consequences. c. a stage of resistance. d. developmental impairment. e. a state of exhaustion.

ANS: A, C, E The GAS was viewed as a reaction to stress consisting of three distinct stages; a pattern of alarm, followed by a stage of resistance as a person attempts to compensate for changes induced by the alarm stage. A state of exhaustion follows if the person cannot successfully adapt during the stage of resistance or if stress remains unrelieved. When stress reaches chronic, harmful levels, deleterious consequences follow, from compromised immune function to weight gain to developmental impairment. Deleterious consequences and developmental consequences, then, are a product of unsuccessful GAS, not a part of the syndrome.

The nurse is interviewing a patient who claims to be in the middle of a crisis situation. The nurse should: (Select all that apply.) a. determine the patient's view of the situation. b. be aware that denial is never a coping mechanism for people in crisis. c. point out that the patient is repeating information and ask him to stop. d. assess for the potential for suicide/homicide. e. assess coping mechanisms and support systems.

ANS: A, D, E Use the interview to determine a patient's view of the situation that provoked stress, assess safety issues, coping resources, any possible maladaptive coping, and adherence to prescribed medical recommendations, such as medication or diet. If your patient is experiencing a crisis, assess safety concerns such as potential for suicide or homicide and ability to care for one's own activities of daily living. Finally, assess alternatives, coping mechanisms, and support systems. If the patient uses denial as a coping mechanism, be alert to whether the person overlooks necessary information. Listen for any recurrent themes in the patient's conversation.

Reviewing sexuality changes associated with aging is important because: a. very few older women experience any type of sexual problems. b. in older men, the penis does not become firm as quickly. c. ejaculation remains the same throughout life. d. ejaculation is quicker with aging.

ANS: B Approximately 50% of older women experience some type of sexual problem such as low desire or vaginal dryness. In men, the penis does not become firm as quickly and is not as firm as it is at a younger age. Ejaculation takes longer to achieve and is shorter in duration, and the erection often diminishes more quickly.

A patient complains of pain. The nursing order calls for pain medication via injection. The patient is afraid of needles. The nurse can assist the patient through this stressful incident by encouraging the patient to think of a relaxing situation. The nurse's actions can be identified as: a. restorative care. b. cognitive therapy. c. assertiveness training. d. progressive muscle relaxation.

ANS: B Cognitive therapy teaches patients how certain thinking patterns cause symptoms of stress or depression. Cognitive therapy focuses on changing ways of thinking so that a patient feels empowered and in control of his or her own life. Restorative care occurs when a person has recovered from a stressful situation, and is taught stress management skills to reduce the number and intensity of stress responses in future situations. Assertiveness training teaches individuals to communicate effectively regarding their needs and desires. The ability to resolve conflict with others through assertiveness training reduces stress. When a group leader teaches assertiveness, the effects of interacting with other people increase the benefits of the experience. Progressive muscle relaxation diminishes physiological tension through a systematic approach to releasing tension in major muscle groups.

A patient telephones a crisis intervention hotline. The nurse assigned to this center assesses that the patient is experiencing a crisis. What is the most appropriate action for the nurse to take? a. Take control of the situation and tell the patient what needs to be done. b. Define the problem at hand and ensure that the patient is safe. c. Ask the patient how he would like to handle the crisis and follow through. d. Ask the patient to list all of his problems and prioritize which to deal with first.

ANS: B Crisis intervention begins with defining the problem, ensuring patient safety, and providing support. First determine that a patient is safe and is not at risk for injury to self or others, and then use crisis intervention to examine alternatives, make plans, and obtain a commitment to positive action from the patient. Ideally these last three steps are completed collaboratively with a patient, but a patient in crisis may be unable to participate actively and may need a very directive approach or a crisis interventionist. Emphasize focusing on the specific problem, and help a patient to avoid all-encompassing, catastrophic interpretations.

