CH 42 Stress & Adaptation

A client age 35 years is stressed because he is having problems with his superiors at work. The client says that he had an argument with his superiors about his salary. He has become very anxious and has started consuming large amounts of caffeine very frequently. He also suffers from insomnia and gets angry quickly. Which of the following techniques should the nurse suggest to help the client? A) Non-therapeutic coping strategy B) Negative coping strategy C) Therapeutic coping strategy D) Sensory manipulation strategy

Ans: C Feedback: Therapeutic coping strategies usually help the person to acquire insight, gain confidence to confront reality, and develop emotional maturity. Maladaptation results when people use non-therapeutic coping strategies such as mind- and mood- altering substances, hostility and aggression, excessive sleep, avoidance of conflict, and abandonment of social activities. Sensory manipulation involves altering moods, feelings, and physiologic responses by stimulating pleasure centers in the brain using sensory stimuli. Negative coping strategies may provide immediate temporary relief from a stressor, but they eventually cause problems.

A man has noticed bright red blood in his bowel movements for over a month. He says to himself, "Oh, it's just my hemorrhoids." What defense mechanism is the man using? A) Rationalization B) Repression C) Denial D) Compensation

Ans: C Feedback: When using denial as a defense mechanism, an individual is refusing to acknowledge the presence of a condition that is disturbing.

Which area of nursing experiences the highest levels of stress in the work setting? A) Obstetric nurses B) Pediatric nurses C) New graduates D) Aging nurses

Ans: C Feedback:Nursing involves activities and interpersonal relationships that are often stressful. The stress is even greater for two groups of nurses: new graduates and nurses who work in intensive care and emergency care.

A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor? A) Adaptation B) Homeostasis C) Coping mechanism D) Defense mechanism

Ans: C Feedback:When a person is in a threatening situation, immediate responses occur. Those responses, which are often involuntary, are called coping responses. The change that takes place as a result of the response to a stressor is adaptation.

Which of the following statements, made by a senior citizen who has taken a class on stress reduction, would indicate to the nurse the need for further instruction? A) Adults draw on coping skills learned throughout life. B) Family members can be supportive during stress. C) Stress may be positive or negative. D) As one grows older, their stress decreases.

Ans: D Feedback: As a person ages, stress does not decrease; in fact, some people experience increased stressors associated with commonly encountered circumstances, such as experiencing empty-nest syndrome or dealing with the death of family and friends.

What phase of the general adaptation syndrome is a client in when he uses all of his adaptive mechanisms for dealing with stress, leaving no defense against the distress? A) Alarm reaction stage B) Fight-or-flight stage C) Stage of resistance D) Stage of exhaustion

Ans: D Feedback: Exhaustion results when the adaptive mechanisms are exhausted. Without defense against the stressor, the body may either rest and mobilize its defenses to return to normal, or reach total exhaustion and die.

The client is a child age 5 years hospitalized for a surgical procedure. The client is bedwetting. The parents report this is a new behavior and their child is toilet trained. The nurse assesses the client is exhibiting the defense mechanism of ... A) compensation. B) displacement. C) reaction formation. D) regression.

Ans: D Feedback: Regression is a maladaptive behavior in which the client returns to an earlier method of behaving, as seen in the child who is now bedwetting. Compensation is overcoming a perceived weakness by emphasizing a more desirable trait. Displacement is transferring an emotional reaction from one object or person to another. Reaction formation is exhibiting behaviors that are the opposite of what the client would really like to do.

A nurse is preparing to educate a client about care at home. On entering the room, she finds the client pacing around the room, hyperventilating, and complaining of nausea. Based on these manifestations of severe anxiety, what would the nurse do? A) Provide both verbal and written information to the client. B) Ignore the client and teach the family the information. C) Modify the education plan to the client's anxiety level. D) Postpone implementation of the education plan.

Ans: D Feedback: Severe anxiety creates a very narrow focus on specific detail, causing all behavior to be geared toward getting relief. Manifestations include increased motor activity, nausea, and hyperventilation. The person has impaired learning ability. Education should be postponed and help to reduce the anxiety should be provided.

Which of the following questions would be helpful in eliciting data about the effects of stress during a health history? A) "Why are you having so much difficulty breathing at night?" B) "Why do you think smoking and drinking will calm you?" C) "Do you often drink too much and have hangovers?" D) "How does your body feel when you are upset?"

Ans: D Feedback: Stress causes many physiologic manifestations and emotional responses. The question "How does your body feel when you are upset" is nonjudgmental and nonthreatening, and encourages the client to talk about the symptoms he or she has experienced.

