A-RN- Anxiety/Coping
The nurse at a health fair is evaluating a client's completed questionnaire about stress-related life events. The client scored 168 points on the Holmes and Rahe stress scale. Which of the following statements by the nurse provides appropriate interpretation of the impact of stressors on the client's health?
"These life stressors place you at moderate risk for illness." Explanation: Holmes and Rahe's theory of stress response suggests that all life events, whether positive or negative, cause stress. The Holmes and Rahe stress scale ranks life events according to how much stress they cause. Scores are interpreted based on points accumulated. Clients who accumulate points totaling up to 150 are considered to have a low risk of developing illness in the near future. Those with points between 150 and 299 are considered to be in the moderate- to high-risk category. Clients with scores 300 and higher are at the greatest risk of stress-related illness.
A client hospitalized for preterm labor tells the nurse her mother in law blames her for "overdoing it" and causing the preterm labor. Which of the following is the most appropriate response from the nurse?
"Let's talk about how preterm labor occurs, so as to help you understand what causes it." Explanation: The nurse needs to explore the client's feelings to assist her in understanding what happened and to disperse the blame she is feeling. The other responses do not explore feelings experienced by the client and may stop the dialogue with the nurse from continuing.
Drag and Drop question - Click and drag the following steps to place them in the correct order. Question: A 15-year-old client diagnosed with posttraumatic stress disorder (PTSD) is admitted to the unit after slicing both arms with a razor blade. He says, "Maybe my mother will listen to me now. She tells me I am just crazy when I say I am screwed up because my stepdad had sex with me for years." What should the nurse do in order of priority from first to last? All options must be used. 1 Ask the client to talk about appropriate ways to express anger toward his mother. 2 Ask the client to sign a No Harm Contract related to suicide and self-mutilation. 3 Ask the client about the stepdad possibly abusing younger children in the family. 4 Ask the client to be specific about what he means by "screwed up."
1. Ask the client to sign a No Harm Contract related to suicide and self-mutilation. 2. Ask the client about the stepdad possibly abusing younger children in the family. 3. Ask the client to be specific about what he means by "screwed up." 4. Ask the client to talk about appropriate ways to express anger toward his mother. Explanation: The nurse should first assure the client's safety after the client's self-mutilation. Another safety issue is whether the stepdad possibly may be abusing younger children; if so, a police report may need to be filed. Then, it is important to know what the client means exactly by "screwed up" to identify other emotions and behaviors that need attention. It is very common for survivors of childhood sexual abuse to have intense anger at those who did not stop or prevent the abuse, and once the other steps have been taken, the nurse can begin to help the client manage his anger.
Defense mechanisms
Repression, the unconscious exclusion from awareness of painful or conflicting thoughts, impulses, or memories, is the primary ego defense. Other defense mechanisms tend to reinforce anxiety. Introjection is an intense identification in which one incorporates values or qualities of another person or group into one's own ego structure. Regression is a retreat, during a time of stress, to an earlier level of developmental behavioral. Denial is avoiding unpleasant realities by ignoring them.
A nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to order which psychotropic drug regimen on a short-term basis?
Alprazolam, 0.25 mg orally every 8 hours Explanation: Alprazolam's antianxiety properties make it the most appropriate medication for this client. It should only be given very short term because of its addictive apotential and the client should be weaned off from it. Benztropine is an antiparkinsonian agent used to control the extrapyramidal effects of such antipsychotic agents as chlorpromazine hydrochloride and thioridazine hydrochloride. Chlorpromazine is used to control the severe symptoms (hallucinations, thought disorders, and agitation) seen in clients with psychosis. Buspirone is an antianxiety agent but takes several weeks before it is effective in reducing anxiety. Thus it would not help this client who needs immediate assistance. Alprazolam provides immediate relief.
Which term refers to the primary unconscious defense mechanism that blocks intense, anxiety-producing situations from a person's conscious awareness?
Repression Explanation: Repression, the unconscious exclusion from awareness of painful or conflicting thoughts, impulses, or memories, is the primary ego defense. Other defense mechanisms tend to reinforce anxiety. Introjection is an intense identification in which one incorporates values or qualities of another person or group into one's own ego structure. Regression is a retreat, during a time of stress, to an earlier level of developmental behavioral. Denial is avoiding unpleasant realities by ignoring them.
Holmes and Rahe stress scale
Holmes and Rahe's theory of stress response suggests that all life events, whether positive or negative, cause stress. The Holmes and Rahe stress scale ranks life events according to how much stress they cause. Scores are interpreted based on points accumulated. Clients who accumulate points totaling up to 150 are considered to have a low risk of developing illness in the near future. Those with points between 150 and 299 are considered to be in the moderate- to high-risk category. Clients with scores 300 and higher are at the greatest risk of stress-related illness.