The student nurse was late for clinical rounds because she had to change the tire on her car. She is in the process of preparing pain medication for her patient when her nursing instructor asks her to identify the drug classification of the medication that she is preparing. The student nurse is very frustrated, becomes tearful, and states, "I can't seem to crush this tablet correctly." This reaction to the instructor is most likely a result of what ego-defense mechanism? a. Compensation b. Displacement c. Denial d. Dissociation

ANS: B Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one's surroundings.

The nurse is talking to a patient who was involved in a motor vehicle accident. The patient asks the nurse why there was no sensation of pain at the time of the accident. The best explanation would be: a. "Vasopressin was released to decrease pain sensation." b. "Endorphins are released during a time of stress to reduce pain." c. "Alcohol reduces the perception of stress when injury occurs." d. "You probably have chronic high levels of cortisol to help with chronic pain."

ANS: B Endorphins are hormones that interact with the opiate receptors in the brain to reduce our perception of pain and produce a sense of well-being. Vasopressin increases reabsorption of water by the kidneys and induces vasoconstriction, thereby raising blood pressure. It has no effect on pain sensation. Unhealthy coping choices, such as the use of alcohol or tobacco, negatively affect a person's health as well as increasing the perception of stress. Persistent elevated cortisol levels are associated with chronic health conditions, such as obesity, heart disease, depression and anxiety, diabetes, and osteoporosis.

The patient is a 16-year-old teenager who is in the clinic for his annual check-up. During the assessment, the nurse asks the patient about his use of tobacco. Although he denies smoking, he tells the nurse that he dips snuff. He tells the nurse that he started last year because all his friends do it. The nurse recognized this as a stressor of which of the following? a. Body image b. Identity c. Role performance d. Sexuality

ANS: B Identity involves the sense of individuality and being distinct and separate from others. Cultural identity develops from identifying and socializing within an established group and through incorporating the responses of individuals who do not belong to that group into one's self-concept. Body image involves attitudes related to the perception of the body, including physical appearance, femininity and masculinity, youthfulness, health, and strength. Role performance is the way in which a person views his or her ability to carry out significant roles. Common roles include mother or father, wife or husband. Sexuality is a broad term that refers to all aspects of being sexual. Our sexual health is based on our ability to form healthy relationships with others.

A patient who was injured in a motor vehicle accident is taken via ambulance to the emergency department. The nurse performing the physical assessment knows that, according to the general adaptation syndrome, the patient should be expected to exhibit: a. increased blood flow to the intestines. b. increased heart rate. c. decreased blood pressure. d. decreased blood glucose levels.

ANS: B In the early part of the twentieth century, the fight-or-flight response was described. This arousal of the sympathetic nervous system prepares a person for action by increasing heart rate; diverting blood from the intestines to the brain and striated muscles; and increasing blood pressure, heart rate, respiratory rate, and blood glucose levels.

The patient is a 66-year-old patient who has been admitted to the hospital for a transient ischemic attack (TIA). Her health care provider has told her that she should consider retiring from her high-stress position as a hospital administrator. The patient is distraught over this suggestion. The nurse caring for her recognizes the most likely cause of distress is a result of a change in which of the following? a. Body image b. Role performance c. Self-esteem d. Identity

ANS: B Role performance is the way in which a person views his or her ability to carry out significant roles. This patient is being told that she will have to give up her role as an administrator. Body image involves attitudes related to the perception of the body, including physical appearance, femininity and masculinity, youthfulness, health, and strength. There are no overt bodily changes here. Self-esteem is an individual's overall sense of personal worth or value. This could be an issue, but it is based in the change in her role. Identity involves the sense of individuality and being distinct and separate from others. Being "oneself" or living a life that is genuine and authentic is the basis of true identity. What was true of self-esteem can be true of identity.

