Coping prep u
Adaptation to acute and chronic illness or to traumatic injury involves two sets of adaptive tasks
1. General tasks (as in the case of any situational stress) involve maintaining self-esteem and personal relationships and preparing for an uncertain future. 2. Illness-related tasks include such stressors as losing independence and control, handling pain and disability, and carrying out the prescribed medical regimen
The nurse is caring for a client diagnosed with terminal cancer who wishes to use meditation and prayer to be cured. What is the appropriate nursing action
Advocate for the client's choice -Nurses are accountable to act as a client's advocate, even if the client's choices are not in alignment with the nurse's personal choices. The nurse should not assume that a chaplain is desired, nor administer chemotherapy without further dialoguing with the client. Explaining that meditation and prayer are not curative is not helpful in supporting the client's wishes
Progressive relaxation
consists of systematically tensing and relaxing various muscle groups from head to toe
The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. At what stage of stress is the client
exhaustion stage -The client is in the exhaustion stage when one or more adaptive/resistive mechanisms can no longer protect the person experiencing a stressor; this results in exhaustion
social readjustment rate scale
less than 150 is low risk, 150 to 199 is mild risk, 200 to 299 would be considered a moderate risk, and over 300 would be a major risk
A school nurse is listening to a teen describe symptoms related to his schoolwork. The boy states he can't focus when studying, is unable to eat and sleep, and felt like he was going to "pass out" the other day during a geometry test. The nurse believes the teen is experiencing which disorder
moderate anxiety response -Inability to concentrate, nausea, insomnia, dizziness, and hyperventilation are all symptoms of moderate-level anxiety
Stress is often greater for
new graduate nurse working in an emergency or intensive care unit
After failing a nursing exam, the nursing student states, "That exam written terribly." What coping strategy would the nursing instructor identify
rationalization -Rationalization is relieving oneself of personal accountability by attributing responsibility to someone or something else. By claiming the exam is written poorly, the student is relieved of the personal responsibility. Denial is simply rejecting information. Repression is forgetting about the stressor. Suppression is is purposeful avoidance of the topic or issue causing stress
Which data is most appropriate for the nurse to include when assessing an older adult client's capacity to adapt to current stressors
social losses, network of social factors, and advanced age -Advanced age, loss of social network, and social losses are correct because these can diminish older adults' ability to cope and may provoke the onset of physical or emotional disorders. Religious belief and one's attitude is incorrect because these vary as to how older adults adapt to stress. Numbers of children, level of education, and life expectations do not determine how older adults adapt to stress
A nurse is assessing a client with stress-related problems. Which factor influences responses to stressors
social support -A person's response to stressors depends on social support, intensity of the stressor, number of stressors, duration of the stressor, physical health status, life experiences, coping strategies, personal beliefs, attitudes, and values
A group of nursing students is learning about the body's response to stress. Which system is responsible for initiating the fight-or-flight response to stress
sympathetic nervous system
A client is admitted to the oncology unit with a diagnosis of leukemia. Her sister comes to visit. The healthy sibling tells the nurse that her sister is sick because "I got mad at her and wished she would go away." Based on this information, the nurse would estimate the sister's age to be
7 years old -This is an example of magical thinking. Magical thinking is a common reaction to stress in a school-aged child
Which response to long-term stress may present itself in clients
Alcoholism • Hypertension • Bulimia -Stress that becomes a chronic problem over time can lead to maladaptive coping and further evidence of disease. It has been linked to eating disorders, substance abuse, cardiovascular disease, cancer, and immune system dysfunction
environmental stress
Environmental stress is common when individuals move to a new location, even if that move is voluntary. It is associated with a lack of familiarity with the sights, smells, and sounds of the location. Relocation also requires alteration in daily routine which is in itself stressful
A mother tells the school nurse that her 5-year-old is refusing to go to school and won't accept a "school night" bedtime. The school nurse knows the mother will need more instruction when the mother makes which statement
I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer -Each developmental stage includes tasks that must be achieved so that normal growth and development can occur, but change can be stressful. In a school-age child, starting school and being around strangers can be challenging. One way to counteract the anxiety is to introduce them to others in social situations, and teach acceptable social behaviors, before they start school
Four daughters of a client diagnosed with brain death after a myocardial infarction are trying to come to terms with this stressor. Which statement from one of the daughters shows the nurse that they are coping effectively with their mother's situation
Is it okay if I ask our pastor to come and say a prayer with us in Mom's room -Family coping can be influenced by shared values and culture, economics, environment, past events, and religion. Blaming, projection, and denial can be unhealthy ways to defend against a stressor. An effective way to help these daughters cope with grieving and loss might be seeking out the support of a respected member of their religious community
An occupational health nurse at an oil refinery on the gulf coast of Texas performs client education with a man in his mid-40s. The client is being seen after having suffering a chemical burn in an accident at the refinery. Which type of stressor has this client been exposed to
