EAQ Chp 38 Stress and Coping
The nurse is teaching stress management techniques to a patient. Which instructions should the nurse give the patient to manage stress? Select all that apply. -"Eat whatever you feel like." -"Listen to music that you enjoy." -"Sleep more." -"Exercise for 15 to 30 minutes every day." -"Engage yourself in pleasurable activities."
-Listen to music that you enjoy -Exercise for 15 to 30 minutes everyday -Engage yourself in pleasurable activities Rationale When teaching about stress management, the nurse should encourage the patient to listen to good music because it relaxes the mind. Exercise induces a sense of well-being. Engaging in pleasurable activities will help to offer a break from monotonous life. Giving instructions such as eating whatever the patient feels like and sleeping more are inappropriate. Eating and sleeping more are ineffective coping strategies. STUDY TIP: As you read the correct answer in a study guide, also consider why the wrong answers are incorrect. Why is it inappropriate to tell a patient to sleep more? Why is it inappropriate to tell a patient to "eat whatever you feel like?" Answering those questions will help you solidify the appropriate actions in your mind. Determine what the appropriate instructions would be regarding eating and sleeping. p. 781
What can cause an adventitious crisis in a person? Select all that apply. -Tsunami -Earthquake -Childbirth -Death of a pet -Leg amputation
-Tsunami -Earthquake Rationale An adventitious crisis can be triggered by a major natural disaster, a man-made disaster, or a crime of violence. Therefore, a tsunami or earthquake can result in an adventitious crisis. Childbirth, the death of a pet, or a leg amputation can cause a situational crisis. p. 774
What is the approximate duration (in weeks) required by a person to resolve a crisis? Record your answer using a whole number.
6 weeks Rationale Crisis occurs when a person is under stress and is unable to cope up with it. The event that has caused the crisis usually occurs 1 to 2 weeks before the patient seeks help. A person generally resolves a crisis in some way within approximately 6 weeks. p. 772
What are the different stages of the general adaptation syndrome (GAS)? Select all that apply. A. Alarm reaction B. Resistance C. Appraisal D. Crisis E. Exhaustion
A, B, E Rationale The general adaptation syndrome (GAS) is a reaction to stress. It can be triggered directly by physical stress such as an injury or indirectly by psychological stress. It has three stages that describe how the body reacts to different stressors. These stages include the alarm reaction, resistance stage, and exhaustion stage. The alarm stage is characterized by rising hormone levels. The resistance stage is characterized by body reactions in opposition to the alarm reactions. The exhaustion stage occurs when the body has depleted its resources. Appraisal is the continuous process of being aware of the stressors and the coping mechanisms. Crisis occurs in response to the body's stressors. Test-Taking Tip: Consider the mnemonic, " ARE you so stressed that you have reacted with GAS?" The A is for Alarm reaction, R is Resistance, and E is Exhaustion. You can also create your own mnemonic to remember the stages of the general adaptation syndrome. p. 772
A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn't see how he can go on much longer. What is your best response? A. "Are you thinking of suicide?" B. "You've been doing a good job raising your children. You can do it!" C. "Is there someone who can help you?" D. "You have so much to live for."
A. "Are you thinking of suicide?" Rationale Although this sounds abrupt, the patient usually is relieved that you've broached this issue. For safety reasons it is very important to discuss the patient's suicidal thoughts. Test-Taking Tip: The correct answer may have surprised you because the other three choices share a milder approach. This is an answer that places safety as the highest priority. Think "Safety first!" when answering a question. p. 777
When the nurse asked a patient with depression, "What is on your mind?" the patient responded, "I have had enough of this world. I wish to leave this planet and enter the world of peace." What is the most appropriate, immediate intervention of the nurse? A. Ask if the patient has made any plan for suicide. B. Inform the health care provider immediately. C. Inform the police by telephone or fax. D. Tell the patient that suicide is not a solution to the problems.
