PrepU chapter 42 Stress and Adaptation
A nursing instructor is discussing burnout with a group of graduating nursing students. Which statement might lead the instructor to believe that the particular student has not developed needed coping mechanisms for nursing practice? "I know that I am not prepared to take on a leadership role right now since I am new and need to learn." "There's so much to learn. I have to find a way to balance these new challenges with settling back into my regular life." "I can handle absolutely any situation now. You teachers have trained us well." "I hope I get a good preceptor. I know that will help me get used to this transition."
"I can handle absolutely any situation now. You teachers have trained us well." Anxiety over the uncertainty of succeeding in a new life role is to be expected. Recognizing that this will be a stressor is an important step in positive coping and adaptation. Erroneously thinking that this will not be a challenge is a form of denial, may lead to role conflict and disillusionment, and later can become a burnout situation.
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 get so tired from working long hours at the site." "I guess the smoke in the air brought out my mental addiction to cigarettes." "I can't seem to calm down. I keep seeing those faces and hearing their words every time I close my eyes." "I need to get back to work here at home. That will get me back into a routine."
"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. Reference:
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? "It's so hard to get them into a routine after summer break. I go through this every year with all my kids." "I am bringing him to the orientation so he can meet his teacher and some classmates." "I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." "We've all been talking to him about what school will be like; his brother had the same teacher and really liked her."
"I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." Each developmental stage includes tasks that must be achieved so that normal growth and development can occur, but change can be stressful. In a school-age child, starting school and being around strangers can be challenging. One way to counteract the anxiety is to introduce them to others in social situations, and teach acceptable social behaviors, before they start school.
A 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? "It's so hard to get them into a routine after summer break. I go through this every year with all my kids." "We've all been talking to him about what school will be like; his brother had the same teacher and really liked her." "I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." "I am bringing him to the orientation so he can meet his teacher and some classmates."
"I don't know why he is acting like this. He hasn't had anyone to play with but his little brother all summer." Each developmental stage includes tasks that must be achieved so that normal growth and development can occur, but change can be stressful. In a school-age child, starting school and being around strangers can be challenging. One way to counteract the anxiety is to introduce them to others in social situations, and teach acceptable social behaviors, before they start school.
A client presents with a flare of lupus. Which statement made by the client would cause the nurse to suspect a stress reaction? "I have a fever with this flare." "My joints hurt more with this flare." "I just had an infant 3 weeks ago." "My lupus typically flares twice a year."
"I just had a baby 3 weeks ago." 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 presents with a flare of lupus. Which statement made by the client would cause the nurse to suspect a stress reaction? "My joints hurt more with this flare." "I just had an infant 3 weeks ago." "I have a fever with this flare." "My lupus typically flares twice a year."
"I just had an infant 3 weeks ago." The brain-immune connection suggests that changes in body chemistry during periods of stress may trigger an autoimmune (self-attacking) response like those associated with lupus. While having a baby can be positive it is stress both physically and emotionally and could be a stress trigger for the lupus flare. The other options present differences in lupus flare presentation, which is not specific to a stress response.
Which statement made by the client indicates a need for further teaching regarding stress management? "I manage my stress by taking antianxiety medication." "I manage my stress by exercising once a week." "I manage my stress by going out with friends for an occasional drink." "I manage my stress with occasional alcohol and alprazolam."
"I manage my stress with occasional alcohol and alprazolam." Taking alprazolam with alcohol can produce a temporary relaxation; however, this can result in physical impairment and drug dependence. It is appropriate to manage stress with antianxiety medication, as prescribed by a health care provider, and exercise. It is also appropriate to manage stress by socializing, and alcohol use in moderation does not require further teaching.
The client tells the nurse she has never "gotten over" the loss of her husband 2 years ago. The client states she is drinking alcohol to excess every day and has started smoking, saying both help her cope. What is the best response by the nurse? "It may be time for you to consider a comprehensive treatment program." "This is the way you are coping with the stress. Everyone copes in their own way." "You need to decrease your alcohol consumption and stop smoking for your overall health." "As you learn to better cope, you will see a decrease in your need for these substances."
