Foundations Chapter 38 Stress and Coping
A family of three consisting of a husband, wife, and son were involved in a motor vehicle accident. The husband and wife did not sustain any major injuries, but the child died. What could be the possible outcome of this accident? 1 The husband may have a situational crisis. 2 The wife may have a developmental crisis. 3 The husband may have a developmental crisis. 4 The husband and wife may have an adventitious crisis.
1 A situational crisis occurs when external sources such as a job change, motor vehicle crash, death, or severe illness trigger stress. Therefore, all the people who survived the accident may have a situational crisis. A developmental crisis occurs when there is a change in the developmental stage of a person such as a marriage, the birth of a child, or retirement that requires new coping styles. Therefore, the husband and wife will not have a developmental crisis. An adventitious crisis occurs in situations of a major natural disaster, man-made disaster, or a crime of violence. Therefore, none of the survivors will have an adventitious crisis.
A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. What is your best response? 1 "Are you thinking of suicide?" 2 "You've been doing a good job raising your children. You can do it!" 3 "Is there someone who can help you?" 4 "You have so much to live for.
1 Although this sounds abrupt, the patient usually is relieved that you've broached this issue. For safety reasons it is very important to discuss the patient's suicidal thoughts.
A patient is diagnosed with breast cancer. She is upset about the diagnosis. What is the type of crisis the patient is experiencing? 1 Situational crisis 2 Adventitious crisis 3 Developmental crisis 4 Maturation crisis
1 The patient is experiencing a situational crisis due to the diagnosis. Situational crises are responses to various situations in life, including a job change, chronic illness, or a motor vehicle accident. An adventitious crisis arises from a major natural disaster or a man-made disaster. A developmental or maturation crisis occurs due to a new developmental stage, such as marriage or the birth of a child.
When teaching a patient about the negative feedback response to stress, what does the nurse include to describe the benefits of this stress response? 1 It results in the neurophysiological response. 2 It reduces body temperature. 3 It causes a person to be hypervigilant. 4 It reduces the level of consciousness to conserve energy.
1 The process of negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as shivering to generate body heat to return the body to hormonal homeostasis.
What can cause an adventitious crisis in a person? Select all that apply. 1 Tsunami 2 Earthquake 3 Childbirth 4 Death of a pet 5 Leg amputation
1, 2 An adventitious crisis can be triggered by a major natural disaster, a man-made disaster, or a crime of violence. Therefore, a tsunami or earthquake can result in an adventitious crisis. Childbirth, the death of a pet, or a leg amputation can cause a situational crisis.
A patient is diagnosed with breast cancer. She is upset about the diagnosis. What questions should the nurse ask to assess the coping skills of the patient? Select all that apply. 1 "What is bothering you most right now?" 2 "Have you started drinking and smoking?" 3 "Has your caffeine intake increased?" 4 "What is your monthly income?" 5 "How far is the health care clinic from your house?"
1, 2, 3 Asking the patient about the issues bothering her helps the nurse understand the patient's concerns. Asking whether the patient has started drinking and smoking or has increased her caffeine intake checks the patient's maladaptive skills. Information about monthly income and the distance of the clinic from the patient's home does not help assess coping skills.
The nurse is assessing a 47-year-old, female patient who has been recently diagnosed with carcinoma of the right breast. Her left breast was removed 2 years ago for the same reason. What symptoms in the patient may indicate ineffective coping? Select all that apply. 1 The patient appears poorly groomed. 2 The patient complains of weight gain. 3 The patient laughs inappropriately. 4 The patient is able to meet her basic needs. 5 The patient responds accurately to questions.
1, 2, 3 The nurse should be aware of the characteristics that define ineffective coping. These include poor grooming, weight gain, and inappropriate laughing or crying. A patient who is able to meet basic needs and responds accurately to the questions asked demonstrates effective coping skills.