A. Ask if the patient has made any plan for suicide Rationale A trusting nurse-patient relationship is required to assess a patient's stress level and coping mechanisms. The nurse should start with an open-ended question first to build a rapport. It is important to ask directly about suicidal or homicidal thoughts. If a patient has these thoughts, then the nurse should immediately ask if the patient has any plans to kill himself or herself. The nurse should also inquire about how the patient plans to commit suicide. Thereafter, the nurse can inform the health care provider or police. The nurse can then try to counsel the patient by saying that suicide is not a solution to the problems. p. 777
A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1c, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1c is wrong. My blood sugar levels have been excellent for the last 6 months." Which defense mechanism is the patient using? A. Denial B. Conversion C. Dissociation D. Displacement
A. Denial Rationale Denial is avoiding emotional stress by refusing to consciously acknowledge anything that causes intolerable anxiety. This patient's statements reflect denial about poorly controlled blood sugars. p. 774
The nurse could not get through her licensing exam. After seeing the results, the nurse said, "No! I do not believe this. I prepared for the exam for 2 years. I should have made it through the test. There must be some error in this." What is this kind of response called? A. Denial B. Illusion C. Primary appraisal D. Posttraumatic stress disorder
A. Denial Rationale Denial is one of the types of ego-defense mechanisms used to cope with stressors. In such a case, a person consciously refuses to acknowledge anything that causes intolerable emotional pain. Illusion is a false belief. Evaluating a situation for its personal meaning is called primary appraisal. Posttraumatic stress disorder does not present in this way. Posttraumatic stress disorder occurs when a person experiences a traumatic incident and continues to respond to stressful situations with intense fear and helplessness. The stress in this patient is not due to a traumatic incident. p. 774
When teaching a patient about the negative feedback response to stress, what does the nurse include to describe the benefits of this stress response? A. It results in the neurophysiological response. B. It reduces body temperature. C. It causes a person to be hypervigilant. D. It reduces the level of consciousness to conserve energy
A. It results in the neurophysiological response. Rationale The process of negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as shivering to generate body heat to return the body to hormonal homeostasis. pp. 771-772
During the assessment interview of an older woman experiencing a developmental crisis, what does the nurse say? A. "How is this flood affecting your life?" B. "Since your husband has died, what have you been doing in the evening when you feel lonely?" C. "How is having diabetes affecting your life?" D. "I know this must be hard for you. Let me tell you what might help."
B. "Since your husband has died, what have you been doing in the evening when you feel lonely?" Rationale A developmental crisis occurs as a person moves through life's stages, including widowhood. p. 774
A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse's first assessment for stress, what does the nurse say? A. "Tell me who I can call to help you." B. "Tell me what bothers you the most about this experience." C. "I'll contact someone who can help get you temporary housing." D. "I'll sit with you until other family members can come help you get settled."
B. "Tell me what bothers you the most about this experience." Rationale A patient's appraisal of the crisis is the most important area to address first. p. 777
A crisis intervention nurse is working with a mother whose Down syndrome child has been hospitalized with pneumonia. During this hospitalization, the mother lost her entitlement check. When should the nurse expect the mother to regain stability? A. After 2 weeks when the child's pneumonia begins to improve B. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks C. After 1 month when the child goes home and the mother gets help from a food pantry D. After 6 months when the child is back in school
B. After 6 weeks when she adjusts to the child's respiratory status and reestablishes the entitlement checks Rationale Generally, a person resolves the crisis and reaches psychological equilibrium in about 6 weeks. STUDY TIP: Memory aids can take many forms. They do not have to be serious. If you can exaggerate the s's in the following sentence, the silliness of the exaggeration will help anchor the information in your mind: "It takes approximately six weeks to resolve a crisis" will sound like "It takesss approxsssimately sssixsss weeksss to resssolve the crissssisss." p. 782
A patient's spouse and child died in an accident recently. The patient is extremely depressed and reports nightmares of the event. The patient tells the nurse about plans to be reunited with the family members very soon. What is the priority nursing intervention for this patient? A. Ask the patient if counseling is needed. B. Assess the patient for any suicidal ideas. C. Refer the patient to a psychiatrist. D. Inform the patient about support groups.
