NSG 152 TEST #2

The nurse is working in a health care unit in which there have been rapid changes in health care technology systems in a short time. The nurse is unable to become comfortable with the new systems and is exhausted. The nurse feels a sense of failure and a lack of identity. What does the nurse do now? Select all that apply. 1 Identify limits and responsibilities at work. 2 Spend more time at work to learn the new technology. 3 Strengthen friendships outside of the workplace. 4 Spend off-duty hours in activities such as sports, music, or painting. 5 Spend on-duty hours researching the new technologies.

1 Identify limits and responsibilities at work. 3 Strengthen friendships outside of the workplace. 4 Spend off-duty hours in activities such as sports, music, or painting. The symptoms indicate that the nurse is experiencing burnout. The nurse should now make behavioral changes to cope with workplace stress. These include identifying the limits and responsibilities at work, which helps to focus the nursing efforts. Strengthening friendships outside of the workplace helps the nurse to obtain some relief from workplace stress. Spending off-duty hours engaged in interesting activities such as sports, music, or painting helps the nurse to de-stress. Spending more time at work to learn new technologies or do research would worsen the burnout.

The nurse is assessing a patient who is under immense psychological stress. The nurse finds that the patient shows classic signs of the alarm reaction stage of general adaptation syndrome. What are the signs and symptoms of this stage? Select all that apply. 1 Increased heart rate 2 Low blood pressure 3 Constricted pupils 4 Increased blood glucose levels 5 Increased mental alertness

1 Increased heart rate 4 Increased blood glucose levels 5 Increased mental alertness The alarm reaction stage is the first stage of general adaptation syndrome, which is initiated due to a sudden increase in the activity of the pituitary gland in response to stress. Due to an increase in the hormonal levels and the activity of the autonomic nervous system, there is an increase in heart rate, blood pressure, and blood glucose levels. The person is highly alert and the pupils of the person dilate in order to increase the field of vision.

A postmenopausal patient with high blood pressure suffers from flushing and irritability. This patient refuses to take medications to relieve the postmenopausal symptoms. The nurse suggests that the patient use relaxation therapy. What health benefits of relaxation therapy should the nurse emphasize? Select all that apply. 1 It lowers blood pressure. 2 It induces a peaceful attitude. 3 It relieves flushing and irritability. 4 It increases muscle tension. 5 It reduces pain and anxiety.

1 It lowers blood pressure. 2 It induces a peaceful attitude. 3 It relieves flushing and irritability. 5 It reduces pain and anxiety. Relaxation therapy causes the muscle fibers to elongate, reduces the neural impulses sent to the brain, and decreases the activity of all the body systems. As a result, the blood pressure is reduced. Relaxation therapy induces a peaceful attitude by decreasing activity of all the body systems. It helps to relieve menopausal symptoms such as flushing and irritability by reducing the neural impulses to the brain. It helps to reduce pain and anxiety. Relaxation therapy relaxes muscles and reduces muscle tension, which in turn is helpful in reducing mental tension.

The nurse is interviewing a 37-year-old patient who is not coping well with a recent loss of employment. Which activities should the nurse perform to assess coping in the patient? Select all that apply. 1 Observe the patient's appearance. 2 Ask the patient about changes in eating patterns. 3 Ask the patient about changes in his or her sleeping pattern. 4 Ask the patient about his or her ability to remember a recent event. 5 Observe the patient's response to the questions asked.

1 Observe the patient's appearance. 2 Ask the patient about changes in eating patterns. 3 Ask the patient about changes in his or her sleeping pattern. 5 Observe the patient's response to the questions asked. A disheveled appearance and poor grooming indicate ineffective coping. Changes in eating patterns and a lack of interest in food may indicate the patient is not coping well. Ineffective coping can also alter the sleep pattern. The patient may sleep excessively. An inaccurate response to questions asked and the inability to concentrate indicate ineffective coping.

A patient with colon cancer has problems with appearance, roles, and relationships with family members. Which dimension of the patient's healthy life is being affected by cancer? 1 Social well-being 2 Physical well-being 3 Spiritual well-being 4 Psychological well-being

1 Social well-being Health is a state of complete physical, mental, social, and spiritual well-being. Cancer causes disturbances in appearance, roles, and relationships with family members and affects the patient's social well-being. When physical well-being is affected a cancer patient has disturbances in functional ability, sleep and rest, and appetite. Cancer's effects on a patient's spiritual well-being cause uncertainty, hopelessness, and transcendence. Fear of recurrence, anxiety, and depression indicate that the patient's psychological well-being has been affected.

What stressors is a patient likely to experience in an acute care setting? Select all that apply. 1 Stress related to diagnostic tests and results 2 Stress related to the family's response to the patient's condition 3 Stress related to an altered body image 4 Stress related to lifestyle modifications 5 Stress related to socialization

1 Stress related to diagnostic tests and results 3 Stress related to an altered body image 4 Stress related to lifestyle modifications Stressors affecting a patient in an acute care setting are fear and anxiety related to diagnostic tests and their results. There is also potential fear and stress about a disturbed body image due to surgery or other physical condition. The patient also experiences the stress of adapting to an altered lifestyle because of the medical or physical condition. The patient may not be greatly affected by what the family thinks about his or her condition. Stress related to socialization is more common in elderly patients.

