Stress Response and Management
Which assessment question focuses on determining the resilience of a preteen child? Select all that apply. "Do you like playing video games?" "How do you and your friends have fun?" "How are you adjusting to your new school?" "What would you do if you forgot your homework?" "What job would you like when you grow up?"
"How do you and your friends have fun?" "How are you adjusting to your new school?" "What would you do if you forgot your homework?" "What job would you like when you grow up?"
Which statement by an older adult who recently has had hip replacement surgery supports that his or her positive attitude is contributing to mental health wellness?
"I can't go hiking but I still enjoy walking in the park in the afternoon."
A nurse assesses a survivor of a devastating category 5 tornado. Which comment best indicates this survivor can maintain a sense of control, an intact self-concept, and competency in the face of this stress?
"I have three close friends I can talk to about this experience. They are always there when I need them."
A nurse assesses a survivor of a devastating category 5 tornado. Which comment best indicates this survivor can maintain a sense of control, an intact self-concept, and competency in the face of this stress? 1 "I believe I was destined to experience this loss." 2 "The tornado was not in my control but I should have found a safer place to hide." Correct 3 "I have three close friends I can talk to about this experience. They are always there when I need them." 4 "I lost my home but I suppose I could go live with my parents temporarily. I can tolerate it for a little while."
"I have three close friends I can talk to about this experience. They are always there when I need them."
The nurse teaches a patient with anxiety about stress and triggers. Which statement made by the patient indicates the teaching was effective? "Stress is a negative response." "Eustress is resistance to stress." "People can have good and bad stress." "People with stress are always in distress."
"People can have good and bad stress."
An adult patient admitted with anxiety states "my counselor keeps talking about my stressors. What exactly are stressors?" How does the nurse best response to the patient?
"Stressors are events that threaten your current functioning and require you to adapt."
During a home visit, the nurse finds that an adolescent is upset after failing a midterm exam at school. What positive statement does the nurse use to comfort the adolescent?
"You can learn from this experience and refocus your attention to improve your future performance."
During a home visit, the nurse finds that an adolescent is upset after failing a midterm exam at school. What positive statement does the nurse use to comfort the adolescent? "Do you feel like you should have studied more?" "You should not be upset for such a small reason." "This probably just isn't your best subject, and you should focus on your stronger subjects." "You can learn from this experience and refocus your attention to improve your future performance."
"You can learn from this experience and refocus your attention to improve your future performance."
The nurse is assessing a child in a foster care home. The child's biological parents recently died in an accident. The foster parent tells the nurse that the child projects repressed feelings by making sketches. What should the nurse advise?
"Your child is showing constructive behavior."
Which assessment question focuses upon determining the resilience of a pre-teen child?
-"How are you adjusting to your new school?" -"What would you do if you forgot your homework?" -"How do you and your friends have fun?" -"What job would you like when you grow up?"
What information will the nurse include in medication education for a patient prescribed an antianxiety medication for obsessive-compulsive behavior?
-Benzodiazepines have a quick onset of action. -Caffeine beverages should be avoided. -Antacid use can affect medication absorption.
A patient approaches the nurse to seek advice regarding stress management. What interventions does the nurse suggest to the patient to help relieve stress?
-Exercise daily for at least 30 minutes. -Listen to favorite music. -Get a good massage.
Which interventions will the nurse include in the plan of care of a patient diagnosed with generalized anxiety syndrome (GAS) resulting from stress?
-Going to sleep 30 minutes earlier than usual. -Including 30 minutes of exercise into your daily routine three days a week. -Listening to soothing music to increase relaxation.
A nurse is performing a physical examination of a patient who was fired from work a week ago. Which signs and symptoms would suggest a sympathetic response to the stress?
-Increased respiratory rate. -Dry mouth. -Dilated pupils.
A nurse advises a patient who is stressed to exercise daily to relieve stress. What is the reason for the nurse to consider exercise as a stress-buster?
-It decreases chronic and acute stress. -It decreases level of anxiety. -It decreases sensitivity to stress.
What statement is true regarding normal anxiety?
-It provides the energy needed to achieve tasks related to living. -It motivates people to make and survive change in their lives. -A degree of anxiety is necessary and healthy. -It is a factor in the achievement of personal goals.
Which intervention will the nurse suggest to a patient who is interested in managing stress with the form of meditation called "Mindfulness"?
-Stop whatever you are doing when you become stressed. -Do or think about something that is pleasant or important to you. -Focus on your breathing. -Name the emotion that you are feeling.
The nurse is assessing a child who has moved to a boarding school. On assessment the nurse concludes that the child is suffering from separation anxiety disorder. Which signs would lead the nurse to that assessment? .
-The child is extremely shy. -The child is confused most of the time. -The child demonstrates a lack of self-direction.
Which scenario presents an example of eustress? 1 A senior nursing student addresses invitations to graduation. 2 On her honeymoon, a new bride questions whether she made the right decision to marry. 3 An adult anticipates a coronary artery bypass graft (CABG) to open three occluded vessels. 4 After a diagnostic test, an adult listens as the health care provider says, "I'm afraid I have some bad news."
1 A senior nursing student addresses invitations to graduation.
A nurse who works in a stress management clinic finds that the female patients are more vulnerable to stress- related disorders. What is the most likely reason for this observation? 1 Females are more sensitive to corticotropin-releasing factor. 2 Females have few friends and weak support systems. 3 Females have more stress as compared to male counterparts. 4 Females do not share their problems with others.
