Chapter 37: Stress and Coping Review Questions Flashcards
When teaching a patient about the negative feedback response to stress, the nurse includes which of the following to describe the benefits of this stress response?
- Results in neurophysiological response.
- Reduces body temperature
- Causes a person to be hypervigilant
- Reduces level of consciousness to conserve energy.
Answer: 1.
Negative feedback senses an abnormal state such as lowered body temperature and makes an adaptive response such as shivering to generate body heat to return the body to hormonal homeostasis.
A nurse observes that a patient whose home life is chaotic with intermittent homelessness, a child with spina bifida, and an abusive spouse appears to be experiencing an allostatic load. As a result, the nurse expects to detect which of the following while assessing the patient?
- Posttraumatic stress disorder
- Rising hormone levels
- Chronic illness
- Return of vital signs to normal
Answer: 3.
An increased allopathic load can result in long-term physiological problems and chronic illness. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.
A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, “The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months.” The patient is using the defense mechanism:
- Denial.
- Conversion.
- Dissociation.
- Displacement.
Answer: 1.
Denial is avoiding emotional stress by refusing to consciously acknowledge anything that causes intolerable anxiety. This patient’s statements reflect denial about poorly controlled blood sugars.
When doing an assessment of a young woman who was in an automobile accident 6 months before, the nurse learns that the woman has vivid images of the crash whenever she hears a loud, sudden noise. The nurse recognizes this as ____________.
Answer: Posttraumatic stress disorder (PTSD).
PTSD originates with a person’s experiencing or witnessing a traumatic event and responding with intense fear or helplessness. The car accident is the traumatic event that is causing intense fear or helplessness in this patient.
A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of:
- A situational crisis.
- A maturational crisis.
- An adventitious crisis.
- A developmental crisis.
Answer: 3.
An adventitious crisis is a type of crisis resulting from a natural disaster such as a tsunami.
During the assessment interview of an older woman experiencing a developmental crisis, the nurse asks which of the following questions?
- How is this flood affecting your life?
- Since your husband has died, what have you been doing in the evening when you feel lonely?
- How is having diabetes affecting your life?
- I know this must be hard for you. Let me tell you what might help.
Answer: 2.
A developmental crisis occurs as a person moves through life’s stages, including widowhood.
The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following?
- Loss of autonomy caused by health problems
- Physical appearance, family, friends, and school
- Self-esteem issues, changing family structure
- Search for identity with peer groups and separating from family
Answer: 4.
Answer 1 applies to the older adult. Answer 2 applies to children. Answer 3 applies to preadolescents.
A child who has been in a house fire comes to the emergency department with her parents. The child and parents are upset and tearful. During the nurse’s first assessment for stress the nurse says:
- “Tell me who I can call to help you.”
- “Tell me what bothers you the most about this experience.”
- “I’ll contact someone who can help get you temporary housing.”
- “I’ll sit with you until other family members can come help you get settled.”
Answer: 2.
The patients’ appraisal of the crisis is the most important area to address first.
When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following?
- The amount of family support
- A 3-day diet recall
- A thorough physical assessment
- Threats to safety in her home
Answer: 3.
Physical causes for problems need to be discovered before treatment for psychosocial problems can be initiated.
After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. The nurse’s first response is which of the following?
- “Don’t be sad. People live with cancer every day.”
- “Have you thought about how you are going to tell your family?”
- “Would you like for me to sit down with you for a few minutes so you can talk about this?” 4. “I know another patient whose colon cancer was cured by surgery.”
Answer: 3.
Ask the patient if he would like you to sit down for a few minutes so he can talk. Providing an open-ended question and an opportunity for the patient to talk allows the nurse to assess the patient’s perception of the situation, which is of utmost importance.
A 34-year-old man who is anxious, tearful, and tired from caring for his three young children tells you that he feels depressed and doesn’t see how he can go on much longer. Your best response would be which of the following?
- “Are you thinking of suicide?”
- “You’ve been doing a good job raising your children. You can do it!”
- “Is there someone who can help you?”
- “You have so much to live for.”
Answer: 1.
Although this sounds abrupt, the patient usually is relieved that you’ve broached this issue. For safety reasons it is very important to discuss his suicidal thoughts with the patient.
The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. The nurse realizes that the patient is coping successfully when the patient says:
- “I’m going to learn to drive a car so I can be more independent.”
- “My sister says she feels better when she goes shopping, so I’ll go shopping.”
- “I’ve always felt better when I go for a long walk. I’ll do that when I get home.”
- “I’m going to attend a support group to learn more about multiple sclerosis.”
Answer: 4.
Support groups often benefit people experiencing stress.
A patient newly diagnosed with type 2 diabetes says, “My blood sugar was just a little high. I don’t have diabetes.” The nurse responds:
- “Let’s talk about something cheerful.”
- “Do other members of your family have diabetes?”
- “I can tell that you feel stressed to learn that you have diabetes.”
- With silence.
Answer: 4.
The nurse understands that denial is a defense mechanism that assists in coping with a shock. Therapeutic use of silence gives patients time to process their thoughts.
A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. The supervising nurse recognizes that:
- Nurses who feel stress usually pass the stress along to their patients.
- A nurse who feels stress is ineffective as a nurse and should not be working.
- Nurses who talk about feeling stress are unprofessional and should calm down.
- Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring.
Answer: 4.
Nurses frequently experience stress with the rapid changes in health care technology and organizational restructuring and when the situation seems out of their personal control.
A crisis intervention nurse working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her entitlement check while the child is hospitalized can expect the mother to regain stability after how long?
- After 2 weeks when the child’s pneumonia begins to improve
- After 6 weeks when she adjusts to the child’s respiratory status and reestablishes the entitlement checks
- After 1 month when the child goes home and the mother gets help from a food pantry
- After 6 months when the child is back in school
Answer: 2.
Generally a person resolves the crisis and reaches psychological equilibrium in about 6 weeks.