In the general adaptation syndrome, what happens in the body because of increased epinephrine? Select all that apply. 1 The heart rate increases. 2 Blood glucose levels increase. 3 Oxygen intake increases. 4 Gluconeogenesis increases. 5 Water reabsorption increases.

1 The heart rate increases. 2 Blood glucose levels increase. 3 Oxygen intake increases. When a stressor occurs, the pituitary gland, adrenal medulla, and sympathetic nervous system are activated. These in turn produce hormones that bring about changes in the body. Epinephrine is one of the hormones produced because of the arousal of the sympathetic nervous system and adrenal medulla. Increased epinephrine results in increased heart rate, blood glucose levels, and oxygen intake. Increased epinephrine does not affect gluconeogenesis or water reabsorption. Gluconeogenesis increases because of increased cortisol, and increased water reabsorption occurs due to increased aldosterone.

The nurse is trying to assess if a patient is free from identity stressors. What would suggest that the patient has a strong identity? 1 The patient has been happily married for 10 years. 2 The patient exercises daily. 3 The patient does not abuse substances. 4 The patient is involved in church activities.

1 The patient has been happily married for 10 years. Identity achievement is reflected by a patient's intimate relationships. The patient who has been happily married for 10 years probably has a strong identity. Positive behaviors such as exercising daily, not abusing substances, and being involved in church activities do not indicate that the patient is free of identity stressors.

What are the modes for stress intervention? Select all that apply 1 Increase the resistance to stress. 2 Identify the triggers to stress. 3 Isolate oneself from others to de-stress. 4 Decrease the number of situations that produce stress. 5 Learn skills to reduce the body's response to stress.

1 Increase the resistance to stress. 4 Decrease the number of situations that produce stress. 5 Learn skills to reduce the body's response to stress. Stress intervention should be aimed at helping the patient to resume his or her normal life. There are three modes for stress intervention. These include increasing resistance to stress, decreasing stress-producing situations, and learning skills to reduce the body's physiological response to stress. Increasing resistance to stress helps in perceiving an event as less stressful. Decreasing stress-producing situations helps in preventing activation of the stress response. Learning skills to reduce the body's stress response helps with better coping. Identifying the triggers of stress is an activity during the assessment phase, and not of the intervention phase. Isolating oneself from others during stress is an unhealthy way of coping.

A patient with newly diagnosed diabetes is sitting in the waiting area. She appears sad and anxious. The nurse talks to the patient and tries to make the patient laugh. How does laughter help a person during difficult times? Select all that apply. 1 It increases the pain threshold. 2 It exercises the facial muscles. 3 It boosts immunity. 4 It reduces tension, stress, and anxiety. 5 It increases oxygenation in the body

1 It increases the pain threshold. 3 It boosts immunity. 4 It reduces tension, stress, and anxiety. Laughter has several therapeutic effects on a person's body, mind, and spirit. It increases the pain threshold and the body's immunity. It reduces tension, stress, and anxiety and improves the patient's mood. Exercising facial muscles through laughter does not help a depressed person. Laughter does not increase oxygenation in the body.

The nurse is teaching a group of nursing students about the general adaptation syndrome (GAS). What is true about this phenomenon? Select all that apply. 1 It is triggered directly by a physical event. 2 It consists of four stages of reaction to stress. 3 It is triggered directly by a psychological event. 4 It involves the autonomic nervous and endocrine systems. 5 It is initiated by the pituitary gland after a physical injury.

1 It is triggered directly by a physical event. 4 It involves the autonomic nervous and endocrine systems. 5 It is initiated by the pituitary gland after a physical injury. The GAS is the body's response to stress. It is triggered directly by a physical event. It involves many body systems, especially the autonomic nervous and endocrine systems. When the human body is subjected to physical or emotional stress, the pituitary gland initiates the GAS. It consists of three stages including the alarm reaction, the resistance stage, and the exhaustion stage. The GAS can be initiated indirectly by a psychological stress.

A patient mentions to the nurse that she recently lost her husband in a car accident. Which behaviors could the nurse identify as denial defense mechanisms? Select all that apply. 1 Not accepting the death of her spouse 2 Not sleeping and eating 3 Not disclosing her feelings to anyone 4 Being speechless and numb 5 Shouting and blaming God for her loss

1 Not accepting the death of her spouse 3 Not disclosing her feelings to anyone A denial defense mechanism is a r2eaction to emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Not discussing the loss and not accepting the loss are both denial defense mechanism behaviors. Cessation of eating and sleeping is a conversion defense mechanism. Being speechless and numb are examples of dissociative defense mechanisms. Shouting and blaming God for the loss is an example of the displacement defense mechanism.

A patient is diagnosed with breast cancer. The patient is sad and disappointed. Which assessment activities are appropriate when planning care for this patient? Select all that apply. 1 Observe her nonverbal behavior. 2 Observe the relatives who visit the patient. 3 Assess her economical background. 4 Assess her response to care options. 5 Observe her interactions with others

1 Observe her nonverbal behavior. 4 Assess her response to care options. 5 Observe her interactions with others. Nonverbal behavior such as sad expressions and closed eyes may indicate grief. Observing the patient's responses to care options can give an idea about her feelings and hopelessness. Her interactions with others may reveal a lack of interest and unwillingness to meet others. Observing the patient's relatives may not contribute in planning care for the patient. Assessment of the economic background may not be relevant to the grief response.