1 Females are more sensitive to corticotropin-releasing factor.
Which interventions will the nurse include in the plan of care of a patient diagnosed with generalized anxiety syndrome (GAS) resulting from stress? Select all that apply. Correct 1 Going to sleep 30 minutes earlier than usual. 2 Getting up 30 minutes later each morning. Correct 3 Including 30 minutes of exercise into your daily routine three days a week. 4 Including some form of exercise about 30 minutes before going to bed. Correct 5 Listening to soothing music to increase relaxation.
1 Going to sleep 30 minutes earlier than usual. 3 Including 30 minutes of exercise into your daily routine three days a week. 5 Listening to soothing music to increase relaxation.
A nursing student learns that corticosteroids are released in response to stress. What are the consequences of increased levels of corticosteroids in the body? Correct 1 Increase in muscle endurance 2 Increase in digestive process 3 Increase in immunity level 4 Increase in reproductive function
1 Increase in muscle endurance
A nurse is caring for a patient diagnosed with tension headaches. Which technique does the nurse teach the patient to relieve tension headaches? Correct 1 Progressive muscle relaxation 2 Relaxation response 3 Cognitive reframing 4 Deep breathing exercise
1 Progressive muscle relaxation
Which fact concerning meditation would a nurse include in a discussion with a patient experiencing moderate anxiety and stress? Select all that apply. Correct 1 The strategy helps a person to create personal calmness. Correct 2 The practice quiets the sympathetic nervous system. 3 Meditation is a technique that is learned easily and requires little practice. Correct 4 A visual object, a sound, or even one's own breathing can be the focus. Correct 5 Meditation can be practiced anyplace and at anytime.
1 The strategy helps a person to create personal calmness. 2 The practice quiets the sympathetic nervous system. 4 A visual object, a sound, or even one's own breathing can be the focus. 5 Meditation can be practiced anyplace and at anytime.
Which patient is illustrating eustress? 1 A college student who fails an exam 2 A bride who is planning for her wedding 3 A man who is laid off from his job 4 An adolescent who gets into a fight at school
2 A bride who is planning for her wedding
A patient is extremely depressed after ending a relationship with a partner. The nurse is teaching cognitive reframing techniques to this patient as a means to counteract depression. Which response given by the patient indicates effective teaching by the nurse? 1 "I will never think about my partner again in my life." 2 "I was destined to face this situation in my life." 3 "I have many friends who love and care for me." 4 "'My partner will realize that I was not wrong."
3 "I have many friends who love and care for me."
The nurse is performing stress assessments in outpatients by using Recent Life Changes Questionnaire. Which important point should the nurse keep in mind for obtaining effective results from the questionnaire? 1 The patients experience the same level of stress for all the situations in their lives. 2 Cultural differences of the patients do not influence the level of stress in a given situation. 3 Every patient has a different threshold beyond which disruption occurs for a given situation. 4 The questionnaire does not have variance in scoring with the changes in the stress level.
3 Every patient has a different threshold beyond which disruption occurs for a given situation.
A nurse is performing a physical examination of a patient who was fired from work a week ago. Which signs and symptoms would suggest a sympathetic response to the stress? Select all that apply. 1 Decreased blood pressure 2 Decreased heart rate 3 Increased respiratory rate 4 Dry mouth 5 Dilated pupils
3 Increased respiratory rate 4 Dry mouth 5 Dilated pupils
A nurse advises a patient who is stressed to exercise daily to relieve stress. What is the reason for the nurse to consider exercise as a stress-buster? Select all that apply. 1 It increases muscle tension. 2 It decreases endorphin levels. Correct 3 It decreases chronic and acute stress. Correct 4 It decreases levels of anxiety. Correct 5 It decreases sensitivity to stress.
3 It decreases chronic and acute stress. 4 It decreases levels of anxiety. 5 It decreases sensitivity to stress.
The difference in how various individuals rate their stress may be explained by which concept? 1 Projection 2 Denial 3 Perception 4 Repression
3 Perception
After reviewing the following information, determine what the patient stress score is from the assessment data provided.
344.
A Hispanic woman has been in an abusive relationship for three years. Which comment by this patient is most likely? 1 "I need help with preparing an escape plan." 2 "I feel so depressed about the failure of my marriage." 3 "He is not a good man. His father and brother are also abusive." Correct 4 "I have very bad headaches that make it hard for me to care for my children."
4 "I have very bad headaches that make it hard for me to care for my children."
For the past five months, an adult has been experiencing conflict with a supervisor at work. Which comment by this person reflects adaptive coping related to this stressor? 1 "I've been in trouble at work before. If I keep my head down, it will all blow over." 2 "I keep hoping my supervisor will resign. If that happened, I would be happy at work." 3 "I've always been very opinionated. I think that's the reason for all my troubles with my supervisor." Correct 4 "I'm lucky to have a job but I think it's in my best interest to begin looking at some other opportunities."
4 "I'm lucky to have a job but I think it's in my best interest to begin looking at some other opportunities."
A nurse is educating a patient with anxiety about the stress-relieving technique of mindfulness. Which statement made by the patient indicates effective teaching? 1 "Mindfulness involves progressively tensing then relaxing body muscles." 2 "Mindfulness is a memory system to assist me in short-term memory recall." 3 "Mindfulness involves focusing on an object and repeating a phrase while deep breathing." Correct 4 "Mindfulness involves focusing and paying attention to what is going on around me."
4 "Mindfulness involves focusing and paying attention to what is going on around me."
