Chapter 42: Stress and Adaptation

A client presents with a flare of lupus. Which statement made by the client would cause the nurse to suspect a stress reaction?

"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.

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 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 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.

The nurse is performing an admission intake on a client with dehydration and diarrhea. The client states, "Every time I get stressed, I get diarrhea! Why does this happen?" Which explanation does the nurse share with the client?

"During stress, chemical messengers send signals between the brain and gut causing a variety of gastrointestinal symptoms." Explanation: The physiologic response to stress results in stimulation of the sympathetic nervous system and reduced activity of the parasympathetic nervous system. Chronic stress has shown to cause chronic overactivity or underactivity of the hypothalamus, pituitary, and adrenal glands. Stress and irritable bowel syndrome have a strong correlation. As such, the nurse would explain that stress triggers chemical messengers to send signals between the brain and gut, producing a variety of gastrointestinal symptoms, including diarrhea. Suggesting diarrhea is an unusual response to stress is inaccurate. Suggesting that the diarrhea may be pathological and requires further testing is not making the connection between stress and diarrhea. Questioning the client's hospitalization and suggesting the client see a psychiatrist is belittling the client and suggesting a psychiatric rather than physical cause.

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." 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." 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.

An adolescent client is brought to the clinic by the parents, who inform the nurse that they are concerned that the adolescent is using maladaptive coping mechanisms to deal with a bullying issue at school. Which statement(s) by the parents should the nurse report to the health care provider as correlating with the use of maladaptive coping mechanisms? Select all that apply.

"Our adolescent is sleeping a lot more than usual." "We have tried to discuss the issues so we can find a solution but are met with anger and hostility." "We have found evidence of drug use, which is very unlike our adolescent." Explanation: Indications that the adolescent is using maladaptive coping mechanisms to deal with the bullying situation at school would be: excessive sleeping which prevents facing the conflict, not wanting to discuss the issue or using hostility and aggression when confronted, the use of drugs or mind and mood-altering substances to prevent having to face reality and create a solution. The negative coping mechanisms may provide a brief relief from the stressor, but eventually create problems when used for an extended period. When interacting with friends in social situations or seeing the school counselor, the adolescent is using positive coping strategies to deal with the present issues

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." Explanation: 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.

Which client is experiencing the panic level of anxiety?

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.

An emergency department nurse is caring for four clients. Which client would the nurse suspect as using displacement as a defense mechanism?

A client with a fractured hand after punching a wall Explanation: The defense mechanism of displacement transfers the emotional response from one person to another person or object. The client who punched a wall may have used displacement by punching a wall and not a person. Refusing to look at a traumatic injury can be denial. The adult client crying is demonstrating regression. The client who missed two dialysis appointments is not demonstrating displacement.

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. 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 nurse is most likely to experience the greatest amount of stress related to his or her position as a nurse?

A graduate nurse working on a telemetry unit Explanation: Stress is the body's way of responding to any kind of demand or threat. Stress is often greater for new graduate nurses and nurses who work in settings such as an intensive care unit and emergency care. A nurse with 2 or 10 years has less stress because over time the nurse learns to use knowledge and skills learned to care for a variety of clients. A nurse who is an editor of a nursing journal is also a nurse with clinical experience and is now transitioning into a nursing office job.

Which client is handling stress by using the defense mechanism termed displacement?

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.

Prior to the client's scheduled bone marrow biopsy, the nurse has devoted time to educating him about the rationale and the specific details of the procedure. The nurse's actions constitute what stress management technique?

Anticipatory guidance Explanation: Anticipatory guidance involves preparing a client psychologically for an event in the knowledge that familiarity reduces anxiety. Guided imagery involves the creation of mental image, not education. Relaxation focuses on the control of the body's responses to stress. Normalization is not a specific stress management technique.

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 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.

A freshman college student comes to the health clinic reporting insomnia and difficulty concentrating in class. The student has three red, scaly patches of skin on his arms and chest. The nurse believes the primary nursing diagnosis for this client is:

Anxiety related to stress of achievement in school. Explanation: This student, new to college, is demonstrating classic anxiety symptoms stemming from high stress levels. The best nursing diagnosis would be Anxiety. Sleep deprivation, impaired skin integrity, and disturbances of thought are applicable, but these diagnoses do not address the primary problem.

A nurse hears a client yelling for help from the room. Upon arriving the nurse notes tachypnea and a sense of panic. On further evaluation, the client's heart rate is increased as well as oxygen needs. Which step would the nurse take first to address this client's needs?

