🟪 NCLEX Qs: Stress and Coping

The nurse believes that a client with severe anxiety will benefit from cognitive-behavioral therapy​ (CBT). Which characteristic of CBT should the nurse​ consider? (Select all that​ apply.) The client can safely confront fears. The client can discontinue medications. The client can change unhealthy thoughts. The client can remove stressors. The client can do CBT exercises.

The client can safely confront fears. The client can change unhealthy thoughts. The client can do CBT exercises. In​ CBT, the client can safely confront​ fears, change unhealthy​ thoughts, and do CBT exercises. It does not mean that the client can discontinue medications or remove stressors.

An older adult client is asking the healthcare provider for a medication to deal with the anxiety they are feeling due to the recent deaths of two very close friends. They indicate that they used a benzodiazepine when they were younger and it worked fairly well. Which response by the nurse should address the​ client's request? ​"A benzodiazepine is a good choice when you are​ older, so​ I'll try to get that prescribed for​ you." ​"Thank you for letting me know. I will see if the provider wants to prescribe a​ benzodiazepine." ​"What dose of the medication did you take when you were​ younger, and how long did you take the​ medication?" ​"Benzodiazepines can cause a decrease in​ cognition, so we need to avoid the use of these medications if​ possible."

"Benzodiazepines can cause a decrease in​ cognition, so we need to avoid the use of these medications if​ possible." "Benzodiazepines can cause a decrease in​ cognition, so we need to avoid the use of these medications if​ possible."

The parent of a young child shares with the nurse that the child refuses to play​ outside, go to​ parks, or participate in family gatherings where a dog may be present for fear of getting bitten. Which question should the nurse ask to determine if this behavior meets the​ DSM-5 criteria for​ phobias? ​"How long has your child been exhibiting this​ phobia?" ​"Is your child frightened of all​ dogs?" ​"Does your child have a panic attack if a dog is​ nearby?" ​"Does your child worry constantly about possibly encountering a​ dog?"

"How long has your child been exhibiting this​ phobia?" To be diagnosed as a​ phobia, the symptoms must persist for at least 6​ months, regardless of the​ client's age, so asking how long the symptoms have been present would elicit information to support diagnosis. Asking if the child is frightened of all dogs or if the child has a panic attack when a dog is nearby would not provide information to support definitive diagnosis. Asking if the child worries constantly about encountering a dog would provide information to support diagnosis of generalized anxiety​ disorder, not a phobia. Next Question

11. The nurse is conducting an initial assessment of a client in crisis. When assessing the client perception of the precipitating event that led to the crisis, which is the most appropriate question? "With whom do you live?" "Who is available to help you?" "What leads you to seek help now?" "What do you usually do to feel better?"

"What leads you to seek help now?"

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 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.

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.

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.

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.

Crisis Intervention Steps

1. Assess students level of risk 2. Stabilize the situation w/ counseling interventions 3. Follow up to assess well-being & determine the need for further intervention

shock phase S/S

1. Increased myocardial contractility, which increases CO and blood flow to active muscles 2. Bronchial dilation, which allows increased oxygen intake 3. Increased blood clotting 4. Increased cellular metabolism 5. Increased fat metabolization to make energy available and to synthesize other compounds needed by the body

anxiety vs. fear

1. The source of anxiety may not be identifiable; the source of fear is identifiable 2. Anxiety is related to the future, that is, to an anticipated event. Fear is related to the present 3. Anxiety is vague and fear is definite 4. Anxiety is the result of psychologic or emotional conflict; fear is the result of discrete physical or psychologic entity

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.

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 nurse is interviewing a patient who just received a diagnosis of pancreatic cancer. The patient tells the nurse "I would never be the type to get cancer; this must be a mistake." Which defense mechanism is this patient demonstrating? a. Projection b. Denial c. Displacement d. Repression

B

During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events? 1. Avoidance of stress is an important goal for living 2. Control over one's response to stress is possible 3. Most people have no control over their level of stress 4. Significant others are important to provide care and concern

2. Control over one's response to stress is possible

A nurse is teaching a patient a relaxation technique. Which statement demonstrates the need for additional teaching? a. "I must breathe in and out in rhythm." b. "I should take my pulse and expect it to be faster." c. "I can expect my muscles to feel less tense." d. "I will be more relaxed and less aware."

B

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 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.

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

developmental stressors

Occur at predictable times throughout an individual's life.

A college student visits the school's health center with vague complaints of anxiety and fatigue. The student tells the nurse, "Exams are right around the corner and all I feel like doing is sleeping." The student's vital signs are within normal parameters. What would be an appropriate question to ask in response to the student's verbalizations? a. "Are you worried about failing your exams?" b. "Have you been staying up late studying?" c. "Are you using any recreational drugs?" d. "Do you have trouble managing your time?"

A

A nurse is caring for an older adult in a long-term care facility who has a spinal cord injury affecting his neurologic reflex arc. Based on the patient's condition, what would be a priorityintervention for this patient? a. Monitoring food and drink temperatures to prevent burns b. Providing adequate pain relief measures to reduce stress c. Monitoring for depression related to social isolation d. Providing meals high in carbohydrates to promote healing

A

A nurse teaches problem solving to a college student who is in a crisis situation. What statement best illustrates the student's understanding of the process? a. "I need to identify the problem first." b. "Listing alternatives is the initial step." c. "I will list alternatives after I develop the plan." d. "I do not need to evaluate the outcome of my plan."

A

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.

Upon arrival to the emergency room, the mother of a patient 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? a) Severe anxiety b) A panic attack c) Mild anxiety d) Moderate anxiety

A panic attack Explanation: 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.

A nurse is assessing a patient who complains of migraines that have become "unbearable." The patient tells the nurse, "I just got laid off from my job last week and I have two kids in college. I don't know how I'm going to pay for it all." Which physiologic effects of stress would be expected findings in this patient? Select all that apply. a. Changes in appetite b. Changes in elimination patterns c. Decreased pulse and respirations d. Use of ineffective coping mechanisms e. Withdrawal f. Attention-seeking behaviors

A, B

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 certified nurse midwife is teaching a pregnant woman techniques to reduce the pain of childbirth. Which stress reduction activities would be most effective? Select all that apply. a. Progressive muscle relaxation b. Meditation c. Anticipatory socialization d. Biofeedback e. Rhythmic breathing f. Guided imagery

A, B, E, F

A nurse witnesses a street robbery and is assessing a patient who is the victim. The patient has minor scrapes and bruises, and tells the nurse, "I've never been so scared in my life!" What other symptoms would the nurse expect to find related to the fight-or-flight response to stress? Select all that apply. a. Increased heart rate b. Decreased muscle strength c. Increased mental alertness d. Increased blood glucose levels e. Decreased cardiac output f. Decreased peristalsis

A, C, D

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 parent is waiting outside of the recovery room during a tonsillectomy. The parent who exhibits mild anxiety is the one who: A. Asks a passing nurse if the surgery is over B. Swears at a passing nurse, wondering why no one has been out of surgery yet C. Approaches a passing a nurse expressing concern about the surgery and the child D. Enters the recovery room looking for the child

A. Asks a passing nurse if the surgery is over Rationale: Asks a passing nurse if the surgery is over is an indicator of mild anxiety. All other answers represent behaviors associated with higher levels of anxiety.