A woman, whose friend recently committed suicide, asks the nurse to identify some ways she could cope with her stress regarding the event. Which option would be appropriate to discuss? 1 Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over 2 Antianxiety medication to help her relax 3 Starting a hobby to keep her mind off the troubling event 4 Talking with friends and attending a loss support group
4 Talking with friends and attending a loss support group
Myla, a 29-year-old patient admitted with anxiety, states, "my counselor keeps talking about my stressors. What exactly are stressors?" Your best response to the patient would be: A. "Stressors are events that happen that threaten your current functioning and require you to adapt." B. "Stressors are complicated neuro stimuli that cause mental illness." C. "It's best if you ask questions like that of your provider for a complete answer." D. "Instead of focusing on what stressors are, let's explore your coping skills."
A. "Stressors are events that happen that threaten your current functioning and require you to adapt."
What would a client experience during a progressive relaxation session? A. Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed B. Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter C. Having a nurse enter the client's energy field to rebalance it and bring harmony D. Being led into a positive imaginary sensory experience
A. Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed
What factor exerts the greatest influence on the degree to which various life events upset a specific individual? A. The individual's perception of the event B. The individual's degree of spirituality C. The effect of the individual's health-sustaining behaviors D. The amount of social support available to the individual
A. The individual's perception of the event
A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes A. biofeedback. B. guided imagery. C. therapeutic touch. D. assertiveness training.
A. biofeedback.
Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex, and over the long term it can result in A. insulin resistance. B. a high resting heart rate. C. digestive problems. D. chronic muscle tension.
A. insulin resistance.
Self-help groups are useful for reducing stress because they provide the individual with the stress mediator identified as A. social support. B. cultural support. C. life satisfaction. D. cognitive reframing.
A. social support.
The physiologic basis for the success of guided imagery is A. β-endorphin release raises the pain threshold. B. imagery raises the body level of cortisol and epinephrine. C. the sympathetic nervous system is stimulated to produce a quiet state. D. brain catecholamines are less available to transmit pain impulses.
A. β-endorphin release raises the pain threshold.
A diagnosis of chronic stress is supported by which assessment finding? Select all that apply. Amenorrhea Loss of appetite History of panic attacks Insulin-resistant diabetes Recent treatment for blood clots
Amenorrhea History of panic attacks Insulin-resistant diabetes
What should the nurse do for a patient who is experiencing the alarm stage of stress? Assess for a dry mouth Determine the blood pressure Check oxygen saturation level Assess for signs of depression
Assess for a dry mouth
Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? A. "I do not have the ability to handle that job." B. "I can be successful if I do all the things required to learn the job." C. "I may be fired from the job but eventually I will find something else to do with my life." D. "I can never learn all there is to know for the job."
B. "I can be successful if I do all the things required to learn the job."
Which of the following examples illustrates eustress? A. A college student fails an exam. B. A bride is planning for her wedding. C. A man is laid off from his job. D. An adolescent gets into a fight at school.
B. A bride is planning for her wedding.
The first stage of the general adaptation syndrome can be characterized as A. eustress. B. adaptive. C. maladaptive. D. psychological.
B. adaptive.
A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. This technique is called A. guided imagery. B. cognitive reframing. C. wishful thinking. D. confrontational assertion.
B. cognitive reframing.
The relaxation response calls upon A. sympathetic activation. B. parasympathetic activation. C. brainstem deactivation. D. increased cortisol production by the adrenals.
B. parasympathetic activation.
An Asian client would be most likely to respond to stress by the subjective experience of A. anxiety. B. somatic complaints. C. memory deficiencies. D. sensory perceptual alterations.
B. somatic complaints.
In a clinical interview, a patient says, "My mother and I are afraid of darkness, so we always carry a flashlight with us." Which appropriate theory does the patient demonstrate in this case?
Behavioral therapy.
A patient diagnosed with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The patient uses relaxation techniques to lower blood pressure and is informed of ongoing success by the tone. This process describes Biofeedback Guided imagery Therapeutic touch Assertiveness training
Biofeedback
Which approach to reducing patient stress is most effective in people with low to moderate hypnotic ability? Meditation Biofeedback Journal keeping Breathing exercises
Biofeedback
A nurse advises a stressed patient to perform meditation to decrease stress levels. How does meditation help in relieving stress? By creating a hypometabolic state of quieting the sympathetic nervous system. By allowing switching from the sympathetic mode to the parasympathetic mode. By dampening the cognitive processes likely to induce stress and anxiety reactions. By eliminating muscle contraction and decreasing the related anxiety levels.
By creating a hypometabolic state of quieting the sympathetic nervous system.
Stress reduction is not likely to result in A. reduced pain. B. lower blood pressure. C. decreased cognitive functions. D. decreased gastrointestinal problems.
C. decreased cognitive functions.
An effective stress-reduction technique a nurse might teach an individual with performance anxiety is A. assertiveness. B. journal keeping. C. diaphragmatic breathing. D. restructuring and setting priorities.
C. diaphragmatic breathing.
One effect of stress can be attributed to the stimulation of the hypothalamus-pituitaryadrenal cortex, causing a short-term increase in A. the heart rate. B. triglycerides. C. gluconeogenesis. D. brain norepinephrine.
C. gluconeogenesis.
Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friends with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by: A. projection. B. denial. C. perception. D. repression.
C. perception.
Meditation is successful in promoting stress reduction because it A. prevents endorphin release. B. changes the client's energy field. C. quiets the sympathetic nervous system. D. activates the parasympathetic nervous system.