"It may be time for you to consider a comprehensive treatment program." People exhibiting stress and altered coping through substance use or overeating require a comprehensive treatment program to address their coping and adaptation problems.
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. "We have found evidence of drug use, which is very unlike our adolescent." "Our adolescent is sleeping a lot more than usual." "Friends come over frequently to watch television or play video games." "The school counselor is seeing our adolescent once a week to check in and see how things are going in school." "We have tried to discuss the issues so we can find a solution but are met with anger and hostility."
"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." 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: "Can you call my next-door neighbor for me? I'm so worried that my cat, Clancy, won't have any food or water." "I'm so clumsy. I'm surprised it hasn't happened before this." "They must have given me the wrong medication at the drug store. I don't have trouble with my eyesight." "Does this mean I have to stay here in the hospital?"
"They must have given me the wrong medication at the drug store. I don't have trouble with my eyesight." Defense me'chanisms 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.
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: "Does this mean I have to stay here in the hospital?" "They must have given me the wrong medication at the drug store. I don't have trouble with my eyesight." "I'm so clumsy. I'm surprised it hasn't happened before this." "Can you call my next-door neighbor for me? I'm so worried that my cat, Clancy, won't have any food or water."
"They must have given me the wrong medication at the drug store. I don't have trouble with my eyesight." 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.
The nurse is describing the effect of stress on the body to a group of health practitioners. Which statements accurately describe the role of stress on the health and illness of clients? Select all that apply. As the duration, intensity, or number of stressors increases, a person's ability to adapt is lessened. Recovery from illness and return to normal function are compromised by prolonged stress. Stress has a negative impact on a person as he strives to meet basic human needs at each level. People react to stress in a consistent and predictable manner. The health-illness continuum is affected by stress. The effects of stress on a sick or injured person are usually positive.
- As the duration, intensity, or number of stressors increases, a person's ability to adapt is lessened. - Recovery from illness and return to normal function are compromised by prolonged stress. - The health-illness continuum is affected by stress. The health-illness continuum is affected by stress. Health and homeostatic balance are at one extreme of the continuum; exhaustion and death are at the other extreme. Adaptation is compromised as the duration, intensity, and number of stressors increase. Prolonged stress makes it difficult for a person to recover from illness. For a healthy person, stress can be a positive motivator. Everyone reacts to stress in his own way. If a person is ill, stress has a negative impact on the person and their illness
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: 3 years 15 years 7 years 21 years
7 years 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? 32-year-old who has recently been incarcerated 40-year-old who was fired from work last month 54-year-old who is undergoing marital separation 77-year-old whose spouse just died incarcerated bat giam
77-year-old whose spouse just died Death of a spouse ranks as the most stressful life event on The Social Readjustment Rating Scale. The client whose spouse just died is at highest risk for social readjustment concerns.
Which client is experiencing the panic level of anxiety? A client experiences increased alertness and motivated learning. A client loses control and expresses irrational thinking. A client displays a narrow perception field. A client focuses narrowly on specific detail.
A client loses control and expresses irrational thinking. Panic causes the person to lose control and experience dread and terror. The resulting disorganized state is characterized by increased physical activity, distorted perception of events, and loss of rational thought. Increased alertness and motivated learning describes mild anxiety. Narrowing the focus on a specific detail describes moderate anxiety. A client displaying a narrow perception field shows characteristics of severe anxiety.
Which client is experiencing the panic level of anxiety? A client loses control and expresses irrational thinking. A client focuses narrowly on specific detail. A client displays a narrow perception field. A client experiences increased alertness and motivated learning.
A client loses control and expresses irrational thinking. 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 patient displaying a narrow perception field is a characteristic of severe anxiety
Which response to stressors results from the activation of the local adaptation syndrome (LAS)? A girl quickly withdraws her hand from a stream of hot tap water. A woman's impending job interview has prompted the activation of her fight-or-flight response. A man is experiencing moderate anxiety before meeting with an important client. A man has a sudden urge for a bowel movement before undergoing thoracentesis.