The nurse is performing a first-time assessment of a patient who is extremely stressed. Which are the objective assessments documented by the nurse in the assessment sheet? Select all that apply. 1 Patient's behavior 2 Appearance of the patient 3 Changes in diet of the patient 4 Blood pressure of the patient 5 Social support of the patient
1, 2, 4 Objective assessments are the assessments that are done through observation or measurement. Information such as the patient's behavior and appearance can be observed by the nurse. Blood pressure assessment is also done by the nurse. Thus, these are considered objective assessments. As the nurse is assessing the patient for the first time, the nurse cannot observe the patient's change in diet; the nurse has to ask the patient for this information. The nurse would have to ask the patient regarding the social support system (family, co-workers, etc.). Thus, these assessments would come under subjective assessments.
What are the different stages of the general adaptation syndrome (GAS)? Select all that apply. 1 Alarm reaction 2 Resistance 3 Appraisal 4 Crisis 5 Exhaustion
1, 2, 5 The general adaptation syndrome (GAS) is a reaction to stress. It can be triggered directly by physical stress such as an injury or indirectly by psychological stress. It has three stages that describe how the body reacts to different stressors. These stages include the alarm reaction, resistance stage, and exhaustion stage. The alarm stage is characterized by rising hormone levels. The resistance stage is characterized by body reactions in opposition to the alarm reactions. The exhaustion stage occurs when the body has depleted its resources. Appraisal is the continuous process of being aware of the stressors and the coping mechanisms. Crisis occurs in response to the body's stressors.
A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The patient's facial expressions and mannerisms demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The nurse understands that the patient is experiencing caregiver role strain. What interventions should the nurse plan for the mother and son? Select all that apply. 1 Refer the son to respite care. 2 Refer the patient to support groups. 3 Prescribe antidepressants to the patient. 4 Admit the patient to the psychiatric ward. 5 Advise the patient to do yoga and meditation.
1, 2, 5 The priority nursing intervention should be the son, who has Down syndrome. The son can participate in respite care. This would reduce the caregiver burden much more successfully than in-home services. Other measures that can reduce stress in the mother include referring her to support groups to seek help. These groups help to lower stress related to caregiving. The patient can also do yoga and meditation to manage stress. Prescribing antidepressants to the mother is not required as she is not depressed. The patient does not suffer from a psychiatric illness; therefore, admission to a psychiatric ward is not required
A patient mentions to the nurse that she recently lost her husband in a car accident. Which behaviors could the nurse identify as denial defense mechanisms? Select all that apply. 1 Not accepting the death of her spouse 2 Not sleeping and eating 3 Not disclosing her feelings to anyone 4 Being speechless and numb 5 Shouting and blaming God for her loss
1, 3 A denial defense mechanism is a reaction to emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Not discussing the loss and not accepting the loss are both denial defense mechanism behaviors. Cessation of eating and sleeping is a conversion defense mechanism. Being speechless and numb are examples of dissociative defense mechanisms. Shouting and blaming God for the loss is an example of the displacement defense mechanism.
The nurse is working in a health care unit in which there have been rapid changes in health care technology systems in a short time. The nurse is unable to become comfortable with the new systems and is exhausted. The nurse feels a sense of failure and a lack of identity. What does the nurse do now? Select all that apply. 1 Identify limits and responsibilities at work. 2 Spend more time at work to learn the new technology. 3 Strengthen friendships outside of the workplace. 4 Spend off-duty hours in activities such as sports, music, or painting. 5 Spend on-duty hours researching the new technologies.
1, 3, 4 The symptoms indicate that the nurse is experiencing burnout. The nurse should now make behavioral changes to cope with workplace stress. These include identifying the limits and responsibilities at work, which helps to focus the nursing efforts. Strengthening friendships outside of the workplace helps the nurse to obtain some relief from workplace stress. Spending off-duty hours engaged in interesting activities such as sports, music, or painting helps the nurse to de-stress. Spending more time at work to learn new technologies or do research would worsen the burnout.
The nurse is attending to a patient with posttraumatic stress disorder (PTSD) following a motor vehicle accident. The patient lost his left leg in the accident. When completing an assessment of this patient, what are the things that the nurse should take care of? Select all that apply. 1 Ask open-ended questions. 2 Ask questions that the patient can answer with a yes or no. 3 Take the patient's medical history and observe the patient's nonverbal behavior. 4 In order to make the assessment, consult with the patient's partner regarding the patient's medical history. 5 Learn about the patient by asking questions as well as by observing his or her nonverbal behavior.