C. quiets the sympathetic nervous system.
The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious as the information is presented. Soon the patient begins to report dizziness and heart pounding. The nurse observes obvious trembling and the patient appears confused. What is the nurse's immediate intervention?
Ceasing any further attempt at preoperative teaching at this time.
A nurse is teaching progressive muscle relaxation to a patient. Which instruction does the nurse include in the teaching?
Contract and relax the muscle groups alternately.
Which statement made by a teenager indicates an increased risk for poor stress management as a result of a psychosocial factor? Correct 1 "I couldn't survive if my boyfriend left me." 2 "My father tried to kill himself when I was 10 years old." 3 "Our religion does not accept homosexuality as a lifestyle choice." 4 "In my culture mental illness is thought of as a punishment, not a sickness."
Correct 1 "I couldn't survive if my boyfriend left me."
A nurse is caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm? Correct 1 Dry mouth 2 Constricted pupils 3 Decrease in heart rate 4 Drop in blood pressure
Correct 1 Dry mouth
What would a patient experience during a progressive relaxation session? Correct 1 Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed 2 Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter 3 Having a nurse enter the patient's energy field to rebalance it and bring harmony 4 Being led into a positive imaginary sensory experience
Correct 1 Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed
Which statement by an older adult who recently has had hip replacement surgery supports that his or her positive attitude is contributing to mental health wellness? 1 "I know I can't go hiking like I did but I really miss it so much." Correct 2 "I can't go hiking but I still enjoy walking in the park in the afternoon." 3 "If I work really hard in rehabilitation, I think I'll be able to hike again next spring." 4 "Hiking gave me such pleasure but if I can't hike, I'll just have to get used to it."
Correct 2 "I can't go hiking but I still enjoy walking in the park in the afternoon."
Over a five-year period, an adult experienced liver failure. A liver transplant was performed. During the immediate postoperative period, which intervention could the nurse recommend to enhance healing and reduce the harmful effects of stress? 1 Aerobic exercise Correct 2 Listening to music 3 Attending a support group 4 Occasional chocolate treats
Correct 2 Listening to music
A client who is experiencing great stress associated with a disturbing new diagnosis asks the nurse, "Do you think saying a prayer would help?" The answer the nurse should give is A. "Of course you may pray if you wish. I'll leave you alone." B. "At the moment we should continue the stress assessment." C. "Shall I call the chaplain for you?" D. "If you find comfort in prayer, I'd encourage you to pray."
D. "If you find comfort in prayer, I'd encourage you to pray."
Which approach to reducing client stress is most effective in people with low to moderatehypnotic ability? A. Meditation B. Breathing exercises C. Journal keeping D. Biofeedback
D. Biofeedback
What tool might be useful in assessing the amount of stress a client has experienced in the past year? A. NANDA Handbook B. DSM-IV-TR C. Quick Mental Status Assessment D. Life-Changing Event Questionnaire
D. Life-Changing Event Questionnaire
Melissa, whose friend recently committed suicide, asks you some ways she could cope with her stress regarding the event. Which of the following options would be appropriate to discuss with Melissa? A. Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over B. Antianxiety medication to help her relax C. Starting a hobby to keep her mind off the troubling event D. Talking with friends and attending a loss support group
D. Talking with friends and attending a loss support group
An advantage of the Holmes and Rahe updated life event and social readjustment scale is that it A. focuses on the presenting symptoms. B. identifies the client's perception of events. C. considers the client's various mediating factors. D. assesses stress threshold and potential for future illness.
D. assesses stress threshold and potential for future illness.
The individual initially thinks, "I'll never get through this huge assignment," but then amends the thought to "I can get through the assignment by breaking it into small portions and doing them one by one." This thought process is an example of A. rationalization. B. wishful thinking. C. simple assertion. D. cognitive reframing.
D. cognitive reframing.
High-quality social support relationships have attributes that include A. constructive criticism. B. minor conflict. C. continuous feedback. D. reciprocal closeness.
D. reciprocal closeness
An effective stress-reduction technique a nurse might teach an individual with performance anxiety is Assertiveness Journal keeping Deep breathing Restructuring and setting priorities
Deep breathing
What is the psychological state that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue? Distress Eustress Fight-or-flight response General adaption syndrome
Distress
What is the psychological state that results in anxiety, depression, confusion, helplessness, hopelessness, and fatigue?
Distress.
When assessing an individual who has had several infections in a short period of time, it is important to ask which question initially?
Does the person have an increase in recent stress in his or her life?
The nurse is performing stress assessments in outpatients by using Recent Life Changes Questionnaire. Which important point should the nurse keep in mind for obtaining effective results from the questionnaire?
Every patient has a different threshold beyond which disruption occurs for a given situation.
One effect of stress can be attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex, causing a short-term increase in Heart rate Triglycerides Gluconeogenesis Brain norepinephrine
Gluconeogenesis
One effect of stress can be attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex, causing a short-term increase in
Gluconeogenesis.
Which interventions will the nurse include in the plan of care of a patient diagnosed with generalized anxiety syndrome (GAS) resulting from stress? Select all that apply. Getting up 30 minutes later each morning. Going to sleep 30 minutes earlier than usual. Listening to soothing music to increase relaxation. Including 30 minutes of exercise into your daily routine three days a week. Including some form of exercise about 30 minutes before going to bed.
Going to sleep 30 minutes earlier than usual. Including 30 minutes of exercise into your daily routine three days a week. Listening to soothing music to increase relaxation.