The nurse is caring for a patient who has been diagnosed with chronic pain. The nurse is especially concerned about the patient's self-concept because chronic pain does which of the following? a. Normally has no effect on the ability to function once patients learn to deal with it b. Can often cause increased irritability that can affect self-concept c. Often leads to increased sleep as patients try to "escape" the pain d. Requires pain medication that prevents self-concept alterations

ANS: B When you care for patients who have alterations in self-concept, be particularly alert to the patient who is experiencing chronic pain. Chronic pain predisposes a person to decreased ability to function, irritability, and decreased sleep. These changes negatively affect self-concept. Many medications have actions and side effects that influence a patient's self-concept and sexuality.

A nurse has been working overtime because of high hospital census and a decreased work force. The nurse is concerned about the danger of work-related burnout or compassion fatigue. To combat this risk, the nurse should: a. increase nursing responsibilities at work. b. take control over new areas at work to reduce stress. c. strengthen relationships outside of the hospital. d. hang out with co-workers when not at work.

ANS: C Compassion fatigue occurs as a result of chronic stress and is often associated with the human service professions. Make a clear separation between work and home life. Strengthening friendships outside of the workplace, socially isolating oneself for personal "recharging" of emotional energy, and spending off-duty hours in interesting activities all help reduce burnout. Identify the limits and scope of your responsibilities at work. Recognize the areas over which you have control and the ability to change and those for which you do not have responsibility.

The nurse has recently been promoted to a new management position in her hospital. She is concerned about her new responsibilities and has found that she is having difficulty sleeping at night. This is an example of what ego-defense mechanism? a. Compensation b. Denial c. Conversion d. Displacement

ANS: C Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite). Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute. (Example: A person transfers anger over a job conflict to a malfunctioning computer.)

The nurse works in a small clinic with two other nurses and a nurse practitioner. Recently the nurse has been staying at work longer than usual. His neighbor, a patient at the clinic, asks one of the other employees at the clinic how the nurse is coping since his wife left him. The nurse had not shared this information with his co-workers. The nurse may be coping with his loss with which of the following? a. Compensation b. Conversion c. Denial d. Dissociation

ANS: C Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite). Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one's surroundings.

The nurse is caring for a 34-year-old woman, who was admitted to the hospital with multiple rib fractures. The patient states, "I fell down the stairs. It was all my fault. I can be so stupid at times." The nurse notices healing bruises on the patient's back and buttocks. The patient's husband seems very caring, always holding her hand and often answering questions for her. The nurse should do which of the following? a. Direct her questions toward the husband because he answers most of them anyway. b. Accept the patient's report on how she received her broken ribs. c. Ask the husband to step into the waiting room while the patient is examined. d. Treat the patient's wounds and discharge her home.

ANS: C If you suspect abuse, interview the patient privately. A patient will probably not admit to problems of abuse with the abuser present. Sexual abuse, assault, and rape are also stressors that affect self-concept. Be alert to clues that suggest abuse. In addition, observe the interaction between the patient and partner for additional clues. Controlling behaviors such as speaking for the person or refusing to leave him or her alone with a caregiver are suggestive of emotional and perhaps physical or sexual abuse.

A new nurse is looking for a staff nurse position. She had several instances during clinical rotations in nursing school in which she was late because she studied until the early hours of the morning. According to her circadian rhythm she would be best suited for which of the following positions? a. Full-time 8-hour day/evening rotation b. Part-time 12-hour day/night rotation position c. Full-time 12-hour night position d. Full-time 8-hour day position

ANS: C In general, people doing shift work need to maintain as consistent a sleep and mealtime schedule as possible. Some nurses often ease their coping with shift work by knowing their own circadian rhythms. A nurse who typically thinks well at night and tends to sleep late in the morning will adapt better to night shift than to day shift. Rotating shifts prevent establishment of a consistent sleep and mealtime schedule.

An older adult patient in a long-term care facility recently had a stroke after experiencing a myocardial infarction. The patient is not speaking or eating. The nurse notices an adverse change in vital signs. When a patient is unable to resist the effects of a stressor, the nurse can identify this stage of the general adaptation system as: a. an alarm reaction. b. the resistance stage. c. the exhaustion stage. d. a fight-or-flight response.