1, 3, 5 Always ask the patient open-ended questions because they encourage the patient to express his or her feelings and give more information. It is essential that the nurse assess the patient by asking questions as well as by observing his or her nonverbal behavior. Do not ask the patient questions that can be answered with just yes or no. In order to make the most accurate assessment, the nurse should consult with the patient directly rather than with the patient's partner.
A 34-year-old man is getting married. He is waiting in the church for the bride to arrive. On the way to the church, the bride's father is in a motor vehicle accident and dies at the scene. The bride is grieving the loss of her father. However, the groom is not aware of what has happened. What type of crisis are the bride and the groom experiencing? Select all that apply. 1 The bride is in situational crisis. 2 The groom is in adventitious crisis. 3 The bride is in developmental crisis. 4 The groom is in developmental crisis. 5 The bride is in adventitious crisis.
1, 4 Crisis occurs when a person encounters a major change in his or her life and tries to cope with it. External sources such as a change in job, a car accident, a death, or severe illness provoke situational crisis. A new life developmental stage such as a marriage, the birth of a child, or retirement, requires coping with developmental crisis. A major disaster or crime of violence is example of adventitious crisis.
The nurse is teaching a group of nursing students about the general adaptation syndrome (GAS). What is true about this phenomenon? Select all that apply. 1 It is triggered directly by a physical event. 2 It consists of four stages of reaction to stress. 3 It is triggered directly by a psychological event. 4 It involves the autonomic nervous and endocrine systems. 5 It is initiated by the pituitary gland after a physical injury.
1, 4, 5
A 35-year-old patient approaches the nurse for advice about her children, who are ages 8 and 3 years. The patient informs the nurse that the older son likes drinking milk from his brother's sippy cup. What should the nurse explain to the woman? Select all that apply. 1 The elder son is using a regression defense mechanism. 2 The elder son will develop psychiatric disorders in future. 3 The elder son is using a displacement defense mechanism. 4 The elder son will develop intellectual disability in the future. 5 The elder son obtains psychological protection from stress with this behavior.
1, 5 Regression is a defense mechanism that happens unconsciously to cope with a stressor. It includes actions and behaviors related to an earlier developmental period in life. Defense mechanisms, as a rule, do not result in psychiatric disorders but are very helpful in coping with the stress. The use of defense mechanisms does not predict the development of a psychiatric disorder in the future. Drinking milk from the younger brother's cup is an example of regression; it is not an example of displacement. The use of defense mechanisms does not predict the development of an intellectual disability in the future.
The nurse is assessing a recently married patient who is stressed due to responsibilities towards family and work. The patient tells the nurse that being single was better than being married. What kind of situation or crisis does the patient have? 1 Situational crisis 2 Developmental crisis 3 Posttraumatic stress disorder 4 General adaptation syndrome
2 Crisis occurs when the intensity of stress is beyond the patient's ability to cope. There are three different types of crisis: developmental, situational, and adventitious. A developmental crisis occurs when a new developmental stage occurs in a person's life such as a marriage, the birth of a child, or retirement. A situational crisis occurs when external sources such as a job change or motor vehicle crash provoke stress. Posttraumatic stress disorder occurs when a person experiences a traumatic incident and responds with intense fear and helplessness. The stress in this patient is not due to a traumatic incident. General adaptation syndrome is not a type of crisis. It refers to the process of reaction to stress.
A patient is experiencing chronic stress. Which gland in the patient's body will initiate the general adaptation syndrome (GAS)? 1 Parotid gland 2 Pituitary gland 3 Pineal gland 4 Adrenal gland
2 The general adaptation syndrome is a three-stage reaction that describes how the body responds to stressors through different stages. When the body encounters a physical demand such as an injury, the pituitary gland initiates the GAS. The parotid gland secrets saliva and is not related to the GAS. The pineal and adrenal glands do not initiate the GAS.