After reviewing the following information, which intervention best demonstrates the importance of the research findings?
Include an age- and ability-appropriate exercise routine in each patient's daily routine.
What is the simplest method of reducing stress, anxiety, and mental noise?
Interrupting the thoughts and engaging in abdominal breathing.
The nurse conducted a group therapy session for depressive patients with suicidal intention. After a few sessions, the nurse observed that the patients are expressing hope to live and have increased energy levels and confidence. What technique did the nurse teach the patients during the group therapy?
Journaling.
Over a 5-year period, an adult experienced liver failure. A liver transplant was performed. During the immediate postoperative period, which intervention could the nurse recommend to enhance healing and reduce the harmful effects of stress? Aerobic exercise Listening to music Attending a support group Occasional chocolate treats
Listening to music
A new patient is diagnosed with generalized anxiety disorder. It is most important for the nurse to assess this patient for which additional problem?
Major depressive disorder.
After considering the following information, which nursing intervention would have priority when a patient is experiencing an "attack of the nerves" (ataque de nervios)?
Moving the person away from stairs and furniture so as to minimize injury from a fall
The relaxation response calls upon
Parasympathetic activation.
Which statement is true regarding obsessive-compulsive disorder (OCD)?
Patients diagnosed with OCD should be assessed regularly for risk for suicide.
The nurse is conducting group therapy for geriatric patients. The nurse gives instructions to the patients, "Close your eyes and imagine a peaceful scene, you are very comfortable, nothing is there to disturb you." What feedback given by the patients after the therapy indicates effective therapy? The patients Report relief from pain Are able to remain calm and silent Are able to acknowledge their feelings Are able to empathize with their peers
Report relief from pain
What is the term used to describe the psychological or physical stimuli that are incompatible with the current functioning of an individual and require adaptation in the human body? Endorphins Cytokines Stressors Hormones
Stressors
The nurse is caring for a 35-year-old female patient who reports occasional panic attacks, fatigue, and amenorrhea. What can the nurse infer about this patient? The patient has acute stress. The patient has chronic stress. The patient has a normal response to stress. The patient has a fight-or-flight reaction to stress.
The patient has chronic stress.
A 72-year-old patient is diagnosed with Parkinson's disease and anxiety. The health care provider prescribes a benzodiazepine. The nurse questions this prescription based on what fact related to this classification of medications?
This medication would increase the patient's risk for falls.
A patient scheduled for surgery seems to be anxious. The nurse teaches the patient to practice deep breathing exercises. What is the most appropriate reason for teaching deep breathing exercises to the patient? To help the patient prevent postoperative complications. To prevent preoperative risk of respiratory complications. To dampen the cognitive process involved in anxiety reactions. To promote lung expansion during administration of anesthesia.
To dampen the cognitive process involved in anxiety reactions.
A woman anticipating her wedding ceremony in a week comes to the Urgent Care Clinic with a headache that has been ongoing for three days duration as well as a pounding feeling in her chest. She is concerned that she may be having a stroke or a cerebral vascular accident (CVA). All medical tests are negative. The woman wonders what is happening to her because she feels she is unable to function. What is the best response to her question? You are having difficulty coping with your upcoming wedding. You are experiencing distress because of your upcoming wedding. You are experiencing eustress because of your upcoming wedding. You are being warned by your body that you may have hypertension.
You are having difficulty coping with your upcoming wedding.
A nurse is caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm? a. Dry mouth b. Constricted pupils c. Decrease in heart rate d. Drop in blood pressure
a. Dry mouth indicates that the patient is in the alarm stage. In the alarm stage, the body prepares itself for the fight-or-flight response; this stage is characterized by increased activity of the sympathetic system. Constricted pupils, decreased heart rate, and a drop in blood pressure result from decreased sympathetic system activity. These signs indicate that the body is relaxed. pp. 158-159
After an interview with a patient, the nurse has identified and listed the stressors. What is an example of eustress to the patient? a. Birth of a baby b. Financial overload c. Work-related stress d. Death in the family
a. Eustress is a positive stressor that gives new energy and hope to the patient. Birth of a baby is a eustress that gives positive energy and motivation. However, eustress evokes a physiological response similar to distress. Financial overload, work-related stress, and death in the family are distress. Distresses are negative emotions that cause feelings of confusion, depression, helplessness, and hopelessness. p. 159
The physiologic basis for the success of guided imagery is a. β-endorphin release raises the pain threshold b. Imagery raises the body level of cortisol and epinephrine c. The sympathetic nervous system is stimulated to produce a quiet state d. Brain catecholamines are less available to transmit pain impulses
a. Guided imagery stimulates release of β-endorphins, a brain chemical that raises the individual's pain threshold. In so doing, the guided imagery is responsible for making the patient more comfortable. p. 166, Box 10.3
Which statement made by a teenager indicates an increased risk for poor stress management as a result of a psychosocial factor? a. "I couldn't survive if my boyfriend left me." b. "My father tried to kill himself when I was 10 years old." c. "Our religion does not accept homosexuality as a lifestyle choice." d. "In my culture mental illness is thought of as a punishment, not a sickness."