Attempt to calm the client and administer oxygen 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. The best way to address this is to attempt to calm the client and administer oxygen as needed to maintain oxygen levels and optimal breathing and cardiovascular function. Semi-Fowler position may help with breathing as well as taking deep breaths but is not the immediate need.

Which outcome(s) will the nurse include in the plan of care for a client experiencing caregiver role strain? Select all that apply.

Client will demonstrate appropriate coping strategies. Client will identify support mechanisms to help with stress. Client will identify one or two stressors to eliminate. Explanation: Demonstrating, not only naming, coping strategies is essential for caregivers who are experiencing role strain. Identifying support mechanisms (family, friends, community resources) is helpful in decreasing stress for the caregiver trying to do everything oneself. Identifying one or two stressors to eliminate is realistic, helpful, and can assist the client with feeling some control over the situation. Blaming and confronting others is not a healthy coping mechanism and will likely add to the caregiver's stress. Expecting the caregiver to eliminate all stress is an unrealistic goal that, when unmet, can cause additional stress due to a feeling of failure.

The nurse is caring for a client with chronic pain. Which long-term coping strategies may be helpful in this situation?

Deep breathing and meditation Explanation: Long-term coping mechanisms are positive, constructive ways of dealing with stress and can be effective over long periods. Long-term coping strategies include deep breathing exercises and meditation, as these promote relaxation. Smoking is detrimental to health and should never be used as a coping strategy. Accepting that the pain will never go away is not a coping strategy and may indicate feeling of hopelessness. Taking a tepid sponge bath is done to lower body temperature and may actually worsen discomfort.

A nurse has accepted numerous overtime shifts over the past several months. Which behavior indicates the nurse is experiencing burnout?

Dozing at the desk during downtime Explanation: Burnout can manifest as increased fatigue, anger, disorganization, or other behavior changes related to an increased amount of stress. Dozing at the nurse's station indicates fatigue and is unsafe. Taking smoke breaks, while unhealthy, does not necessarily indicate burnout unless it is a new behavior. Implementing an exercise program is a healthy coping mechanism to help combat stress and burnout. Telling the manager staffing numbers are unsafe is assertive, which can be considered a healthy coping mechanism for stress.

A withdrawn and isolated client is most likely suffering from what type of stressors on basic human 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 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 school nurse is talking with teen related to school and home situations. The teen states, "I can't focus when I study, can't eat or sleep, and I feel like I'm going to pass out sometimes." The nurse believes the teen is experiencing which disorder?

Moderate anxiety response Explanation: Inability to concentrate, nausea, insomnia, dizziness, and hyperventilation are all symptoms of moderate-level anxiety. Alarm reaction is the initial physiologic response to a stressor described in Selye's general adaptation syndrome theory. OCD is a psychiatric pathology. Panic attacks go a step further in the anxiety cascade; the client is unable to function at this level.

A 2-day-old, 28-week gestation preterm infant is being cared for in the neonatal intensive care unit. The mother is recovering from a cesarean section and comes in to visit for the first time today. Determining that stress can affect infant development., what situation does the nurse identify can develop? Select all that apply

Mother's increased cortisol levels lead to increased anxiety and decreased attachment. The inability to hold and touch can lead to delay in bonding between mother and infant. Excessive noise and lights can increase cortisol levels in the neonate. Explanation: Cesarean section is not a contraindication to holding an infant. Many women successfully bond with their infants following a cesarean. Increased cortisol levels can affect the mother and infant by increasing the mothers anxiety which can limit effective bonding. Stress occurs in the infant psychologically by noises and lighting and physiologically by thermoregulation and other factors.

The nurse is assessing a client who was involved in a neighborhood shooting. The client's vital signs show that his body is attempting to adapt to the stressor. What stage of the general adaptation syndrome is this client experiencing

Resistance Explanation: The general adaptation syndrome (GAS) describes the body's general response to stress, a concept essential in all areas of nursing care. Having perceived a threat and mobilized its resources, the body attempts to adapt to the stressor during the resistance stage; vital signs, hormone levels, and energy production return to normal during this stage. The alarm reaction is initiated when a person perceives a specific stressor and various defense mechanisms are activated. Exhaustion results when the adaptive mechanisms can no longer provide defense. Homeostasis is when the body's internal environment is in a balanced state.

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?

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?

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. 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. 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 returning 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 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

A client is dealing with the death of a spouse 10 days ago. The client tells the nurse about not feeling like eating and struggling to get food in. What does the nurse identify is occurring with the client?