B. Assess the patient for any suicidal ideas Rationale When a person witnesses or experiences a traumatic event in life, the patient may respond with intense fear and helplessness. This disorder is called posttraumatic stress disorder (PTSD). The symptoms may include nightmares or flashbacks of the event. Patients with posttraumatic stress disorder may respond through self-destructive ideas or suicidal thoughts. Therefore, the nurse should assess the patient for suicidal ideas and intervene appropriately. The nurse can later arrange for counseling, a psychiatric appointment, or support groups. Test-Taking Tip: Look for answers that support safety! It may seem unusual to assess for suicidal ideas at the first hint of a problem, but this is the safest and most responsible action. You have a duty to protect the patient from self- harm. p. 777
A patient is experiencing chronic stress. Which gland in the patient's body will initiate the general adaptation syndrome (GAS)? A. Parotid gland B. Pituitary gland C. Pineal gland D. Adrenal gland
B. Pituitary gland Rationale The general adaptation syndrome is a three-stage reaction that describes how the body responds to stressors through different stages. When the body encounters a physical demand such as an injury, the pituitary gland initiates the GAS. The parotid gland secrets saliva and is not related to the GAS. The pineal and adrenal glands do not initiate the GAS. STUDY TIP: Remember that the pituitary gland is also called the master gland because it controls so many functions. It is vital in the process of homeostasis, and adapting to chronic stress is definitely part of homeostasis. p. 772
A child performs poorly in mathematics and finds it difficult to improve even after spending more time studying. Which behavior shows that the child is using compensation as a defense mechanism? A. The child is taking lessons from an experienced math tutor. B. The child is practicing more music because the patient is good at music. C. The child is taking herbal supplements to improve memory. D. The child is eating nutritious food and practicing yoga.
B. The child is practicing more music because the patient is good at music Rationale In compensation, a person makes up for a deficiency by strongly emphasizing a feature that is considered an asset. The child uses musical skill as compensation for poor performance in math. Taking math lessons is not a defense mechanism; it is a corrective action to improve competency in math. Taking herbal supplements, eating nutritious food, or practicing yoga are emotion-focused coping skills. p. 774
After the birth of a baby, a divorced mother is finding it difficult to take care of the baby and work at the same time. The patient seeks advice from the nurse to handle this stress effectively. What question does the nurse ask the patient during the crisis assessment? A. "Do you know that you are in a situational crisis? B. "What does your husband do?" C. "How is your work and responsibility as a mother affecting your life?" D. "Where is your husband now? Why didn't you bring him along?"
C. "How is your work and responsibility as a mother affecting your life?" Rationale When a person is experiencing a crisis, the nurse should ask the patient about the impact of the stress on his or her life. The nurse should use lay terms rather than medical jargon such as "situational crisis" when talking to a patient. It is not appropriate at this stage to ask about her husband. p. 777
After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. What is the nurse's first response? A. "Don't be sad. People live with cancer every day." B. "Have you thought about how you are going to tell your family?" C. "I can sit with you for a while, if you would like to talk." D. "I know another patient whose colon cancer was cured by surgery."