The nurse is performing a first-time assessment of a patient who is extremely stressed. Which are the objective assessments documented by the nurse in the assessment sheet? Select all that apply. 1 Patient's behavior 2 Appearance of the patient 3 Changes in diet of the patient 4 Blood pressure of the patient 5 Social support of the patien

1 Patient's behavior 2 Appearance of the patient 4 Blood pressure of the patient Objective assessments are the assessments that are done through observation or measurement. Information such as the patient's behavior and appearance can be observed by the nurse. Blood pressure assessment is also done by the nurse. Thus, these are considered objective assessments. As the nurse is assessing the patient for the first time, the nurse cannot observe the patient's change in diet; the nurse has to ask the patient for this information. The nurse would have to ask the patient regarding the social support system (family, co-workers, etc.). Thus, these assessments would come under subjective assessments.

A 63-year-old patient is retiring from a job at an accounting firm after 20 years in a management role. The patient has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker who raised their five children, babysits for the grandchildren as needed, and belongs to numerous church committees. Which are major concerns for this patient? Select all that apply. 1 The loss of the patient's work role 2 The risk of social isolation 3 The need for the wife to start working 4 How the wife expects to divide household tasks in retirement 5 The age the patient chose to retire

1 The loss of the patient's work role 4 How the wife expects to divide household tasks in retirement The psychosocial stresses of retirement are usually related to role changes with a spouse or within the family and to loss of the work role. Often there are new expectations of the retired person. This patient is not likely to become socially isolated because of the size of the family. Whether the wife will have to work is not a major concern at this time, nor is the age of the patient.

The nurse is assessing a 47-year-old, female patient who has been recently diagnosed with carcinoma of the right breast. Her left breast was removed 2 years ago for the same reason. What symptoms in the patient may indicate ineffective coping? Select all that apply. 1 The patient appears poorly groomed. 2 The patient complains of weight gain. 3 The patient laughs inappropriately. 4 The patient is able to meet her basic needs. 5 The patient responds accurately to questions.

1 The patient appears poorly groomed. 2 The patient complains of weight gain. 3 The patient laughs inappropriately. The nurse should be aware of the characteristics that define ineffective coping. These include poor grooming, weight gain, and inappropriate laughing or crying. A patient who is able to meet basic needs and responds accurately to the questions asked demonstrates effective coping skills.

A patient is diagnosed with breast cancer. She is upset about the diagnosis. What questions should the nurse ask to assess the coping skills of the patient? Select all that apply. 1 "What is bothering you most right now?" 2 "Have you started drinking and smoking?" 3 "Has your caffeine intake increased?" 4 "What is your monthly income?" 5 "How far is the health care clinic from your house?"

1 "What is bothering you most right now?" 2 "Have you started drinking and smoking?" 3 "Has your caffeine intake increased?" Asking the patient about the issues bothering her helps the nurse understand the patient's concerns. Asking whether the patient has started drinking and smoking or has increased her caffeine intake checks the patient's maladaptive skills. Information about monthly income and the distance of the clinic from the patient's home does not help assess coping skills.

A patient lost a job recently due to poor performance at work and has no alternative source of financial support. The patient reports difficulty sleeping and loss of appetite. On medical examination, there is no organic cause found for the patient's symptoms. Which defense mechanism is the patient using? 1 Conversion 2 Dissociation 3 Identification 4 Displacement

1 Conversion There are different types of ego-defense mechanisms used to cope with stressors. In conversion, anxiety is repressed unconsciously, which is then transformed into nonorganic symptoms such as difficulty sleeping or loss of appetite. In dissociation, the patient may experience a subjective sense of numbness and reduced awareness of his or her surroundings. In identification, a person assumes the qualities, characteristics, and actions of another person. In displacement, a person transfers his or her emotions from a stressful situation to a less anxiety-producing substitute.

Which factors are included in a family function assessment? Select all that apply. 1 Cultural practices 2 Decision making 3 Rituals and celebrations 4 Neighborhood crime data 5 Family status of influenza vaccinations

1 Cultural practices 2 Decision making 3 Rituals and celebrations Cultural practices, decision making, rituals, and celebrations are included in a family function assessment. Cultural practices help identify culturally related health practices, diets, and religious practices. Decision making provides information as to how the family copes and meets challenges related to changes in family life or dynamics. Rituals and celebrations address how a family celebrates accomplishments and how they deal with challenges. Neighborhood crime data are relevant for community assessment, but they do not give sufficient information about family function. The status of influenza vaccinations is part of the health processes of the family assessment plan.

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? 1 Denial 2 Illusion 3 Primary appraisal 4 Posttraumatic stress disorder

1 Denial 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.

A single young adult interacts with a group of close friends from college and work. They celebrate birthdays and holidays together. In addition, they help one another through many stressors. Which describes how the young adult views these individuals? 1 Family 2 Siblings 3 Substitute parents 4 Alternative family structure

1 Family Families can be defined biologically, legally, or as a social network with personally constructed ties and ideologies. This young adult views the group of close friends as family.

The nurse is assessing the family of a patient. Which questions should the nurse include to assess the interactive processes of the family? Select all that apply. 1 "How and when did your physical complaints start?" 2 "How do you and your family spend your leisure time together?" 3 "On a scale of 0 to10, what is the rating of your pain in terms of severity?" 4 "Is your family a nuclear family, blended family, or a single-parent family?" 5 "Who establishes your house rules and how are they communicated?"