A nurse is caring for a client who has just had a modified radical mastectomy with immediate reconstruction. She's in her 30s and has two young children. Although she's worried about her future, she seems to be adjusting well to her diagnosis. What should the nurse do to support her coping?
Refer the client to a community support program. Explanation: The client isn't withdrawn and doesn't show other signs of anxiety or depression. Therefore, the nurse can probably safely approach her about talking with others who have had similar experiences, a formal community support group. The nurse may educate the client's spouse or partner and listen to his concerns, but the nurse shouldn't tell the client's spouse what to do. The client must consult with her physician and make her own decisions about further treatment. The client needs to express her sadness, frustration, and fear. She can't be expected to be cheerful at all times.
The nurse is caring for a client with a panic attack. Which nursing intervention is most helpful for this client?
Stay with the client and remaining calm, confident, and reassuring Explanation: A panic-stricken client requires the assistance of a calm person who can provide support and direction. This approach is particularly important because the client already feels frightened and out of control. Having someone remain with the client helps prevent him from feeling isolated and deserted. Encouraging the client to verbalize any fears, feelings, or concerns or encouraging the client to identify what precipitated the attack is futile because the client's level of anxiety prevents him from focusing on precipitating factors. Also, encouraging the client to learn relaxation techniques is not possible at this time as the client is unable to learn new information when the anxiety level is at the panic level. Staying with the client is the best action for the nurse.
`A client is 2 months pregnant. Which factor should the nurse anticipate as most likely to affect her psychosocial transition during pregnancy?
Support from her partner Explanation: Many factors can influence the smoothness of a pregnant client's psychosocial transition. The most important factors are support from her partner, parents, friends, and others; whether the pregnancy was planned or unplanned; and previous childbirth and parenting experiences. Age, socioeconomic status, sexuality concerns, birth stories of family members and friends, and past experiences with health care facilities and professionals may also influence a client's psychosocial transition during pregnancy. The month of her due date and previous health promotion activities don't affect her psychological transition. Readiness for the baby at home usually affects the client during the third trimester, not in the second month.
A primiparous client, who has just given birth to a healthy term neonate after 12 hours of labor, holds and looks at her neonate and begins to cry. The nurse interprets this behavior as a sign of which response?
a normal response to the birth Explanation: Childbirth is a very emotional experience. An expression of happiness with tears is a normal reaction. Cultural factors, exhaustion, and anxieties over the new role can all affect maternal responses, so the nurse must be sensitive to the client's emotional expressions. There is no evidence to suggest that the mother is disappointed in the baby's gender, grieving over the end of the pregnancy, or a candidate for postpartum "blues." However, approximately 80% of postpartum clients experience transient postpartum blues several days after childbirth
A client concerned about being diagnosed with type 2 diabetes tells a nurse, "My mother suffered with diabetes for many years and finally died of kidney failure in spite of treatment. Why should I try if I'm going to go through the same thing?" What is the nurse's most appropriate response? a) "Are you worried that you'll have the same experience as your mother?" b) "Your mother didn't get the proper treatment." c) "There are no guarantees about how diabetes will progress." d) "It sounds like your mother's diabetes wasn't under very good control."
a) "Are you worried that you'll have the same experience as your mother?" Explanation: Asking if the client feels he'll have the same experience as his mother gives him an opportunity to vent underlying anxiety. There's nothing to indicate that his mother's diabetes wasn't under good control or that she had substandard care. Saying there's no guarantee about how diabetes will progress doesn't appropriately address the client's concerns and may increase his anxiety. After the nurse has addressed the client's anxiety, she can more easily address more-specific teaching needs.
The parents of an adolescent girl have recently learned that their daughter has a terminal illness. At first, as they try to cope, they display avoidance behaviors. Then they demonstrate behaviors that indicate possible acceptance of the diagnosis. Which behavior indicates acceptance? a) Expression of feelings, such as sorrow and anger, about the girl's condition b) Failure to recognize the seriousness of the girl's condition despite physical evidence c) Intellectualization about the illness in areas unrelated to the girl's condition d) Avoidance of staff, family members, or the girl herself
a) Expression of feelings, such as sorrow and anger, about the girl's condition Explanation: The ability to express feelings and relate them to the diagnosis is the first step in accepting the situation. Failing to recognize the seriousness of the girl's condition despite physical evidence, intellectualizing about the illness in areas unrelated to the girl's condition, and avoiding staff, family members, or the girl herself are all avoidance behaviors that represent a parent's inability to cope with the situation.