a. Psychosocial risk factors include a poor sense of control over one's life. When the patient expresses an inability to "survive" without the boyfriend, she is demonstrating a belief consistent with such a risk factor. Biological predisposing risk factors include genetic background. Depression is a mental illness with a familial risk factor. Sociocultural predisposing risk factors include religious upbringing and beliefs and cultural background and values. The statements reflecting religious and cultural beliefs could prove to be risks in certain situations. p. 157
A woman anticipating her wedding ceremony in a week comes to the Urgent Care Clinic with a headache that has been ongoing for three days duration as well as a pounding feeling in her chest. She is concerned that she may be having a stroke or a cerebral vascular accident (CVA). All medical tests are negative. The woman wonders what is happening to her because she feels she is unable to function. What is the best response to her question? a. You are having difficulty coping with your upcoming wedding. b. You are experiencing distress because of your upcoming wedding. c. You are experiencing eustress because of your upcoming wedding. d. You are being warned by your body that you may have hypertension.
a. The physical response of a headache is a common mind-body reaction to a person having difficulty coping with a negative or positive event. The woman may not be distressed about her upcoming wedding. Eustress is the absence of stress. There is no clinical evidence that the woman has hypertension to validate the woman's fear of a stroke. p. 161, Figure 10.4
Which statement regarding stress is correct? SATA a. Humans have a capacity to respond to both internal and external stress. b. Stress results in predictable biochemical, physiological, and behavioral changes. c. Reaction to stress is central to many human mental health disorders. d. It is a fact that vulnerability to mental illness influences the likelihood of adverse stress responses. e. A stressful childhood makes a person better able to avoid adverse stress responses as an adult.
abc. Stress is natural, and humans have evolved with a capacity to respond to internal and external situations. A classic definition of stress is that it is a negative emotional experience that results in predictable biochemical, physiologic, cognitive, and behavioral changes directed at adjusting to the effects of the stress or altering the stress itself. Stress and the responses to it are central to psychiatric disorders and the provision of mental health care. Early exposure to stressful events actually sensitizes people to stress in later life. In other words, people who are exposed to high levels of stress as children, especially during stress-sensitive developmental periods, have a greater incidence of all mental illnesses as adults. It is not known, however, if severe stress causes a vulnerability to mental illness or if vulnerability to mental illness influences the likelihood of adverse stress responses. pp. 156-157
Which factor is most likely to affect how a person reacts to stress and anxiety? SATA a. Age b. Gender c. Culture d. Chronic illness e. Life experiences
abce. Responses to stress and anxiety are affected by factors such as age, gender, culture, life experience, and lifestyle, all of which may work to either lessen or increase the degree of emotional or physical influence and the sequelae (consequence or result) of stress. Chronic illness generally is not recognized as an influence on coping abilities. p. 160
Which intervention will the nurse suggest to a patient who is interested in managing stress with the form of meditation called "mindfulness"? SATA a. Focus on your breathing. b. Name the emotion that you are feeling. c. Tense and relax your muscles as a distraction. d. Stop whatever you are doing when you become stressed. e.Do or think about something that is pleasant or important to you.
abde. The technique of mindfulness requires that one stops whatever it is one is doing, breathe, observe emotions, and proceed with something of importance. Muscle relaxation and tensing is not a component of this technique. p. 167
A nurse understands that a patient is chronically stressed. The patient's score on the Recent Life Changes questionnaire was 223. What could be the possible life-changing events in the patient's life? SATA a. Death of a child b. Major change in sleeping habits c. New close, personal relationship d. Separation from spouse as a result of marital problems e. An injury or illness that kept the patient in bed for a week or more
abe. Life change units for the death of a child is 123, a major change in sleeping habits is 26, and an injury or illness that kept the patient in the hospital is 74. The sum of total units is 223. The life change score for having a new close, personal relationship is 37. The life change units for separation from spouse due to marital problems is 53. Only the combination of three stressors such as the death of a child, a major change in sleeping habits, and injury or illness that kept the patient in the hospital will add up to 223. pp. 163-164, Table 10.3
After reviewing the following information, identify which life events were perceived as increasing in stressfulness over a 40-year period? a. Birth of a child b. Death of a friend c. Death of a spouse d. Becoming unemployed e. Children leaving the home
ade. Over the last 40 years, there has been an increase in the perceived stress associated with employment issues, birth of a child, and children leaving their birth homes. The stress associated with the death of a friend has remained constant, whereas the death of a spouse is now perceived as less stressful. p. 163, Table 10.2
During a group therapy session, the nurse teaches deep breathing exercises to patients with anxiety. In the next session the nurse instructs one of the patients to demonstrate a deep breathing exercise to other members of the group. Which action performed by the patient indicates effective teaching by the nurse? a. The patient holds the breath for 7 seconds. b. The patient exhales slowly through the mouth. c. The patient raises the hands and stands straight. d. The patient repeats the exercise for 50 seconds.
b. Deep breathing exercises are a useful technique to cope with anxiety and stress. While performing deep breathing, the patient should exhale air completely and slowly through the mouth. It helps to relax the muscles of the mouth, tongue, and jaw. The patient must not stand and raise the hands. The patient must choose a comfortable position like lying down or sitting straight on a chair and should relax the shoulders and chest. It facilitates proper circulation of the blood throughout the body and relaxes all the muscles. The patient should hold the breath for three seconds so that the lungs are completely filled with air containing oxygen and the blood gets oxygenated. Holding the breath for 7 seconds can cause apnea. The patient must repeat the exercise for at least 2 to 5 minutes for achieving relaxation. Repeating the exercise for 50 seconds will not give effective results. p. 165
A patient who is experiencing great stress associated with a disturbing new diagnosis asks the nurse, "Do you think saying a prayer would help?" The answer the nurse should give is, a. "Shall I call the chaplain for you?" b. "If you find comfort in prayer, I'd encourage you to pray." c. "Of course you may pray if you wish. I'll leave you alone." d. "At the moment we should continue the stress assessment."