2 "How do you and your family spend your leisure time together?" 4 "Is your family a nuclear family, blended family, or a single-parent family?" 5 "Who establishes your house rules and how are they communicated?" While assessing a family, the nurse should focus on the family and the relationships between the family members. In the interactive process assessment, the nurse tries to understand the interactive relationship between the patient and his or her family. For this assessment, the nurse may ask how the family spends their leisure time. The nurse also may ask the patient if the family is nuclear, blended, or single parent. The nurse can also ask who sets the house rules. This gives a proper assessment of the family structure. Asking about how and when the health-related issues began helps to assess the physical complaint, not the family. Similarly, rating the severity of pain helps to assess the physical complaint.

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 1 "Eat whatever you feel like." 2 "Listen to music that you enjoy." 3 "Sleep more." 4 "Exercise for 15 to 30 minutes every day." 5 "Engage yourself in pleasurable activities.

2 "Listen to music that you enjoy." 4 "Exercise for 15 to 30 minutes every day." 5 "Engage yourself in pleasurable activities. 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.

The nurse is assessing the interactive process of a family. How does the nurse analyze the family's interactive processes? Select all that apply. 1 Assess family transitions. 2 Assess family relationships. 3 Assess the social support of the family. 4 Evaluate the strategies used by the family to cope with stress. 5 Assess family roles.

2 Assess family relationships. 3 Assess the social support of the family. 5 Assess family roles. Assessment of the interactive process of the family involves determining the family relationships and determining whether the family is an extended or a nuclear family. The nurse should assess the social support of the family. The nurse should also assess the family roles such as wage earner, disciplinarian, and problem solver. Family transitions such as death and divorce are indicative of the developmental process in the family. Evaluating coping strategies helps the nurse learn about the family's coping process.

The nurse is caring for a patient who lost his spouse in an accident. Which assessment findings would indicate ineffective coping in the patient? Select all that apply. 1 Accurate response to questions asked 2 Inability to fall asleep at night 3 Inappropriate laughing 4 Lack of interest in food 5 Inability to concentrate

2 Inability to fall asleep at night 3 Inappropriate laughing 4 Lack of interest in food 5 Inability to concentrate Ineffective coping manifests as a change in sleep pattern. The patient may not be able to fall asleep at night. The patient may show inappropriate behavior such as laughing without a reason. The patient may have a change in appetite and may lack interest in food. The patient may not answer the questions properly due to an inability to concentrate. An accurate response to questions asked indicates effective coping.

The nurse is explaining the physiological mechanism underlying the fight-or-flight mechanism to a patient. The nurse says that the medulla oblongata plays a major role in controlling the response of the body to a stressor. What are the functions of medulla oblongata when the body is stressed? Select all that apply. 1 Constricted pupils 2 Increased respiratory rate 3 Increased mental alertness 4 Increased blood pressure 5 Increased blood glucose levels

2 Increased respiratory rate 4 Increased blood pressure Through its connection via the autonomic nervous system, the medulla oblongata is responsible for increasing respiratory rate, heart rate, blood pressure, and respirations as a response to stress. Increased alertness is due to the action of the reticular formation. Increased blood glucose levels occur due to the action of the pituitary. Dilated, not constricted, pupils are a response to stress.

The nurse is teaching a group of students about different coping mechanisms. What is true about ego-defense mechanisms? Select all that apply. 1 They can lead to mania in a person. 2 They are used by people unconsciously. 3 They can lead to major depression in a person. 4 They usually do not lead to psychiatric disorders. 5 They offer psychological protection from a stressful event.

2 They are used by people unconsciously. 4 They usually do not lead to psychiatric disorders. 5 They offer psychological protection from a stressful event. Ego-defense mechanisms are one of the coping mechanisms people use unconsciously. Psychiatric disorders usually do not occur because of ego-defense mechanisms. The defense mechanisms regulate emotional distress and help a person cope with stress indirectly. They offer psychological protection from a stressful event. They do not result in mania or depression in the patient.

Diane is a hospice nurse who is caring for the Robinson family. This family is providing end-of-life care for their grandmother, who has terminal breast cancer. When Diane visits the home 3 times a week, she focuses on symptom management for the grandmother and assists the family with coping skills. Of what is Diane's approach an example? 1 Family as context 2 Family as patient 3 Family as system 4 Family as structure

2 Family as patient When the family as patient is the approach, family processes and relationships (e.g., parenting or family caregiving) are the primary focuses of nursing care. The family as a context approach focuses primarily on an individual member, whereas the family as a system is caring for the family as context plus the family as patient. Family structure is an attribute of families and is based on complex relationships of the family members.

A patient is in the terminal stages of cancer. The nurse learns that the patient's caregiver is extremely stressed and has not been able to take time for a personal life. How can the nurse provide relief to the caregiver? 1 Ask the caregiver to withhold caregiving activities. 2 Help the caregiver set a regular time for respite. 3 Explain the need to focus more on the patient now and less on the caregiver's personal life. 4 Encourage the caregiver by praising his or her actions.

2 Help the caregiver set a regular time for respite. The nurse may provide relief to the caregiver without compromising the patient's care by helping him or her set a regular time for rest and personal time. Withholding care would hamper the patient's situation. Even though the patient needs the caregiver's help, the caregiver's personal life is also important. Expressing appreciation about the caregiver's work is nice, but it is not necessarily helpful in providing relief to the caregiver.

