ch 30 Flashcards
An older patient presents to the outpatient clinic with a chief complaint of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patient’s chief complaint?
a. The patient is responsible for caring for two school-age grandchildren.
b. The patient’s daughter works to support the family.
c. The patient is being treated for hypertension and is overweight.
d. The patient has recently lost her spouse and needed to move in with her daughter.
ANS: D
The stress of losing a loved one and having to move are important contributing factors for stress-related symptoms in older people. Caring for children will increase the patient’s sense of worth. Being overweight and being treated for hypertension are not the most likely causes of insomnia or headache. The patient’s daughter may have added stress due to working, but this should not directly affect the patient.
A patient who was recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. Which action should the nurse take?
a. Ask the healthcare provider for a psychiatric referral.
b. Administer the PRN sedative medication every 4 hours.
c. Suggest the use of a home caregiver to the patient’s family.
d. Plan to reinforce and repeat teaching about diabetes management.
ANS: D
Because behavioral responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, patient teaching will need to be repeated. Psychiatric referral or home caregiver referral will not be needed for these expected short-term cognitive changes. Sedation will decrease the patient’s ability to learn the necessary information for self-management.
A diabetic patient who is hospitalized tells the nurse, “I don’t understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up.” Which response by the nurse is appropriate?
a. “It is probably just coincidental that your blood sugar is high when you are ill.”
b. “Stressors such as illness cause the release of hormones that increase blood
sugar.”
c. “Increased blood sugar occurs because the kidneys are not able to metabolize
glucose as well during stressful times.”
d. “Your diet is different here in the hospital than at home, and that is the most
likely cause of the increased glucose level.”
ANS: B
The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. The increase in blood sugar is not coincidental. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.
A patient has not been sleeping well because he is worried about losing his job and not being able to support his family. The nurse takes the patient’s vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths/min, and his blood pressure is 166/88 instead his usual 110–120/76–84 range. Which nursing intervention or recommendation should be used first?
a. Go to sleep 30–60 minutes earlier each night to increase rest.
b. Relax by spending more time playing with his pet dog.
c. Slow and deepen breathing via use of a positive, repeated word.
d. Consider that a new job might be better than his present one.
ANS: C
The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident in his elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system (i.e., Benson’s relaxation response) will counter the sympathetic nervous system’s arousal, normalizing these vital-sign changes and reducing the physiologic demands stress is placing on his body. Other options do not address his physiologic response pattern as directly or immediately.
The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to control which physiological function?
a. Switch from the sympathetic mode of the autonomic nervous system to the
parasympathetic mode.
b. Alter the internal state by modifying electronic signals related to physiologic
processes.
c. Replace stress-producing thoughts and activities with daily stress-reducing
thoughts and activities.
d. Reduce catecholamine production and promote the production of additional
β-endorphins.
ANS: A
When the sympathetic nervous system is operative, the individual experiences muscular tension and an elevated pulse, blood pressure, and respiratory rate. Relaxation is achieved when the sympathetic nervous system is quieted and the parasympathetic nervous system is operative. Modifying electronic signals is the basis for biofeedback, a behavioral approach to stress reduction. Altering thinking and activities from more-stressful to less-stressful reflects the cognitive approach to stress management. Reducing catecholamine production is the basis for guided imagery’s effectiveness.
A patient tells the nurse, “I’m told that I should reduce the stress in my life, but I have no idea where to start.” Which would be the best initial nursing response?
a. “Why not start by learning to meditate? That technique will cover everything.”
b. “In cases like yours, physical exercise works to elevate mood and reduce
anxiety.”
c. “Reading about stress and how to manage it might be a good place to start.”
d. “Let’s talk about what is going on in your life and then look at possible options.”
ANS: D
In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. As a result, further assessment is indicated before potential solutions can be explored. Suggesting further exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.
A patient tells the nurse “My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking.” Which response would be in keeping with the doctor’s recommendations?
a. Teaching the patient to recognize, reconsider, and reframe irrational thoughts
b. Encouraging the patient to imagine being in calming circumstances
c. Teaching the patient to use instruments that give feedback about bodily functions
d. Provide the patient with a blank journal and guidance about journaling
ANS: A
Meaning-focused coping leads the individual to focus on his/her own values and beliefs to modify the personal interpretation and response to a problem. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient’s manner of thinking.
A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for follow-up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress?
a. The patient’s wife reports that he spends more time sitting quietly at home.
b. He reports that his appetite, mood, and energy levels are all good.
c. His systolic blood pressure has gone from the 140s to the 120s (mm Hg).
d. He reports that he feels better and that things are not bothering him as much.