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." The patient is using the defense mechanism: a. Denial. b. Conversion. c. Dissociation. d. Displacement.

A. Denial

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. 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.

While performing discharge planning for a client recovering from a stroke, the nurse may use which factor as an indication of a client's potential for effective coping? A. How the client and family understand stressors, and their ability to provide a supportive environment B. The education level of the client C. The client's confidence in his abilities to care for himself at home D. The client having insurance in addition to Medicare.

A. How the client and family understand stressors, and their ability to provide a supportive environment Rationale: Effective coping is not dependent upon one's education level. Confidence is an important element of coping, but may not be based on the reality of the client's current condition. This may help the client afford community resources not covered by Medicare, but this alone does not indicate a client's or family's ability to cope.

When discussing their father's behavior during a family counseling session, a brother says to his sister, "Sure, Dad was rough, but not as bad as Grandma. Don't you remember Grandma? She was much worse. If it weren't for her, he would have been OK." The defense mechanism the brother is using is: A. Projection B. Rationalization C. Minimization D. Compensation

A. Projection Rationale: He is not justifying his father's behaviors by faulty logic or ascribing motives. He is not minimizing by not acknowledging his father's behavior. He is not compensating by emphasizing a more desirable trait of his father. He is projecting the behavior being discussed to his grandmother.

Which of the following are considered defense mechanisms? (Select all that apply.) A. Projection B. Minimization C. Compensation D. Reinventing

A. Projection B. Minimization C. Compensation Rationale: Defense mechanisms may be adaptive or maladaptive. Compensation, denial, displacement, identification, intellectualization, introjection, minimization, projection, rationalization, reaction formation, regression, repression, sublimation, substitution, and undoing are considered defense mechanisms.

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. Results in neurophysiological response 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.

The nurse is working with a client who is having a panic attack. The client has been pacing back and forth in the back hallway for the past 45 minutes. How should the nurse immediately respond to this​ behavior? Contacting the unit counselor to meet with the client immediately to discuss the cause of the panic Attempting to divert the client with another type of activity Allowing the client to pace to help diffuse energy Administering anxiolytics as prescribed

Allowing the client to pace to help diffuse energy Allowing pacing or harmless repetitive physical tasks for the client who is experiencing a panic attack can help diffuse negative energy. While an anxiolytic may ultimately be​ needed, it would not be the immediate response. Asking the client to take a break or participate in another activity would likely increase anxiety and would not be the correct immediate response.

1. Marlene talks with Mr. Wexler about his diagnoses and care plan. She explains to him that he is experiencing both situational and adventitious crises as a result of his experience in the Middle East. The frame of reference for Mr. Wexler's crises is which of the following? A. Mr. Wexler's point of view B. Mr. Wexler's medical history C. Mr. Wexler's girlfriend's point of view D. Mr. Wexler's care plan

Answer: A Rationale: The view of the person experiencing the crisis is the frame of reference for the crisis.

4. Marlene teaches Mr. Wexler how to interpret the impact of his military experience and violent act toward his girlfriend. She is teaching him how to take an ________________ of himself.

Answer: Appraisal Rationale: Appraisal is how people interpret the impact of the stressor on themselves or on what is happening and what they are able to do about it.

3. Marlene teaches Mr. Wexler about crisis management. Most crises are resolved within 2 weeks. A. True B. False

Answer: B Rationale: A crisis is generally resolved in some way within approximately 6 weeks, with the goal of crisis intervention and management being to return the person to a precrisis level of functioning.

2. Mr. Wexler says to Marlene, "I'm worried about how my hospital stay and illness affects the rest of my life. How am I supposed to support myself and my girlfriend if I'm in the hospital?" The uncertainty associated with hospitalization and illness is a _______________ factor.

Answer: Situational Rationale: Situational factors lead to situational stress, which arises from changes such as being hospitalized and unable to work.

8. A nurse is observing a 32-year-old client who is experiencing alcohol withdrawal. What symptoms might the nurse see?

Answer: tremors, disorientation, fast heart rate and agitation

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 nurse is performing an assessment of a woman who is 8 months pregnant. The woman states, "I worry all the time about being able to handle becoming a mother." Which nursing diagnosis would be most appropriate for this patient? a. Ineffective Coping related to the new parenting role b. Ineffective Denial related to ability to care for a newborn c. Anxiety related to change in role status d. Situational Low Self-Esteem related to fear of parenting

C

6. Which defense mechanism allows an individual to return to a point in development when nurturing and dependency were needed and accepted with comfort? A) Displacement B) Compensation C) Regression D) Rationalization

C) Regression

The client most likely to be experiencing a negative situational stress response is: A. An 18-year-old beginning college in a new state B. An 80-year-old victimized by a telephone scam C. A 5-year-old adjusting to a new baby sister D. A 23-year-old mother of two preschoolers who is beginning college

B. An 80-year-old victimized by a telephone scam Rationale: An 18-year-old beginning college in a new state is experiencing a situational stress response. The other answers are examples of developmental stressors.

A nurse is responsible for preparing patients for surgery in an ambulatory care center. Which technique for reducing anxiety would be most appropriate for these patients? a. Discouraging oververbalization of fears and anxieties b. Focusing on the outcome as opposed to the details of the surgery c. Providing time alone for reflection on personal strengths and weaknesses d. Mutually determining expected outcomes of the care plan

D

The nurse is teaching a client who is experiencing anxiety about possible medications that can be used to manage the symptoms of anxiety. Which medication should the nurse discuss with the​ client? (Select all that​ apply.) Beta blocker Antipsychotic Cortisol Benzodiazepine Antidepressant

Beta blocker Antipsychotic Benzodiazepine Antidepressant Antidepressants,​ antipsychotics, benzodiazepines, or beta blockers can be used to manage symptoms of anxiety. Cortisol is a glucocorticosteroid hormonal stress​ mediator; its pharmaceutical forms may be used to treat​ inflammation, not anxiety.