The nurse is explaining family structure to a group of nursing students. Which type of family structures need to be modified? Select all that apply. 1 Open structure 2 Very rigid structure 3 Blended family 4 Extremely open structure 5 Adaptable family structure

2 Very rigid structure 4 Extremely open structure A very rigid structure dictates the ability of one family member to do a task. The family faces difficulty when the member is unable to do the specified task. Extremely open structure may lead to inconsistent behavior patterns, which can confuse the family members. An open structure can promote healthy family relationships, because the family can adjust to sudden changes. The adaptable family structure makes it easy for family members to adapt during a crisis or sudden changes and still maintain healthy relationships. A blended family is not a type of family structure.

Which event in the patient's life would be considered stress occurring due to a maturational factor? 1 Adjusting to an acute illness 2 Transferring to a job in a new location 3 A changing family structure because of divorce 4 The uncertainty associated with treatment methods

3 A changing family structure because of divorce There are numerous factors affecting the individual's life span. Maturational factors affect the mood of an individual and vary according to the life stage. Therefore, the changing of family structure because of divorce is a maturational factor producing stress in an individual. Situational stress arises from personal or family health changes or job relocation. These factors include adjusting to illness, transferring a job to a new location, and uncertainty associated with treatment methods.

A head nurse is teaching the physiology of fight-or-flight responses to student nurses. Which system is responsible for these phenomena? 1 Renin-angiotensin system 2 Respiratory system 3 Sympathetic nervous system 4 Parasympathetic nervous system

3 Sympathetic nervous system 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.

What is the most important nursing intervention that the nurse should provide to a patient who is diagnosed with ineffective coping related to improper nutrition? 1 Teaching the patient about dietary guidelines 2 Encouraging the patient to take a short afternoon nap 3 Using an active listening approach when talking with the patient 4 Encouraging the patient to contact a friend and take a walk every day

3 Using an active listening approach when talking with the patient For ineffective coping, it is most important for the nurse to use an active listening approach when talking with a patient about improper nutrition. The nurse can teach a patient with imbalanced nutrition who is not experiencing ineffective coping about dietary guidelines. The nurse encourages the patient diagnosed with fatigue to contact a friend to take a daily walk, and to take a short nap in the afternoon.

The nurse is caring for a 70-year-old patient who lives with her children and grandchildren in an extended family. The patient is suffering from chronic bronchitis and does not want to be admitted to the hospital. The family has decided to take care of her at home. The patient's 35-year-old daughter takes care of the patient. What questions should the nurse ask to assess the coping process of the family? Select all that apply. 1 "How did your family solve their previous problems?" 2 "How does your family celebrate different festivals?" 3 "Does your family give equal importance to all members?" 4 "How does your family solve financial problems?" 5 "Do your family members suffer from any addictions?"

1 "How did your family solve their previous problems?" 4 "How does your family solve financial problems?" 5 "Do your family members suffer from any addictions?" Questions about the problem-solving skills of the family help the nurse to determine the best coping strategies. The nurse needs to ask about any past financial problems and how the family dealt with them. This information helps the nurse to assess the family's coping abilities. Similarly, asking about the family's addiction history may help the nurse learn how the family handles crises. Asking about festival celebrations and the relative importance of family members speaks to the family's cultural background and beliefs, but does not help the nurse determine the family's ability to cope with crises.

What are the different stages of the general adaptation syndrome (GAS)? Select all that apply. 1 Alarm reaction 2 Resistance 3 Appraisal 4 Crisis 5 Exhaustion

1. Alarm reaction 2. Resistance 5. Exhaustion 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.

A family includes a mother, stepfather, two teenage biological daughters of the mother, and a biological daughter of the father. Of what type of family is this an example? 1 A nuclear family 2 A blended family 3 An extended family 4 An alternative family

2 A blended family Blended families result when two people who have children from a previous marriage or relationship marry.

A patient newly diagnosed with colon cancer has withdrawn from family members. Which strategy should the nurse use to assist the patient at this time? 1 Obtain a prescription for a psychiatric evaluation. 2 Encourage the patient to identify fears and verbalize feelings. 3 Allow the patient to remain withdrawn to avoid drawing attention to this behavior. 4 Explain to the patient that newer treatments permit many people to survive colon cancer.

2 Encourage the patient to identify fears and verbalize feelings. The nurse recognizes that the patient could be expressing feelings of grief. The nurse should encourage the patient to verbalize feelings and identify fears. This would help the patient to move through the phases of the grief process. The patient does not need a psychiatric evaluation, as this is a normal grief process and not a psychiatric disorder. The patient should not be left alone because the patient needs support to cope with the illness. Explaining newer treatment options may not affect the grief process.

Which nursing intervention is important for the well-being of a cancer patient and family members who all may be in distress?

2 Encouraging honest communication During the period of cancer and treatment, patients and family members will experience severe stressful events that cause distress. Because of this distress, patients may try to hide their thoughts and concerns related to the illness. Therefore, the nurse encourages honest communication, which promotes the well-being of the patient and family. The nurse provides assistance in daily living activities for severely ill and older patients to promote their functional well-being. However, such assistance does not help to relieve distress. The nurse encourages healthy lifestyle behaviors to prevent the incidence of secondary cancer or the occurrence of further damage. It does not relieve the family's distress. The nurse includes the patient's cultural practices in the care plan to provide culturally competent and congruent care, not to relieve the family's distress.