A girl quickly withdraws her hand from a stream of hot tap water. The local adaptation syndrome (LAS) is a localized response of the body to stress. It involves only a specific body part (such as a tissue or organ) instead of the whole body. The reflex pain response is a response to physiologic stress that is a component of the local adaptation syndrome (LAS). Psychological anxiety and the activation of the fight-or-flight response are not considered to be manifestations of the local adaptation syndrome. The sudden urge for a bowel movement involves the entire gastrointestinal system and not a tissue or organ.
Which client is handling stress by using the defense mechanism termed displacement? A man with symptoms of prostate cancer refuses to see a doctor. An athlete who doesn't make the team concentrates on body-building instead. A mother who is angry at her husband shouts at the kids to "keep quiet." A man who forgets his medication blames his wife for putting it away.
A mother who is angry at her husband shouts at the kids to "keep quiet." Displacement is described as transferring (displacing) an emotional reaction from one object or person to another object or person, as with the mother who is angry at her husband and shouts at the kids to "keep quiet." The athlete who doesn't make a team and instead concentrates on body-building represents the defense mechanism of compensation. A man with symptoms of prostate cancer refusing to see a doctor is displaying the defense mechanism of denial. A man who forgets his medication and blames his wife for putting it way is demonstrating the defense mechanism of projection.
Upon arrival to the emergency room, the mother of a client involved in a motor vehicle accident becomes upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breathe. What is the mother likely experiencing? Severe anxiety A panic attack Moderate anxiety Mild anxiety
A panic attack Panic causes the person to lose control and experience dread and terror. Panic is characterized by a disorganized state, increased physical activity, difficulty communicating, agitation, trembling, dyspnea, palpitations, a choking sensation, and sensations of chest pressure or pain. Severe anxiety creates a narrow focus on specific detail; moderate anxiety leads to a focus on immediate concerns; and mild anxiety is often present in day-to-day living. It increases alertness and perceptual fields.
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? Guided imagery Anticipatory guidance Normalization Relaxation
Anticipatory guidance 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 Guided imagery Biofeedback Meditation
Anticipatory guidance /an-ˈti-sə-pə-ˌtȯr-ē/ 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: Sleep Deprivation related to change in living arrangements. Disturbed Thought Processes related to increased scholastic workload. Impaired Skin Integrity related to psoriasis. Anxiety related to stress of achievement in school.
Anxiety related to stress of achievement in school. 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? Place the client in the semi-Fowler position and have the client explain what happened to cause this reaction Attempt to calm the client and administer oxygen Administer an antianxiety medication and report to the health care provider Offer a distraction by asking about the client's family or interests and continue to monitor vitals
Attempt to calm the client and administer oxygen 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.
When nurses become overwhelmed in their jobs and develop symptoms of anxiety and stress, they are experiencing what condition? Adaptation syndrome Culture shock Burnout Ineffective coping
Burnout The feeling of being overwhelmed in one's job and development of symptoms of anxiety and stress is referred to as burnout. Burnout can be compared with the exhaustion stage of anxiety and is characterized by a wide range of behaviors.
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 confront those responsible for additional stress. Client will identify support mechanisms to help with stress. Client will demonstrate appropriate coping strategies. Client will identify one or two stressors to eliminate. Client will eliminate all stress in a period of 6 months.
Client will demonstrate appropriate coping strategies. Client will identify support mechanisms to help with stress. Client will identify one or two stressors to eliminate. 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.
A nurse has accepted numerous overtime shifts over the past several months. Which behavior indicates the nurse is experiencing burnout? Taking smoke breaks during the shift Dozing at the desk during downtime Telling the manager staffing numbers are unsafe Beginning a rigorous exercise program
Dozing at the desk during downtime 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? Safety and security needs Self-esteem needs Physiologic needs Love and belonging needs
Love and belonging needs 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.
