NUR 108 Ch 42 Stress and Adaptation

A teen is worried that her boyfriend is under "a lot of stress" with his home life, classes, clubs, community service, and part-time work. She asks the nurse what medication he should take to "calm down." Which response would be best? "What medication is he taking now? I can recommend something, but we need to make sure there won't be an interaction with something else." "It sounds like he is in too many extracurricular activities. Can you convince him to drop out of some of those clubs?" "Do you think he would be willing to sit down and talk with me? I'd like to get to know him better so I can suggest some healthy alternatives." "Isn't he passing his classes? Did you tell his parents this was happening?"

"Do you think he would be willing to sit down and talk with me? I'd like to get to know him better so I can suggest some healthy alternatives." Explanation: The most therapeutic approach would be to enlist the girl's help in getting the boy to sit down and discuss what is happening with someone trained in therapeutic communication. Decreasing the activities may help but may be unacceptable to the young man. Directing attention to his academic problems, asking the girlfriend about health issues and medications, and asking about parental involvement at this stage may damage the trust relationship the nurse has with them.

A Red Cross volunteer has recently returned from assisting families in the Northwest who survived a devastating forest fire. She is having trouble sleeping and has taken up smoking again. Which statement by her leads the nurse to suspect a nursing diagnosis of Caregiver Role Strain related to stress from disaster volunteer activities? "I can't seem to calm down. I keep seeing those faces and hearing their words every time I close my eyes." "I get so tired from working long hours at the site." "I need to get back to work here at home. That will get me back into a routine." "I guess the smoke in the air brought out my mental addiction to cigarettes."

"I can't seem to calm down. I keep seeing those faces and hearing their words every time I close my eyes." Explanation: This person is exhibiting a physiologic response to stress while also taking up a negative coping solution to diminish the symptoms. Reliving the events that were stressful is a common complaint when under anxiety. The other statements do not demonstrate the burden of role strain.

A mother tells the school nurse that her 5-year-old is refusing to go to school and won't accept a "school night" bedtime. The school nurse knows the mother will need more instruction when the mother makes which statement? "I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." "I am bringing him to the orientation so he can meet his teacher and some classmates." "It's so hard to get them into a routine after summer break. I go through this every year with all my kids." "We've all been talking to him about what school will be like; his brother had the same teacher and really liked her."

"I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." Explanation: Each developmental stage includes tasks that must be achieved so that normal growth and development can occur, but change can be stressful. In a school-age child, starting school and being around strangers can be challenging. One way to counteract the anxiety is to introduce them to others in social situations, and teach acceptable social behaviors, before they start school.

A client presents with a flare of lupus. Which statement made by the client would cause the nurse to suspect a stress reaction? "My lupus typically flares twice a year." "I just had a baby 3 weeks ago." "I have a fever with this flare." "My joints hurt more with this flare."

"I just had a baby 3 weeks ago." Explanation: The brain-immune connection suggests that changes in body chemistry during periods of stress may trigger an autoimmune (self-attacking) response like those associated with lupus. While having a baby can be positive, it is stress, both physically and emotionally, and could be a stress trigger for the lupus flare. The other options present differences in lupus flare presentation, which is not specific to a stress response.

Which statement made by the client indicates a need for further teaching regarding stress management? "I manage my stress by taking anti-anxiety medication." "I manage my stress with occasional alcohol and alprazolam." "I manage my stress by going out with friends for an occasional drink." "I manage my stress by exercising one time a week."

"I manage my stress with occasional alcohol and alprazolam." Explanation: Taking alprazolam with alcohol can produce a temporary relaxation; however, this can result in physical impairment and drug dependence. It is appropriate to manage stress with anti-anxiety medication and exercise. It is also appropriate to manage stress by socializing, and alcohol in moderation does not require further teaching.

A client has just been diagnosed with a brain tumor after recurring headaches prompted his physician to order a CT scan. The client may be experiencing the nursing diagnosis of Ineffective Denial if he states: "I really need to get back to my job because I'm falling behind on a lot of tasks." "I've done some online research, and there are some really promising new treatments out there." "I had a coworker whose wife had a brain tumor and she managed to recover." "I'm going to do everything I can to beat this thing."

"I really need to get back to my job because I'm falling behind on a lot of tasks." Explanation: Fixating on work responsibilities indicates that the client may be making an attempt to disavow the reality of the situation at hand. Expressions of optimism (promising new treatments) and determination (my friend recovered and I can beat this thing) are often effective responses to an anxiety-provoking situation.

The nurse is explaining to a group of high school students how the nervous system helps regulate homeostasis. Which statements by the nurse are correct? Select all that apply. "The sympathetic nervous system is responsible for the flight-or-fight response." "The parasympathetic nervous system increases peristalsis." "The nervous system constricts vessels to essential organs during a stress response." "The sympathetic nervous system will slow the heart rate once a threat is over." "The nervous system decreases cardiac output using the sympathetic nervous system."

"The sympathetic nervous system is responsible for the flight-or-fight response." "The parasympathetic nervous system increases peristalsis." Explanation: The sympathetic nervous system is responsible for the flight-or-fight response to a threat. With the flight-or-fight response, vasoconstriction happens to the nonessential organs. This increases the blood flow to the essential organs and also increases cardiac output. The parasympathetic nervous system controls normal body functions such as digestion. It also will slow the heart rate once a perceived threat is over.