A nurse caring for patients in a hospital setting uses anticipatory guidance to prepare them for painful procedures. Which nursing intervention is an example of this type of stress management? a. The nurse teaches a patient rhythmic breathing to perform prior to the procedure. b. The nurse tells a patient to focus on a pleasant place, mentally place himself in it, and breathe slowly in and out. c. The nurse teaches a patient about the pain involved in the procedure and describes methods to cope with it. d. The nurse teaches a patient to create and focus on a mental image during the procedure in order to be less responsive to the pain.

C

A nurse is assessing the developmental levels of patients in a pediatric office. Which person would a nurse document as experiencing developmental stress? a. An infant who learns to turn over b. A school-aged child who learns how to add and subtract c. An adolescent who is a "loner" d. A young adult who has a variety of friends

C

A nurse is caring for a patient in the shock or alarm reaction phase of the GAS. Which response by the patient would be expected? a. Decreasing pulse b. Increasing sleepiness c. Increasing energy levels d. Decreasing respirations

C

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.

13 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. The nurse's first response is which of the following? A. "Don't be sad. People live with cancer every day." B. "Have you thought about how you are going to tell your family?" C. "Would you like for me to sit down with you for a few minutes so you can talk about this?" D. "I know another patient whose colon cancer was cured by surgery."

C. "Would you like for me to sit down with you for a few minutes so you can talk about this?"

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. A thorough physical assessment 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.

4. A college student presents to the counseling center because they are having difficulty dealing with having been informed that, due to continued poor grades, they are being dismissed from the college. Which statement by the student to the nurse counselor should indicate the use of the ego defense mechanism projection? A. "While I'm very upset and my parents will be angry, I can just transfer to another college to get my degree." B. "It's really not all my fault. The major I was in and all the credit hours I was taking would make it difficult for anyone to be successful." C. If my instructor had let me make up the exam I missed, I wouldn't be in this situation." D. "I don't think all of the grades are right. If they aren't, I can stay in school."

C. If my instructor had let me make up the exam I missed, I wouldn't be in this situation."

The mother of a 38yr/old female recently died due to complications from a surgery which required an unexpected colostomy. After her mothers death, the daughter states "My mother would have never wanted to live with a colostomy." The daughter is exhibiting which defense mechanism? A. Denial B. Substitution C. Intellectualization D. Rationalization

C. Intellectualization

A bystander at an automobile accident is excited and alarmed. He feels nauseated and dizzy, has difficulty focusing, and the pulse is elevated. What level of anxiety is the bystander feeling? A. Mild B. Moderate C. Severe D. Panic

C. Severe Rationale: Mild anxiety symptoms include increased arousal, few if any gastric symptoms, and minor if any respiratory or circulatory changes. Moderate anxiety symptoms include a narrowed focus of attention; selectively inattentive, slightly increased heart and respiratory rate; and "butterflies in the stomach." Panic symptoms include agitation, unpredictable responses, distorted perception, dyspnea, palpitations, and feelings of impending doom.

7. The nurse is teaching a patient about therapies for Obsessive Compulsive Disorder. What therapies would the nurse discuss with the patient?

Cognitive-behavioral therapy (CBT) and Antidepressants

A nurse interviews a patient who was abused by her partner and is staying at a shelter with her three children. She tells the nurse, "I'm so worried that my husband will find me and try to make me go back home." Which data would the nurse most appropriately document? a. "Patient displays moderate anxiety related to her situation." b. "Patient manifests panic related to feelings of impending doom." c. "Patient describes severe anxiety related to her situation." d. "Patient expresses fear of her husband."

D

A visiting nurse is performing a family assessment of a young couple caring for their newborn who was diagnosed with cerebral palsy. The nurse notes that the mother's hair and clothing are unkempt and the house is untidy, and the mother states that she is "so busy with the baby that I don't have time to do anything else." What would be the priority intervention for this family? a. Arrange to have the infant removed from the home. b. Inform other members of the family of the situation. c. Increase the number of visits by the visiting nurse. d. Notify the care provider and recommend respite care for the mother.

D

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.

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. "What do you mean when you say you can't go on any longer?" 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.

A client in a violent marriage must decide whether to continue in her marriage. The most appropriate nursing diagnosis for this client is: A. Defensive coping B. Caregiver role strain C. Ineffective denial D. Decisional conflict

D. Decisional conflict Rationale: The client is uncertain what the next action should be. The client is not struggling with care giving, denying reality, or projecting a falsely positive self-evaluation.

A nurse feels vulnerable after a child dies following a lengthy resuscitation effort. A positive coping strategy for the nurse is to: A. Take a sedative when getting home B. Accept it as part of a day's work C. Review the resuscitation until mistakes are found to explain the child's death D. Meet with others who participated in the resuscitation to grieve together

D. Meet with others who participated in the resuscitation to grieve together Rationale: Nurses must learn positive coping strategies to deal with stress and prevent burnout. The nurse needs to tune into feelings rather than suppress and numb them with sedatives. A child's death is always extraordinary. It is important for the nurse to deal with the grief. The nurse makes the assumption that a mistake caused the child's death, rather than recognizing that people do the best they can in desperate circumstances and that even children cannot always be resuscitated. Reviewing resuscitations can be useful if done to improve overall care.

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. Search for identity with peer groups and separation from family 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.

Which of the following is a physiological response experienced during the exhaustion stage of general adaptation syndrome? a) Increased mental alertness b) Vasoconstriction c) The initiation of neuroendocrine activity d) Decreased blood pressure

Decreased blood pressure Explanation: The stage of exhaustion is often accompanied by decreased blood pressure and vasodilation. Increased mental alertness and the initiation of neuroendocrine activity are associated with the alarm reaction of the GAS.

The children of a 60-year-old woman are distraught at her apparent lack of recovery following a stroke several weeks earlier. The patient's daughter has frequently directed harsh criticism toward the nurses, accusing them of a substandard effort in rehabilitating her mother despite their best efforts. What defense mechanism may the patient's daughter be exhibiting? a) Sublimation b) Regression c) Displacement d) Denial

Displacement Explanation: The daughter may be transferring her feelings about her mother's health status to the care providers, an act that involves the displacement of the emotional reaction to another person. Denial about her mother's potential for recovery may underlie her response, but this is not demonstrated as clearly as displacement.

The nurse would recognize that short-term pharmacological treatment may be appropriate if an anxious patient's nursing diagnoses includes which of the following? a) Social isolation b) Decisional conflict c) Disturbed sleep pattern d) Defensive coping

Disturbed sleep pattern Explanation: The nurse should recognize that diagnoses relating to conflict, coping, and decisional conflict are less amenable to pharmacologic treatment. Disturbances in sleep patterns, however, are often addressed by the appropriate use of hypnotic medications.