The nurse is caring for a patient who lost his spouse in an accident. Which assessment findings would indicate ineffective coping in the patient? Select all that apply. 1 Accurate response to questions asked 2 Inability to fall asleep at night 3 Inappropriate laughing 4 Lack of interest in food 5 Inability to concentrate
2, 3, 4, 5 Ineffective coping manifests as a change in sleep pattern. The patient may not be able to fall asleep at night. The patient may show inappropriate behavior such as laughing without a reason. The patient may have a change in appetite and may lack interest in food. The patient may not answer the questions properly due to an inability to concentrate. An accurate response to questions asked indicates effective coping.
A patient is diagnosed with breast cancer. She is upset about the diagnosis. What assessment findings indicate ineffective coping related to the stress of her illness? Select all that apply. 1 The patient gives appropriate answers to the questions asked. 2 The patient sleeps excessively. 3 The patient laughs inappropriately. 4 The patient shows lack of interest in food. 5 The patient has lost 11 lbs (5 kg) of weight in 2 weeks.
2, 3, 4, 5 Sleeping excessively is an ineffective coping mechanism to escape reality. Laughing inappropriately is an inappropriate behavior and indicates ineffective coping. A lack of interest in food may indicate depression and ineffective coping. Similarly, weight loss may be a sign the patient is not coping well. Giving appropriate answers to questions indicates the patient is able to concentrate and implies that the patient is coping well with the illness.
The nurse is caring for a 16-year-old patient who is under immense stress. He is depressed because his mother had a stroke and he is the only caregiver. The nurse previously prepared a care plan and asked the patient to follow the same at home. The patient came back for reevaluation after 1 month of the initial appointment. Which questions should the nurse ask in order to find out the effectiveness of the interventions? Select all that apply. 1 "How is your mother?" 2 "Has your fatigue level decreased?" 3 "Which music do you prefer listening to?" 4 "What changes have you brought about in your day-to-day life?" 5 "How will you perform the progressive relaxation technique?"
2, 4 During reevaluation, the nurse should ask questions that would reflect upon the effectiveness of the patient's care plan. The nurse should ask whether the stress and fatigue levels have reduced and what changes the interventions have brought to his daily life. Asking about his mother's recovery is irrelevant to assessing the effectiveness of the plan. Asking about the type of music the patient prefers listening to should be done during the initial assessment because, listening to music could be an effective intervention to induce relaxation. Understanding of the progressive relaxation technique should be assessed during evaluation in the first session.
The nurse is explaining the physiological mechanism underlying the fight-or-flight mechanism to a patient. The nurse says that the medulla oblongata plays a major role in controlling the response of the body to a stressor. What are the functions of medulla oblongata when the body is stressed? Select all that apply. 1 Constricted pupils 2 Increased respiratory rate 3 Increased mental alertness 4 Increased blood pressure 5 Increased blood glucose levels
2, 4 Through its connection via the autonomic nervous system, the medulla oblongata is responsible for increasing respiratory rate, heart rate, blood pressure, and respirations as a response to stress. Increased alertness is due to the action of the reticular formation. Increased blood glucose levels occur due to the action of the pituitary. Dilated, not constricted, pupils are a response to stress.
The nurse is teaching a group of students about different coping mechanisms. What is true about ego-defense mechanisms? Select all that apply. 1 They can lead to mania in a person. 2 They are used by people unconsciously. 3 They can lead to major depression in a person. 4 They usually do not lead to psychiatric disorders. 5 They offer psychological protection from a stressful event.
2, 4, 5 Ego-defense mechanisms are one of the coping mechanisms people use unconsciously. Psychiatric disorders usually do not occur because of ego-defense mechanisms. The defense mechanisms regulate emotional distress and help a person cope with stress indirectly. They offer psychological protection from a stressful event. They do not result in mania or depression in the patient.