ANS: C The exhaustion stage occurs when the body is no longer able to resist the effects of the stressor and the struggle to maintain adaptation drains all available energy. The physiological response intensifies, but the person has so little energy left that adaptation to the stressor diminishes. The body can no longer defend itself against the impact of the event, and if the stress continues, it damages the heart along with other bodily organs and lowers resistance to illness. In the alarm stage, rising hormones result in an increased blood pressure, blood glucose levels, epinephrine and norepinephrine levels, heart rate, blood flow to muscles, oxygen intake, and mental alertness. This change in body systems prepares an individual for fight or flight and lasts from 1 minute to many hours. During the resistance stage, the body stabilizes and responds in an opposite manner to the alarm stage.

After a large weight loss a patient tells the nurse, "There still is a fat person inside of me." This type of statement illustrates a flaw in what self-concept component? a. Role performance b. Identity stressor c. Self-esteem d. Body image

ANS: D Body image depends only partly on the reality of the body. When physical changes occur, individuals may or may not incorporate these changes into their body image. For example, people who have experienced significant weight loss do not perceive themselves as thin and may still tell you there is still a "fat person" inside. Role performance is the way in which a person views his or her ability to carry out significant roles. Common roles include mother or father, wife or husband, daughter or son, sister or brother, employee or employer, and nurse or patient. Identity stressors affect an individual's identity, but identity is particularly vulnerable during adolescence. Self-esteem is an individual's overall sense of personal worth or value.

As a nurse caring for a patient with a colostomy that resulted from the treatment of a benign tumor of the bowel. The most appropriate classification of this self-concept component is which of the following? a. Role performance stressor b. Sexuality stressor c. Identity stressor d. Body image stressor

ANS: D Changes in the appearance or function of a body part require an adjustment in body image. An individual's perception of the change and the relative importance placed on body image in the individual's self-concept will affect the significance of the loss or change. Throughout life a person undergoes many role changes. Normal changes associated with maturation result in changes in role performance. Sexuality stressors are issues related to sexuality on a regular basis. Identity stressors affect an individual's identity, but identity is particularly vulnerable during adolescence.

The nurse is assigned a patient who has experienced the alarm reaction and continues to recover. The nurse knows that the primary hormone impacting the stress response in the resistance stage of the general adaptation syndrome is: a. vasopressin. b. adrenaline. c. noradrenaline. d. cortisol.

ANS: D Corticotropin stimulates the adrenal gland to increase the production of corticosteroids, including cortisol, the primary hormone impacting the stress response. Cortisol increases blood glucose, enhances the brain's use of glucose, and increases the availability of substances for tissue repair. Vasopressin increases reabsorption of water by the kidneys and induces vasoconstriction, thereby raising blood pressure. The adrenal gland also releases catecholamines, adrenaline, and noradrenaline, which are important parts of the alarm reaction.

The nurse is caring for an elderly patient who has a urinary catheter in place and is showing signs of altered self-concept. In dealing with this age group it is probably safe to assume which of the following? a. Sexuality concerns are not an issue. b. Sexual activity is probably harmful. c. Sexually active seniors are always heterosexual. d. Sexually active elderly adults have better overall health.

ANS: D Give priority to patients in middle and older adulthood when you address sexuality concerns caused by illness, medications, or physical changes. Research has shown middle and older age adults who are sexually active have greater independence, better overall health, and longer life expectancy. In addition, you should not assume all older patients are heterosexuals.

The patient, a busy executive who works 80 hours a week, is admitted for angina. The patient is demonstrating physical signs of stress related to the work environment. An appropriate nursing intervention for this patient includes releasing muscle tension every 2 hours. This type of intervention is best known as: a. regular exercise. b. assertiveness training. c. cognitive therapy. d. progressive muscle relaxation.