b. People who include spiritual solutions to physical or mental distress often gain a sense of comfort and support that could aid in healing and lowering stress. Even prayer by itself can elicit the relaxation response, which is known to reduce stress physically, emotionally, and immunologically. p. 162
Which interventions will the nurse include in the plan of care of a patient diagnosed with generalized anxiety syndrome (GAS) resulting from stress? SATA a. Getting up 30 minutes later each morning. b. Going to sleep 30 minutes earlier than usual. c. Listening to soothing music to increase relaxation. d. Including 30 minutes of exercise into your daily routine three days a week. e. Including some form of exercise about 30 minutes before going to bed.
bcd. Chronically stressed people often are fatigued, so going to sleep 30 to 60 minutes earlier each night for a few weeks is suggested. If fatigue persists, try going to bed another 30 minutes earlier, but sleeping later in the morning is not helpful and can disrupt body rhythms. Exercise can dissipate chronic and acute stress by decreasing levels of anxiety, depression, and sensitivity to stress. A recommended level of exercise is at least 30 minutes, three or more times a week, but it is best to exercise at least 3 hours before bedtime. Listening to music increases the sense of relaxation. pp. 158-160, Table 10.1
Which assessment question focuses on determining the resilience of a preteen child? a. "Do you like playing video games?" b. "How do you and your friends have fun?" c. "How are you adjusting to your new school?" d. "What would you do if you forgot your homework?" e. "What job would you like when you grow up?"
bcde. The resilient child has the following characteristics: adaptability to changes in the environment, ability to form nurturing relationships with other adults when the parent is not available, ability to distance self from emotional chaos, good social intelligence, good problem-solving skills, and ability to perceive a long-term future. Whether the child is interested in a specific topic, such as video games, isn't as relevant as the other questions. p. 159
A nurse advises a patient who is stressed to exercise daily to relieve stress. What is the reason for the nurse to consider exercise as a stress-buster? a. It increases muscle tension. b. It decreases levels of anxiety. c. It decreases endorphin levels. d. It decreases sensitivity to stress. e. It decreases chronic and acute stress.
bde. Exercise is a great stress-buster. A half-hour of exercise performed three or more times a week tends to dissipate chronic and acute stress by diminution of the stress response. It also decreases the anxiety levels by inducing relaxation. Regular exercise decreases one's sensitivity to stress, thereby decreasing the adverse effects of stress on the body. Exercise tends to provide relaxation by decreasing the muscle tension and increasing the endorphin levels. p. 160, Table 10.1
A nurse is caring for a chronically stressed patient. What are suggestions that would help the patient relieve stress? SATA a. Sleeping later in the morning than usual b. Talk to a therapist to process stress c. Regularly drinking coffee, tea, colas, and chocolate drinks d. Going to sleep 30 to 60 minutes earlier each night for a few weeks e. Exercising at least 30 minutes three or more times a week
bde. Exercise can dissipate chronic and acute stress and may decrease levels of anxiety, depression, and sensitivity to stress. Fatigue occurs more often in chronically stressed people and can be reduced by getting sufficient sleep early in the night. Sleeping later in the morning can disrupt body rhythms and so is not particularly helpful in reducing stress. Caffeine intake leads to more energy consumption and increased muscle pain. Talking to a therapist may be useful for a patient with a stress disorder but may not be necessary for all patients who experience stress. p. 160, Box 10.1
The nurse provides care to a patient who presents with uneasiness and reports feeling stressed. What does the nurse recognize as psychological stressors? a. Pain b. Divorce c. Trauma d. Job loss e. Retirement f. Birth of a new baby
bdef. Retirement, job loss, divorce, and the birth of a new baby are psychological stressors, or events that stimulate emotional arousal, fatigue, fear, and other similar sensations. Trauma and pain are examples of physiological stressors, which are physical conditions. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 160
A nurse is educating a patient with anxiety about the stress-relieving technique of mindfulness. Which statement made by the patient indicates effective teaching? a. "Mindfulness involves progressively tensing then relaxing body muscles." b. "Mindfulness is a memory system to assist me in short-term memory recall." c. "Mindfulness involves focusing and paying attention to what is going on around me." d. "Mindfulness involves focusing on an object and repeating a phrase while deep breathing."
c. Mindfulness is a technique used for relaxation. It involves focusing on the present and paying attention to what is going on around you. Progressively tensing then relaxing body muscles is used in progressive muscle relaxation. The purpose of mindfulness is to induce relaxation, not improve short-term memory. Focusing on an object and repeating a word or phrase while breathing deeply is a technique used in the Benson-Henry protocol. p. 167
Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? a. "I do not have the ability to handle that job." b. "I can never learn all there is to know for the job." c. "I can be successful if I do all the things required to learn the job." d. "I may be fired from the job but eventually I will find something else to do with my life."
c. Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. "I do not have the ability to handle that job," "I may be fired from the job but eventually I will find something else to do with my life," and "I can never learn all there is to know for the job" are all negative cognitive distortions that would prevent the individual from succeeding. p. 167
A patient scheduled for surgery seems to be anxious. The nurse teaches the patient to practice deep breathing exercises. What is the most appropriate reason for teaching deep breathing exercises to the patient? a. To help the patient prevent postoperative complications. b. To prevent preoperative risk of respiratory complications. c. To dampen the cognitive process involved in anxiety reactions. d. To promote lung expansion during administration of anesthesia.