A client who has ulcerative colitis says to the nurse, "I cannot take this anymore; I am constantly in pain, and I cannot leave my room because I need to stay by the toilet. I do not know how to deal with this." Based on these comments, the nurse should determine the client is experiencing: a) difficulty coping. b) disturbed thought. c) extreme fatigue. d) a sense of isolation.
a) difficulty coping. Explanation: It is not uncommon for clients with ulcerative colitis to become apprehensive and have difficulty coping with the frequency of stools and the presence of abdominal cramping. During these acute exacerbations, clients need emotional support and encouragement to verbalize their feelings about their chronic health concerns and assistance in developing effective coping methods. The client has not expressed feelings of fatigue or isolation or demonstrated disturbed thought processes.
When assessing a 17-year-old client with depression for suicide risk, which question would be best? a) "Can you tell me what you think about suicide?" b) "What movies about death have you watched lately?" c) "Are you thinking about killing yourself?" d) "Has anyone in your family ever committed suicide?"
c) "Are you thinking about killing yourself?" Explanation: Asking whether the client is thinking about killing herself is the most direct and therefore the best way to assess suicide risk. Knowing whether the client has recently watched movies on suicide and death, what the client thinks about suicide, or about previous suicides of family members will not tell the nurse whether the client herself is thinking about committing suicide right now.
The client is a 17-year-old single mother who has given birth. On her first postpartum day, the client seems overwhelmed with her new baby and asks the nurse how she is supposed to interact with her baby when all the baby does is eat and sleep. Which of the following actions would be most effective for the nurse to use to facilitate mother-infant attachment? a) Demonstrate different positions for holding the baby. b) Encourage the client to pay attention to her baby. c) Show the client how the baby initiates interaction with her and attends to her. d) Encourage the client to watch a video on attachment.
c) Show the client how the baby initiates interaction with her and attends to her. Explanation: Teaching the client how her baby comes prepared to interact with her will help her see that they are in a reciprocal relationship. This will help the client identify in the future other cues the baby is using to communicate with her and will increase the opportunities for attachment. Encouraging the client to pay attention to her baby may imply that the nurse does not believe the client is appropriately responding to her baby. Encouraging the client to watch a video may imply that the nurse is not interested in communication or spending time with her. Demonstrating different positions for holding the baby may be part of the teaching to facilitate mother-infant attachment, but this is only a small portion of attachment measures and it is more appropriate to teach the client about her newborn's interaction cues.
A client says he's stressed by his job but enjoys the challenge. What should the nurse suggest? a) Spend more time with his family. b) Change jobs. c) Leave work at work. d) Take stress-management classes.
d) Take stress-management classes. Explanation: The nurse should suggest stress-management classes, which would identify factors that contribute to stress in the client's life and teach him how to manage stress more effectively. The client may not have to leave a job he enjoys. The information provided by the client doesn't indicate that spending too little time with his family and taking his job home with him contribute to the client's stress.
The nurse is caring for a client in panic level anxiety. Which findings should the nurse anticipate? Select all that apply. a) Nausea, muscle tension, and paleness b) Dry mouth, headache, and sweating c) Fight, flight, or freeze response d) Perceptual field narrowed to immediate task e) Increased blood pressure and pulse
• Increased blood pressure and pulse • Fight, flight, or freeze response Explanation: Anxiety is an emotion that has four levels or degrees with accompanying physiological, psychological, and cognitive responses. As the levels increase from mild to moderate to severe to panic, the individual is less able to focus, concentrate, think, process information, and learn. The body reacts to the fight or flight response. In the above question, moderate level of anxiety symptoms include nausea, muscle tension, looking pale, narrowed perceptual field, headache, dry mouth, and sweating. Increased blood pressure and pulse could also be moderate anxiety but would be acceptable as a correct answer because of the adrenaline response in increased anxiety. Fight, flight, or freeze response is also correct. In panic level the person focuses only on themselves or the problem and may be violent or mute.
The mother of an infant with hemophilia tells the nurse that she is planning to do home teaching when the child reaches school age. She does not want her child in school because the teacher will not watch the child as well as she would. The mother's comments represent what common parental reaction to a child's chronic illness? a) over-protection b) devotion c) insecurity d) mistrust
a) over-protection Over-protection is a typical parental reaction to chronic illness in a child. Characteristics include sacrifice of self and family for the child, failure to recognize the child's capabilities and sense of responsibility, placement of overly stringent restrictions on play and peer friendship, and a lack of confidence in other peoples' capabilities.