The emergency department nurse suspects that an older adult client who fell and broke her hip is using a defense mechanism when the client states: "They must have given me the wrong medication at the drug store. I don't have trouble with my eyesight." "I'm so clumsy. I'm surprised it hasn't happened before this." "Does this mean I have to stay here in the hospital?" "Can you call my next-door neighbor for me? I'm so worried that my cat, Clancy, won't have any food or water."

"They must have given me the wrong medication at the drug store. I don't have trouble with my eyesight." Defense mechanisms are psychological tools individuals use to deal with high levels of anxiety from stressors. Clients under extreme stress may self-protect by using denial and rationalization; they may convince themselves that the problem didn't happen or was not caused by them, or that it must have resulted from someone else's mistake. Additionally, the denial may be nonacceptance of the developmental stressors of aging.

A client who is recently divorced reports sleeping during the day and an inability to adapt to the life change. Which teaching by the nurse would promote healthy adaptation? "It's best to just procrastinate; then you can do everything all at once." "Try making a list to prioritize what needs to be done." "Thinking about the past will help you move forward." "You should get a dog so you will feel needed."

"Try making a list to prioritize what needs to be done." Explanation: Procrastination only prolongs and intensifies the original stressor and does not help the client cope or move forward. Making a list prioritizing what needs to be accomplished and attending to that which is most important or difficult is often helpful in moving forward. Thinking about the past does not help the client move forward. While pet ownership can be therapeutic for some, it can be stressful for others.

A client is admitted to the oncology unit with a diagnosis of leukemia. Her sister comes to visit. The healthy sibling tells the nurse that her sister is sick because "I got mad at her and wished she would go away." Based on this information, the nurse would estimate the sister's age to be: 7 years 15 years 3 years 21 years

7 years Explanation: This is an example of magical thinking. Magical thinking is a common reaction to stress in a school-aged child.

The nurse is caring for four clients. Which client does the nurse identify as the highest risk for social readjustment concerns? 77-year-old whose spouse just died 54-year-old who is undergoing marital separation 32-year-old who has recently been incarcerated 40-year-old who was fired from work last month

77-year-old whose spouse just died Explanation: Death of a spouse ranks as the most stressful life event on The Social Readjustment Rating Scale. The client whose spouse just died is at highest risk for social readjustment concerns.

Which client is experiencing the panic level of anxiety? A client loses control and expresses irrational thinking. A client experiences increased alertness and motivated learning. A client focuses narrowly on specific detail. A client displays a narrow perception field.

A client loses control and expresses irrational thinking. Explanation: Panic causes the person to lose control and experience dread and terror. The resulting disorganized state is characterized by increased physical activity, distorted perception of events, and loss of rational thought. Increased alertness and motivated learning describes mild anxiety. Narrowing the focus on a specific detail describes moderate anxiety. A client displaying a narrow perception field shows characteristics of severe anxiety.

Which response to stressors results from the activation of the local adaptation syndrome (LAS)? A girl quickly withdraws her hand from a stream of hot tap water. A woman's impending job interview has prompted the activation of her fight-or-flight response. A man is experiencing moderate anxiety before meeting with an important client. A man has a sudden urge for a bowel movement before undergoing thoracentesis.

A girl quickly withdraws her hand from a stream of hot tap water. Explanation: The local adaptation syndrome (LAS) is a localized response of the body to stress. It involves only a specific body part (such as a tissue or organ) instead of the whole body. The reflex pain response is a response to physiologic stress that is a component of the local adaptation syndrome (LAS). Psychological anxiety and the activation of the fight-or-flight response are not considered to be manifestations of the local adaptation syndrome. The sudden urge for a bowel movement involves the entire gastrointestinal system and not a tissue or organ.

Which client is handling stress by using the defense mechanism termed displacement? An athlete who doesn't make the team concentrates on body-building instead. A man with symptoms of prostate cancer refuses to see a doctor. A mother who is angry at her husband shouts at the kids to "keep quiet." A man who forgets his medication blames his wife for putting it away.

A mother who is angry at her husband shouts at the kids to "keep quiet." Explanation: Displacement is described as transferring (displacing) an emotional reaction from one object or person to another object or person, as with the mother who is angry at her husband and shouts at the kids to "keep quiet." The athlete who doesn't make a team and instead concentrates on body-building represents the defense mechanism of compensation. A man with symptoms of prostate cancer refusing to see a doctor is displaying the defense mechanism of denial. A man who forgets his medication and blames his wife for putting it way is demonstrating the defense mechanism of projection.

Upon arrival to the emergency room, the mother of a client involved in a motor vehicle accident becomes upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breathe. What is the mother likely experiencing? A panic attack Mild anxiety Moderate anxiety Severe anxiety

A panic attack Panic causes the person to lose control and experience dread and terror. Panic is characterized by a disorganized state, increased physical activity, difficulty communicating, agitation, trembling, dyspnea, palpitations, a choking sensation, and sensations of chest pressure or pain. Severe anxiety creates a narrow focus on specific detail; moderate anxiety leads to a focus on immediate concerns; and mild anxiety is often present in day-to-day living. It increases alertness and perceptual fields.