Physiologic Physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders. Psychosocial stressors include both real and perceived threats. Environmental stressors are items found in our surroundings such as noise and crowds. Socioeconomic stressors relate to income and home life (such as low household income and low occupational status of the householder
Which statements accurately describe the body's defense mechanisms against stressors? Select all that apply
Projection occurs when a person's thoughts or impulses are attributed to another person. • Repression occurs when a person voluntarily excludes an anxiety-producing event from conscious awareness -Defense mechanisms are unconscious reactions to stressors and protect one's self-esteem and are useful in mild to moderate anxiety; however, if they are used too much they can distort reality and lead to problems with relationships. Projection occurs when a person's thoughts or impulses are attributed to another person. Repression occurs when a person voluntarily excludes an anxiety-producing event from conscious awareness. Withdrawal is considered a coping mechanism. Displacement occurs when a person transfers (displaces) an emotional reaction from one object or person to another object or person. Reaction formations occur when a person develops conscious attitudes and behavior patterns that are opposite to what he would really like to do
A nurse is providing care for client who experienced a stroke. Which nursing intervention reflects tertiary level of prevention
Provide care transition at discharge for speech therapy -Tertiary prevention minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease. An example is speech therapy to help restore ability. Blood pressure and mental status exams are examples of secondary prevention associated with the acute stroke. Discussing family history is also secondary prevention in terms of assessing for further risk factors
A medical student is experiencing major life changes—the board exam, an internship, and a wedding all within 2 months of graduation. She is particularly susceptible to which conditions
Psoriasis • Rheumatoid arthritis • Asthma -Increased stress (allostatic load) can predispose a person to illness, even if the stressor is a positive event. Psoriasis, rheumatoid arthritis, and asthma are examples of stress-related illness
A nurse is assessing a client who has recently lost her husband. During the interview the nurse realizes that the client is unable to cope with the loss. The client finds it difficult to organize daily tasks or solve problems effectively. Which suggestion would be most appropriate for the nurse to suggest as a crisis intervention
Seek assistance from family and friends -The nurse should suggest that the client seek assistance from family and friends as a crisis intervention. Adequate support during a crisis and its resolution can help clients realistically perceive the problem and reinstitute coping strategies
The nurse is explaining to a group of high school students how the nervous system helps regulate homeostasis. Which statements by the nurse are correct
The sympathetic nervous system is responsible for the flight-or-fight response." • "The parasympathetic nervous system increases peristalsis -The sympathetic nervous system is responsible for the flight-or-fight response to a threat. With the flight-or-fight response, vasoconstriction happens to the nonessential organs. This increases the blood flow to the essential organs and also increases cardiac output. The parasympathetic nervous system controls normal body functions such as digestion. It also will slow the heart rate once a perceived threat is over
Which client would the nurse expect to have negative coping skills
a 19-year-old diagnosed with schizophrenia who is heading off to college -All of these clients will be facing stressors and need to develop adaptation skills. The client with schizophrenia, a chronic but manageable psychiatric illness, is most at risk for reacting negatively to the new life stressor. Clients with mental illness may have decreased physiologic reserve with which to effectively cope and adapt
In contrast to anxiety, fear is characterized by
a cognitive response to a known threat -Fear is a cognitive response to a known threat, while anxiety is the emotional response to that threat. Fear does not necessarily resolve in the short term, and an action plan may or may not be formulated by the individual. The fact that fear involves the identification of a known threat does not necessarily mean that the object of fear is objectively real
A nursing student is engaging in a conversation with a nursing instructor that the student intensely dislikes. Which nursing student behavior is consistent with reaction formation
being extremely nice to the nursing instructor -Reaction formation involves acting just the opposite of one's true feelings; thus, being extremely nice to the nursing instructor is the opposite of what the student feels
Which stressor collected during the assessment process for an adult client requires priority intervention by the nurse
being fired from one's job -Being fired from one's job is information that is collected during the assessment process for adult clients and requires priority intervention. This is because being fired from one's job is a very stressful situation that personally and directly affects the client, and may impact the client's well being
An intensive care unit (ICU) nurse with 11 years of experience has been frequently absent or late for shifts, has been verbally abusive with coworkers she feels are unskilled at the technological tasks of the job, and cursed under her breath at a distraught family member today. The nurse manager is threatening to suspend her if it happens again. The ICU nurse may be experiencing
burnout -Burnout is the term used to describe behaviors that occur when a person is overwhelmed with the demands of a situation and is similar to the exhaustion stage of anxiety. This is commonly seen in nurses who work in high-stress environments. The individual in this scenario may have a great allostatic load and/or sleep deprivation, but there is no evidence of this in the given scenario. Repression is when a person copes by unconsciously denying the occurrence of a stressful event
The client is agitated, sweating, and hyperventilating. The first action of the nurse is to