A client found sitting on the floor of the bathroom in the day treatment clinic has moderate lacerations on both wrists. Surrounded by broken glass, she sits staring blankly at the lacerations. What is the most important action for the nurse to take next to the client? a) Sit quietly next to her. b) Approach the client slowly while speaking in a calm voice, calling her by her name, and telling her that the nurse is there to help her. c) Enter the room quietly and move next to the client to assess her injuries. d) Call for staff back-up before entering the room and restraining the client.
b) Approach the client slowly while speaking in a calm voice, calling her by her name, and telling her that the nurse is there to help her. Explanation: Ensuring the safety of the client and the nurse is the priority at this time. Therefore, the nurse should approach the client cautiously while calling her name and talking to her in a calm, confident manner. The nurse should keep in mind that the client shouldn't be startled or overwhelmed. After explaining that she is there to help, the nurse should carefully observe the client's response. If the client shows signs of agitation or confusion or poses a threat, the nurse should retreat and request assistance. The nurse shouldn't attempt to sit next to the client or examine her injuries without first announcing her presence and assessing the dangers of the situation.
Which suggestion would be most helpful to the parents of a 2-year-old child when managing separation anxiety during hospitalization? a) Tell the child the time they are leaving and returning. b) Keep the visit time short. c) Bring the child's favorite toys from home. d) Leave while the child is sleeping.
c) Bring the child's favorite toys from home. Explanation: Bringing a child's favorite toys, security blanket, or familiar objects from home can make the transition from home to hospital less stressful. The child receives comfort and reassurance from these items. Leaving without explaining may decrease the child's trust in the parents, ultimately adding to the child's level of anxiety. The parents should tell their toddler when they are leaving and when they will return, not by time but in relation to the child's usual activities (e.g., by bedtime). Typically, 2-year-old children have a limited sense of time. Short parental visits do not satisfy a toddler's overwhelming need for comfort because toddlers need to spend lots of time with parents due to separation anxiety.
The mother of a 4-year-old child with juvenile idiopathic arthritis (JIA) is worried that her child will have to stop attending preschool because of the illness. Which response by the nurse would be most appropriate? a) "It may be difficult for your child to attend school because of the side effects of the medications he will be prescribed." b) "Your child will probably need to wear splints and braces so that his joints will be supported properly." c) "Your child should be encouraged to attend school, but he will need extra time to work out early morning stiffness." d) "You should keep your child at home from school whenever he experiences discomfort or pain in his joints."
c) "Your child should be encouraged to attend school, but he will need extra time to work out early morning stiffness." Explanation: Socialization is important for this preschool-age child, and activity is important to maintain function. Because children with JIA commonly experience most problems in the early morning after arising, they need more time to "warm up." Adverse effects may or may not occur. The child's normal routine needs to be maintained as much as possible. Although splints and braces may be needed, they are worn during periods of rest, not activity, to maintain function.
A nurse is assessing available support systems for a client in the community mental health clinic. The client is divorced, has no siblings, and both parents died last year. The client has contact with once-supportive former in-laws; however, the client describes a strained relationship since the divorce. With regard to the relationship with the in-laws, what knowledge does the nurse use to plan care? a) Strong social support is of relatively little importance as a coping factor. b) The relationship with the in-laws can enhance the client's sense of control. c) Low-quality support relationships often negatively affect coping in a crisis. d) The in-laws offer the only opportunity to obtain social support for the client.
c) Low-quality support relationships often negatively affect coping in a crisis. Explanation: Strong social support enhances mental and physical health, providing a significant buffer against distress. Relationships of low-quality support are known to impact a person's coping effectiveness negatively.
Which client action should the nurse judge to be a healthy coping behavior for a male adolescent after an appendectomy? a) refusing to fill out the menu, and allowing the nurse to do so b) insisting on wearing a T-shirt and gym shorts rather than pajamas c) avoiding interactions with other adolescents on the nursing unit d) not taking telephone calls from friends so he can rest
c) insisting on wearing a T-shirt and gym shorts rather than pajamas Explanation: Adolescents struggle for independence and identity, needing to feel in control of situations and to conform to peers. Control and conformity are often manifested in appearance, including clothing, and this carries over into the hospital experience. The adolescent feels best when he is able to look and act as he normally does, for example, wearing a T-shirt and gym shorts. Adolescents normally want to interact with peers and commonly seek every opportunity to do so. Avoiding other adolescents on the nursing unit or not taking phone calls from friends might suggest ineffective coping behavior. Refusing to fill out the menu and allowing the nurse to do so demonstrate dependent behavior, not a healthy coping mechanism.
A client periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, the client may experience: a) a decreased heart rate. b) heightened concentration. c) a decreased respiratory rate. d) a decreased perceptual field.
d) a decreased perceptual field. Explanation: Panic is the most severe level of anxiety. During a panic attack, a client's perceptual field, narrows. He becomes more focused on himself, less aware of surroundings, and unable to process information from his environment. His decreased perceptual field impairs his attention and ability to concentrate. During an acute panic attack, the client may experience an increase, not a decrease, in heart and respiratory rates, resulting from stimulation of the sympathetic nervous system.