A group of students who are studying for final exams are talking about ways to better deal with stressful events in life. One student​ suggests, "During the finals​ week, we should avoid biogenic​ stressors." How should the students follow that​ advice? (Select all that​ apply.) ​Don't smoke cigarettes. ​Don't drink fluids with caffeine in them. ​Don't worry about the test results. ​Don't stay up all night studying. ​Don't go outside into freezing temperatures

Don't smoke cigarettes. ​Don't drink fluids with caffeine in them. ​Don't go outside into freezing temperatures Biogenic stressors directly trigger the stress​ response, without the individual needing to know about their presence. This is true of​ caffeine, nicotine, and extreme temperatures. The student staying up all night knows the effect of delayed sleep and can choose to end a study session. Students can choose to worry about the test​ results, or they can choose to be confident about the outcome.

10. A nurse at Nurseslabs Medical Center is developing a care plan for a female client with post-traumatic stress disorder. Which of the following would she do initially? Instruct the client to use distraction techniques to cope with flashbacks Encourage the client to put the past in proper perspective. Encourage the client to verbalize thoughts and feelings about the trauma. Avoid discussing the traumatic event with client.

Encourage the client to verbalize thoughts and feelings about the trauma.

The nurse is preparing a teaching material for parents regarding symptoms of anxiety in children and adolescents. Which​ symptom, common to both age​ groups, should the nurse​ include? (Select all that​ apply.) Excessive worrying Stomachaches Muscle tension Shyness Headaches and body aches Frequent need to urinate

Excessive worrying Stomachaches Muscle tension Headaches and body aches Stomachaches, muscle​ tension, excessive​ worrying, and headaches and body aches are symptoms of anxiety common to both adolescents and children. Shyness can be a symptom of anxiety in children. Frequent need to urinate can be symptom common in adolescents.

A client reports a series of stressful events. They also report that they feel very hopeless and​ empty, are having difficulty solving even minor​ problems, and are fantasizing about what it would be like if all of these things had not happened. Which of these indicators of stress should be considered psychologic​ indicators? (Select all that​ apply.) Feeling empty Helplessness Hopelessness Difficulty solving minor problems Fantasizing

Feeling empty Helplessness Hopelessness Psychologic indicators of stress include​ hopelessness, helplessness, and feeling empty. Fantasizing and having difficulty solving problems are cognitive indicators of stress.

The nurse is presenting to a community group about mental disorders that are more common among women than among men. Which disorder should the nurse​ include? (Select all that​ apply.) Generalized anxiety disorder Anxiety disorder Phobia ​Obsessive-compulsive disorder Insomnia

Generalized anxiety disorder Anxiety disorder Phobia Anxiety disorders and generalized anxiety disorder are more common among women than among men. Phobia also strikes women twice as often as it does men.​ Obsessive-compulsive disorder is equally common among men and women. Insomnia is a​ symptom, not a disorder.

A client contacts the nurse asking to see the healthcare provider due to fears that they have​ "something terribly​ wrong." This client frequently professes the same fear that something is wrong in one body system or​ another, and has had multiple types of diagnostic testing over the​ years, which has not identified any medical issue. The client also reports vague symptoms such as difficulty​ sleeping, headache, muscle​ tension, feeling out of​ breath, and digestive issues. Which anxiety disorder should the nurse most likely expect that the client is​ experiencing? ​Obsessive-compulsive disorder Generalized anxiety disorder Panic disorder Phobias

Generalized anxiety disorder The somatic symptoms described by this client are characteristic of generalized anxiety disorder. Manifestations of generalized anxiety disorder include preoccupation with health​ issues, difficulty​ relaxing, trouble​ sleeping, and various somatic complaints. These are not clinical manifestations of​ phobias, panic​ disorder, or​ obsessive-compulsive disorder.

The nurse presents information about the​ "fear worry​ center" in the brain. Which information should the nurse include about how the fear center affects the risk for anxiety​ disorders? Hormone secretion blocks the risk of anxiety disorders. Oxygenation decreases the risk of anxiety disorders. Perfusion balances the risk of anxiety disorders. Hypersensitivity increases the risk of anxiety disorders.

Hypersensitivity increases the risk of anxiety disorders. Hypersensitivity of the fear center​ (amygdala) in the brain increases the risk of anxiety disorders. It is not a matter or​ perfusion, oxygenation, or hormone secretion.

Which statement demonstrates an understanding of​ Maslow's hierarchy of​ needs, when a client prioritizes a choice to react to a​ stressor? ​Self-esteem is the most important level of need. Individuals might have their own priorities. Everyone chooses to satisfy basic requirements first. Coping with stressors is a part of safety needs.

Individuals might have their own priorities. Individuals might have their own priorities. Not everyone chooses to satisfy the same basic requirements first. Coping with stressors can be part of any​ level, and there is no most important level of need.

Read this case study to answer the rest of these questions

Mr. Matt Wexler is being admitted to the psychiatric unit at the Veteran's Affairs (VA) hospital for violent behavior. He is a 28-year-old soldier who has just returned from three tours in Afghanistan. His girlfriend stated that he tried to strangle her when he confused her with an undercover Afghani secret agent. Marlene is the nursing student assigned to Mr. Wexler. She reviews his intake forms and health care provider's orders. His diagnoses are posttraumatic stress disorder (PTSD), paranoia, and psychosis.

The family of a client share with the nurse that the client has always been a​ hoarder, but since their father​ died, the behavior has now gotten to the point where the home is no longer safe. Which classification of disorders related to stress and coping does the​ client's behavior​ fit? ​Trauma- and​ stressor-related disorders ​Obsessive-compulsive and related disorders Anxiety disorders Depression and​ depression-related disorders

Obsessive-compulsive and related disorders Hoarding is classified as an​ obsessive-compulsive and related disorder. It is not classified as an anxiety disorder or​ trauma- and​ stressor-related disorder. There is not a classification labeled depression and​ depression-related disorders.

As an occupational health nurse at an oil refinery on the Gulf coast of Texas you are doing patient education with a man in his mid-forties. The patient is being seen after having been exposed to a chemical spill at the refinery. What type of stressor has this patient been exposed to? a) Psychiatric b) Psychosocial c) Physiologic d) Physical

Physical Explanation: Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. These facts make the other options incorrect.