An older adult client assumed care of a parent with dementia and had to decrease work hours to stay and home and care for the parent. Due to the decrease in hours, it is difficult to meet financial obligations. What actions by the nurse would be appropriate for this client? Select all that apply. Have the client make an appointment with social services to assist with financial resources. Make a referral to the case manager to determine available resources. Encourage the client to find another family member to care for the parent. Inform the client that the parent needs to go into a long-term care facility. Suggest the client join a support group for caregivers of parents with dementia.
Make a referral to the case manager to determine available resources. Have the client make an appointment with social services to assist with financial resources. Suggest the client join a support group for caregivers of parents with dementia. Caring for a family member with dementia can be a very stressful life event but can also be rewarding. Determining what available resources can be used, such as social, financial, and physical assistance; is an appropriate intervention that can make life much easier. Support groups are also a positive intervention and the client may find resources available through that avenue. It is not the nurse's role to have the client ask another family member to care for the parent or suggest that they would be better off in a long-term care facility.
A school nurse is talking with an adolescent related to school and home situations. The adolescent 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 adolescent is experiencing which disorder? Obsessive-compulsive disorder (OCD) Moderate anxiety response Psychological alarm reaction Panic attacks
Moderate anxiety response 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 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 keep the home environment noise free tense and relax muscle groups systematically perform meditation to relax
Seek assistance from family and friends. 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.
A client asks about general adaptation syndrome (GAS). Which details provided by the nurse are correct? Select all that apply. It can be a response to physiologic or psychological stress. GAS requires psychological hospitalization for treatment. There are three stages to GAS. The resistance stage usually lasts for less than a day. The alarm stage of GAS can last from minutes to hours.
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. 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.
The nurse at the student health center is seeing a group of nursing students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What does guided imagery involve? the use of progressive tensing and relaxing of muscles to release tension in each muscle group using positive self-image to increase and intensify physical workouts in the gym, which decreases stress the mindful use of a word, phrase, or visual image that allows oneself to be distracted and temporarily escape from stressful situations the use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations
The mindful use of a word, phrase, or visual image which allows one's self to be distracted and temporarily escape from stressful situations.
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. This behavior is known as repression. This behavior is sublimation. This behavior is reaction formation.
This behavior is called regression. 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 discussing stressors with the nurse and is describing how she feels better when she takes a brisk walk. The client's action is an example of: appraisal. adaptation. secondary appraisal. buffering.
adaptation. 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? exhaustion pathological resistance alarm
alarm 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 client experiencing a stressor. Pathological response is not a phase of GAS.
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? exercise alcohol use cocaine use projection
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 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? depression cardiac dysrhythmias elevated potassium levels elevated glucose levels
elevated glucose levels 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. detrimental /detrəˈmen(t)l/ bat loi
The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. At what stage of stress is the client? alarm stage resistance stage exhaustion stage secondary stage
exhaustion stage The client is in the exhaustion stage, when one or more adaptive/resistive mechanisms can no longer protect the person experiencing a stressor; this results in exhaustion. The effects of stress-related neurohormones suppress the immune system, and the body is open to various ailments. In the alarm stage, the person is prepared for a fight-or-flight response. In the resistance stage, the client's body is returned to the homeostasis state. Consequently, one or more organs or physiologic processes may eventually lead to increased vulnerability to stress-related disorders, or progression to the stage of exhaustion. The secondary stage is not a stage related to stress.
The nurse is providing care to the following clients. The nurse assesses the client exhibiting maladaptive behavior as the client who is: overweight, consumes 1,600 calories/day, and exercises 30 minutes a day 5 times each week. participating in a smoking cessation program after her father was diagnosed with lung cancer. 84 years old with multiple health problems and requesting to see an end-of-life care specialist. experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live."
experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live." The client who has a terminal illness and makes the above statement is in denial. The other clients exhibit appropriate behaviors for their situations.