C. "I can sit with you for a while, if you would like to talk." Rationale Ask the patient if he would like you to sit down for a few minutes so he can talk. Asking an open-ended question and providing an opportunity for the patient to talk allow the nurse to assess the patient's perception of the situation, which is of utmost importance. Test-Taking Tip: Look for answers that allow the patient to express feelings. p. 776
When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, what does one of the first assessments include? A. The amount of family support B. A 3-day diet recall C. A thorough physical assessment D. Threats to safety in the home
C. A thorough physical assessment Rationale Physical causes for problems need to be discovered before treatment for psychosocial problems can be initiated. Test-Taking Tip: Safety cannot be overemphasized in nursing practice. Thus, your awareness of practices that support safety should guide you in responding to test questions. A thorough physical assessment and examination of medications is essential in such a case. p. 776
Which type of crisis is an earthquake that has killed more than 7000 people? A. A situational crisis B. A maturational crisis C. An adventitious crisis D. A developmental crisis
C. An adventitious crisis Rationale An adventitious crisis is also known as a disaster crisis. It occurs due to a major natural disaster or man-made disaster. A situational crisis occurs due to external sources such as a job change, a motor vehicle crash, or severe illness. A maturational crisis is also known as a developmental crisis. Developmental stages such as marriage, pregnancy, and the birth of a child require new coping styles. Failure to cope with the exposure to stressors during these stages leads to developmental crises. p. 774
A head nurse is teaching the physiology of fight-or-flight responses to student nurses. Which system is responsible for these phenomena? A. Renin-angiotensin system B. Respiratory system C. Sympathetic nervous system D. Parasympathetic nervous system
C. Sympathetic nervous system Rationale People experience stress in day-to-day activities. Stress stimulates thinking processes and helps people to be alert. The fight-or-flight response helps a person to prepare for action. These responses occur because of the arousal of the sympathetic nervous system. The renin-angiotensin system helps in maintaining electrolyte and fluid balance. The respiratory system does not initiate fight-or-flight responses. The parasympathetic system counteracts the action of the sympathetic nervous system. STUDY TIP: If you confuse the sympathetic with the parasympathetic nervous system, use this mnemonic: the parasympathetic system can be nicknamed the "rest-and-digest system." Notice the r in parasympathetic and in rest. There is no r in sympathetic, so you can recall that sympathetic refers to the fight-or-flight system. p. 771
The nurse is assessing the coping skills of a patient who lost his mother and is depressed. Which response by the patient will show that the patient is coping well? A. "I always feel better when I paint. I think it might help me to relieve depression." B. "My friend said that she drinks a good red wine when she is depressed. I will try that at home." C. "My grief will be resolved only when I go to a different world altogether." D. "I have been going to a support group that I find is very good and I am resuming my studies."
D. "I have been going to a support group that I find is very good and I am resuming my studies" Rationale A patient who is coping well would feel better than before and would try to resume the activities of daily life. Therefore, the statement that the patient feels good and is resuming studies indicates that the patient is coping well with the loss. The statement that the patient feels better when painting indicates that the patient has been speculating about various strategies that might help. Drinking alcohol is not a healthy sign of coping and should be discouraged. The statement that the patient wants to go to another world indicates that the patient has suicidal ideations. p. 774
The nurse is evaluating the coping success of a patient experiencing stress from after being diagnosed with multiple sclerosis and psychomotor impairment. Which statement indicates that the patient is coping successfully? A. "I'm going to learn to drive a car so I can be more independent." B. "My sister says she feels better when she goes shopping, so I'll go shopping." C. "I've always felt better when I go for a long walk. I'll do that when I get home." D. "I'm going to attend a support group to learn more about multiple sclerosis."
D. "I'm going to attend a support group to learn more about multiple sclerosis." Rationale Support groups often benefit people experiencing stress. STUDY TIP: Support groups often benefit people experiencing stress. If your study group can also function as a support group for the experience of being a nursing student, that's super! pp. 778, 781
A patient who is diagnosed with terminal colon cancer says, "It's just a stomach infection; I don't have any cancer, and it's a wrong diagnosis." What does the nurse do? A. Refer the patient to a psychiatrist immediately. B. Show the laboratory reports to the patient. C. Explain the similarity between stomach infections and colon cancer. D. Allow the patient to use denial as a coping mechanism.
D. Allow the patient to use denial as a coping mechanism Rationale The patient is using denial as a coping mechanism to deal with the stress. Therefore, the nurse should allow some time for the patient to cope with the stress before giving more information about the cancer or further process. The patient is overwhelmed by the diagnosis of cancer and does not need a consultation with a psychiatrist. The nurse should not offend the patient by showing the laboratory reports. Telling the patient that a stomach infection and colon cancer manifest with similar symptoms indicates giving false assurance. p. 774
While performing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. Which response is this? A. The fight-or-flight response B. The general adaptation syndrome C. The exhaustion stage D. Posttraumatic stress disorder (PTSD)
D. Posttraumatic stress disorder (PTSD) Rationale PTSD originates with a person's experiencing or witnessing a traumatic event and responding with intense fear or helplessness. The car accident is the traumatic event that is causing intense fear or helplessness in this patient. p. 774
