Stress and coping

Which factor should a nurse anticipate having the most influence on the outcome of a client facing a crisis situation?

previous coping skills

The nurse is preparing a preoperative teaching plan for a client who is undergoing a bilateral breast reduction. Which aspect of the plan is the priority?

psychosocial integrity

A client with colon cancer experiences an increase in feelings of anxiety and depression and has suicidal ideation. The nurse realizes that these feelings occur during which stage of the disease?

recurrence of the disease

The major goal of therapy in crisis intervention is to:

resolve the immediate problem.

The nurse is conducting a counseling session with a client experiencing posttraumatic stress disorder (PSTD) using a 2-way video telehealth system from the hospital to the client's home, which is 2 hours away from the nearest mental health facility. What are expected outcomes of using telehealth as a venue to provide health care to this client? Select all that apply. The client will:

save travel time from the house to the health care facility. avoid reliving a traumatic event which might be precipitated by visiting a health care facility. receive health care for this mental health problem.

A nurse is caring for a spiritually distressed client. Which are the factors affecting spiritual distress? Select all that apply.

self-alienation chronic illness sociocultural deprivation

A nurse is teaching a client stress management. Which techniques would be considered adaptive coping skills? Select all that apply.

set realistic goals for each day practice relaxation techniques balance sleep, rest, and exercise

When reviewing the plan of care for a client with Alzheimer's disease, which intervention would the nurse question?

stress management

A client with rheumatoid arthritis states, "I cannot do my household chores without becoming tired. My knees hurt whenever I walk." Which goal for this client should take priority?

Conserve energy.

On admission to the inpatient psychiatric unit, a client's facial expression indicates severe panic. The client repeatedly states, "I know the police are going to shoot me. They found out that I'm the child of the devil." What should the nurse say to initiate a therapeutic relationship with this client?

"Hello, my name is ___. I'm a nurse, and I'll care for you when I'm on duty. Should I call you ___, or do you prefer something else?"

A client is scheduled to have an elective mandibular osteotomy to correct a mandibular fracture sustained in an accident 6 months earlier. Which statement by the client indicates to the nurse that the client is having difficulty coping?

"I'll be glad to have my jaw fixed because my wife thinks I don't look like myself."

The mother tells the nurse that the diagnosis of colic upsets her because she knows her infant will continue to have colicky pain. Which response by the nurse would be most appropriate?

"It can be difficult to listen to your baby cry so loud and so long, so try to make sure that you get some free time."

The parents of a child who requires skeletal traction are unable to visit their child for more than 1 hour a day because there are five other children at home and both parents work outside of the home. The nurse recognizes expressions of guilt in both parents. To help alleviate this guilt, the nurse should make which statement?

"It is important that you visit even for 1 hour."

An adolescent client is admitted to a psychiatric day treatment program due to severe lower back pain since her mother's death 3 years ago. Medical examinations have not discovered a physical cause for her pain. She cares for her four younger siblings after school and on weekends because of her father's long work hours. Which predischarge statement indicates that treatment for her condition has been successful?

"My back pain is worse on weekends with more responsibility and homework."

Which client statement indicates that the client has coped effectively with a relationship problem?

"We are really listening to each other about our different view on issues."

A true crisis state, involving a period of severe disorganization, is difficult to endure emotionally and physically. The nurse recognizes that a client will only be able to tolerate being in crisis for how long?

4 to 6 weeks

A shy middle school student set up a social network site. A popular student sent a message that included a suggestive picture of himself and suggested the student send a similar picture. When the student sent back a picture of himself dressed only in his boxers, the popular student sent it to all his friends and encouraged them to pass it along. Soon the whole school had seen the picture identified as "Joe's Crotch." The student was so humiliated that he tried to hang himself but was found by his parent before he succeeded. Which outcomes would be most realistic and appropriate with regard to this situation? Select all that apply.

All students in the school are educated about the risks of cyberbullying and how to respond to it. The popular student who sent the message to his friends is disciplined by the school authorities. Joe can use the Internet after being educated about cyberbullying and completing a safety plan. Through therapy, Joe learns social skills to improve his confidence level and help him relate to peers more easily.