If a nurse assessed the vital signs of a person who was in the initial alarm reaction stage (shock phase) of the GAS, what would be the expected findings? A) Slow, deep breathing B) Fatigue and lethargy C) Hypotension D) Hypertension

Ans: D Feedback: The alarm reaction is initiated when a person perceives a specific stressor and various defense mechanisms are activated. The initial or shock phase is characterized by increased energy, oxygen intake, cardiac output, blood pressure, and mental alertness.

Which of the following group of terms best describes anxiety? A) Cognitive, known threat, depression B) Cognitive, visible threat, anger C) Known source, prolonged, solely physical D) Unknown cause, emotional, apprehensive

Ans: D Feedback: The most common human response to stress is anxiety. Anxiety is a vague, uneasy feeling of discomfort or dread, an emotional response to a threat. The source is often nonspecific or unknown. It is a feeling of apprehension caused by anticipating a danger.

Which of the following is an example of developmental stress? A) A newborn who needs to be fed by bottle B) A school-age child learning to read C) A teenager learning to drive a car D) A middle adult accepting signs of aging

Ans: D Feedback:Developmental stress occurs as a person progresses through the normal stages of growth and development, from birth to old age. Within each stage, certain tasks must be achieved to resolve the crisis and reduce the stress. The middle adult has the developmental task of accepting physical signs of aging.

A woman who was assaulted in the street is brought to the emergency room for observation. A nurse documents that the woman has difficulty communicating verbally, is agitated, and complains of chest pain and a sense of impending doom. What type of anxiety is this client experiencing? A) Mild anxiety B) Moderate anxiety C) Severe anxiety D) Panic

Ans: D Feedback:Panic causes the person to lose control and experience dread and terror. The resulting disorganized state is characterized by increased physical activity, distorted perception of events, and loss of rational thought. Panic is manifested by difficulty communicating verbally, agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, and sensations of chest pain or pressure.

Which of the following are considered internal stressors? Select all that apply. A) loud noises B) pollution C) illness D) hormonal change E) fear F) cold stress

C) illness D) hormonal change E) fear

According to Pender, Murdaugh, & Parsons, (2006), which of the following are major sources of stress in society? Select all that apply. A) interpersonal relationships B) physical threat C) performance demands D) religious affiliations E) environmental effects F) disease states

A) interpersonal relationships C) performance demands

Which of the following best describes stress? A) A response to changes in the normal balanced state B) A perception that something is threatening C) A response to internal environment for homeostasis D) A localized response of a tissue or organ to a stressor

Ans: A Feedback: Stress is a condition in which the human system responds to changes in its normal balanced state. Stress results from a change in the environment that is perceived as a challenge, a threat, or a danger, and can have both positive and negative effects.

The nurse walks into the client's room and finds her sobbing uncontrollably. When the nurse asks what the problem is, the client responds I am so scared. I have never known anyone who goes into a hospital and comes out alive. On this client's care plan the nurse notes a nursing diagnosis of Ineffective coping related to stress. What is the best outcome you can expect for this client? A) Clients will adapt relaxation techniques to reduce stress. B) Clients will be stress free. C) Clients will avoid stressful situations. D) Client will start an anti-anxiety agents

Ans: A Feedback: Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the client needs to adopt coping mechanisms that are effective for dealing with stress, such as relaxation techniques. The other options are incorrect because it is unrealistic to expect a client to be stress free; avoiding stressful situations and starting an anti-anxiety agent are not the best answers as outcomes for ineffective coping.

A client has been brought to the health care facility with accident-related injuries. During the initial interview, the client becomes agitated, upset and is unable to answer any more of the nurse's questions. What does the nurse conclude about the condition of the client? A) The client's mind is preparing for a fight-or-flight response as he relates the incident. B) The client's mind is numb, and he is not able to react to further questions from the nurse. C) The brain is receiving less oxygen with each passing minute, which does not allow him to speak. D) The brain is sending chemicals to the bloodstream that make the client afraid of the questions.

Ans: A Feedback: The client is currently in the alarm stage, where the stimulating neurotransmitters and neurohormones are released, which prepare the client for a fight-or-flight response. The brain, at this time, receives more oxygen to sharpen the senses and coordination. The brain also sends more chemicals to the bloodstream, which helps the client to keep alert for an extended period of time.

