Fundamentals Wk 7 CH 37 Stress and Coping

Which nursing student statement regarding a victim of assault who has post traumatic stress disorder (PTSD) indicates a need for further education?

"Acute stress disorder is similar to PTSD in duration of symptoms."

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?

"Are you thinking of suicide?"

The nurse is assessing the coping skills of a patient who lost his mother and is depressed. Which response by the patient will show that the patient is coping well?

"I have been going to a support group that I find is very good and I am resuming my studies."

The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says:

"I'm going to attend a support group to learn more about multiple sclerosis."

A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress, what does the nurse say?

"Tell me what bothers you the most about this experience."

While interviewing a patient who is experiencing a developmental crisis, the nurse is assessing the patient's perception of stressors. Which question should the nurse ask during the assessment?

"What is bothering you most right now?"

The nurse is assessing a patient who is demonstrating symptoms of severe stress. The nurse interviews the patient to learn whether the patient is using any maladaptive coping skills to reduce stress. Which question would the nurse ask?

- "Have you started sleeping excessively?" - "Do you live alone or with family?" - "Have you started smoking or drinking?"

Which time frame would be the approximate duration required by a person to resolve a crisis?

6 wks

A crisis intervention nurse is working with a mother whose child with Down syndrome has been hospitalized with pneumonia. During this hospitalization, the mother lost her entitlement check. After which time frame would the nurse expect the mother to regain stability?

6 wks, when she adjusts to the child's respiratory status and reestablishes the entitlement checks

The nurse plans care for a 16-year-old mad taking into consideration the stressors experienced most commonly by adolescents. Which consideration would the nurse be aware of?

A search for identity with peer groups and separation from family

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. Which crisis is this an example of?

Adventitious

Which type of crisis is an earthquake that has killed more than 7000 people?

Adventitious

A victim of a violent mugging experiences increased blood volume, glucose levels, and epinephrine, and norepinephrine amounts. Which stage of general adaptation syndrome (GAS) in this person experiencing?

Alarm

The nurse observes that a patient whose home life is chaotic including intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, which clinical manifestation would the nurse expect to detect while assessing the patient?

Chronic illness

Which ego-defense mechanism helps a patient with psychosis make up for a deficiency by emphasizing a positive feature?

Compensation

Which ego-defense mechanism would a patient with psychosis display if he or she opens up a music school to make up for the perceived deficiency?

Compensation

Which ego-defense mechanism would a patient with psychosis display if he or she complains of sudden paralysis in the right hand after receiving medication he or she did not want?

Conversion

In which ego-defense mechanism would a patient with the mental conflict of psychosis be transformed into a physical symptom?

Conversions

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?

Denial

A victim of sexual assault pretends the attack did not happen. Which ego-defense mechanism is the victim using to cope?

Denial

The nurse could not get through her licensing exam. After seeing the results, the nurse said, "No! I do not believe this. I prepared for the exam for 2 years. I should have made it through the test. There must be some error in this." What is this kind of response called?

Denial

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?

Developmental crisis

During a stress response, on which aspect does a secondary appraisal focus?

Different coping strategies available to a person with stress

Which hormone increases blood glucose levels during physiological stress?

Epinephrine

While performing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. Which response is this?

Posttraumatic stress disorder (PTSD)

A teenage victim of physical abuse begins sucking her thumb. Which ego-defense mechanism would this exemplify?

Regression

Which ego-defense mechanism would a patient with schizophrenia display if he or she insists on having dolls in bed before going to sleep?

Regression

The nurse manager is teaching about levels of stress prevention according to the Neuman Systems Model. What information does the nurse include in the teachings?

Rehabilitation of physically challenged persons is called tertiary prevention.

When teaching a patient about the negative feedback response to stress, which information would the nurse include to describe the benefits of this stress response?

Results in neurophysiological response.

During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions?

Since your husband has died, what have you been doing in the evening when you feel lonely?

A head nurse is teaching the physiology of fight-or-flight responses to student nurses. Which system is responsible for these phenomena?

Sympathetic nervous system

A child performs poorly in mathematics and finds it difficult to improve even after spending more time studying. Which behavior shows that the child is using compensation as a defense mechanism?

The child is practicing more music because the patient is good at music

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?

The husband may have a situational crisis

Which nursing student statement regarding hormonal regulation during the different stages of general adaptation syndrome (GAS) indicates a need for further education?

"During the resistance stage, hormone levels rise rapidly."

The nurse is caring for a patient who lost his spouse in an accident. Which assessment findings would indicate ineffective coping in the patient?

- Inability to fall asleep at night - Inappropriate laughing -Lack of interest in food - Inability to concentrate

A patient is diagnosed with depression. Which sign or symptom is the nurse likely to find in the patient?

- Loss of appetite - Extreme fatigue - Disheveled appearance

The nurse is assessing a patient who developed posttraumatic stress disorder (PTSD) after witnessing a plane crash. What would be the findings in this patient?

- Nightmares of the plane crash - Flashback of the plane crash

The nurse is interviewing a 37-year-old patient who is not coping well with a recent loss of employment. Which activities should the nurse perform to assess coping in the patient?

- Observe the patient's appearance. - Ask the patient about changes in eating patterns. - Ask the patient about changes in his or her sleeping pattern. - Observe the patient's response to the questions asked.

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?