A client is experiencing mood swings after a stroke and often has episodes of tearfulness that are distressing to the family. Which is the best technique for the nurse to instruct family members to try when the client experiences a crying episode?

Attempt to divert the client's attention.

Prior to going to surgery, the client tells the nurse that it is not possible to hear without a hearing aid and asks to wear it to surgery and recovery. What is the nurse's best response?

Call the surgery unit to explain the client's concern, and ask if the client can wear the hearing aid to surgery.

The nurse is developing an education plan for clients with hypertension. The nurse should emphasize which long-term goal for the clients?

Commit to lifelong therapy.

A client who is admitted to an alcohol treatment program says, "I'm going to have a small morning drink to face the day. Usually, I just keep drinking." The nurse understands the client is in which stage of alcoholism?

Crucial phase

A client is undergoing a bone marrow aspiration and biopsy. The client is very worried about the procedure. What should the nurse do to prepare the client for the procedure?

Encourage the client to take slow, deep breaths to relax.

A toddler admitted in respiratory distress keeps pulling at the oxygen mask, trying to remove it. Which interventions are indicated? Select all that apply.

Have the parent read to the child. Encourage the parent to hold the child.

A client is ready to be discharged following an inguinal hernia repair. Which criteria must the client meet before the nurse can discharge the client? Select all that apply. The client:

is able to tolerate oral fluids. can walk to the bathroom unassisted. has voided.

An 80-year-old woman who identifies herself as a devout Catholic has recently relocated to an assisted-living facility. The woman is pleased with most aspects of her new living situation, but laments the fact that she is no longer close to the church where she was in the habit of attending daily mass each morning. What nursing diagnosis may apply to this problem that the woman has identified?

Impaired Religiosity

A 35-year-old has been killed as a result of a terrorist attack. What should the nurse advise the friends and relatives of the victim to do during the early stages of the recovery process? Select all that apply.

Keep in contact with other family and friends. Attend memorial or religious services. Use relaxation techniques and physical activities. Attend community meetings with others who have lost loved ones.

A nurse is caring for a client recently diagnosed with cancer and experiencing moderate situational anxiety. Which interventions would the nurse include in the care plan? Select all that apply.

Maintain a calm, nonthreatening environment. Encourage the client to verbalize concerns regarding the diagnosis. Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress.

A pediatric client is given morphine for postoperative pain following a fracture repair. As the nurse is assessing the client for pain 4 hours later, his parent leaves the room, and the child begins to cry. What assessment does the nurse make about the child's pain?

less tolerant of pain because he is upset

A client is scheduled for an ileostomy. Which would be most helpful in preparing the client psychologically for the surgery?

Provide a brief, thorough explanation of all preoperative and postoperative procedures.

A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. She tells the nurse that she feels like she is going crazy. Which intervention should the nurse use first?

Reassure the client that her feelings are typical reactions to serious trauma.

A client is in the acute phase of rheumatoid arthritis. In which order of priority from first to last should the nurse establish the goals? All options must be used.

Relieve pain. Preserve joint function. Prevent joint deformity. Maintain usual ways of accomplishing tasks.

During the early postpartum period, a nurse is evaluating several clients' attachment to their neonates. Which client is the highest priority for the nurse?

one whose parent died recently

A client expresses to the nurse that they cannot get the mental support needed to prepare to undergo treatment for leukemia. Which nursing diagnosis is most appropriate for the client?

Spiritual distress

The nurse is discussing concerns about sexual activity with a client with chronic renal failure. Which strategy would be most useful?

Suggest using alternative forms of sexual expression and intimacy.

While collecting data from a client diagnosed with impulse-control disorder (and who displays violent, aggressive, and assaultive behavior), the nurse can expect to find which of the following? Select all that apply.

The client functions well in other areas of life. The degree of aggression is disproportionate to the stressor. The client has a history of parental substance abuse or a chaotic, abusive family life.