The prenatal nurse is completing an assessment on a client who is currently at 20 weeks of gestation. The client indicates that she is struggling with an overwhelming sense of anxiety and fears that she is becoming depressed. Prior to becoming​ pregnant, the client had been taking a selective serotonin reuptake inhibitor​ (SSRI) but stopped the medication due to the pregnancy. Which intervention should the nurse suggest initially to help the client deal with the​ anxiety? Asking the healthcare provider about resuming the SSRI but at a lower dose Asking the healthcare provider to prescribe another SSRI that has been found not to increase the risk of birth defects Encouraging the client to find a good support system that can help her manage the anxiety Recommending cognitive-behavioral therapy

Recommending cognitive-behavioral therapy During​ pregnancy, women need to be careful concerning use of​ medications, particularly SSRIs. The safest approach would be to try cognitive-behavioral therapy initially. Another SSRI may have less of a​ risk, but should not be the initial approach. While a support system may be​ helpful, the client is indicating being overwhelmed and possibly​ depressed, so cognitive-behavioral therapy would be the best approach.

A client has presented to the healthcare provider with symptoms of hypertension. The client tells the nurse that for the past year they have been dealing with the legal ramifications of an accident that they caused while under the influence of alcohol. According to​ Selye's general adaptation syndrome​ (GAS), the client is in which stage of​ adaptation? Exhaustion Homeostasis Resistance Alarm

Resistance During the second stage of​ GAS, the stage of​ resistance, the body attempts to restore homeostasis while continuing to respond to the stressor. With chronic exposure to a stressor such as in this​ situation, the body may maintain resistance to the primary​ stressor, and resistance to other stressors may be diminished and result in hypertension. This scenario does not reflect the stages of alarm or exhaustion. Homeostasis is not a stage in GAS.

9. A mother of two goes in for her yearly checkup. Complains to her doctor she has been unable to sleep lately. She has also been suffering from diarrhea, nausea, and heart palpitations. As she is describing her symptoms the doctor realizes she is trembling and seems disoriented. What level of severity of anxiety is this patient experiencing? Mild Moderate Severe Panic

Severe

stimulus-based models

Stress is defined as a stimulus, a life event, or set of circumstances that arouses physiological and or psychological reactions that my increase the individual's vulnerability to illness.

A client is discussing recent difficulties with mild anxiety due to stress at work. They ask the nurse about ways that they can manage the​ anxiety, because they really do not want to take medication. Which intervention should the nurse​ include? (Select all that​ apply.) Teaching the client how to recognize stress triggers Encouraging the client to use​ self-management and diversion techniques to cope with stress Instructing the client to reduce environmental stimuli Teaching the client how to differentiate between different levels of stress Speaking slowly and using a​ low-pitched voice with the client

Teaching the client how to recognize stress triggers Encouraging the client to use​ self-management and diversion techniques to cope with stress Teaching the client how to differentiate between different levels of stress Interventions for mild anxiety​ include: 1) teaching clients how to recognize stress triggers so that they can respond using healthy coping strategies before anxiety levels​ rise; 2) teaching clients how to differentiate between different levels of stress to help them determine if their response is appropriate or​ inappropriate; and​ 3) encouraging clients to use​ self-management and diversion techniques to cope with stress. The interventions of speaking slowly using a​ low-pitched voice and instructing the client to reduce environmental stimuli are appropriate to address​ panic, not mild anxiety.

resistance stage

The second stage of the general adaptation syndrome, when there are intense physiological efforts to either resist or adapt to the stressor.

The nurse therapist is assessing an older adult. The client and the nurse are from different cultures. Which factor could complicate the​ nurse's assessment of the​ client? (Select all that​ apply.) The​ client's cognitive changes The​ client's physical illness The​ client's age difference from the therapist The​ client's normal, healthy cultural response The​ client's work experience

The​ client's cognitive changes The​ client's physical illness The​ client's normal, healthy cultural response The​ client's physical​ illness, cognitive​ changes, and​ normal, healthy cultural response might complicate the assessment. The​ client's age difference and work experience should not complicate the assessment.

mild anxiety

This first level of anxiety occurs in the normal experience of everyday living and allows people to perceive reality in sharp focus.

TRUE or FALSE: Stress may be referred to as positive or negative.

True (This is true. Selye referred to the demands that produce the adaptive response as stressors and noted that stress is unavoidable. He labeled negative stress as distress (stress that is beyond the ability of the affected person to cope with or adapt to effectively), which can cause physical illness or emotional dysfunction. He identified positive stress as eustress (motivational stress), which is associated with effective coping and adaptation. Eustress is thought to be essential for normal growth and development.)

reaction formation

causes people to act exactly opposite to the way they feel (ex: married couple and wife is attracted to husbands friend and reacts by being mean to him)

spiritual stress

challenge one's beliefs and values (ex: religion, morals)

fear

a feeling of dread; a cognitive response to a known threat

introjection

a form of identification that allows for the acceptance of others' norms and values into oneself, even when contrary to one's previous assumptions (ex: older sibling tells younger sibling to look both ways before crossing the street)

Which statement by a patient would indicate the use of effective coping strategies? (Select all that apply.) a. "Each month, my wife and I attend a support group for parents of children with autism." b. "Talking with my spiritual adviser may challenge my thinking on how best to handle this situation." c. "I've invited my son to join me for drinks at the bar each night on his way home from work so we can spend more time together." d. "We are looking into joining the new health club facility in our neighborhood." e. "After working all day, I eat dinner in front of the television while my family sits at the kitchen table."

a, b, d (Support groups, spiritual advisors, and health clubs all offer services that can enhance coping skills. The daily use of alcohol is not a healthy coping strategy, even if it involves spending time with family. Eating in front of the television promotes obesity and social isolation.)

Which short-term goal would be most appropriate for a patient with the nursing diagnosis Anxiety related to upcoming diagnostic tests, as evidenced by expressions of concern and pacing around the room? a. Patient will discuss specific aspects of concern. b. Nurse will administer prescribed antianxiety medication. c. Patient will understand diagnostic test procedures. d. Nurse will describe test procedures in detail to allay concerns.

a. Patient will discuss specific aspects of concern. (Having the patient discuss specific aspects of concern allows the nurse the opportunity to assess the patient's level of anxiety and what interventions might be most appropriate to help allay the stated concerns. Goals must be patient-centered, measurable, and realistic. None of the other three goals meet these criteria. Two of the goals are nurse-focused. The action "understand" is not measurable.)

The patient has just been told that he has cancer. When the nurse assesses the patient at shift change, his heart rate and respirations are elevated. What type of response is this to stress? a. Physiologic b. Psychological c. Somatic d. Neurologic

a. Physiologic Increases in heart rate and respirations are physiologic in nature.