- Patient's behavior - Appearance of the patient - Blood pressure of the patient

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?

- Refer the son to respite care - Refer the patient to support groups - Advise the patient to do yoga and meditate

Which point is true about appraisal?

- Refers to evaluating an event for its personal meaning - How people interpret the impact of the stressor on themselves - How people interpret an event and react to it

The nurse is explaining to a patient about the various factor that could induce stress. which example would the nurse provide to explain situational factors that might cause stress?

- Sudden transfer of a job - Health-related problems in obese people - Caregiving responsibilities for a family member who has had a stroke

In general adaptation syndrome, which response occurs in the body because of increased epinephrine?

- The heart rate increases - Blood glucose levels increase - Oxygen intake increases

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?

- The patient appears poorly groomed. - The patient complains of weight gain. - The patient laughs inappropriately

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?

- The patient sleeps excessively. - The patient laughs inappropriately. - The patient shows lack of interest in food. - The patient has lost 11 lbs (5 kg) of weight in 2 weeks.

Which factor is true about general adaptation syndrome (GAS)?

- Triggered directly by a physical event - Involves the autonomic nervous and endocrine systems - Initiated by the pituitary gland after a physical injury

A patient approaches the nurse for advice about her children, a 3-year-old and 8-year-old. The patient informs the nurse that the older child likes drinking milk from the sibling's sippy cup. Which explanation regarding the older child by the nurse would be appropriate?

- Using a regression defense mechanism - Coping with stress by this behavior

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, what does one of the first assessments include?

A thorough physical assessment

Which nursing question is concerned with the safety of a patient who is experiencing hallucinations?

- "How are you sleeping?" - "Do you have any thoughts of harming yourself or others?" - "Have you had an accidents at home, in the car, at school, or on the job?"

The nurse is teaching stress management techniques to a patient. Which instructions should the nurse give the patient to manage stress?

- "Listen to music that you enjoy." - "Exercise for 15 to 30 minutes every day." - "Engage yourself in pleasurable activities."

A nurse is interviewing a patient who has bipolar disorder. Which nursing question would be related to the patient's perception of stress?

- "What do you believe is causing you mental or emotional strain?" - "How does this event or condition impact you now and how might it in the future?" - "What impact does this event have on your sleep, appetite, and lifestyle patterns?"

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?

- "What is bothering you most right now?" - "Have you started drinking and smoking?" - "Has your caffeine intake increased?"

Which factor can contribute to situational stress for a patient diagnosed with posttraumatic stress disorder (PTSD), paranoia, and psychosis?

- Adjusting to chronic illness - Limited access to health care providers - Paying for medical bills and expenses

Which common response is associated with general adaptation syndrome (GAS)?

- Alarm - Resistance - Exhaustion

Which stage encompasses general adaptation syndrome (GAS)?

- Alarm Reaction - Resistance - Exhaustion

Which information is true about ego-defense mechanisms?

- Are used by people unconsciously - Usually do not lead to psychiatric disorders - Offer psychological protection from a stressful event

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?

- Ask open-ended questions. - Take the patient's medical history and observe the patient's nonverbal behavior. - Learn about the patient by asking questions as well as by observing his or her nonverbal behavior

A 45-year-old single mother lives with her 10-year-old son who has Down syndrome. The mother's facial expressions demonstrate fatigue and malaise. She has an unkempt appearance and has no interest in going out and meeting people. The nurse understands that the mother is experiencing caregiver role strain. What findings noted by the nurse indicate caregiver role strain?

- Fatigue and malaise - Unkempt appearance - Lack of interest in socialization

What activities are performed during a crisis intervention approach?

- Helping the patient make the mental connection between the stressful event and his or her reaction to it - Helping the patient become aware of present feelings such as anger, grief, or guilt - Helping the patient explore coping mechanisms, and identifying new methods of coping

Which activity is included in the primary level of stress prevention?

- Identifying individuals who are at risk - Identifying population at risk of developing stress

Which event in the patient's life would be considered stress occurring due to a maturational factor?

A changing family structure because of divorce

A patient who is diagnosed with terminal colon cancer says, "It's just a stomach infection; I don't have any cancer, and it's a wrong diagnosis." What does the nurse do?

Allow the patient to use denial as a coping mechanism

When teaching a patient progressive muscle relaxation techniques, the nurse asks the patient to take deep breaths. Which instruction would be next after breathing deeply?

Alternately tighten and relax specific muscle groups

Which ego-defense mechanism does a patient with psychosis demonstrate by refusing to consciously acknowledge anything that causes intolerable emotional pain?

Denial

Which ego-defense mechanism would a patient with schizophrenia exhibit when he or she refuses to believe the diagnosis?

Denial

Which ego defense mechanism does the nurse suspect in the patient who breaks objects when he experiences high levels of stress?

Displacement

With which ego-defense mechanism would a patient with psychosis unconsciously manifest behavior similar to an idolized individual?

Displacement

A victim of sexual assault is brought into the emergency department. When the nurse asks if the patient knows where she is, the patient is completely confused. Which ego-defense mechanism might this patient be experiencing?

Dissociation

A staff nurse is talking with the nursing supervisor about the stress she feels on the job. Which factor does the supervising nurse recognize?

Nurses frequently experience stress with rapid changes in healthcare technology and organizational restructuring

Which gland in the patient's body will initiate general adaptation syndrome (GAS)?

Pituitary