A client was at home alone when a tornado struck and damaged the structure. What type of crisis does the nurse address in the care of this client? Adventitious Developmental Situational Maturational

Adventitious Explanation: There are three types of crises: maturational, situational, and adventitious. Adventitious crises are accidental and unexpected events, resulting in multiple losses and major environmental changes, such as fires, hurricanes, earthquakes, and floods. Maturational crises occur during developmental events that require role change. Situational crises occur when a life event disrupts a person's psychological equilibrium, such as loss of a job or loved one. Developmental crisis does not exist.

The nurse is caring for a client diagnosed with terminal cancer who wishes to use meditation and prayer to be cured. What is the appropriate nursing action? Advocate for the client's choice. Explain that meditation and prayer are not curative. Arrange for a chaplain to visit with the client. Prepare to administer chemotherapy as ordered.

Advocate for the client's choice. Explanation: Nurses are accountable to act as a client's advocate, even if the client's choices are not in alignment with the nurse's personal choices. The nurse should not assume that a chaplain is desired, nor administer chemotherapy without further dialoguing with the client. Explaining that meditation and prayer are not curative is not helpful in supporting the client's wishes.

The nurse is evaluating anxiety levels in the assigned client group. What should the nurse identify related to the four levels of anxiety that occur in people's lives? Select all that apply. Moderate anxiety is present in day-to-day living, and it increases alertness and perceptual fields. Although mild anxiety may interfere with sleep, it also facilitates problem solving. Mild anxiety is manifested by a quivering voice, tremors, increased muscle tension, and a slight increase in respirations and pulse. Severe anxiety creates a very narrow focus on specific detail, causing all behavior to be geared toward getting relief. Severe anxiety causes a person to lose control and experience dread and terror. During the panic stage, the person cannot learn, concentrates only on the present situation, and often experiences feelings of impending doom.

Although mild anxiety may interfere with sleep, it also facilitates problem solving. Severe anxiety creates a very narrow focus on specific detail, causing all behavior to be geared toward getting relief. During the panic stage, the person cannot learn, concentrates only on the present situation, and often experiences feelings of impending doom. Explanation: Mild anxiety is present in day-to-day living. It increases alertness and perceptual fields and motivates learning and growth; it may interfere with sleep, but it facilitates problem solving to occur. Moderate anxiety narrows a person's perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details. Moderate anxiety is manifested by a quivering voice, tremors, increased muscle tension, a report of "butterflies in the stomach," and slight increases in respirations and pulse. Severe anxiety creates a very narrow focus on specific details, causing all behavior to be geared toward getting relief. The person has impaired learning ability and is easily distracted. Panic causes the person to lose control and experience dread and terror. The resulting disorganized state is characterized by increased physical activity, distorted perception of events, and loss of rational thought. The person is unable to learn, concentrates only on the present situation, and often experiences feelings of impending doom.

A client is refusing to get out of bed the day after hip surgery. The nurse knows that for the intervention to be safe, therapeutic, and nonthreatening, she will need to not only enlist the client's cooperation, but also her willing participation. Which stress reduction technique does the nurse acknowledge as the best choice in this situation? Anticipatory guidance Guided imagery Biofeedback Meditation

Anticipatory guidance Explanation: Anticipatory guidance is the technique wherein the nurse uses teaching about a procedure to prepare the client for what is to come. This can help foster trust, diminish fear of the unknown, and lessen the chance of a negative response to necessary treatments. Guided imagery, biofeedback, and meditation would take time to learn and would not be effective in this current situation.

Which statement correctly explains a person's interactions with basic human needs? As a person strives to meet basic human needs at each level, stress can serve as either a stimulus or barrier. Basic human needs and responses to stress are generalized. Basic human needs and responses to stress are unaffected by sociocultural backgrounds, priorities, and past experiences. Stress affects all people in their attainment of basic human needs in the same manner.

As a person strives to meet basic human needs at each level, stress can serve as either a stimulus or barrier. Explanation: Both the attainment of basic human needs and the adaptation to stress require energy and motivate behaviors. As a person strives to meet basic human needs at each level, stress can be either a stimulus or a barrier. How basic human needs are met and responses to stress are unique to the person, depending on the individual's sociocultural background, priorities, and past experiences. In all people, the failure to meet needs results in an imbalance in homeostatic mechanisms and, eventually, illness.

When nurses become overwhelmed in their jobs and develop symptoms of anxiety and stress, they are experiencing what condition? Culture shock Adaptation syndrome Ineffective coping Burnout

Burnout Explanation: The feeling of being overwhelmed in one's job and development of symptoms of anxiety and stress is referred to as burnout. Burnout can be compared with the exhaustion stage of anxiety and is characterized by a wide range of behaviors. Culture shock is a feeling of uneasiness or uncertainty in different and unfamiliar surroundings. The change that takes place as a result of the response to a stressor is adaptation. Ineffective coping means that a person does not deal effectively with stressors.

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? Caregiver Role Strain Ineffective Coping Compromised Family Adjustment Anxiety

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.

A client responds to an approaching diagnostic test with a rapidly beating heart and hands that are shaking. This is the result of what type of response? Coping responses Stress adaptation Defense mechanism Withdrawal behavior

Coping responses Explanation: Coping mechanisms are immediate responses and are often involuntary. The heart beating rapidly and hands that are shaking are considered coping mechanisms. The change that takes place as a result of the response to a stressor is stress adaptation. Defense mechanisms protect one's self-esteem and are useful in mild to moderate anxiety; if they are used to an extreme, however, they distort reality and create problems with relationships. Withdrawal is a type of coping mechanism.