The nurse is providing care to the following clients. The nurse assesses the client exhibiting maladaptive behavior as the client who is: participating in a smoking cessation program after her father was diagnosed with lung cancer. 84 years old with multiple health problems and requesting to see an end-of-life care specialist. experiencing a terminal illness and states, "If I pray to God and go to church each week, I will live." overweight, consumes 1,600 calories/day, and exercises 30 minutes a day 5 times each week.
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? blaming others for the sexual abuse behaving like a young child having no memory of the sexual abuse refusing to believe that the sexual abuse occurred
having no memory of the sexual abuse 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.
The nurse is reviewing the care of a client who is experiencing the exhaustion stage. Which sign or symptom does the nurse expect to find? lower-than-normal range sodium levels lower-than-normal magnesium levels higher-than-normal iron levels higher-than-normal blood glucose levels
higher than normal blood glucose levels The higher than normal blood glucose level occurs in a response to the prolong level of cortical, which is produced to inhibit insulin in order to meet the increased need for energy when a person is stressed.
A client's body uses physiologic mechanisms from within to respond to internal changes and maintain an essential balance. This process is known as: stress. homeostasis. self-regulation. fight-or-flight response.
homeostasis. Explanation: To maintain health, the body's internal environment must remain in a balanced state. Various physiologic mechanisms within the body respond to internal changes to maintain relative constancy in the internal environment, which is referred to as homeostasis. Stress is a condition in which the human system responds to changes in its normal balanced state, and results from a change in one's internal or external environment that is perceived as a challenge, a threat, or a danger. Self-regulation is a mechanism that helps to maintain homeostasis. Fight-or-flight response occurs during the alarm reaction stage of the general adaptation syndrome. Reference:
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? visiting a psychic buying a new car deciding to no longer attend his family reunion picnic joining the local garden club
joining the local garden club While each individual's response to stress is different, we know that coping mechanisms can be healthy or unhealthy. Buying things, isolating oneself socially, or looking for support in questionable places can be ways of coping but are not necessarily healthy. Joining a social group of people with similar interests can provide distraction and serve as an outlet for feelings of sadness and loss.
A client is experiencing a stress response each time the family visits the room. What nursing intervention is most appropriate? do not intervene and allow the client to work out the family issue limit the family visits to once daily explain that family visits and support are important tell the family they are causing too much stress
limit the family visits to once daily 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.
A client is experiencing a stress response each time the family visits the room. What nursing intervention is most appropriate? do not intervene and allow the client to work out the family issue tell the family they are causing too much stress explain that family visits and support are important limit the family visits to once daily
limit the family visits to once daily 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.
A nurse is teaching a client regarding effective coping strategies. Which teaching will the nurse include? Select all that apply. turning to a higher power avoiding crowds and social activity making an appointment with a counselor practicing yoga and relaxation sleeping during the day writing a list of pros and cons
making an appointment with a counselor writing a list of pros and cons practicing yoga and relaxation turning to a higher power 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 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? cultural beneficial maladaptive generational
maladaptive Substance use, beginning or increasing smoking, oversleeping, overeating, undereating, oversleeping, overexercising, excessive daydreaming, and fantasizing are various ways that individuals with the inability to cope with stress successfully deal with stress.
A recently retired client reports that he has been able to sleep only 3 hours a night and that he has nausea, frequent urination, and headaches. He is asking the nurse what she thinks is going on with his health. What is the most probable cause of his symptoms? herniated lumbar disc obstructive sleep apnea moderate anxiety type 2 diabetes
moderate anxiety 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.
A nurse is providing care for client who experienced a stroke. Which nursing intervention reflects the tertiary level of prevention? assess blood pressure every 4 hours discuss family history of hypertension provide care transition at discharge for speech therapy conduct mental status assessment every 2 hours
provide care transition at discharge for speech therapy 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? denial suppression repression rationalization
rationalization 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.
