Mental Health: Physiological & Psychological Responses to Stress

FLAG A nurse is leading a group of clients who are using the Holmes-Rahe Life Stress Inventory Scale to self-assess stressors in their life. Which of the following findings indicates the highest degree of stress? a. A client who has reported being assigned more responsibility at work b. A client with children who will be relocating to a new city for work. c. A client who is returning to college following the loss of their job d. A client who is recently separated from their spouse

c. A client who is returning to college following the loss of their job A client who is returning to college after losing a job is dealing with two significant stressors simultaneously.

A nurse is caring for a client undergoing a procedure and encourages the client to imagine themselves lying on the beach. Which of the following coping styles is the nurse suggesting? Guided imagery Deep breathing Fantasy Adjusting expectations

Guided imagery The nurse is suggesting guided imagery. In guided imagery, the client imagines being in a place that represents calmness and relaxation.

A nurse is caring for a client in a clinic. The client states, "I am overwhelmed by stress." Which of the following should the nurse identify as the highest priority question to ask the client? "Do you have any relatives who have problems with stress?" "How much physical activity do you typically get in a day?" "What kinds of things do you find helpful for coping with your stress?" "How much sleep do you get each night?"

"What kinds of things do you find helpful for coping with your stress?" The highest priority during an initial assessment would be to determine what the client is doing to cope with stress at present, preferably via an open-ended inquiry.

A nurse is facilitating a group session on adaptive defense mechanisms. The nurse should identify which of the following client statements as examples of adaptive defense mechanisms? (Select all that apply.) a. "When I get stressed out, I like to go to the gym." b. "I volunteer at a local substance use help group." c. "When I get home from school, it's hard to hear things for hours after." d. "When people are mean to me, I am mean right back to them." e. "I was so upset after I failed my exam that I broke my laptop."

"When I get stressed out, I like to go to the gym" is correct. This is an example of sublimation, which is an adaptive defense mechanism. Sublimation occurs when an individual puts their energy into something constructive to change stressful feelings or emotions. "I volunteer at a local substance use help group" is correct. Volunteering at a substance abuse help group is an example of an adaptive defense mechanism. This would be altruism, which is when an individual transforms their feelings and emotions by helping others who are experiencing something similar. "When I get home from school, it's hard to hear things for hours after" is incorrect. This is an example of conversion, a maladaptive defense mechanism. Conversion occurs when an individual experiences a loss of sensory functioning. "When people are mean to me, I am mean right back to them" is incorrect. This is a maladaptive example of a identification. Identification occurs when an individual is assuming the characteristics of the individual who is expressing negative feelings towards them. "I was so upset after I failed my exam that I broke my laptop" is incorrect. This is an example of a maladaptive use of regression. Regression is when an individual returns to a previous developmental stage of behavioral, cognitive, or emotional functioning.

A nurse is caring for a client who has emphysema and recently reduced their level of activity because they fear developing dyspnea. When teaching the client to use guided imagery, which of the following should the nurse encourage the client to visualize? Walking on a beach without using supplemental oxygen Sleeping comfortably and soundly, without respiratory distress Placing their hand to feel the rise and fall of their chest Dangling feet in a pool and taking regular deep breaths

Dangling feet in a pool and taking regular deep breaths. The client has a dysfunctional perspective of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Encouraging the client to imagine a regular breathing pattern will help improve oxygen-carbon dioxide exchange and facilitate relaxation.

A nurse is discussing individual and environmental factors of stress response with a group of newly licensed nurses. The nurse should include which of the following as individual factors? (Select all that apply.) a. Perception b. Temperament c. Lifestyle d. Culture e. Religion

Perception is correct. Perception is an individual factor that determines how a client may react to stress. Temperament is correct. Temperament is an individual factor that determines how a client may react to stress. Lifestyle is correct. Lifestyle is an individual factor that determines how a client may react to stress. Culture is incorrect. Culture is considered an environmental factor, not an individual factor. Religion is incorrect. Religion is considered an environmental factor, not an individual factor.

A nurse is caring for a client who has a history of anxiety and hypertension. The nurse should recommend which of the following relaxation techniques for the client? a. Biofeedback b. Prayer c. Reading a book d. Drawing

a. Biofeedback This relaxation method teaches the client physical and mental exercises to help control their specific automatic physical body functions, such as heart rate, blood pressure, and temperature.