A nurse is caring for a pregnant client in labor. Which technique should the nurse instruct the client to do to mange stress? Low-intensity exercise Deep breathing Thought stopping Biofeedback

Deep breathing Explanation: The nurse should suggest that the client take deep breaths to manage stress related to childbirth. Low-intensity exercise, thought stopping, and biofeedback are inappropriate relaxation techniques when the client is in labor.

A withdrawn and isolated client is most likely suffering from what type of stressors on basic human needs? Physiologic needs Safety and security needs Self-esteem needs Love and belonging needs

Love and belonging needs Explanation: Effects of stress on basic human needs varies with each individual, but there are certain characteristics that are commonly seen with stressors on the basic human needs. Withdrawal and isolation from others is commonly seen when stressors are placed on love and belonging needs. Stressors on physiologic, safety/security, and self-esteem needs have other common characteristics.

What is a general task for a client adapting to acute and chronic illness? Maintain self-esteem Handle pain Carry out medical treatment Confront family problems

Maintain self-esteem Explanation: Adaptation to acute and chronic illness or to traumatic injury involves two sets of adaptive tasks:1. General tasks (as in the case of any situational stress) involve maintaining self-esteem and personal relationships while preparing for an uncertain future.2. Illness-related tasks include such stressors as losing independence and control, handling pain and disability, and carrying out the prescribed medical regimen.

A nurse is making a follow-up phone call to a client who reported being raped. The client answers the phone and states, "I don't know what you are talking about. I have never been raped." What action should the nurse take? Offer support, recognizing that the client may be using repression as a defense mechanism. Apologize and end the phone call. Report the statements to the police department. Provide a detailed account of what the client stated when reporting the event.

Offer support, recognizing that the client may be using repression as a defense mechanism. Explanation: The defense mechanism of repression allows the individual to remove the situation that causes anxiety from his or her consciousness. Give the client support information such as a phone number to a rape intervention hotline or local support chapter. Ending the phone call and reporting the statements to the police without investigating the possible use of repression would be inappropriate. Providing a detailed account of the event per the client's statements may cause increased stress or anxiety, which would be better handled in a face-to-face situation.

The nurse provides education about physiologic stressors. The nurse recognizes the education to be effective when the client identifies which physiologic stressors? Select all that apply. Outside temperature of 100 degrees Upper respiratory infection Excessive protein in the diet Rheumatoid arthritis Accidental death of a child

Outside temperature of 100 degrees Upper respiratory infection Excessive protein in the diet Rheumatoid arthritis Explanation: A physiologic stressor can include excessive temperatures, infections, illness, and imbalances in nutrition. The death of a child would be a psychological stressor.

A client with cancer has recovered from tumor removal surgery and is now stable while undergoing a chemotherapy treatment schedule. She is not having any symptoms at this time and is continuing to work and enjoy social events. What stage of the general adaptation syndrome (GAS) would the nurse place her in? Alarm reaction Exhaustion Resistance Reflex pain response

Resistance Explanation: This client's situation is an example of the resistance stage of the GAS. Stress is continuing, but the client is maintaining homeostasis. Alarm is the initial stage when major stress is encountered. Exhaustion is when homeostasis can no longer be achieved. The reflex pain response is part of the local adaptation syndrome.

A nurse is meeting with a young woman who has recently lost her mother, lost her job, and moved with her husband to a new city. She is reporting acute anxiety and depression. What does the nurse know about stress that would be helpful with this client's situation? Adaptation often fails during stressful events and results in homeostasis. Stress is a part of our lives and eventually this young woman will adapt. Acute anxiety and depression are seldom associated with stress. Sometimes too many stressors disrupt homeostasis, and if adaptation fails, the result is disease.

Sometimes too many stressors disrupt homeostasis, and if adaptation fails, the result is disease. Explanation: Four concepts—constancy, homeostasis, stress, and adaptation—are key to the understanding of steady state. Homeostasis is maintained through emotional, neurologic, and hormonal measures; stressors create pressure for adaptation. Sometimes too many stressors disrupt homeostasis, and if adaptation fails, the result is disease. When adaptation fails, the result is disease. If a person is overwhelmed by stress, that person may never adapt. Acute anxiety and depression are frequently associated with stress.

A client asks about general adaptation syndrome (GAS). Which details provided by the nurse are correct? Select all that apply. The alarm stage of GAS can last from minutes to hours. It can be a response to physiologic or psychological stress. There are three stages to GAS. GAS requires psychological hospitalization for treatment. The resistance stage usually lasts for less than a day.

The alarm stage of GAS can last from minutes to hours. It can be a response to physiologic or psychological stress. There are three stages to GAS. Explanation: There are three stages to GAS: the alarm stage, the resistance stage, and the exhaustion stage. GAS can be in response to a physiologic or psychological stressor. The alarm stage is usually the shortest stage, lasting minutes to hours. Individuals progress through the resistance and exhaustion phase at different speeds depending on coping mechanisms and situations. Hospitalization is generally not required to treat GAS, but the nurse must recognize that GAS can impact all clients.

A toilet trained toddler was admitted to the hospital for dehydration. Upon returing home, the toddler becomes incontinent of urine and stool. The parent is concerned regarding this return to previous behavior and calls the pediatric clinic. What is the nurse's best response to the parent? This behavior is sublimation. This behavior is called regression. This behavior is known as repression. This behavior is reaction formation.