A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. What is this is an example of? 1 A situational crisis 2 A maturational crisis 3 An adventitious crisis 4 A developmental crisis
3 An adventitious crisis is a type of crisis resulting from a natural disaster such as a tsunami.
Which type of crisis is an earthquake that has killed more than 7000 people? 1 A situational crisis 2 A maturational crisis 3 An adventitious crisis 4 A developmental crisis
3 An adventitious crisis is also known as a disaster crisis. It occurs due to a major natural disaster or man-made disaster. A situational crisis occurs due to external sources such as a job change, a motor vehicle crash, or severe illness. A maturational crisis is also known as a developmental crisis. Developmental stages such as marriage, pregnancy, and the birth of a child require new coping styles. Failure to cope with the exposure to stressors during these stages leads to developmental crises.
The nurse observes that a patient whose home life is chaotic including intermittent homelessness, a child with spina bifida, and an abusive spouse who appears to be experiencing an allostatic load. As a result, what does the nurse expect to detect while assessing the patient? 1 Posttraumatic stress disorder 2 Rising hormone levels 3 Chronic illness 4 Return of vital signs to normal
3 An increased allostatic load can result in long-term physiological problems and chronic illness. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.
After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. What is the nurse's first response? 1 "Don't be sad. People live with cancer every day." 2 "Have you thought about how you are going to tell your family?" 3 "I can sit with you for a while, if you would like to talk." 4 "I know another patient whose colon cancer was cured by surgery."
3 Ask the patient if he would like you to sit down for a few minutes so he can talk. Asking an open-ended question and providing an opportunity for the patient to talk allow the nurse to assess the patient's perception of the situation, which is of utmost importance.
When teaching the patient progressive muscle relaxation techniques, the nurse asks the patient to take deep breaths. What would be the next instruction after breathing deeply? 1 Sit in a comfortable position. 2 Close your eyes and try to relax. 3 Relax all the muscle groups at one time. 4 Alternately tighten and relax specific muscle groups.
4 Anxiety causes muscle tension and progressive muscle relaxation is a technique used to relax the muscle groups. A person usually achieves a relaxed state after deep chest breathing. Once this is done, the patient is then asked to alternately tighten and relax specific muscle groups. The instructions, "sit in a comfortable position" and "close your eyes," are given before asking the patient to do deep breathing. This helps to relax the body. Not all the muscle groups should be worked on at the same time.
Which ego defense mechanism does the nurse suspect in the patient who breaks objects when he experiences high levels of stress? 1 Denial 2 Regression 3 Identification 4 Displacement
4 Displacement is the defense mechanism that occurs when the emotions are transferred from one target to another target that is considered less stressful or neutral. Therefore, the patient is exhibiting the displacement defense mechanism. Denial is the refusal to acknowledge the existence of a real situation or the feelings associated with it. Regression is retreating to an earlier level of development and the comforting measures associated with that level of functioning. Identification is an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual whom one admires.
A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The patient's facial expressions and manners demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The patient states that she feels worthless and is overburdened with her responsibilities. What are the differential nursing diagnoses for this patient? Select all that apply. 1 Anemia 2 Psychosis 3 Depression 4 Ineffective coping 5 Caregiver role strain
4, 5 The patient feels worthless and is unable to cope with stressful events in her life; therefore, the diagnosis should be ineffective coping. The patient is feeling overburdened with the caregiving responsibilities of her son. Therefore, an additional diagnosis should be caregiver role strain. Anemia and depression are medical diagnoses and are not indicated in this case
A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." Which defense mechanism is the patient using? A. Denial. B. Conversion. C. Dissociation. D. Displacement.
A Denial is avoiding emotional stress by refusing to consciously acknowledge anything that causes intolerable anxiety. This patient's statements reflect denial about poorly controlled blood sugars.