A nurse is caring for a client who is exhibiting hypervigilance and restlessness. The client states, "I need to figure a way out of this mess." The nurse should recognize that the client is most likely in which of the following stages of anxiety? a. Mild b. Moderate c. Severe d. Panic

a. Mild The client is experiencing a mild level of anxiety. A mild level of anxiety can manifest in hypervigilance and restlessness. At this stage, the client may be open to problem solving and is likely at a peak level of concentration. Moderate A client experiencing a moderate level of anxiety may have increased vital signs and a diminished level of concentration. Severe A client experiencing a severe level of anxiety may report somatic symptoms and be unwilling to problem solve. Panic A client experiencing a panic level of anxiety may be unaware of their surroundings or display fight, flight, faint, freeze, or fawn behaviors.

A nurse is assisting in the care of a client who states, "When I am stressed at work, I can't help coming home and arguing with my partner." The nurse should recognize that the client is exhibiting which of the following defense mechanisms? Intellectualization Projection Sublimation Displacement

Displacement This client is exhibiting displacement, which is a maladaptive defense mechanism. In displacement, an individual redirects their stress to someone they feel safe with instead of directing it toward the cause of the stressor.

A nurse is reinforcing teaching about physiological responses to stress with a group of clients. The nurse should include which of the following short-term physiological changes in the teaching? (Select all that apply.) a. Increase in muscular tension, blood pressure, and triglycerides b. Increase in heart rate and respiratory rate c. Corticosteroid release increases stamina and impedes digestion d. Cortisol release increases glucogenesis and reduces fluid loss e. Increased immune system function f. Increased risk of depression, autoimmune disorders, and heart disease

Increase in muscular tension, blood pressure, and triglycerides is correct. This is a short-term physiological response to stress. Increase in heart rate and respiratory rate is correct. This is a short-term physiological responses to stress. Corticosteroid release increases stamina and impedes digestion is correct. This is a short-term physiological response to stress. Cortisol release increases glucogenesis and reduces fluid loss is correct. This is a short-term physiological response to stress. Increased immune system function is incorrect. Stress would cause the immune system to decrease rather than increase. Increased risk of depression, autoimmune disorders, and heart disease is incorrect. Increased risk of cancer, cardiovascular disease, depression, and autoimmune disease are all long-term (chronic) effects of stress.

A nurse is educating a group of clients on the concept of hardiness. Which of the following statements should the nurse include in the teaching? a. "The foundation of hardiness is the ability to fixate on a stressor in an effort to suppress negative thinking." b. "Hardiness is a personality trait that refers to how a person reacts to the world around them." c. "Hardiness is a genetic predisposition that is non-modifiable." d. "The foundation of hardiness is a positive self-perception and attitudes of hopefulness."

d. "The foundation of hardiness is a positive self-perception and attitudes of hopefulness." A positive self-perception about one's abilities, skills, and capacity to manage stress, along with an attitude of hopefulness is the foundation of hardiness and provides a protective factor when managing stress.

A nurse is caring for a client who has been newly diagnosed with a terminal illness and is experiencing significant stress. The client states, "Do you think a prayer would help?" Which of the following statements should the nurse make? a. "It could be that prayer is your only hope." b. "We do not have evidence that prayer helps, but it wouldn't hurt." c. "I can help you feel calmer by teaching you meditation exercises." d. "You may find prayer gives comfort and lowers your stress."

d. "You may find prayer gives comfort and lowers your stress." Many clients find that spiritual measures, including prayer, are helpful in mediating stress. Studies have shown that spiritual practices can enhance the client's sense of well-being. When a client suggests a viable means of reducing stress, it should be supported by the nurse.

A nurse is providing care to a client who was recently involved in a motor-vehicle crash. The nurse should identify that the client is in the moderate stage of anxiety based on which of the following behaviors? a. Answering questions with the response, "I am glad to be alive." b. Becoming unconscious after seeing a video of the accident c. Jumping off the bed and running out the door d. Practicing deep breathing with the nurse

d. Practicing deep breathing with the nurse The ability to learn and practice coping skills is a sign of mild and moderate levels of anxiety. Answering questions with the response, "I am glad to be alive." Repeating phrases is a sign of severe level of anxiety. Becoming unconscious after seeing a video of the accident Dissociation, or fainting, is seen in the panic level of anxiety. Jumping off the bed and running out the door This type of behavior is seen in the panic level of anxiety.