The client is a single parent being seen at an employee wellness clinic. The client tells the nurse he has three school-age children who participate in various activities. He states, "Every night, I am taking them to soccer practice, football practice, Girl Scouts. I have to fix dinner and then go over homework. I have no time for myself. I am so tired." The client exhibits tremors of his hands. Blood pressure is 140/88 mm Hg, heart rate is 98 beats/minute, and respirations are 30 breaths/minute. Data best supports which of the following nursing diagnoses? A) Stress Overload related to single parenting B) Defensive Coping related to inability to appraise stressors C) Hopelessness related to multiple responsibilities D) Disturbed Sleep Pattern related to anxiety

Ans: A Feedback: The client is stating his stressors and a reaction to the stressor when he states, "I am so tired." This would support Stress Overload. Defensive Coping would be not appropriate as he can state stressors in his life. He does not express Hopelessness in his statement to the nurse. The nurse needs more data, such as difficulty falling asleep and interrupted sleep, to support Disturbed Sleep Pattern.

Which diagnoses would be written for stress as the cause of the problem? A) Anxiety related to conflicts about values and goals in life B) Caregiver Role Strain related to long-term stress of care for a parent with Alzheimer's disease C) Spiritual Distress related to inability to accept diagnosis of terminal illness D) Hopelessness related to presence of disabling physical injuries

Ans: A Feedback:Assessment data may reveal stress to be the problem as seen in answer A, or the etiology of a problem as seen in answers B, C, and D.

The wife of a client on hospice at home is diagnosed with "caregiver burden." Which of the following best describes this syndrome? A) Prolonged stress from caring for a family member at home B) Inability to provide competent care for a family member C) Insufficient funds to pay for medical care of a family member D) Effect of the illness causing stress in siblings

Ans: A Feedback:Caring for a family member at home for long periods can cause prolonged stress. Called caregiver burden, this stress response includes chronic fatigue, sleep problems, and an increased incidence of stress-related illnesses, such as high blood pressure and heart disease.

Of the following physiologic stressors, which one is a physical agent? A) Heat B) Drugs C) Bacteria D) Hypoxia

Ans: A Feedback:Physiologic stressors have both a specific effect (altered body structure and function) and a general effect (stress response). Heat is a physical agent that is a physiological stressor.

A client with an inflamed appendix is feeling pain in the stomach area. What is the term for this body response to stress? A) Local adaptation syndrome B) General adaptation syndrome C) Physiological homeostasis D) Fight-or-flight response

Ans: A Feedback:The local adaptation syndrome is a localized response of the body to stress. It involves only a specific body part (such as a tissue or organ) instead of the whole body. The stress precipitating the LAS may be traumatic or pathologic.

Which of the following responses to stressors results from the activation of the local adaptation syndrome? A) A girl quickly withdraws her hand from a stream of hot tap water. B) A woman's impending job interview has prompted the activation of her fight-or-flight response. C) A man is experiencing moderate anxiety before meeting with an important client. D) A man has a sudden urge for a bowel movement before undergoing thoracentesis.

Ans: A Feedback:The reflex pain response is a response to physiological stress that is a component of the local adaptation syndrome. Psychological anxiety and the activation of the fight-or-flight response are not considered to be manifestations of the local adaptation syndrome.

A client who is being seen at a physician's office states that he has "bad headaches all the time." Diagnostic tests are normal. What is this type of response to stress called? A) Psychosomatic disorder B) Acute illness C) Chronic illness D) Pretend disorder

Ans: A Feedback: Each person reacts to stress in his or her own way. With prolonged stress, some may develop diarrhea, others headaches. Such illnesses are real and are called psychosomatic disorders because the physiologic alterations are thought to be at least partially caused by psychological influences.

Which of the following body systems are the primary controllers of homeostatic mechanisms? Select all that apply. A) Autonomic nervous system B) Endocrine system C) Respiratory system D) Cardiovascular system E) Gastrointestinal system

Ans: A, B Feedback: The autonomic nervous system and the endocrine system primarily control homeostatic mechanisms. Involved to a lesser degree are the respiratory, cardiovascular, gastrointestinal, and renal systems.

An individual steps into a tub of very hot water and immediately jumps out again. What mechanism caused this response? A) Inflammatory response B) Reflex pain response C) General adaptation syndrome D) Fight-or-flight response

Ans: B Feedback: The reflex pain response is a rapid and automatic response of the central nervous system to pain that serves as a protective mechanism to prevent injury.