c. Deep breathing exercises help to promote relaxation by dampening the cognitive processes that are likely to be involved in stress and anxiety reactions. Thus, they decrease the anxiety of the patient. Deep breathing exercises help to prevent post-operative complications, and promote lung expansion; but they are not applicable to the patient who is anxious before a surgery. Deep breathing exercises do not prevent preoperative risk of complications. p. 165, Box 10.2
Which patient is illustrating eustress? a. A man who is laid off from his job b. A college student who fails an exam c. A bride who is planning for her wedding d. An adolescent who gets into a fight at school
c. Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. Failing an exam, getting laid off from a job, and getting into a fight at school all describe distress, or a negative energy. p. 159
What would a patient experience during a progressive relaxation session? a. Being led into a positive imaginary sensory experience b. Having a nurse enter the patient's energy field to rebalance it and bring harmony c. Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed d. Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter
c. Instruction on sequential tensing and relaxing muscles provides a description of Benson's method of progressive relaxation. Being attached to a machine that uses sound describes biofeedback. Rebalancing an energy field describes therapeutic touch. Positive imaging describes a component of guided imagery. p. 166
The nurse teaches a patient with anxiety about stress and triggers. Which statement made by the patient indicates the teaching was effective? a. "Stress is a negative response." b. "Eustress is resistance to stress." c. "People can have good and bad stress." d. "People with stress are always in distress."
c. Stress can take positive or negative forms. Distress is a negative and draining energy, but eustress is a positive and beneficial energy in response to more positive types of stress. Not all people with stress are in distress. Stress is not always a negative response. Eustress is a positive beneficial energy, not resistance to stress. Test-Taking Tip: Key words or phrases in the question stem such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. No real absolutes exist in life; however, every rule has its exceptions, so answer with care. p. 159
The relaxation response calls on a. Sympathetic activation b. Brainstem deactivation c. Parasympathetic activation d. Increased cortisol production by the adrenals
c. Sympathetic activation prepares the individual for the fight-or-flight response. Parasympathetic activation has the opposite effect. p. 158
An effective stress-reduction technique a nurse might teach an individual with performance anxiety is a. Assertiveness b. Journal keeping c. Deep breathing d. Restructuring and setting priorities
c. Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. p. 165, Box 10.2
A nurse teaches a patient a technique for examining negative thoughts and restating them in positive ways. This technique is called Guided imagery Wishful thinking Cognitive reframing Confrontational assertion
cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative
High-quality social support relationships have attributes that include a. Minor conflict b. Constructive criticism c. Continuous feedback d. Reciprocal closeness
d. High-quality social support relationships are relatively conflict free, close, confiding, and reciprocal. p. 161
When assessing an individual who has had several infections in a short period, it is important to ask which question initially? a. Does the person have an autoimmune disease? b. Does the person have a genetic history for a depressed immune system? c. Does the person come in contact with multiple children? d. Does the person have an increase in recent stress in his or her life?
d. Stress is a common factor that can have negative effects on a person's health. A series of stressful events can be contributing factors to illness. Although it is true that persons with an autoimmune disease or a genetic history of a depressed immune system are vulnerable to infections, these are less common reasons. Exposure to multiple children with infections can increase a person's risk for infections as well but again is less likely a cause than stress. p. 157
During a home visit, the nurse finds that an adolescent is upset after failing a midterm exam at school. What positive statement does the nurse use to comfort the adolescent? a. "Do you feel like you should have studied more?" b. "You should not be upset for such a small reason." c. "This probably just isn't your best subject, and you should focus on your stronger subjects." d. "You can learn from this experience and refocus your attention to improve your future performance."
d. The nurse uses the method of cognitive reframing to change the patient's perception of stress and encourage empowering self-statements such as "you can learn from this experience." Positive statements could help the patient become hopeful and motivated to perform better. Saying that the adolescent should not be upset for failing the test, questioning if he or she studied enough, or suggesting that the student isn't very good at this subject are negative statements. The nurse may inadvertently discourage the student rather than motivate or comfort the student. p. 167
A Hispanic woman has been in an abusive relationship for 3 years. Which comment by this patient is most likely? a. "I need help with preparing an escape plan." b. "I feel so depressed about the failure of my marriage." c. "He is not a good man. His father and brother are also abusive." d. "I have very bad headaches that make it hard for me to care for my children."
d. The patient is experiencing severe stress but expressing it somatically. The overwhelming majority of Asians, Africans, and Central Americans tend to express distress in somatic terms and actually experience it physically. In the correct answer, the patient has expressed her distress about the abuse with complaints of headaches. Although Western European and North American cultures tend to subscribe to a psychophysiologic view of stress and somatic distress, this is not the dominant view in other cultures. The incorrect responses depict emotional recognition of stress associated with the abuse. p. 162
A nurse is caring for a young patient who complains of stress due to work. What is an appropriate statement when teaching cognitive reframing to the patient? a. "I am not worthy of any appraisal." b. "I have messed up all the projects that I manage." c. "I deserve to be fired from my job." d. "I am competent enough to close this profitable deal."
d. Cognitive reframing involves changing the patient's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. Cognitive reframing helps to improve self-esteem. Cognitive reframing does not include negative statements related to self-worth, competency, and efficiency. p. 167
Which physiologic responses are associated with severe long-term stress? Select all that apply. Obesity Hypotension Atherosclerosis Protein breakdown Stimulation of the immune system
obesity atherosclerosis protein breakdown