This behavior is called regression. Explanation: Children often regress to soiling diapers or demanding a bottle when they are ill and this is called regression. Repression is excluding an anxiety provoking event from conscious awareness. Reaction formation is when a person develops conscious attitudes and behavior patterns that are opposite to what he or she would really like to do. Sublimation is when a person substitutes a socially acceptable goal for one whose normal channel of expression is blocked.

In contrast to anxiety, fear is characterized by: a cognitive response to a known threat. the creation of an action plan to deal with a perceived threat. a real, rather than perceived, threat. short-term resolution.

a cognitive response to a known threat. Explanation: Fear is a cognitive response to a known threat, while anxiety is the emotional response to that threat. Fear does not necessarily resolve in the short term, and an action plan may or may not be formulated by the individual. The fact that fear involves the identification of a known threat does not necessarily mean that the object of fear is objectively real.

A middle-age adult discusses with the nurse the loss of his job due to frequent illness. The nurse recognizes the client's loss of his income as which of the following? a stressor a coping mechanism adaptation homeostasis

a stressor Explanation: A stressor is anything that is perceived as challenging, threatening, or demanding. Loss of a job and financial insecurity are external stressors. Coping mechanisms are ways to which external or internal stress is managed, adapted to, or acted upon. Examples include yelling or being angry at everything. Adaption is a change or the process of change by which a client becomes better suited to a problem. An example is a client requesting a low-sodium diet or choosing low-sodium foods to assist with their diagnosis of hypertension. Homeostasis is the tendency toward a relatively stable equilibrium between interdependent elements, especially as maintained by physiological processes.

Many families are sheltering in the local middle school gymnasium during a severe tornado outbreak. Many homes have been destroyed and lives lost. The community health nurse expects to see negative stress reactions to the crisis, such as: a young wife asking everyone repeatedly if they know where her husband is. an older adult couple staying near each other constantly. a young boy asking everyone if they need some water or food. a man enlisting others to help him look for lost pets.

a young wife asking everyone repeatedly if they know where her husband is. Explanation: Disasters are considered adventitious crises. Those who are affected will utilize coping skills, good or bad, to maintain homeostasis. Positive coping might involve supporting loved ones and helping others adapt. Negative coping might include denial, anger, withdrawal, and panic.

A client is discussing stressors with the nurse and is describing how she feels better when she takes a brisk walk. The client's action is an example of: appraisal. secondary appraisal. buffering. adaptation.

adaptation. Explanation: Adaptation is the process of adjusting to, or accommodating, a stressor. Appraisals involve the subjective evaluation of a potential stressor. Buffering is something that reduces the intensity of stress.

A nurse hears a client yelling for help from his room. The nurse runs to the client's room, and upon arriving in the room, the nurse's heart rate and oxygen demands have increased. What phase of the general adaptation syndrome (GAS) is best described by the nurse's physiologic changes? alarm reaction resistance exhaustion rest and recovery

alarm reaction The alarm reaction is initiated when a person perceives a specific stressor and the person experiences an increase in energy level, oxygen intake, cardiac output, blood pressure, and mental alertness. Intensity and recovery when there is an increase in the energy level, oxygen intake, cardiac output, blood pressure, and mental alertness. The intensity stage occurs after alarm reaction. Resistance occurs when the body attempts to adapt to the stressor and vital signs, hormone levels, and energy production are trying to return to normal. Exhaustion results when the adaptive mechanisms are exhausted.

A nurse hears a client yelling for help from his room. The nurse runs to the client's room, and upon arriving in the room, the nurse's heart rate and oxygen demands have increased. What phase of the general adaptation syndrome (GAS) is best described by the nurse's physiologic changes? alarm reaction resistance exhaustion rest and recovery

alarm reaction Explanation: The alarm reaction is initiated when a person perceives a specific stressor and the person experiences an increase in energy level, oxygen intake, cardiac output, blood pressure, and mental alertness. Intensity and recovery when there is an increase in the energy level, oxygen intake, cardiac output, blood pressure, and mental alertness. The intensity stage occurs after alarm reaction. Resistance occurs when the body attempts to adapt to the stressor and vital signs, hormone levels, and energy production are trying to return to normal. Exhaustion results when the adaptive mechanisms are exhausted.

While conducting the physical assessment of a client, the nurse notes an increase in the blood glucose level. Upon inquiry, the client discloses that lately he has been under a lot of stress at work. Which stage of stress is the client experiencing? alarm stage resistance stage exhaustion stage tertiary stage

alarm stage Explanation: The client is most likely in the alarm stage of stress if the blood glucose level is increasing rapidly. This occurs when the body is responding to a stressor by raising the blood glucose as a reserve for meeting increased energy requirements. The stage of resistance is characterized by restoration of normalcy. Physiologic exhaustion occurs when one or more adaptive/resistive mechanisms can no longer protect the person experiencing a stressor. There is no tertiary stage; however, tertiary prevention minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease.

A 56-year-old construction worker is in for his annual physical. As the nurse takes his vital signs, he tells her that his blood pressure may be a little off this morning. He tells the nurse that he is recently unemployed, is quite stressed, and is having a hard time coping. He feels like he needs to numb the pain. What is the nurse most concerned about regarding this client? cocaine use projection exercise alcohol use

alcohol use Explanation: Alcohol use is a common altered coping pattern for individuals with poor coping skills. It is legal and easily accessible. Phrases such as "I just cannot cope" and "I need to numb the pain" are common among those who misuse alcohol.