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? rationalization reaction formation repression regression
repression 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? primary stage alarm stage exhaustion stage resistance stage
resistance stage The client is in the resistance stage, where the body has returned to the homeostasis state. The mind or brain is normal again, so the incident does not affect the client anymore. In the alarm stage, the stimulating neurotransmitters and neurohormones prepare the client for a fight-or-flight response. When one or more adaptive/resistive mechanisms can no longer protect the client experiencing a stressor, exhaustion occurs. The body loses its capability to fight stress. The primary stage is not related to stages of stress and is applicable for stress prevention.
Which behaviors represent effective coping mechanisms? Select all that apply. sleeping 3 hours a night sleeping 14 hours a night learning relaxation techniques denying responsibility for a DUI conviction taking a vacation setting limits with family members who upset you
setting limits with family members who upset you learning relaxation techniques taking a vacation 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: panic. moderate. severe. mild.
severe. 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? explain that the physical symptoms are all in their head Immediately administer an antiemetic. contact the primary care provider sit with the client and ask them about their feelings
sit with the client and ask them about their feelings 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? eating habits personal hygiene social support economic status
social support Explanation: A person's response to stressors depends on social support, intensity of the stressor, number of stressors, duration of the stressor, physical health status, life experiences, coping strategies, personal beliefs, attitudes, and values. A person's response to stressors is independent of education, eating habits, economic status, or personal hygiene.
A client is on a stress management program. She states that she is open to trying a guided meditation class. When helping her get started, a nurse tells her that which of the following is not important? a quiet environment an open attitude soft music a focus of attention
soft music Music may be helpful for some but is not essential for meditation.
A middle-age woman's father has passed away, and her mother requires physical and emotional help due to disabilities. The woman is married and raising two children, along with working full time. All of the factors described are: illnesses. stressors. stimuli. demands.
stressors. Stress is defined as any event or set of events (a stressor) that causes a response. Everyday triggers associated with work or social relationships and uncommon events such as natural disasters, physical trauma, injuries, illnesses, divorce, death of a loved one, or loss of a job are commonly recognized stressors.
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? respiratory system endocrine system parasympathetic nervous system sympathetic nervous system
sympathetic nervous system 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.
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? parasympathetic nervous system endocrine system respiratory system sympathetic nervous system
sympathetic nervous system Explanation: Functions of the sympathetic nervous system under stressful conditions bring about the fight-or-flight response. Sometimes called the rest-and-digest system, the parasympathetic system conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. The endocrine system is the collection of glands that produce hormones that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood. The respiratory system is a series of organs responsible for taking in oxygen and expelling carbon dioxide. The primary organs of the respiratory system are the lungs, which carry out this exchange of gases.
The nurse determines that a client understands instruction regarding progressive relaxation when the client states that the technique requires: tensing and relaxing various muscle groups. using a biofeedback machine. focusing on pleasant images. using a mantra in a relaxed position.
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.
Which emotional clinical manifestations of stress should the nurse anticipate when providing care to an adolescent client? constipation, dry mouth, and excessive sleep withdrawal, depression, and angry outbursts anxiety disorders, flare of acne, and headaches forgetfulness, impaired concentration, and preoccupation
withdrawal, depression, and angry outbursts Withdrawal, depression, and angry outbursts are correct and are examples of emotional signs and symptoms of stress. Constipation, dry mouth, and excessive sleep are examples of physical signs and symptoms of stress. Anxiety disorders, flare of acne, and headaches are examples of stress-related disorders. Forgetfulness, impaired concentration, and preoccupation are examples of cognitive signs and symptoms of 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. assessing the client's response to stress assisting in maintaining a network of social support implementing stress management techniques preventing additional stressors ignoring the stressors
• preventing additional stressors • assessing the client's response to stress • implementing stress management techniques • assisting in maintain a network of social support
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. The mother's cesarean section will impair her ability to hold and bond. Excessive noise and lights can increase cortisol levels in the neonate. Mother's increased cortisol levels lead to increased anxiety and decreased attachment. Stress does not affect the newborn The inability to hold and touch can lead to delay in bonding between mother and infant.