The physiologic response to stress is a. activation of the autonomic nervous system with increased heart rate and respirations. b. activation of the parasympathetic nervous system with relaxation of smooth muscle and decreased secretions. c. activation of the autonomic nervous system with peripheral vasodilation, decreased blood pressure, and pupil constriction. d. activation of the parasympathetic nervous system with increased gastric emptying, dry mouth, and adrenal suppression.

a. activation of the autonomic nervous system with increased heart rate and respirations. The physiologic response to stress is the activation of the autonomic nervous system, resulting in an increase in heart rate, blood pressure, and respirations along with pupil dilation and a decrease in gastric motility and blood flow to the skin.

The stages of Selye's General Adaptation Response are a. alarm, resistance, and exhaustion. b. excitement, adaptation, and coping. c. activation, coping, and adaptation. d. appraisal, reaction, and resolution.

a. alarm, resistance, and exhaustion. The GAS consists of three stages: alarm reaction, resistance, and exhaustion. Most stressful events involve only the first two, but some ongoing demands can exceed the body's resources and lead to the final stage of exhaustion.

undoing

action or words designed to cancel some disapproved thoughts, impulses, or acts in which the person relieves guilt by making reparation (ex: abused wife the abuser husband buys a gift to make up for it)

exhaustion stag

adaption that the body made during the second stage cannot be maintained

panic S/S

agitation, unpredictable responses, trembling, poor motor coordination, unable to learn, dyspnea, palpitations, choking, chest pain/pressure, feeling of impending doom, sweating

social stress

alter a person's relationship with others (ex: loss of friends)

intellectualization

an emotional response that normally would accompany an uncomfortable incident is evaded by the use of rational explanation that remove from the incident any person significance and feelings (ex: refusing to apologize when in the wrong)

stressor

anything causing a person to experience stress; change in the balanced state

cognitive indicators: structuring

arrangement of a situation so that threatening events do not occur (ex: studying for a check off to pass)

cognitive indicators: self-control

assuming a manner and facial expression that convey a sense of being in control or in charge (ex: take a deep breath and ac confident before performing a check off)

stress: respiratory disorders

asthma, hay fever, TB

denial

attempt to ignore unacceptable realities by refusing to acknowledge them (ex: women finds a lump in breast and says its not there and doesn't seek treatment)

identification

attempt to manage anxiety by imitating the behavior of someone feared or respected (ex: bully copies actions of how father treats him)

reflex pain response

automatic response of the central nervous system to the stimulus of pain

5. A client expresses to the nurse that she constantly feels irritated and loses her temper. During the course of the interview, the nurse finds that the client takes care of her mother who was confined to bed following a stroke. The client struggles to balance caring for her family and her mother. Which nursing diagnosis would the nurse most likely identify for this client? a) Compromised family adjustment b) Caregiver role strain c) Ineffective coping d) Anxiety

b) Caregiver role strain

A client expresses to the nurse that she constantly feels irritated and loses her temper. During the course of the interview, the nurse finds that the client takes care of her mother who was confined to bed following a stroke. The client struggles to balance caring for her family and her mother. Which nrusing diagnosis would the nurse most likely identify for this client? a) Compromised family adjustment b) Caregiver role strain c) Ineffective coping d) Anxiety

b) Caregiver role strain Explanation: The most appropriate nursing diagnosis is caregiver role strain because the client feels tired and fatigued by struggling to care for her mother and fulfilling family needs. Ineffective coping, compromised family adjustment, and anxiety would be inappropriate nursing diagnoses based on the information provided.

What are some developmental stressors for older adults? Select All That Apply a) Aging b) Retirement c) Children d) Death of spouse or friends

b) Retirement c) Children d) Death of spouse or friends

The nurse has been assigned the same patients for the past 4 days. Two of the patients demand a great deal of attention, and the nurse feels anxious and angry about being given this assignment again. What action would demonstrate the most effective way for the nurse to cope with the patient care assignment? a. Share complaints about the assignment with the nurse manager. b. Prioritize the patients' needs, and identify a specific time period for care for each patient. c. Talk with the patients, and explain that they cannot expect so much personal attention. d. Trade assignments with another nurse who is unaware of the concerns regarding the patient assignment.

b. Prioritize the patients' needs, and identify a specific time period for care for each patient. (Prioritizing care and setting aside time to spend with specific patients constitute the most effective coping strategy for the nurse to use. Sharing concerns with the nurse manager does not demonstrate strong problem-solving skills; it merely shows a desire to complain. Trading assignments diminishes the continuity of care during which patient trust and nurse-patient relationships are developed. Patients are always the focus of nursing care and should not be given the impression that the nurse does not have time to care or listen to their concerns.)

countercheck phase

changes produced in the body during the shock phase are reversed thus a person is mobilized to react during the shock phase of the alarm reaction

developmental stressors: Adolescent

changing physique, relationships involving sexual attraction, exploring independence, choosing a career

A patient is newly diagnosed with diabetes and requires insulin injections. He requests information about classes offered by the diabetes educator. Which type of coping technique is this patient using? a. Emotion-focused b. Problem-focused c. Avoidance d. Denial

b. Problem-focused (Problem-focused coping techniques are aimed at altering or removing a stressor. If this patient gains the skills to administer his own injections from the diabetes educator, he will remove a major stressor associated with a new diabetes diagnosis. Emotion-focused coping techniques, avoidance, and denial are all psychological techniques, rather than a psychomotor-based activity, which is required in this situation.)

There is great variation among individual responses to the same stressor. In addition to age, nutritional status, and genetic inheritance, which additional factor influences the expression of stress response and reflects the complex psychological processing involved? a. The amount of stress b. The individual's appraisal of the stressor c. The context of the stressful event d. The type of stressor

b. The individual's appraisal of the stressor (Stress appraisal, the affected person's attribution of meaning to a stressful event, influences the expression of this stress response and reflects the complex psychological processing involved.)

developmental stressors: Child

beginning school, establishing peer relationships, peer competition

General Adaptation Syndrome

biochemical model of stress describing the body's general response to stress

projection

blame is attached to others to the environment for unacceptable desire, thoughts, and mistakes (ex: disliking someone and believing it is because they do not like you)

A mother of two goes in for her yearly checkup. Complains to her doctor she has been unable to sleep lately. She has also been suffering from diarrhea, nausea, and heart palpitations. As she is describing her symptoms the doctor realizes she is trembling and seems disoriented. What level of severity of anxiety is this patient experiencing? A) Mild B) Moderate C) Severe D) Panic

c Severe

When using a stress assessment tool with a patient from another culture, what factor(s) must the nurse take into consideration? (Select all that apply.) a. Specific methods of managing stress are revealed in using stress assessment tools. b. Stress assessment tools should be used only for persons living in North America. c. Stress assessment tools may not be appropriate for all people of all ages. d. Resistance resources become evident when stress assessment tools are analyzed. e. Adaptations may need to be made to the assessment tool based on circumstances.

c, e (It is not possible to use stress assessment tools in some situations. Stress assessment tools must be adapted to specific age groups, cultures, and circumstances to be most effective in gathering pertinent data. Stress assessment tools identify only stressors that the person is experiencing and not methods of managing stress or the person's resistance resources.)