A teenage girl is discussing her recent breakup with her boyfriend. She tells the nurse she just stays in bed all day and cannot seem to feel any better. She says she is only relieved of the pain while sleeping. The nurse identifies this coping strategy as: avoidance coping. buffering. chronic stress. adaptation.

avoidance coping. Explanation: Temporary mechanisms called avoidance coping may alleviate the feelings of anxiety brought on by the stress for a short period of time, but the stressor still needs to be dealt with.

Family conflict around the care of a recently hospitalized woman has escalated to the point that crisis intervention may be required. This process should begin with: clear identification of the relevant problem. presentation of clear, achievable, and evidence-based solutions. careful and objective analysis of different proposed options. comparison of the family's situation to other similar situations.

clear identification of the relevant problem. Explanation: Crisis intervention is a problem-solving technique that begins with the identification of the problem. This precedes the identification of options and assessment of proposed solutions. Once the problem is identified by the client and the crisis team is way, interventions should be then be developed by the team members. The crisis intervention is very individualized and should not be compared to other families. Analysis is the last step of the process.

The nurse involved in coordinating a support group for spinal cord injury clients learns that one of the participants in the support group was a college athlete prior to his diving accident. The client informs the group that he earned a scholarship based upon his athletic abilities and not his academic performance, and after the injury, he focused his energies on his studies. He has been on the dean's list for two semesters. What defense mechanism is illustrated in this scenario? compensation sublimation projection reaction formation

compensation Explanation: Compensation is overcoming a perceived weakness by emphasizing a more desirable trait or achieving in a more comfortable area. Sublimation involves a person substituting a socially acceptable goal for one whose normal channel of expression is blocked. Projection is a person's thoughts or impulses attributed to someone else. Reaction formation is the development of conscious attitudes and behavior patterns that are opposite to what he would prefer to do.

A client who responds to bad news concerning his lab reports by crying uncontrollably is handling stress by using: adaptation technique. coping mechanism. withdrawal behavior. defense mechanism.

coping mechanism. Explanation: Anxiety often is managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. Coping mechanisms are immediate responses and are often involuntary. Crying is considered a coping mechanism. The change that takes place as a result of the response to a stressor is adaptation. Withdrawal is a type of coping mechanism. Defense mechanisms protect one's self-esteem and are useful in mild to moderate anxiety; if they used to an extreme, however, they distort reality and create problems with relationships.

In human beings, the physiologic response to a stressor includes the: sympathetic nervous system slowing the heart rate. hypothalamus secreting adrenocorticotropic hormone. hypothalamus secreting thyroid-stimulating hormone. epinephrine increasing the blood-glucose level.

epinephrine increasing the blood-glucose level. Homeostasis in physiologic systems is maintained within a narrow range around a set point through continual changes in internal processes. Adjustments in heart rate, blood pressure, body temperature, fluid and electrolyte balance, blood glucose concentration, and blood oxygen level occur automatically to maintain proper system functioning and survival.

A young woman, who has recently suffered acute stress, asks the nurse why she seems to be more sensitive to stress than her husband. The nurse explains that a contributor to this phenomenon is: thyroid production. adrenal function. estrogen levels. cortisol. glucose.

estrogen levels. Explanation: Women have higher levels of estrogen, which are associated with greater sensitivity to stress and a tendency towards being emotionally supportive and building meaningful relationships.

The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. At what stage of stress is the client? alarm stage exhaustion stage resistance stage secondary stage

exhaustion stage Explanation: The client is in the exhaustion stage, when one or more adaptive/resistive mechanisms can no longer protect the person experiencing a stressor; this results in exhaustion. The effects of stress-related neurohormones suppress the immune system, and the body is open to various ailments. In the alarm stage, the person is prepared for a fight-or-flight response. In the resistance stage, the client's body is returned to the homeostasis state. Consequently, one or more organs or physiologic processes may eventually lead to increased vulnerability to stress-related disorders, or progression to the stage of exhaustion. The secondary stage is not a stage related to stress.

The nurse is providing care to the following clients. The nurse assesses the client exhibiting maladaptive behavior as the client who is: overweight, consumes 1,600 calories/day, and exercises 30 minutes a day 5 times each week. participating in a smoking cessation program after her father was diagnosed with lung cancer. experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live." 84 years old with multiple health problems and requesting to see an end-of-life care specialist.

experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live." Explanation: The client who has a terminal illness and makes the above statement is in denial. The other clients exhibit appropriate behaviors for their situations.

A nurse working on an oncology floor often sits with her clients in a calm, quiet, dimly lit environment and describes a walk along the ocean's shore. The nurse provides details of the walk and verbally paints a picture for the client. What best defines this form of stress management? guided imagery meditation anticipatory guidance biofeedback

guided imagery Explanation: Guided imagery involves creating a mental image based upon a verbal description offered by another individual. Biofeedback is a method of gaining mental control of the autonomic nervous system and regulating body responses. Meditation involves relaxing major muscle groups and repeating a word silently during exhalation. Anticipatory guidance focuses on physiologically preparing a person for an unfamiliar or painful event.