A patient is experiencing chronic stress. Which gland in the patient's body will initiate the general adaptation syndrome (GAS)? 1 Parotid gland 2 Pituitary gland 3 Pineal gland 4 Adrenal gland

2 Pituitary gland 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.

The nurse is teaching the parents of a school-aged child about the risks of physical and sexual abuse and methods necessary to educate the child about them. Which level of Maslow's hierarchy of needs is the nurse addressing? 1 Self-esteem 2 Safety and security 3 Love and belonging 4 Physiological needs

2 Safety and security The nurse is instructing the parents to teach the child about physical and sexual abuse to ensure the child's physical and psychological safety. Therefore, the nurse is addressing the safety and security level of Maslow's hierarchy of needs. The nurse addresses the child's need to feel love and belonging when instructing the parents to behave politely and provide protection. The nurse addresses the physiological needs of Maslow's hierarchy when instructing the parents to provide proper nutrition and shelter for their child. The nurse addresses self-esteem when patients are undergoing major psychological setbacks in life or are depressed.

Which environmental issue is a hindrance to activity and exercise? 1 Hormonal changes and increased osteoclastic activity with increasing age 2 Work sites reluctant in motivating employees for physical fitness regimens 3 A patient's decisions to change his or her behavior to include a daily exercise routine 4 A patient's knowledge, values, and beliefs about exercise in relation to health

2 Work sites reluctant in motivating employees for physical fitness regimens Activity and exercise promotion (or lack thereof) at work sites is an environmental factor that affects a patient's ability to exercise. Hormonal changes and increased osteoclastic activity with increasing age are developmental factors that affects activity and exercise. A patient's decision to change his or her behavior to include a daily exercise routine and the patient's knowledge, values, and beliefs about exercise in relation to health are behavioral factors that influence activity and exercise.

The nurse performs a job assessment of a patient who is extremely stressed. Which questions should the nurse ask while doing the assessment? Select all that apply. 1 "Do you have pets at home?" 2 "Do you get irritated frequently?" 3 "Could you please describe your work?" 4 "How much time do you spend for exercise?" 5 "Has there been any change in sleep pattern recently?"

2 "Do you get irritated frequently?" 3 "Could you please describe your work?" 5 "Has there been any change in sleep pattern recently?" During the job assessment, the nurse should ask about the patient's increase in irritability or nervousness. Such behavior may be a sign of stress at the workplace. The nurse should be aware of the nature of work of the patient. Stress at the workplace can interfere with sleeping and eating patterns. The nurse should gather information about this as well while doing the job assessment. Asking about pets and exercise duration is irrelevant while doing job assessment. These questions are related to assessment of lifestyle.

The nurse is assessing a patient who is demonstrating symptoms of severe stress. The nurse interviews the patient to learn whether the patient is using any maladaptive coping skills to reduce stress. Which questions should the nurse ask? Select all that apply. 1 "What do you think of when you are awake?" 2 "Have you started sleeping excessively?" 3 "Do you have high blood pressure?" 4 "Do you live alone or with family?" 5 "Have you started smoking or drinking?"

2 "Have you started sleeping excessively?" 4 "Do you live alone or with family?" 5 "Have you started smoking or drinking?" Use of maladaptive coping skills can be assessed by finding out whether the patient has started sleeping, eating, or drinking excessively, or has started staying alone. These behaviors indicate that the patient is not coping well. Asking what the patient is thinking when awake could be helpful to find out the patient's appraisal of stress. Asking questions about high blood pressure or the patient's medications gives the nurse an idea about the patient's adherence to healthy practices.

The nurse is assessing a family. Which question should the nurse include to assess the coping process of the family? 1 "When somebody is ill in the house, who is the caregiver?" 2 "What do you do as a family for relaxation and leisure?" 3 "How does your family solve the problems you face?" 4 "Who forms the house rules and how are they communicated?"

3 "How does your family solve the problems you face?" Asking how the family solves their problems helps to understand the coping process of the family. Asking whom the caregiver is helps to assess the health process. Asking what the family does for relaxation helps to assess the interactive process. Asking who forms the house rules helps to assess the interactive process of the family

A nursing student is learning about the different types of families. What could be an example of a blended family? 1 A woman raising her son alone after her husband's death 2 A homosexual couple raising a daughter on their own 3 A woman bringing her adopted son into a new family when she remarries 4 A grandfather taking care of his granddaughter after his daughter's demise

3 A woman bringing her adopted son into a new family when she remarries A blended family is formed when parents bring children who may or may not be biologically related to them into a new, joint-living situation. Hence, a woman bringing her adopted son into a new family when she remarries is an example of blended family. A woman raising her son alone after her husband's death is an example of single-parent family. A homosexual couple raising a daughter on their own is an example of an alternative family. A grandfather taking care of his granddaughter after his daughter's demise is also an example of an alternative family.

By what is a family's access to adequate health care, opportunity for education, sound nutrition, and decreased stress affected? 1 Development 2 Family function 3 Family structure 4 Economic stability

4 Economic stability The ability of families to meet health care, educational, and basic needs is often affected by the economic resources of the family.

The nurse is caring for a family with a series of health-related issues. How does the nurse evaluate the health process of the family? 1 Assess the family's values. 2 Look for family transitions. 3 Identify family resistance resources 4 Identify possible family illness stressors.

4 Identify possible family illness stressors. Identification of family illness stressors is helpful in evaluating the health processes of the family. Assessment of family values helps identify the family's integrity processes. Studying family transitions helps assess the family's developmental process. Identifying family resistance resources is helpful in assessing the coping process of the family.