This is part of the normal sympathetic stress response. Explanation: Some individuals lose their appetite during stressful situations. This is actually part of the normal sympathetic stress response that diminishes appetite and digestive function. Sympathetic nervous system (SNS) activity, however, should be short-term, and a person's appetite should return.

In contrast to anxiety, fear is characterized by:

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.

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. 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

An adolescent entering high school voices anxiety over changing schools. Stating anxiety is an act of:

adaptation. Explanation: Adaptation is generally considered a person's capacity to flourish and survive, even with in times of adversity.

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:

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.

The nurse is preparing to administer an injection to an adult client and states, "Try to stay as still as possible." Which stage of the General Adaptation Syndrome (GAS) is the nurse addressing by making this statement?

alarm Explanation: The alarm stage is correct, because this stage prepares the client for a "fight-or-flight" response to overcome the perceived danger, such as the injection of a needle. Stage of resistance is designed to restore homeostasis and is therefore incorrect. Stage of exhaustion occurs when more adaptive or resistive mechanisms are no longer to protect the patient experiencing a stressor. Pathological response is not a phase of GAS.

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 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?

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. 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.

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?

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.

An intensive care unit (ICU) nurse with 11 years of experience has been frequently absent or late for shifts, has been verbally abusive with coworkers she feels are unskilled at the technological tasks of the job, and cursed under her breath at a distraught family member today. The nurse manager is threatening to suspend her if it happens again. The ICU nurse may be experiencing:

burnout. Explanation: Burnout is the term used to describe behaviors that occur when a person is overwhelmed with the demands of a situation and is similar to the exhaustion stage of anxiety. This is commonly seen in nurses who work in high-stress environments. The individual in this scenario may have a great allostatic load and/or sleep deprivation, but there is no evidence of this in the given scenario. Repression is when a person copes by unconsciously denying the occurrence of a stressful event.

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. 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 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 laboratory results by crying uncontrollably is handling stress by using:

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.

The client is a single mother of two children who attends college and works full time. She is seeing the college nurse due to a crying outburst in class. The last step of crisis intervention that the nurse employs is:

determining if the outcome has been achieved. Explanation: Crisis intervention is a five-step problem-solving technique. The last step is to evaluate outcome achievement. The other options precede evaluation.

A client has experienced the loss of a loved one and is in the grieving process. The grief following this stressful event may be documented as what type of event?

distress. Explanation: Stress is unavoidable. The resulting feelings of angst and grief are sometimes labeled distress.

A client with diabetes mellitus is experiencing acute stress. The nurse identifies that the client will be secreting excess levels of cortisol. What should the nurse monitor the client for related to the increased levels of cortisol?

elevated glucose levels Explanation: Under acute stress, cortisol is released and can raise glucose levels. In a client with diabetes, the elevations in glucose levels can be detrimental. The nurse does not need to monitor for depression, elevated potassium, or cardiac dysrhythmias in relation to the elevated cortisol levels

A 78-year-old widower was recently relocated to an assisted living facility. His aunt used to live in this facility and always talked fondly about her fellow residents and the staff. However, the nurse has noticed that the client has spent most of his time in his room alone. What type of stress is the nurse most concerned about with this client?

environmental stress Explanation: Environmental stress is common when individuals move to a new location, even if that move is voluntary. It is associated with a lack of familiarity with the sights, smells, and sounds of the location. Relocation also requires alteration in daily routine, which is in itself stressful. Physiological or biological stress is an organism's response to a stressor such as an environmental condition such as shock. Psychological stress is a feeling of strain and pressure. Sociocultural stress is between developing people and the culture in which they live.

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:

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.

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?

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.

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?

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:

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 client who has a history of sexual abuse is demonstrating repression. What client behavior does the nurse expect?

having no memory of the sexual abuse Explanation: Repression is forgetting about the stressor or removing the experience from the subconscious. Blaming others is a sign of displacing anger. Refusal to believe is a sign of denial. Childish behavior is demonstrative of regression.

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?

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.

Which are considered internal stressors? Select all that apply.

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).

The nurse is caring for a client who is exhibiting signs of stress. Which cognitive symptom associated with stress does the nurse recognize?

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?

joining the local garden club Explanation: 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?

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.