ANS: D Muscles tense in the presence of anxiety-provoking thoughts and events. With progressive muscle relaxation physiological tension diminishes through a systematic approach to releasing tension in major muscle groups. A regular exercise program improves muscle tone and posture, controls weight, reduces tension, improves circulation, triggers release of endorphins, and promotes relaxation. Assertiveness training teaches individuals to communicate effectively regarding their needs and desires. The ability to resolve conflict with others through assertiveness training reduces stress.

A 4-year-old boy has been admitted to the hospital with pneumonia. He has been in the hospital for 3 days and has suddenly started to become incontinent of urine. The nurse knows that this is most likely a result of what ego-defense mechanism? a. Compensation b. Conversion c. Denial d. Regression

ANS: D Regression is coping with a stressor through actions and behaviors associated with an earlier developmental period. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite). Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain.

A 35-year-old new mother returns to the clinic for her 6-week postpartum check. When discussing questions regarding the patient's sexual health the nurse should do which of the following? a. Assume that permission to discuss sexuality issues is implied. b. Seek knowledge about sexual health in general. c. Make therapeutic suggestions early and adjust as needed. d. Refer the patient to a professional with advanced training if necessary.

ANS: D The PLISSIT Assessment of Sexuality method suggests that the nurse gain permission to discuss sexuality issues, limit information to sexual health problems being experienced, make specific suggestion only when the nurse is clear about the problem, and refer the patient to professionals with advanced training if necessary.

Body image is an important concept relative to psychosocial development. In dealing with body image issues, the nurse must do which of the following? a. Understand that skinny people always see themselves as thin. b. Realize that body image is never associated with self-esteem. c. Recognize that physical changes always lead to changes in body image. d. Be aware that female adolescents more frequently struggle with issues than males.

ANS: D The development of secondary sex characteristics and changes in body fat distribution has a tremendous impact on the self-concept of an adolescent. Female adolescents struggle more with body image issues than do their male counterparts. Body image depends only partly on the reality of the body. When physical changes occur, individuals may or may not incorporate these changes into their body image. For example, people who have experienced significant weight loss do not perceive themselves as thin and may still tell you there is still a "fat person" inside. Body image issues are often associated with negative self-concept and self-esteem.

The nurse is attempting to obtain a sexual history on a patient who is being evaluated for a possible hysterectomy. The nurse should do which of the following? a. Assume that the patient will not appreciate questions about sexual practices. b. Avoid information relative to medication effect on sexuality. c. Use specific gender terms to emphasize sexuality. d. Recognize that many patients welcome the chance to talk about their sexuality.

ANS: D With experience you will come to recognize that many patients welcome the opportunity to talk about their sexuality, especially when they are experiencing difficulty in sexual functioning. Once you approach the topic, the patient is able to talk about concerns and explore possible ways to resolve the problem. You may worry that the patient will not appreciate being asked about sexuality and sexual practices. However, patients want to know how medications, treatments, and surgical procedures influence their sexual relationships. Use gender-neutral terms and questions when completing the sexual history.

A nurse works on an oncology unit and has a lot of stress in her life. Which of the following situational factors would be considered work stress? a. Caring for a family member who has Alzheimer's disease b. Being diagnosed with a chronic back injury c. Finding out that a parent has lung cancer d. Having a disagreement with her nurse manager

ANS: D Work stress for nurses happens with work overload, heavy physical work, shift work, patient concerns (dealing with death and medical treatment), and interpersonal problems with other health care professionals and staff. Adjusting to chronic illness can result in situational stress, but is not work related. Furthermore, the stress experienced while caring for someone with a chronic illness (such as Alzheimer's disease) can lead to adverse health consequences but is also not work related. Another non-work-related stressor would be caring for a family member who has cancer. Those family members caring for cancer patients have been shown to display immunologic changes that can contribute to the development of inflammatory disease.