calmy state you appear to be upset -The client is exhibiting signs of panic. All of these options are appropriate nursing interventions. The first option is for the nurse to approach the client in a calm, reassuring manner
The nurse involved in coordinating a support group for spinal cord injury clients learns that one of the participants in the support group was a college athlete prior to his diving accident. The client informs the group that he earned a scholarship based upon his athletic abilities and not his academic performance, and after the injury, he focused his energies on his studies. He has been on the dean's list for two semesters. What defense mechanism is illustrated in this scenario
compensation -Compensation is overcoming a perceived weakness by emphasizing a more desirable trait or achieving in a more comfortable area. Sublimation involves a person substituting a socially acceptable goal for one whose normal channel of expression is blocked. Projection is a person's thoughts or impulses attributed to someone else. Reaction formation is the development of conscious attitudes and behavior patterns that are opposite to what he would prefer to do
A client who responds to bad news concerning his lab reports by crying uncontrollably is handling stress by using
coping mechanism -Anxiety often is managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. Coping mechanisms are immediate responses and are often involuntary. Crying is considered a coping mechanism. The change that takes place as a result of the response to a stressor is adaptation. Withdrawal is a type of coping mechanism. Defense mechanisms protect one's self-esteem and are useful in mild to moderate anxiety; if they used to an extreme, however, they distort reality and create problems with relationships
A client who has a history of sexual abuse is demonstrating repression. What client behavior does the nurse expect
having no memory of the sexual abuse -Repression is forgetting about the stressor or removing the experience from the subconscious
In evaluating the therapeutic outcome of using biofeedback to help a client work through a stressful situation, the nurse would expect the client to
maintain vital signs within normal limits -Biofeedback is the relaxation technique that involves clients learning to use mental processes to control their physiologic responses to events. Clients can learn to alter their autonomic nervous system and control their vital signs and uncomfortable symptoms
A nurse is assisting a neurologist, who is assessing the norepinephrine (noradrenaline) level of a client who is reporting stress. Which function does norepinephrine (noradrenaline) perform
heightens arousal and increases energy -Norepinephrine (noradrenaline) heightens arousal and increases energy. Acetylcholine and dopamine promote coordinated movement. Serotonin stabilizes mood, induces sleep, and regulates the temperature of a person. Substance P transmits the sensation of pain, whereas endorphins and enkephalins interrupt the transmission of substance P and promote a sense of well-being
A client asks the nurse how cortisol works. What is the appropriate nursing response
it suppresses the immune response -Cortisol suppresses the immune response, causes atrophy of lymphoid tissues, decreases capillary permeability to prevent tissue swelling, and prevents release of proinflammatory mediators. It does not strengthen lymphoid tissue, increase capillary permeability, or cause the release of proinflammatory mediators
Upon arrival to the emergency room, the mother of a client involved in a motor vehicle accident becomes upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breathe. What is the mother likely experiencing
panic attack -Panic causes the person to lose control and experience dread and terror. Panic is characterized by a disorganized state, increased physical activity, difficulty communicating, agitation, trembling, dyspnea, palpitations, a choking sensation, and sensations of chest pressure or pain. Severe anxiety creates a narrow focus on specific detail; moderate anxiety leads to a focus on immediate concerns; and mild anxiety is often present in day-to-day living, and it increases alertness and perceptual fields
During a counseling session a client states, "I just try to forget about my spouse hitting me." Which coping mechanism should the nurse document based on this client's statement
repression -Repression is the coping mechanism that this client is using, in which the client has removed the experience of being abused from conscious memory. Reaction formation is a coping mechanism that sees an individual acting just the opposite of one's feelings. Rationalization is relieving oneself of personal accountability by attributing responsibility to someone or something else. Regression is behaving in a manner that is characteristic of a much younger age
A client with cancer has recovered from tumor removal surgery and is now stable while undergoing a chemotherapy treatment schedule. She is not having any symptoms at this time and is continuing to work and enjoy social events. What stage of the general adaptation syndrome (GAS) would the nurse place her in
resistance -This client's situation is an example of the resistance stage of the GAS. Stress is continuing, but the client is maintaining homeostasis. Alarm is the initial stage when major stress is encountered. Exhaustion is when homeostasis can no longer be achieved
Which behaviors represent effective coping mechanisms? Select all that apply
taking a vacation • learning relaxation techniques • setting limits with family members who upset you -Coping mechanisms can have positive or negative effects on a client's well-being. All of these examples represent coping, either effective or ineffective
Which emotional clinical manifestations of stress should the nurse anticipate when providing care to an adolescent client
withdrawal, depression, and angry outburst -Withdrawal, depression, and angry outbursts are correct and are examples of emotional signs and symptoms of stress. Constipation, dry mouth, and excessive sleep are examples of physical signs and symptoms of stress. Anxiety disorders, flare of acne, and headaches are examples of stress-related disorders. Forgetfulness, impaired concentration, and preoccupation are examples of cognitive signs and symptoms of stress