A 10-year-old girl was playing on a slide at a playground during a summer camp. She fell and broke her arm. The camp notified the parents and took the child to the emergency department according to the camp protocol for injuries. The parents arrive at the emergency department and are stressed and frantic. The 10-year-old is happy in the treatment room, eating a Popsicle and picking out the color of her cast. What is the correct order for the nurse's discussion with the parents? 1. "Can I contact someone to help you?" 2. "Your daughter is happy in the treatment room, eating a Popsicle and picking out the color of her cast." 3. "I'll have the doctor come out and talk to you as soon as possible." 4. "Let me help you two calm down a bit so I can take you to your daughter." A. 2, 4, 3, 1 B. 4, 2, 1, 3 C. 3, 1, 4, 2 D. 2, 3, 4, 1
A First and most important the parents need to know the immediate status of their daughter. Letting them know the situation will help to relieve their immediate stress. Second, helping the parents calm down and reduce their stress will allow them to see their daughter without increasing the 10-year-old's anxiety. Third, let the parents know you recognize their need to talk to the doctor as soon as possible and you will act as their advocate to get that accomplished. Last, but important, you want to ask if there is anyone you can call to help. There may be children who need to be picked up from camp/day care, and a neighbor or grandparent may be able to assist.
When teaching a patient about the negative feedback response to stress, the nurse includes which of the following to describe the benefits of this stress response? A. Results in neurophysiological response B. Reduces body temperature C. Causes a person to be hypervigilant D. Reduces level of consciousness to conserve energy
A Negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as shivering to generate body heat to return the body to hormonal homeostasis.
A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. Which of the following are true about work-related stress? (Select all that apply.) A. Job-related stress can affect the quality of patient care. B. Stress can affect nurses' efficiency and decision making. C. Nurses who talk about feeling stress are unprofessional and should calm down. D. Nurses frequently experience stress with the rapid changes in health care technology. E. Nurses cannot resolve job-related stress.
A, B, D Nurses frequently experience stress with the rapid changes in health care and when the situation seems out of their personal control. When job stress remains unresolved, patient care and clinical decision making can be affected because the stress is perceived as uncontrolled and all consuming.
During the assessment interview of an older woman who is recently widowed, the nurse suspects that this woman is experiencing a developmental crisis. Which of the following questions provide information about the impact of this crisis? (Select all that apply.) A. With whom do you talk on a routine basis? B. What do you do when you feel lonely? C. How is having diabetes affecting your life? D. I know this must be hard for you. Let me tell you what might help. E. Do you have any changes in lifestyle habits: sleeping, eating, smoking, and drinking?
A, B, E A developmental crisis occurs as a person moves through the stages of life, including widowhood. It is important to gather information about how this crisis affects her interactions, coping with loneliness, and any changes in lifestyle habits. Although stress can affect diabetes, there is nothing in this situation that states that the woman has diabetes. Saying, "I know this must be hard for you. Let me tell you what might help" is unacceptable, because the whole purpose of assessment is to gather data and let the patient tell his or her story.
A crisis intervention nurse is working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her child's disability payment while the child is hospitalized. The mother worries that her daughter will fall behind in special-school classes during hospitalization. Which strategies are effective in helping this mother cope with these stressors? (Select all that apply.) A. Referral to social service process reestablishing the child's disability payment B. Sending the child home in 72 hours and having the child return to school C. Coordinating hospital-based and home-based schooling with the child's teacher D. Teaching the mother signs and symptoms of a respiratory tract infection E. Telling the mother that the stress will decrease in 6 weeks when everything is back to normal
A, C, D The stressors for this parent are her child's illness, missing school, and loss of disability payments. Obtaining resources to resolve these stressors will reduce the mother's stress load and allow her to focus on helping her child improve and preventing another respiratory tract infection. Discharging the child in 72 hours with a return to school may not be best for the child's physical condition and may make the situation worse. Giving the mom a 6-week time frame is unrealistic because everyone's time frame is different. The mom may also need to adjust to a "new normal."
A patient with type 2 diabetes is experiencing a lot of work-related stress and is fearful of losing his job. In addition, his wife is threatening divorce. His blood sugar is elevating, and his doctors want him to attend some stress-management classes. He says, "My blood sugar can't be high because of my work stress." What causes blood glucose to rise during stress? (Select all that apply.) A. Increases in antidiuretic hormone (ADH) B. Increases in cortisol C. Increases in aldosterone D. Increases in adrenocorticotropic hormone (ACTH) E. Increases in epinephrine
B, D, E With stress the general adaptation syndrome is present. Glucose levels rise because ACTH stimulates cortisol, and gluconeogenesis occurs; the body creates new glucose from nonglucose sources (proteins and fats); cortisol alone increases gluconeogenesis; the sympathetic nervous system causes increased epinephrine, which elevates blood glucose. In the person with diabetes, these physiological responses can cause blood glucose levels to elevate beyond normal. ADH and aldosterone affect sodium and/or water balance and do not affect blood glucose.