ANS: C
Objective measures tend to be the most reliable means of gauging progress. In this case, the patient’s elevated blood pressure, an indication of the body’s physiologic response to stress, has diminished. The wife’s observations regarding his activity level are subjective, and his sitting quietly could reflect his having given up rather than improved. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiologic changes from stress and may not reflect improved coping with stress. The patient’s report that he feels better and is not bothered as much by his circumstances could also reflect resignation rather than improvement.
The nurse is reviewing the care plan for a patient experiencing difficulty coping with stress. Which action should the nurse implement to assist the patient?
a. Identifying the cause of fear
b. Accessing a community support group
c. Identifying relaxation methods
d. Reviewing an educational pamphlet
ANS: A
Identifying the cause of a negative perception is the first step in helping an individual to be able to utilize coping strategies. Accessing a community support group is an example of accessing resources to enhance coping. Identifying relaxation methods is an example of developing an action plan. Reviewing an educational pamphlet is an example of using education to enhance coping.
The nurse is developing a care plan for a patient with ineffective coping skills. Which intervention would be an example of a problem-focused coping strategy?
a. Scheduling a regular exercise program
b. Attending a seminar on treatment options
c. Identifying a confidant to share feelings
d. Attending a support group for families
ANS: C
Problem-focused strategies are used to find solutions or improvement to the underlying stressor, such as accessing community resources or attending educational seminars. Exercise, emotional support, and support groups are emotion-based strategies that create a feeling of well-being.
The school nurse is assessing coping skills of high school students who attend an alternative school for students at high risk to not graduate. What is the priority concern that the nurse has for this student population?
a. Altered vital sign readings
b. Inaccurate perceptions of stressors
c. Increased risk for suicide
d. Decreased access to alcoholic beverages
ANS: C
Adolescents with poor coping have increased risk for drug and alcohol use, risky sexual behaviors, and suicide. Pulse, respiratory rate, and blood pressure may change during stress, but patient safety is the priority concern. Adolescents may have inaccurate perceptions of stressors, and this actually increases the risk for unsafe behaviors. Adolescents under stress are more at risk for increasing their access to alcohol and illegal drugs.
A patient is the primary caregiver for a disabled family member at home, and has now been unexpectedly hospitalized for surgery. What action can the nurse take to enhance the coping ability of the patient?
a. Ask if there is another family member who can help at home while the patient is
in the hospital.
b. Plan to transfer the patient to a rehabilitation unit after surgery to allow
uninterrupted time to recover.
c. Coordinate an ambulance transfer of the family member to an alternate family
member’s home.
d. Ask social services to assess what the patient’s needs will be after discharge to
home.
ANS: A
The best action by the nurse is to help the patient develop an action plan to assess what resources may already be available to meet responsibilities at home. A long absence from the home on a rehabilitation unit does not address the immediate need to provide care for the disabled family member. An ambulance transfer to another family member is premature until the placement is identified as an appropriate placement based on the disabled person’s needs, availability to provide the care by another, and distance of the transfer. Assessing the patient’s needs after discharge does not address the immediate need to provide care for the disabled family person.
After a management decision to admit terminal care patients to a medical unit, the nursing manager notes that nursing staff on the unit appear tired and anxious. Staff absences from work are increasing. The nurse manager is concerned that staff may be experiencing stress and burnout at work. What action would be best for the manager to take that will help the staff?
a. Ask administration to require staff to meditate daily for at least 30 minutes.
b. Have a staff psychologist available on the unit once a week for required counseling.
c. Have training sessions to help the staff understand their new responsibilities.
d. Ask support staff from other disciplines to complete some nursing tasks to
provide help.
ANS: C
Feeling unprepared for work responsibilities contributes to stress and poor coping in the workplace. Administration cannot require that staff participate in meditation or counseling sessions, although these can be recommended and encouraged. Asking other disciplines to assume nursing tasks is not appropriate for their scope of practice.
The nurse has been asked to administer a coping measurement instrument to a patient. What education would the nurse present to the patient related to this tool?
a. “This tool will let us compare your stress to other patients in the hospital.”
b. “This tool is short because it only measures the negative stressors you are
experiencing.”
c. “You will need to ask your parents about stressors you had as a child to complete
this tool.”
d. “This tool will help assess recent positive and negative events you are
experiencing.”
ANS: D
Coping measurement tools measure recent positive and negative life events as perceived by the individual. There is no objective scale for comparison with other patients because each person reacts differently to stressors. Both negative and positive events are assessed. Childhood stressors are not part of this type of evaluation as they are intended to measure recently occurring events.
Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient? (Select all that apply.)
a. Assess for bradycardia.
b. Ask about epigastric pain.
c. Observe for increased appetite.
d. Check for elevated blood glucose levels.
e. Monitor for a decrease in respiratory rate.
ANS: B, C, D
The physiologic changes associated with the acute stress response can cause changes in appetite, increased gastric acid secretion, and elevation of blood glucose levels. Stress causes an increase in the respiratory and heart rates.