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. What does the supervising nurse recognize? Nurses who feel stress usually pass the stress along to their patients. 2 A nurse who is stressed is ineffective as a nurse and should not be working. 3 Nurses who talk about feeling stress are unprofessional and should calm down. 4 Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.

4 Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring. Nurses frequently experience stress because of the rapid changes in health care technology, organizational restructuring, and when situations appear to be out of their personal control.

A patient who has been using relaxation wants a better response. The nurse recommends the addition of biofeedback. Which is an expected outcome related to using this additional modality? 1 To eat less food 2 To control diabetes 3 To live longer with acquired immunodeficiency syndrome (AIDS) 4 To learn how to control some autonomic nervous system responses

4 To learn how to control some autonomic nervous system responses Biofeedback is a mind-body technique that teaches self-regulation and voluntary control over specific physiological responses, including autonomic nervous system responses. Eating less food, controlling diabetes, and living longer with acquired immunodeficiency syndrome (AIDS) are not outcomes of biofeedback.

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?

4. "I have been going to a support group that I find is very good and I am resuming my studies."

Maturational factors

stressors vary with life stages adolescents, midlife, old age

How do you reduce caregiver role strain?

Identify support groups to obtain additional help in providing care will reduce caregiver role strain. A schedule to provide groceries and meals to the caregiver and the patient can reduce the caregiver's burden. Setting alternate schedules to help the primary caregiver can give the caregiver some time to rest. Community resources can be of help in providing transportation or respite care and should be identified. The primary caregiver should not function continuously and family members should alternate schedules to help the primary caregiver.

The nurse is teaching a family whose caretakers are in the "sandwich generation" of taking care of older parents while raising adolescents and adopting some young children. Which instruction does the nurse recommend for the further development of family status? Select all that apply. 1 "Take up the parental roles." 2 "Develop intimate peer relationships." 3 "Adjust the marital system to make space for children." 4 "Begin a shift toward concern for the older generation." 5 "Realign relationships as parenting and grandparenting roles."

1 "Take up the parental roles." 3 "Adjust the marital system to make space for children." 5 "Realign relationships as parenting and grandparenting roles." The nurse teaches the family about the changes that are required to promote its future development. The nurse will insist that the parents accept their parenting roles to find a more comfortable and balanced way of living. The nurse requests changes in the marital system that will promote space for the children. The nurse also will teach about the realignment of relationships that include parenting and grandparenting. This promotes growth and a deeper sense of connectedness with all members of the family. The nurse should instruct an unattached young adult to develop intimate peer relationships to promote high energy in day-to-day activities. In a family with adolescents, the nurse teaches about a shift toward concerns for older adults. This is because the "sandwich generation" is more prone to stressors due to taking a dual-caretaker role in taking care of both children and aging parents.

A patient with prostate cancer is in the terminal stage of the disease and wishes to have home care. How can the nurse help the family achieve optimal end-of-life care? Select all that apply. 1 Advise the family members to apply for hospice care. 2 Provide grief support measures. 3 Motivate family members to consider euthanasia. 4 Leave the patient alone at the time of death. 5 Educate the family about the dying process.

1 Advise the family members to apply for hospice care. 2 Provide grief support measures. 5 Educate the family about the dying process. The nurse should help the family members obtain hospice care for the last days of the patient's life. Providing grief support to the family helps them to cope better with the anticipated loss. Educating the family members about the dying process helps them become mentally prepared for the loss. Euthanasia is not an ethically acceptable part of end-of-life care and is not legal in many countries. The nurse should arrange to provide privacy for the patient at the time of death but should not leave the patient alone.

The nurse is attending to a 46-year-old female patient who suffers from chronic stress due to conflicts with her husband. Which physiological problems is the patient predisposed to? Select all that apply. 1 Hypertension 2 Depression 3 Sleep deprivation 4 Bipolar disorder 5 Chronic fatigue syndrome

1 Hypertension 2 Depression 3 Sleep deprivation 5 Chronic fatigue syndrome When the stress response is chronically activated, the heart rate, blood pressure, and cardiac output are also chronically raised, which cause excessive wear and tear on the body. It can further lead to hypertension, depression, sleep deprivation and chronic fatigue. The chronic elevation of the heart rate, blood pressure, and cardiac output do not cause bipolar disorder, which is a psychiatric disorder.

A patient is diagnosed with a chronic illness. How should the nurse counsel the patient and the family members to encourage coping? Select all that apply. 1 Counsel them so that they can accept the change in health status. 2 Provide the patient emotional and psychological support. 3 Understand that a patient and family who need nursing counseling are psychologically disabled. 4 Assist the patient in managing stress and developing interpersonal relationships. 5 Understand that a patient requiring nursing counseling has normal adjustment difficulties and may be upset or frustrated.

1 Counsel them so that they can accept the change in health status. 2 Provide the patient emotional and psychological support. 4 Assist the patient in managing stress and developing interpersonal relationships. 5 Understand that a patient requiring nursing counseling has normal adjustment difficulties and may be upset or frustrated. During counseling, the nurse must counsel the patient to accept the change in health status. Once the change has been accepted, the patient can start taking care of himself or herself. Counseling involves emotional, psychological, intellectual, and spiritual support, not just emotional and psychological support. Counseling helps in managing stress and developing interpersonal relationships. A patient and family who need nursing counseling have normal adjustment difficulties and may be upset or frustrated, but they are not always psychologically disabled.