A nurse is discussing risk factors of negative stress responses with a group of clients. The nurse should include which of the following risk factors in the discussion? (Select all that apply.) Birth order Temperament Interpersonal violence Health behaviors Financial stability Sex

Birth order is incorrect. Birth order has not been identified as increasing the risk for experiencing stress. Temperament is correct. A client's temperament can affect how they experience and handle stress. Interpersonal violence is correct. Social risk factors, such as interpersonal violence, can predispose clients to an increased stress response. Health behaviors is correct. A client's health and health behaviors can affect how they experience and handle stress. Financial stability is incorrect. Financial insecurity can impact how clients experience and handle stress, but it is not identified as a risk factor. Sex is incorrect. Biological and genetic makeup of the client—including underlying health conditions, sex, and age—are factors that influence the stress response, but they are not risk factors.

A nurse is caring for a client who is exhibiting manifestations of anxiety. Which of the following manifestations would the nurse expect to see increase during the client's flight or flight response? (Select all that apply.) a. Blood pressure b. Heart rate c. Respiratory rate d. Bowel sounds e. Pupillary response

Blood pressure is correct. Blood pressure, heart rate, respiratory rate, and pupillary response are all affected by the body's physiological responses to stress. Heart rate is correct. Blood pressure, heart rate, respiratory rate, and pupillary response are all affected by the body's physiological responses to stress. Respiratory rate is correct. Blood pressure, heart rate, respiratory rate, and pupillary response are all affected by the body's physiological responses to stress. Bowel sounds is incorrect. Bowel sounds would decrease in a flight or flight response. Respiratory rate is correct. Blood pressure, heart rate, respiratory rate, and pupillary response are all affected by the body's physiological responses to stress.

A nurse is caring for a client who is experiencing chronic stress. Which of the following does the nurse anticipate that the client will report? (Select all that apply.) Increased anxiety Recurring sinus infections Feelings of depression Sudden bursts of energy Daily overeating Heart palpitations

Increased anxiety is correct. With chronic stress, the body becomes overwhelmed resulting from the accumulation of the effects of the stressors over time. Some of the psychological and physiological effects of chronic stress include depression, anxiety, and recurring infections. Recurring sinus infections is correct. With chronic stress, the body becomes overwhelmed resulting from the accumulation of the effects of the stressors over time. Some of the psychological and physiological effects of chronic stress include depression, anxiety, and recurring infections. Feelings of depression is correct. With chronic stress, the body becomes overwhelmed resulting from the accumulation of the effects of the stressors over time. Some of the psychological and physiological effects of chronic stress include depression, anxiety, and recurring infections.

A nurse is assisting in the care of a client who states, "My cardiologist told me that I need to reduce stress. What is the best way for me to do that?" Which of the following responses should the nurse make first? "Physical exercise has been shown to be beneficial in reducing stress." "Self-help books are a good way to learn strategies to reduce stress." "It might be a good idea for you to try painting to help reduce your stress." "Tell me more about the stressors that you are facing in your life."

Tell me more about the stressors that you are facing in your life." Using the nursing process as a priority framework, assessment of the client comes first. By assessing the stressors that the client is facing, the nurse is able to discuss options that may be most beneficial to the client.

A nurse is assisting in planning education for a group of teachers on personality traits. Which of the following traits describes a student who is eager to learn? a. Openness b. Extraversion c. Conscientiousness d. Agreeableness

a. Openness Openness describes an individual who is eager to learn and experience new things. Extraversion Extraversion describes an individual who is assertive and outgoing. Conscientiousness Conscientiousness describes an individual who is efficient and organized. Agreeableness describes an individual who is forgiving, warm, and not demanding.

A nurse is caring for a client who was in a motor-vehicle crash. The client states, "I had to get home before 6pm so I had to drive really fast." Which of the following defense mechanisms is the client exhibiting? a. Rationalization b. Displacement c. Identification d. Altruism

a. Rationalization This client is exhibiting rationalization. In rationalization, a person uses reason or logic to avoid or explain the stressor and avoid their emotions.

A nurse is providing teaching about stress with a client. The nurse should identify that which of the following client statements indicates an understanding of the teaching? a. "My stressor will all go away when I retire." b. "My stress could be related to my culture." c. "My attitude about my stressor can influence my coping." d. "I can decrease my stress by getting a new job."

c. My attitude about my stressor can influence my coping." A client's perception of themselves and their capability of managing stressors determines how they express their psychological and emotional response to stress.