Which intervention would be most appropriate for the nurse to include in the care plan for a patient who is experiencing constipation and increased heart and respiratory rates? a. Time management b. Decreased grain intake c. Relaxation therapy d. Regimented exercise

c. Relaxation therapy Relaxation therapy typically lowers the person's heart and respiratory rates while increasing gastric motility. Not enough information is provided to indicate the need for time management. Both decreased grain intake and regimented exercise may exacerbate the patient's problems.

The hormone used as a physiologic marker for stress is a. ACTH. b. ADH. c. cortisol. d. Aldactone.

c. cortisol. Measurement of cortisol, found in the blood, urine, and saliva, is the standard for laboratory assessment of physiologic stress.

coping: short-term

can reduce stress to tolerable limit temporarily but are ineffective was to permanently deal with reality (ex: people turn to drugs an alcohol to solve problem but never does)

stress

condition in which the human system responds to change in its normal balanced state

cognitive indicators: suppression

consciously putting a thought or feeling out of mind (ex: just finished exam and don't let yourself think about the next exam for a week)

stress: gastrointestinal disorders

constipation, diarrhea, duodenal ulcer, anorexia nervosa, obesity, ulcerative colitis

coping: long-term

constructie and realistic; changes in lifestyle or using problem solving decision making instead of anger (ex: like style changes in response to high cholesterol)

severe anxiety

consumes most of the person's energies and requires intervention

stress: cardiovascular disorders

coronary artery disease, essential hypertension, CHF

compensation

covering up a real or perceived weakness by emphasizing a trait one considers more desirable (ex: not good in school but excels in sports)

burnout

cumulative state of frustration with the work environment that develops over a long time; behaviors exhibited as the result of prolonged occupational stress

14. The nurse is interviewing a client with complaints of chronic fatigue. The nurse understands that the client has a sedentary lifestyle and suggests that the client start low-intensity exercise. Which of the following exercises would be appropriate for the nurse to suggest the client engage in initially? a) Brisk walking b) Running c) Cycling d) Gardening

d) Gardening

A nurse is assessing an obese teenager who is unhappy and stressed out because she has not lost weight despite working out at the gym. The physician asks the nurse to try the modeling intervention for stress management for the client. Which of the following actions should the nurse perform when adhering to the modeling intervention? a) Ask the client to undergo liposuction surgery. b) Ask the client to change her exercise regimen. c) Ask the client to cut down on her food intake. d) Introduce the client to someone with a positive attitude.

d) Introduce the client to someone with a positive attitude. Explanation: The nurse should introduce the client to a person who demonstrates a positive attitude or behavior as this promotes the ability to learn an adaptive response. The nurse should not ask the client to change her exercise regime, cut down on her food intake, or undergo liposuction surgery as that could lead to further medical complications.

You are the nurse caring for a 72-year-old female who is recovering from abdominal surgery on the Medical Surgical unit. The surgery was very stressful and prolonged and you note on the chart that her blood sugars are elevated yet she in not been diagnosed with diabetes. To what do you attribute this elevation in blood sugars? a) It is a result of antidiuretic hormone. b) She must have had diabetes prior to surgery. c) She has become a diabetic from the abdominal surgery. d) The blood sugars are probably a result of the "fight-or-flight" reaction.

d) The blood sugars are probably a result of the "fight-or-flight" reaction. Explanation: During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to glucose, the result is elevated blood sugars. Option A is incorrect, antidiuretic hormone is released during stressful situations and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Option B is incorrect; assuming the patient had diabetes prior to surgery demonstrates a lack of understanding of stress induced hyperglycemia. Option C is incorrect, there is no evidence presented in the question other than are elevated blood sugars that would support a diagnosis of diabetes.

In the immediate postoperative period after open-heart surgery, a patient who is not a diabetic has elevated blood glucose levels. What physiologic stress response best describes the rationale for the patient's increased blood sugar? a. Release of epinephrine b. Secretion of CRH c. Circulation of endorphins d. Increase in corticosteroids

d. Increase in corticosteroids (Corticosteroids increase serum glucose levels and inhibit the inflammatory response. Often patients who have experienced extreme physiologic stress will require short-term insulin therapy until their corticosteroid and blood glucose levels return to normal. Epinephrine, CRH, and endorphins all respond to stress; however, corticosteroids are directly responsible for the increase in this patient's blood sugar.)

developmental stressors: Older Adult

decreasing physical abilities and health, changes in residence, retirement and reduced income, death of spouse and friends

severe anxiety S/S

difficult communication, increased motor activity, inability to relax, fearful facial expression, inability to focus, easily distract, learning Beverly impaired, tachycardia, hyperventilation, HA, dizziness, and nausea

sublimation

displacement of energy associated with more primitive sexual or aggressive drives into socially accepted activities (ex: super aggressive male purses wrestling)

stress: skin disorders

eczema, pruritus (itching), urticaria (hives), psoriasis

coping: problem-focused

efforts to improve a situation by making changes or taking some action (ex: stressful job so change jobs)

anger

emotional state consisting of a subjective feeling of animosity or strong displeasure

cognitive indicators: fantasy

ends differently from reality (ex: daydreaming)

depression

extreme feeling of Danes, depsiare, dejection, lack of worth, or emptiness short-term/long-term

crisis intervention

five-step problem-solving technique to promote adaptation and improve future coping

defense mechanisms

forms of self-deception; unconscious process the self uses to protect itself from anxiety or threats to self-esteem

coping: adaptive

helps the person to deal effectively with stressful events and minimizes distress associated with them (ex: person accepts diagnosis)

stress: metabolic disorders

hyperthyroidism, hypothyroidism, diabetes

coping: emotion-focused

includes thoughts and actions that relieve emotional distress (ex: mediation but don't deal with the problem

mild anxiety S/S

increased questioning, mild restlessness, sleeplessness, increased arousal and alertness, uses learning to adapt

intellectual stress

influence person's perceptual and problem solving abilities (ex: situational problems)

cognitive indicators: problem-solving

involves thinking through the threatening situation using specific steps and arriving to a solution

depression S/S

irritability, inability to concentrate, hard to make decisions, loss of sexual desire, crying, sleep disturbances, social withdrawal

rationalization

justification of certain questionable behaviors (ex: elder man forgot appt and blames someone else)

localized adaptation syndrome

localized response in the body, usually short term, reflex pain response, and inflammatory response

inflammatory response

localized response of the body to injury or infection; protective mechanism that eliminates invading pathogens and allows for tissue repair to occur