A student is preparing for her first client care assignment. She wakes up at 4 AM with a pounding pulse and diarrhea. What type of adaptive response to stress is she experiencing? A) General adaptation syndrome B) Mind-body interaction C) Local adaptation syndrome D) Coping or defense mechanism

Ans: B Feedback: The student's response to stress exemplifies the mind-body interaction and illustrates a link between psychological stressors and the physiologic stress response. A person perceives a threat on an emotional level as though it is a physiologic threat, and the body prepares itself for the fight-or-flight response.

The client is under immediate stress. The nurse assesses which sign as an effect of the sympathetic system? A) Blood sugar of 65 mg/dL B) Heart rate of 102 beats/minute C) Increased bowel sounds D) Cool, clammy skin

Ans: B Feedback: When stressed, the client's sympathetic system is activated, which causes an increase in heart rate. The sympathetic system also stimulates release of glycogen, which increases blood glucose levels and dilates skeletal muscle blood vessels. This would most likely cause warm skin. The parasympathetic system, which functions under normal conditions and at rest, stimulates secretion of digestive juices and the smooth muscle of the digestive tract, thus leading to increased peristalsis.

Which of the following illnesses has been associated with long-term stress? A) Bacterial infections B) Cardiovascular disease C) Renal disease D) Fractures

Ans: B Feedback:Long-term stress affects physical status, increasing the risk for disease or injury. High levels of stress are associated with cardiovascular disease, gastrointestinal disorders, and cancer. These diseases are the result of a combination of factors, including the GAS, eating patterns, lifestyle, and coping mechanisms.

Various physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment. The state that results is called what? A) Nirvana B) Homeostasis C) Fight-or-flight response D) Anxiety

Ans: B Feedback:To maintain health, the body's internal environment must remain in a balanced state. Various physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment, which is called homeostasis.

A nurse teaches a client deep-breathing exercises to help control his anxiety. This is considered what type of stress management technique? A) Meditation B) Relaxation C) Anticipatory guidance D) Guided imagery

Ans: B Feedback:Two helpful relaxation activities, to be practiced three or four times at each session, are deep breathing and progressive muscle relaxation. A person practicing meditation sits comfortably with closed eyes, relaxes the major muscle groups, and repeats the selected word silently with each exhalation. Anticipatory guidance focuses on psychologically preparing a person for an unfamiliar or painful event. In guided imagery, a person creates a mental image, concentrates on the image, and becomes less responsive to stimuli (including pain).

What is the term for the change that takes place in response to a stressor? A) Rehabilitation B) Adaptation C) Positive movement D) Negative movement

Ans: B Feedback:When a person is in a threatening situation, immediate and often involuntary responses occur. The change that takes place in response to a stressor is adaptation.

When discussing his problem, a client tells the nurse that he is always doing small, petty jobs for everyone and he is not happy about it. Because of this, he is feeling stressed and has been getting into fights with his wife. What should the nurse suggest to help the client overcome this problem? A) Change jobs. B) Avoid people who dump tasks on him. C) Take control of the situation. D) Avoid doing petty jobs.

Ans: C Feedback: A behavioral technique for modifying stress is to take control rather than become immobilized. This is also known as alternative behavior. Another behavioral approach to reduce stress is to sometimes say "no," in order to avoid becoming overwhelmed and more stressed. Changing jobs, avoiding the person, or avoiding the petty jobs would not help.

Cold temperatures and loud noises are stressors to one person but not another. Why does this occur? A) Although the perception is the same, the response is individualized. B) Both individuals will respond the same, depending on the situation. C) The perception and effects of stressors are highly individualized. D) The internal environment of one person is more selective.

Ans: C Feedback: A stressor is anything that is perceived as challenging, threatening, or demanding. Stressors may be internal or external. The perception and effects of the stressors are highly individualized.

A friend has lost her job and is becoming increasingly anxious to the point of crisis. What type of crisis is she experiencing? A) Adventitious B) Maturational C) Situational D) Emotional

Ans: C Feedback: Crises may be maturational, situational, or adventitious. Situational crises occur when a life event, such as the loss of a job, disrupts a person's psychological equilibrium.

A nurse is educating a client about the benefits of exercise in reducing stress. How often would the nurse recommend the client exercise? A) Two hours every day B) One hour once a week C) 30 to 45 minutes, most days of the week D) 60 to 75 minutes, four to five times a week

Ans: C Feedback: General health guidelines recommend that an exercise program consist of 30 to 45 minutes of moderate activity most days of the week. Exercise improves one's general sense of well-being, relieves tension, and enables one to cope better with day-to-day stressors.