While assessing a patient and her family, the nurse observes that the patient's daughter is stressed with her multiple responsibilities of caring for her mother, her own family, and doing her job. What advice should the nurse give her to reduce this stress? Select all that apply. 1 Explore additional resources such as respite care. 2 Quit her job and take care of her mother. 3 Accept her limits and ask for additional help. 4 Continue doing things the way she has been. 5 Take time off or ask her boss for a more flexible work schedule.

1 Explore additional resources such as respite care. 3 Accept her limits and ask for additional help. 5 Take time off or ask her boss for a more flexible work schedule. Individuals who care for their children and their aged parents belong to the sandwich generation. The patient's daughter in this case has to manage multiple responsibilities, and it takes a toll on her. Often in such situations, the caregiver feels that she can handle it all and doesn't need any help. The nurse should tell the daughter to access additional resources such as respite care and additional help from family members. The nurse should tell the daughter to accept her limitations. The nurse can also suggest that she take time off work or ask for a more flexible work schedule. Advising her to leave the job or continue managing as she has been is not good advice.

The nurse is learning about the types of families. Which types of families would the nurse classify as crisis-proof families? Select all that apply. 1 Families with a flexible structure 2 Families who exhibit control over their environment 3 Families lacking control over their environment 4 Families who accept help from outside the family system 5 Families with a rigid structure without any adaptability

1 Families with a flexible structure 2 Families who exhibit control over their environment 4 Families who accept help from outside the family system A crisis-proof family, also known as an effective family, has a flexible structure and allows adaptable performance of tasks. This family has control over their environment and influences the immediate environment of home, neighborhood, and school. They accept help from outside of the family system. Families lacking control over their environment or having a rigid structure without any adaptability are ineffective and crisis-prone.

The nurse is taking care of a terminally ill patient in a cancer unit. The patient has a wife and two children. Which healthy family attributes would be especially helpful to the family because they take care of the patient at the terminal stage? Select all that apply. 1 Hardiness 2 Friendship 3 Resiliency 4 Compatibility 5 Privacy

1 Hardiness 3 Resiliency Hardiness and resiliency are the two factors that contribute to long-term health. Family hardiness contributes to a family's resiliency in the face of illness. Hardiness and resiliency foster a sense of control that allow an active rather than passive orientation in adapting to stressful events. Friendship, compatibility, and privacy are not the primary factors of a healthy family.

While interviewing a patient who is experiencing a developmental crisis, the nurse is assessing the patient's perception of stressors. Which question should the nurse ask during the assessment? 1 "Do you live alone or with others?" 2 "Do you have high blood pressure?" 3 "Have you started drinking or smoking?" 4 "What is bothering you most right now?"

4 "What is bothering you most right now?" Stressors are tension-producing stimuli. The nurse assesses the patient's perception of the stressor when there is a problem that the patient cannot solve. Therefore, the nurse asks the patient about what aspects, if any, are bothering him or her. To determine the patient's coping style and method, the nurse asks the patient about living conditions in order to assess situational support. The nurse asks the patient about blood pressure control to determine the patient's adherence to health care practices. The nurse also asks the patient about habits such as drinking and smoking to determine the coping strategies used during stress.

The nurse plans care for a 16-year-old male taking into consideration the stressors experienced most commonly by adolescents. What should the nurse consider? 1 A loss of autonomy caused by health problems 2 Physical appearance, family, friends, and school 3 Self-esteem issues, changing family structure 4 A search for identity with peer groups and separation from family

4 A search for identity with peer groups and separation from family During adolescence, the teenager is searching for his or her identity and usually identifies more with peers and less with the family group. The loss of autonomy caused by health problems applies to the older adult. Stressors related to physical appearance, family, friends, and school apply to children. Self-esteem issues and a changing family structure apply to preadolescents.

A family consists of a mother and her 3-year-old daughter. This is an example of which kind of family? 1 A nuclear family 2 A blended family 3 An extended family 4 A single-parent family

4 A single-parent family A single-parent family is one in which one parent takes care of the child or children. A nuclear family consists of the husband, wife, and their children. A blended family is formed when parents bring children from previous relationships into a new, joint living setting. An extended family includes a nuclear family and relatives.

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? 1 Refer the patient to a psychiatrist immediately. 2 Show the laboratory reports to the patient. 3 Explain the similarity between stomach infections and colon cancer. 4 Allow the patient to use denial as a coping mechanism.

4 Allow the patient to use denial as a coping mechanism. 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.

When teaching the patient progressive muscle relaxation techniques, the nurse asks the patient to take deep breaths. What would be the next instruction after breathing deeply? 1 Sit in a comfortable position. 2 Close your eyes and try to relax. 3 Relax all the muscle groups at one time. 4 Alternately tighten and relax specific muscle groups.

4 Alternately tighten and relax specific muscle groups. Anxiety causes muscle tension and progressive muscle relaxation is a technique used to relax the muscle groups. A person usually achieves a relaxed state after deep chest breathing. Once this is done, the patient is then asked to alternately tighten and relax specific muscle groups. The instructions, "sit in a comfortable position" and "close your eyes," are given before asking the patient to do deep breathing. This helps to relax the body. Not all the muscle groups should be worked on at the same time.

Resiliency

The ability of the family to cope with the unexpected.