A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of: A. A situational crisis. B. A maturational crisis. C. An adventitious crisis. D. A developmental crisis.
C An adventitious crisis is a type of crisis resulting from a natural disaster such as a tsunami.
When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following? A. The amount of family support B. A 3-day diet recall C. A thorough physical assessment D. Threats to safety in her home
C Stress often causes symptoms similar to physical illnesses. Physical causes for problems need to be investigated and treated before treatment for stress-related symptoms can be initiated.
The nurse is interviewing a patient in the community clinic and gathers the following information about her: she is intermittently homeless, a single parent with two children who have developmental delays, and is suffering from chronic asthma. She does not laugh or smile, does not volunteer any information, and at times appears close to tears. She has no support system and does not work. She is experiencing an allostatic load. As a result, which of the following would be present during complete patient assessment? (Select all that apply.) A. Posttraumatic stress disorder B. Rising hormone levels C. Chronic illness D. Return of vital signs to normal E. Depression
C, E An increased allopathic load can result in long-term physiological and psychological problems such as chronic illness and depression. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.
The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. Which of the following statements indicate that the patient is beginning to cope with the diagnosis? (Select all that apply.) A. "I'm going to learn to drive a car so I can be more independent." B. "My sister says she feels better when she goes shopping, so I'll go shopping." C. "I'm going to let the occupational therapist assess my home to improve efficiency." D. "I've always felt better when I go for a long walk. I'll do that when I get home." E. "I'm going to attend a support group to learn more about multiple sclerosis."
C, E Inviting the occupational therapist into the patient's home and attending support groups are early indicators that the patient is recognizing some of the challenges of the disease and participating in positive realistic activities to cope with the stressors related to changes in physical functioning. The other options relate to independence and other coping strategies but do not address coping with the specific challenges of the disease.
The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following? A. Loss of autonomy caused by health problems B. Physical appearance, family, friends, and school C. Self-esteem issues, changing family structure D. Search for identity with peer groups and separation from family
D Stressors that apply to preadolescents are self-esteem issues and a changing family structure. A loss of autonomy caused by health problems applies to the older adult. Stressors that apply to children are physical appearance, family, friends, and school.
A 34-year-old single father who is anxious, tearful, and tired from caring for his three young children tells the nurse that he feels depressed and doesn't see how he can go on much longer. Which of the following would be the nurse's best response? A. "Are you thinking of suicide?" B. "You've been doing a good job raising your children. You can do it!" C. "Is there someone who can help you during the evenings and weekends?" D. "What do you mean when you say you can't go on any longer?"
D You need to get information about what the gentleman means when he says he can't go on any longer. He might be thinking of turning his children over to a grandparent or seeking other child-care arrangements. Asking about suicide initially might be premature. Asking, "Are you thinking of suicide?" prematurely might shut the patient down entirely. If the patient talks about suicide, for safety reasons it is very important to further discuss his suicidal thoughts and refer to the appropriate health care professional. Asking the open-ended question provides an opportunity to understand what the person is thinking and open lines of communication.
After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. Which of the following are appropriate responses or actions of the nurse? (Select all that apply.) A. "I know another patient whose colon cancer was cured by surgery." B. Straighten the patient's bed and room C. "Have you thought about how you are going to tell your family?" D. "Would you like for me to sit down with you for a few minutes so you can talk about this?" E. Sit quietly with the patient
D, E Sitting quietly or asking the patient if he would like you to sit down for a few minutes so he can talk are both effective. This provides the patient some quiet time, knowing that someone is there. Allowing the patient to talk allows the nurse to assess the patient's fears, knowledge, and perception of the situation, which is of utmost importance. The other responses are telling the patient what to do or giving reassurance, and the situation does not call for either of these.