Local Adaptation Syndrome

localized response of the body to stress, precipitated by trauma or pathology

developmental stressors: Young Adult

marriage, leaving home, managing a home, occupation starting, education cont., children

response-baed models

nonspecific response of the body to any and of demand made upon it

minimization

not acknowledging the significance of one's behavior (ex: acts as nothing was done)

adaption

of living with other things and environmental conditions

external stressors

originate outside the individual (ex: marriage, school, death)

internal stressors

originate within a person (ex: infections, disease, depression)

panic

overpowering, frightening level of anxiety causing the person to lose control

coping mechanisms

patterns of behavior used to neutralize, deny, or counteract anxiety

developmental stressors: Middle Adult

physical changes of aging, maintaining a social status, standard of living, growing children, aging parents

psychosomatic disorder

physiologic alterations and illness believed to be due to psychological influences

crisis

point at which body temperature drops rapidly to normal; occurs when coping and defensive mechanisms are no longer effective, resulting in high levels of anxiety, disorganized behavior, and the inability to function normally

15. A woman who was sexually assaulted a month ago presents to the emergency department with complaints of recurrent nightmares, fear of going to sleep, repeated vivid memories of the sexual assault, and inability to feel much emotion. The nurse recognizes the signs and symptoms of which medical problem? 1. A) Trauma 2. B) Fight or flight response 3. C) Posttraumatic stress disorder 4. D) Alarm reaction

post-traumatic stress disorder

emotional stress

produce negative or unconstructive feelings about the self (ex: depression, low self-concept)

regression

resorting to an earlier level of functioning that is less demanding and responsible (ex: potty trained child goes through traumatic event and starts bed-wetting again)

coping: maladaptive

result in unnecessary distress for the person and others associated with the person or stressful event; ineffective (ex: person remains angry about a diagnosis)

stress: musculoskeletal disorders

rheumatoid arthritis, low back pain, migraine HA, muscle tension

caregiver burden

stress responses experienced during prolonged periods of home care by family caregivers

alarm reaction

the alarm reaction is the initial reaction to a stressor

fight or flight response

the body preparing itself against threat, to either resist (fight) or evade (flight) the danger

moderate anxiety

the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated

allostasis

the process of achieving stability or homeostasis through physiologic or behavioral change

substitution

the replacement of highly values, unacceptable, or unavailable object by a less valuable, acceptable, or available object

shock phase

the stressor may be perceived consciously or unconsciously by the person

repression

threatening thoughts, feelings, and desires, are kept from becoming conscious (ex: depressed person thinks of hurting self)

physical stress

threatens a persons physiologic homeostasis (ex: weight loss, high BP, elevated HR)

displacement

transferring or discharging of emotional reactions from one object or person to another (ex: employee angry with co-worker and kicks a chair)

situational stressors

unpredictable and may occur at any time during life

anxiety

vague sense of impending doom or apprehension precipitated by new and unknown experiences

Homeostasis

various physiologic and psychological mechanisms respond to changes in the internal and external environment to maintain a balanced state

moderate anxiety S/S

voice tremors, pitch changes, facial twitches, shakiness, increased muscle tension, narrowed focus of attention, learning slightly impaired, slightly increased respiratory and HR, mild gastric symptoms (butterflies)

A mother has brought her​ 12-year-old daughter for therapy. The daughter witnessed a horrific motor vehicle crash in which several​ people, including​ children, were killed. The​ mother, who was with the child at that​ time, says,​ "I don't understand why she still seems affected by the crash.​ I'm not." Which statement by the nurse is most appropriate to help the mother better understand the​ daughter's situation? ​"A young​ person's memory bank is much more detailed than an​ adult's." ​"A young​ person's response can vary significantly from that of an​ adult." ​"A young​ person's coping responses are part of the skills they are born​ with." ​"A young​ person's negative experience can be erased by piling on positive​ events."

​"A young​ person's response can vary significantly from that of an​ adult." The therapist should let the mother know that a young​ person's response can vary significantly from that of an adult. It is not a matter of detailed memories or piling on positive events. Coping responses are​ learned, rather than being present at birth.

A college student presents to the counseling center because they are having difficulty dealing with having been informed​ that, due to continued poor​ grades, they are being dismissed from the college. Which statement by the student to the nurse counselor should indicate the use of the ego defense mechanism​ projection? ​"If my instructor had let me retake an exam I missed when I was​ sick, I​ wouldn't be in this​ situation." ​"While I'm very upset and my parents will be​ angry, I can just transfer to another school and still get my​ degree." ​"I don't think that all of the grades are accurate. If they​ aren't, then I can stay in​ school." ​"It's really not all my fault. The major I was in and the number of credit hours I was taking would be difficult for anyone to be​ successful."

​"If my instructor had let me retake an exam I missed when I was​ sick, I​ wouldn't be in this​ situation." Projection involves blaming others for shortcomings. In this​ case, the student is blaming an instructor for the​ failure, which would be projection. Stating that the student​ doesn't think the grades are accurate would be rationalization or​ denial, not projection. Stating that they can just transfer to another school would be minimization. Stating that it is really not their fault would be rationalization.

The nurse is working with an older adult who is having side effects from medications for an anxiety disorder. The nurse wants to refer the client for​ psychotherapy, but the client is adamant and​ states, "I​ don't want to see a​ psychiatrist; that's for crazy​ people!" Which reassurance should the nurse give the​ client? (Select all that​ apply.) ​"With therapy, you can stop taking your medications right​ away." ​"Therapists see many people who do not have mental​ disorders." ​"Other professionals offer therapy besides​ psychiatrists." ​"Therapy can help manage the symptoms of​ anxiety." ​"Therapy added to medications has more success than medications​ alone."

​"Therapists see many people who do not have mental​ disorders." ​"Other professionals offer therapy besides​ psychiatrists." ​"Therapy can help manage the symptoms of​ anxiety." ​"Therapy added to medications has more success than medications​ alone." Other professionals offer therapy besides psychiatrists. Therapy added to medications has more success than medications alone. Therapy can help manage the symptoms of anxiety. Therapists see many people who do not have mental health disorders. Therapy and medications are not an​ either-or situation; the client can continue taking the medications.