In evaluating the therapeutic outcome of using biofeedback to help a client work through a stressful situation, the nurse would expect the client to:

maintain vital signs within normal limits. Explanation: Biofeedback is the relaxation technique that involves clients learning to use mental processes to control their physiologic responses to events. Clients can learn to alter their autonomic nervous system and control their vital signs and uncomfortable symptoms. Identifying support services, redemonstrating procedures, and understanding medications can reduce stressful feelings, but they are not biofeedback principles.

A nurse is teaching a client regarding effective coping strategies. Which teaching will the nurse include? Select all that apply.

making an appointment with a counselor writing a list of pros and cons practicing yoga and relaxation turning to a higher power Explanation: Making an appointment with a counselor is an appropriate step in positive coping. Writing a list of pros and cons is a problem-solving technique used in positive coping. Practicing yoga and relaxation is similar to progressive relaxation, which is a positive coping strategy. Turning to a higher power can also be a sign of positive coping. Excessive sleeping and social avoidance are signs of maladaptive coping.

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 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 middle-aged adult discusses the loss of a job due to frequent illness. Which will the nurse discuss with the client to assist in problem-solving the loss?

practicing meditation or yoga Explanation: Coping is the process of applying thoughts and actions to deal with stressful events. There are various mechanisms to coping. An example of a normal, long-term coping mechanism is learning and practicing meditation or yoga. A short-term and possibly unhealthy coping mechanism is drinking alcohol or "pill popping" (e.g., taking aspirin or tranquilizers). Searching for a job with adequate health insurance does not address the client's current issue and the job search may add more stress.

The nurse is making preparations for a group of clients who have been experiencing some stressful events in their lives. Which nursing strategies should the nurse use to assist these clients? Select all that apply.

preventing additional stressors assessing the client's response to stress implementing stress management techniques assisting in maintaining a network of social support Explanation: Preventing additional stressors will eliminate the cumulative effects of other stressors. Assessing the client's response to stress will help indicate how well the client is adapting to the stressors. Implementing stress management techniques will provide strategies to assist the clients in mitigating further stressors. Maintaining a network of social support will provide the clients with other individuals to share their concerns with. Ignoring the stressors will just add to the cumulative effect or other stressful life events; it will not remove the stress.

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 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 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 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?

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?

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.

A nurse is assessing a client who has recently lost her husband. During the interview the nurse realizes that the client is unable to cope with the loss. The client finds it difficult to organize daily tasks or solve problems effectively. Which suggestion would be most appropriate for the nurse to suggest as a crisis intervention?

seek assistance from family and friends Explanation: The nurse should suggest that the client seek assistance from family and friends as a crisis intervention. Adequate support during a crisis and its resolution can help clients realistically perceive the problem and reinstitute coping strategies. Performing meditation, tensing and relaxing muscle groups systematically for progressive relaxation, and keeping the home environment noise free are methods to calm and relax the client that may not necessarily help in crisis intervention.

Which behaviors represent effective coping mechanisms? Select all that apply.

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.

The young adult client is awaiting diagnostic test results for cancer. The client will not sit in the chair and is pacing in the room. The client's heart rate is 112 bpm and respirations are 32 breaths/min. The client's speech is rapid and makes little sense. The nurse assesses the client level of anxiety as:

severe. Explanation: Severe anxiety is manifested by difficulty communicating verbally, increased motor activity, tachycardia, and hyperventilating. Mild anxiety is present in everyday living and is manifested by restlessness and increased questioning. Moderate anxiety is manifested by a quavering voice, tremors, increased muscle tension, and slight increases in heart and respiration rates. Panic is manifested by difficulty with verbal communication, agitation, poor motor control, tachycardia, hyperventilation, palpitations, choking sensation, and chest pain or pressure.

A client with persistent nausea is diagnosed with somatization. What is the appropriate nursing action when the client reports nausea?

sit with the client and ask them about their feelings Explanation: Somatization is manifesting an emotional stress through a physical disorder. Treating the nausea with an antiemetic will not get at the root cause of the emotional issue. Contacting the primary care provider is not appropriate, as the diagnosis of somatization is present. Explaining that the physical symptoms are all in the client's head is not therapeutic. Sitting with the client to explore what is really going on is most appropriate nursing response.

A nurse is assessing a client with stress-related problems. Which factor influences responses to stressors?

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?

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

A high school student comes to the nurse's office to discuss her anxiety regarding an upcoming test. Her test-taking anxiety is a (an)

stressor. Explanation: Stress, coping, and adaptation are interrelated. Survival depends upon successful coping responses to ordinary and sometimes extraordinary circumstances and challenges.

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 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. 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.