A nurse recognizes improvement in a client with the nursing diagnosis of Ineffective role performance related to the need to perform rituals. Which behaviors indicate improvement? Select all that apply.

The client refrains from performing rituals during stress. The client verbalizes that he uses "thought stopping" when obsessive thoughts occur. The client verbalizes the relationship between stress and ritualistic behaviors.

A shy 12-year-old girl who must change school systems just before she begins junior high school begins cutting her arms to relieve the stress that she feels about leaving long-standing friends, having to develop new friendships, and meeting high academic standards in her new school. After she has been cutting for a few weeks, her parent discovers the injuries and takes her to a psychiatrist mental health provider who prescribes a therapeutic group at the local mental health center and medication to help decrease her anxiety. Which findings indicate that the girl had made appropriate progress toward recovery? Select all that apply.

The girl says she has developed a friendship with a girl in her class and one in her therapy group. The girl wears short-sleeved and/or sleeveless tops when the weather is warm. The girl's grades are good, and her hours of study are not excessive.

A client with posttraumatic stress disorder needs to find new housing and wants to wait for a month before setting another appointment to see the nurse. How should the nurse interpret this action?

a necessary break in treatment

A chronically ill school-age child is most vulnerable to which stressor?

anxiety over school absences

A nurse interviews the family of a client hospitalized with severe depression and suicidal ideation. What family assessment information is essential when formulating an effective discharge plan? Select all that apply.

communication patterns role expectations current family stressors

The nurse interviews the family of a client who is hospitalized with severe depression and suicidal ideation. Which family assessment information is essential to formulating an effective plan of care? Select all that apply.

communication patterns role expectations current family stressors

A client is admitted to the emergency department after being sexually assaulted. The nurse notes that the client is sitting calmly and quietly in the examination room and recognizes this behavior as a protective defense mechanism. What defense mechanism is the client exhibiting?

denial

The parent of a soldier who was killed 2 days ago is admitted after a serious suicide attempt. The client is medically stable, and a safety plan is in place. During a talk with the nurse, the client says, "Terrorism and war are holding me and the whole world hostage. It's so unfair. I would rather be dead than live alone in constant fear." Which nursing interventions are important in the next few days? Select all that apply.

discussing effective ways to express justifiable anger teaching stress management and relaxation techniques identifying community groups for relatives of military personnel strategizing about ways to increase a personal sense of security

A client who comes to the crisis center in a very distressed state tells the nurse, "I just can't get over being fired last week. I've asked for help. I've talked to friends. I've tried everything to get through this, but nothing is working. Help me!" Which initial crisis intervention strategy should the nurse use?

emotion management

An infant diagnosed with Hirschsprung's disease is scheduled to receive a temporary colostomy. When the nurse is initially discussing the diagnosis and treatment with the parents, which action by the nurse would be most appropriate?

encouraging them to ask questions

A client admitted to the psychiatric unit for treatment of a panic attack comes to the nurses' station in obvious distress. After finding the client short of breath, dizzy, trembling, and nauseated, a nurse should first:

escort the client to a quiet area and suggest that he use a relaxation exercise he's been taught.

After a third arrest for abusing a neighbor's cat, a client is admitted to the psychiatric unit for treatment of antisocial personality disorder. This client has a history of conduct disorder. Which action is most appropriate for the nurse assigned to this client?

examining personal feelings toward the client

Since the diagnosis of stomach cancer, the client has been having trouble sleeping and is frequently preoccupied with thoughts about how life will change. The client says, "I wish my life could stay the same." The nurse determines that the client is experiencing which problem?

going through a grieving process

A nurse is assessing a client for lifestyle factors that might affect normal coping. Which factor should the nurse most likely consider?

inadequate diet

In a client with amyotrophic lateral sclerosis (ALS) and respiratory distress, which finding is the earliest sign of reduced oxygenation?

increased restlessness

A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. The client is being admitted to the stress unit with the diagnosis of acute stress disorder. The client tells the nurse in a matter-of-fact manner that her husband is paraplegic, "but that is better than total paralysis." Which protective mechanism is the client exhibiting?

intellectualization