-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.
A client was at home alone when a tornado struck and damaged the structure. What type of crisis does the nurse address in the care of this client? Situational Developmental Maturational Adventitious
Adventitious There are three types of crises: maturational, situational, and adventitious. - Adventitious crises are accidental and unexpected events, resulting in multiple losses and major environmental changes, such as fires, hurricanes, earthquakes, and floods. - Maturational crises occur during developmental events that require role change. - Situational crises occur when a life event disrupts a person's psychological equilibrium, such as loss of a job or loved one. Developmental crisis does not exist.
The nurse is caring for a client who is exhibiting signs of stress. Which cognitive symptom associated with stress does the nurse recognize? difficulty falling asleep impaired concentration lack of interest in sex angry outbursts
Impaired concentration 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 nurse is making a follow-up phone call to a client who reported being raped. The client answers the phone and states, "I don't know what you are talking about. I have never been raped." What action should the nurse take? Offer support, recognizing that the client may be using repression as a defense mechanism. Apologize and end the phone call. Report the statements to the police department. Provide a detailed account of what the client stated when reporting the event.
Offer support, recognizing that the client may be using repression as a defense mechanism. The defense mechanism of repression allows the individual to remove the situation that causes anxiety from his or her consciousness. Give the client support information such as a phone number to a rape intervention hotline or local support chapter. Ending the phone call and reporting the statements to the police without investigating the possible use of repression would be inappropriate. Providing a detailed account of the event per the client's statements may cause increased stress or anxiety, which would be better handled in a face-to-face situation.
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? Reflex pain response Exhaustion Alarm reaction Resistance
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 providing a seminar about stress. Which information should the nurse include? Select all that apply. People can have a positive or negative reaction to stress. Adaptation occurs to maintain balance from stress. Stressors are only psychological. One effective coping mechanism will inhibit stressors. Stress can be physical and psychological.
Stress can be physical and psychological. People can have a positive or negative reaction to stress. Adaptation occurs to maintain balance from stress. Stress can be both physical and psychological. Stressors are neither positive nor negative but can cause a person to react either positively or negatively. The body seeks homeostasis by adapting to stress. Stress cannot be inhibited by one coping mechanism.
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 a form of maladaptive coping. This is a personal coping style. This is an example of the resolution of loss. This is part of the normal sympathetic stress response.
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.
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 man enlisting others to help him look for lost pets. a young boy asking everyone if they need some water or food. a young wife asking everyone repeatedly if they know where her husband is. an older adult couple staying near each other constantly.
a young wife asking everyone repeatedly if they know where her husband is. 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 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: adaptation. avoidance coping. buffering. chronic stress.
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 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: allostatic load. burnout. repression. sleep deprivation.
burnout. 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: presentation of clear, achievable, and evidence-based solutions. careful and objective analysis of different proposed options. clear identification of the relevant problem. comparison of the family's situation to other similar situations.
clear identification of the relevant problem. 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? reaction formation sublimation compensation projection
compensation
A client is having a stress response related to a recent accident while boating. What does the nurse identify will be excreted from the adrenal cortex in response to this reaction? cortisol epinephrine insulin thyroxine
cortisol Cortisol is the main glucocorticoid hormone from the adrenal cortex. Cortisol affects glucose metabolism, which is necessary for increased energy expenditure.
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: having the client select an acceptable solution to her problem. asking the client, "What would happen if you did this solution?" outlining several solutions to the crisis with the client. determining if the outcome has been achieved.
determining if the outcome has been achieved. Crisis intervention is a five-step problem-solving technique. The last step is to evaluate outcome achievement. The other options precede evaluation.
A young woman, who has recently suffered acute stress, asks the nurse why she seems to be more sensitive to stress than her husband. The nurse explains that a contributor to this phenomenon is: thyroid production. glucose. estrogen levels. adrenal function. cortisol.
estrogen levels. 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.