A nurse is assisting in the care of a client who attempted to die by suicide. The client is currently undergoing cognitive behavioral therapy. Which of the following statements by the client indicates that the therapy has been effective? a. "I have removed all of the mirrors from my house." b. "I guess I am fortunate to have survived my suicide attempt." c. "It is hard to go out when you know that everyone is laughing at you." d. "At least now when people stare at me, I have enough courage to tell them off."

b. "I guess I am fortunate to have survived my suicide attempt." Cognitive behavioral therapy works to help the client adjust to or unlearn negative thoughts and change them to more positive thoughts, attitudes, or emotions. This statement by the client indicates that the therapy has been effective because the client has changed their negative thoughts to a positive thought.

A nurse is leading a group of clients in an outpatient setting. The nurse should recognize which of the following client statements as an example of a maladaptive defense mechanism? a. "When I get overly stressed at work, I need to just get out of there and go for a walk at lunch." b. "When my partner yells at the dog I run and hide, but I don't know why I do that." c. "When I am overly stressed, I will just sit and watch a movie to help me relax." d. "Losing my child to cancer is so painful that I decided to raise money for cancer research so nobody else has to go through this."

b. "When my partner yells at the dog I run and hide, but I don't know why I do that." This is an example of repression, which is a maladaptive defense mechanism. In repression, a client can admit that they have certain feelings or reactions about a stressor, but they will avoid thinking or talking about what led up to those feelings.

A nurse is teaching a client about potential risks of chronic stress. Which of the following conditions should the nurse include as a potential risk? a. Peripheral vascular disease b. Diabetes c. Seizures d. Meningitis

b. Diabetes Chronic stress is known to increase the risk of many mental and physical conditions, including type 2 diabetes mellitus. PVD Chronic exposure to cortisol can increase an individual's risk for developing cardiovascular disease, obesity, anxiety, and insomnia, not peripheral vascular disease. Seizures Chronic exposure to cortisol can increase an individual's risk for developing cardiovascular disease, obesity, anxiety, and insomnia, not seizures. Meningitis Chronic exposure to cortisol can increase an individual's risk for developing cardiovascular disease, obesity, anxiety, and insomnia, not meningitis.

A nurse is reinforcing education to a client who is afraid of heights and is planning to drive across a high bridge. The nurse should identify that which of the following structures stimulates the automatic nervous system? a. Thalamus b. Hypothalamus c. Parietal lobe d. Pituitary gland

b. Hypothalamus The client will find that driving across a high bridge is stressful. The hypothalamus functions as the command-and-control center, responding to signals of stress by engaging the autonomic nervous system. Thalamus The thalamus processes messages associated with pain and wakefulness but will not stimulate the autonomic nervous system. Parietal lobe The parietal lobe is responsible for interpretation of other sensations but will not stimulate the autonomic nervous system. Pituitary Gland The pituitary gland may be involved in other aspects of the client's response but will not stimulate the autonomic nervous system.

A nurse in a mental health clinic is observing a client in the day room. The nurse should identify which of the following actions by the client as a maladaptive defense mechanism? a. The client is sitting down and is painting a picture. b. he client tells another client that all of the therapists are mean. c. The client crumbles up their paper and throws it across the room. d. The client is talking about starting a fundraiser for other people who lost everything in a fire.

b. he client tells another client that all of the therapists are mean. This client is exhibiting splitting, which is a maladaptive defense mechanism. The maladaptive defense mechanism of splitting is when a person is unable to accept that an individual can have both good and poor aspects but believes someone is all "bad" or all "good."

A nurse is assisting in the care of a client whose partner recently died. The client asks, "Do you think meditation helps with stress?" Which of the following responses should the nurse make? a. "I will give you some meditation techniques that I use to help with stress." b. "There is no clinical evidence that meditation helps, but it wouldn't hurt." c. "You may find meditation gives comfort and lowers your stress." d. "Using meditation along with another effective coping strategy may help you."

c. "You may find meditation gives comfort and lowers your stress." This response addresses the client's concerns and affirms the client's choice to try meditation as a form of stress management.

A nurse is caring for a client who states, "I am so stressed over my upcoming reunion because I am not as successful as most of my classmates." Which of the following therapies for stress related disorders may benefit this client? a. Aversion therapy b. Biofeedback c. Cognitive reframing d. Desensitization therapy

c. Cognitive reframing This client would benefit from cognitive reframing, which is a technique used to change the way a person thinks about something. Aversion therapy Aversion therapy is used to treat clients with a substance use disorder. Biofeedback Biofeedback uses biosensors to monitor physiological responses to stressors in order to inform the client how their body responds to stress. Desensitization therapy Desensitization therapy is used to treat clients who have phobias.