A nurse is assisting a neurologist, who is assessing the norepinephrine (noradrenaline) level of a client who is reporting stress. Which function does norepinephrine (noradrenaline) perform? stabilizes mood and regulates temperature promotes coordinated movement heightens arousal and increases energy transmits sensation of pain

heightens arousal and increases energy Explanation: Norepinephrine (noradrenaline) heightens arousal and increases energy. Acetylcholine and dopamine promote coordinated movement. Serotonin stabilizes mood, induces sleep, and regulates the temperature of a person. Substance P transmits the sensation of pain, whereas endorphins and enkephalins interrupt the transmission of substance P and promote a sense of well-being.

A client's body uses physiologic mechanisms from within to respond to internal changes and maintain an essential balance.This process is known as: stress. self-regulation. homeostasis. fight-or-flight response.

homeostasis. To maintain health, the body's internal environment must remain in a balanced state. Various physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment, which is referred to as homeostasis. Stress is a condition in which the human system responds to changes in its normal balanced state, and results from a change in one's internal or external environment that is perceived as a challenge, a threat, or a danger. Self-regulation is a mechanism that helps to maintain homeostasis. Fight-or-flight response occurs during the alarm reaction stage of the general adaptation syndrome.

Which are considered internal stressors? Select all that apply. loud noises pollution illness hormonal change fear

illness hormonal change fear Explanation: A stressor is anything that is perceived as challenging, threatening, or demanding. Stressors may be internal (e.g., an illness, a hormonal change, or fear) or external (e.g., loud noise or cold temperature).

A young woman who has just started college is 6 weeks into the semester and has several tests and assignments due in approximately 3 days. She has developed a sore throat and fever. The development of illness is related to: immunosuppression with stress. exposure to streptococcus. decreased energy. sleep deprivation.

immunosuppression with stress. Chronic stress is associated with immunosuppression.

The nurse is caring for a client who is exhibiting signs of stress. Which cognitive symptom associated with stress does the nurse recognize? angry outbursts lack of interest in sex difficulty falling asleep impaired concentration

impaired concentration Explanation: Impaired concentration is consistent with a cognitive symptom associated with stress. Difficulty falling asleep and lack of interest in sex are physical symptoms associated with stress, and angry outbursts are emotional symptoms associated with stress.

A 65-year-old client has experienced the death of a parent and a family pet in the span of 1 month. Which action is a coping mechanism that demonstrates adaptation? deciding to no longer attend his family reunion picnic buying a new car joining the local garden club visiting a psychic

joining the local garden club While each individual's response to stress is different, we know that coping mechanisms can be healthy or unhealthy. Buying things, isolating oneself socially, or looking for support in questionable places can be ways of coping but are not necessarily healthy. Joining a social group of people with similar interests can provide distraction and serve as an outlet for feelings of sadness and loss.

A client is experiencing a stress response each time the family visits the room. What nursing intervention is most appropriate? tell the family they are causing too much stress limit the family visits to once daily explain that family visits and support are important do not intervene and allow the client to work out the family issue

limit the family visits to once daily Explanation: When a person is experiencing a stressor, it is important for the nurse to reduce or eliminate the stress. In this case, it is appropriate to limit the family visiting time to allow the client to recover without experiencing a stress response. Telling the family they are causing the stress is not therapeutic. Telling the client that the family should be there invalidates the client's feelings. Doing nothing is not an appropriate response to decrease or remove the stressor.

An adolescent describes a dysfunctional home life to the nurse and reports smoking marijuana to help cope with the situation. How will the nurse identify this form of coping? beneficial maladaptive generational cultural

maladaptive Explanation: Substance use, beginning or increasing smoking, oversleeping, overeating, undereating, oversleeping, overexercising, excessive daydreaming, and fantasizing are various ways that individuals with the inability to cope with stress successfully deal with stress.

A recently retired client reports that he has been able to sleep only 3 hours a night and that he has nausea, frequent urination, and headaches. He is asking the nurse what she thinks is going on with his health. What is the most probable cause of his symptoms? type 2 diabetes obstructive sleep apnea moderate anxiety herniated lumbar disc

moderate anxiety Explanation: This client may have increased anxiety from adjusting to retirement, a significant life stressor. There are not enough data to identify any of the other disorders as being present.

An occupational health nurse at an oil refinery on the Gulf Coast of Texas performs client education with an adult client. The client is being seen after having suffering a chemical burn in an accident at the refinery. Which type of stressor has this client been exposed to? physiologic psychosocial maturational socioeconomic

physiologic Explanation: Physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders. Psychosocial stressors include both real and perceived threats. Environmental stressors are items found in our surroundings, such as noise and crowds. Socioeconomic stressors relate to income and home life (such as low household income and low occupational status of the householder).

A nurse is providing care for client who experienced a stroke. Which nursing intervention reflects the tertiary level of prevention? provide care transition at discharge for speech therapy assess blood pressure every 4 hours conduct mental status assessment every 2 hours discuss family history of hypertension

provide care transition at discharge for speech therapy Explanation: Tertiary prevention minimizes the consequences of a disorder through aggressive rehabilitation or appropriate management of the disease. An example is speech therapy to help restore ability. Blood pressure and mental status exams are examples of secondary prevention associated with the acute stroke. Discussing family history is also secondary prevention in terms of assessing for further risk factors.

After failing a nursing exam, the nursing student states, "That exam was written terribly." What coping strategy would the nursing instructor identify? rationalization denial repression suppression

rationalization Explanation: Rationalization is relieving oneself of personal accountability by attributing responsibility to someone or something else. By claiming the exam is written poorly, the student is relieved of the personal responsibility. Denial is simply rejecting information. Repression is forgetting about the stressor. Suppression is purposeful avoidance of the topic or issue causing stress.

A client who is a single parent of two small children is working two part-time jobs. The client comes into the clinic for an appointment looking disheveled and fatigued. Which health promotion activities would this client benefit from? Select all that apply. reduction of stressors perfection reduction using aggressiveness cognitive behavioral therapy antianxiety medications

reduction of stressors perfection reduction Explanation: Assertiveness, not aggressiveness, is a preferred health promotion strategy. CBT is a treatment, not health promotion. Medications are also a treatment.

During a counseling session a client states, "I just try to forget about my spouse hitting me." Which coping mechanism should the nurse document on the basis of this client's statement? reaction formation rationalization repression regression

repression Explanation: Repression is the coping mechanism that this client is using, in which the client has removed the experience of being abused from conscious memory. Reaction formation is a coping mechanism that sees an individual acting just the opposite of one's feelings. Rationalization is relieving oneself of personal accountability by attributing responsibility to someone or something else. Regression is behaving in a manner that is characteristic of a much younger age.

A nurse has been caring for a client who experienced a physical assault a year ago. The client now describes being "totally recovered from it." Which stage of stress is the client currently experiencing? alarm stage exhaustion stage resistance stage primary stage

resistance stage Explanation: The client is in the resistance stage, where the body has returned to the homeostasis state. The mind or brain is normal again, so the incident does not affect the client anymore. In the alarm stage, the stimulating neurotransmitters and neurohormones prepare the client for a fight-or-flight response. When one or more adaptive/resistive mechanisms can no longer protect the client experiencing a stressor, exhaustion occurs. The body loses its capability to fight stress. The primary stage is not related to stages of stress and is applicable for stress prevention.

Which behaviors represent effective coping mechanisms? Select all that apply. setting limits with family members who upset you learning relaxation techniques taking a vacation sleeping 14 hours a night sleeping 3 hours a night denying responsibility for a DUI conviction

setting limits with family members who upset you learning relaxation techniques taking a vacation Explanation: Coping mechanisms can have positive or negative effects on a client's well-being. All of these examples represent coping, either effective or ineffective.

A nurse is assessing a client with stress-related problems. Which factor influences responses to stressors? eating habits social support economic status personal hygiene

social support Explanation: A person's response to stressors depends on social support, intensity of the stressor, number of stressors, duration of the stressor, physical health status, life experiences, coping strategies, personal beliefs, attitudes, and values. A person's response to stressors is independent of education, eating habits, economic status, or personal hygiene.

A client is on a stress management program. She states that she is open to trying a guided meditation class. When helping her get started, a nurse tells her that which of the following is not important? a quiet environment an open attitude soft music a focus of attention

soft music Music may be helpful for some but is not essential for meditation.

A dancer has suffered a fall injury, which will prevent participation in a much-anticipated event. The fall is classified as what? stressor adaptation chronic stress resolution

stressor Explanation: A stressor can be a number of things, including environmental changes, alterations in routine activities of daily living, unexpected traumas, or tragedies.

A group of nursing students is learning about the body's response to stress. Which system is responsible for initiating the fight-or-flight response to stress? sympathetic nervous system parasympathetic nervous system endocrine system respiratory system

sympathetic nervous system Explanation: Functions of the sympathetic nervous system under stressful conditions bring about the fight-or-flight response. Sometimes called the rest-and-digest system, the parasympathetic system conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood. The respiratory system is a series of organs responsible for taking in oxygen and expelling carbon dioxide. The primary organs of the respiratory system are the lungs, which carry out this exchange of gases.

The nurse determines that a client understands instruction regarding progressive relaxation when the client states that the technique requires: tensing and relaxing various muscle groups. using a mantra in a relaxed position. focusing on pleasant images. using a biofeedback machine.

tensing and relaxing various muscle groups. Explanation: Progressive relaxation consists of systematically tensing and relaxing various muscle groups from head to toe. Progressive relaxation provides a method of identifying particular muscle groups and distinguishing between sensations of tension and tranquility.

A 7-year-old boy has been the victim of abuse. He appears stoic and disconnected while being interviewed by the nurse. Although he currently has a painful injury, he does not cry or flinch when the area is touched. The nurse understands that: the child has learned to cope by shutting off his feelings. the child is mentally ill. the child is refusing to cooperate with the interview. the abuse is likely short-lived.

the child has learned to cope by shutting off his feelings. Explanation: Children in an abusive home may find ways to protect themselves through forms of escape, such as talking to imaginary friends or learning to shut off feelings.

The nurse at the student health center is seeing a group of nursing students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What does guided imagery involve? the use of progressive tensing and relaxing of muscles to release tension in each muscle group using positive self-image to increase and intensify physical workouts in the gym, which decreases stress the mindful use of a word, phrase, or visual image that allows oneself to be distracted and temporarily escape from stressful situations the use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations

the mindful use of a word, phrase, or visual image that allows oneself to be distracted and temporarily escape from stressful situations Explanation: Guided imagery is the mindful use of a word, phrase, or visual image for the purpose of distracting oneself from distressing situations or consciously taking time to relax or re-energize. Progressive tensing and relaxing of muscles describes progressive muscle relaxation. Using positive self-image to increase workouts in the gym is not an identified technique. Relaxing with music is not guided imagery.