Stress and Coping Flashcards
After the death of several long-term clients, which action indicates the nurse is demonstrating ineffective coping?
1. The nurse talks at length to her partner about the deaths.
2. The nurse keeps busy with other actions and doesn’t think about the deaths for several days.
3. The nurse offers to work extra shifts for several weeks.
4. Several nurses schedule a group session with the agency clergy to discuss the deaths.
- Answer: 3. Rationale: Taking on additional work would only serve as an additional stressor. In addition, a nurse who has not begun resolution of feelings is unlikely to be able to meet clients’ emotional needs. Effective coping may include verbalizing feelings (one-on-one or in groups) or initiating distractions (options 1, 2, and 4). Of course, the nurse may not disclose confidential information to her partner or others who would not already have this information. Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Evaluation. Learning Outcome: 42-6.
The nurse helps a 50-year-old client with diabetes who is to begin giving insulin injections identify previously successful coping strategies that may be useful in the current situation. Which stressor is closely related to the new stressor?
1. Interviewing for a new job
2. Death of a pet while the person was a teenager
3. The person’s partner filing for a divorce
4. Starting to wear eyeglasses at age 30
- Answer: 4. Rationale: Wearing glasses is another example of beginning a new strategy to assist with what will be a lifelong health need even though it is not necessarily a desired change. Interviewing for a job (option 1) is a very short-lived situational stressor. Coping strategies effective while a teenager may not be relevant at age 50 (option 2). Experiencing the stress of a divorce is a social/role stressor quite unlike that of a health problem (option 3). Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Assessment. Learning Outcome: 42-9.
Two people have been in a motor vehicle crash and have similar injuries. According to the transaction-based model, their degree of stress from the crash would be
1. Based on previous experience and personal characteristics.
2. Extremely similar since they had the same stimulus.
3. The identical physiological alarm reaction.
4. Different depending on their external resources and support levels.
- Answer: 1. Rationale: In the transaction model, stress is a very personal experience and varies widely among individuals. Option 2 represents the stimulus model, and option 3 represents the response model of stress. In option 4, external resources and support are a factor in determining stress levels but omit the key aspects of internal/personal influences. Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Assessment. Learning Outcome: 42-1.
A client informed of a cancer diagnosis assures the nurse he is fine. Which of the following is the most indicative physical evidence to the nurse of the client’s stress?
1. Constricted pupils
2. Dilated peripheral blood vessels (flush)
3. Hyperventilation
4. Decreased heart rate
- Answer: 3. Rationale: With stress, respirations increase, pupils dilate, peripheral blood vessels constrict, and the heart rate increases. Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Assessment. Learning Outcome: 42-3.
Immediately after the parents of a hospitalized child are informed that the child has leukemia, the father responds by continuing his usual work schedule, rarely visiting, and asking when the child can return to school. Of the following, which is the least likely to be an appropriate nursing diagnosis at thistime?
1. Ineffective Denial
2. Caregiver Role Strain
3. Fear
4. Compromised Family Coping
- Answer: 2. Rationale: It is too soon for Caregiver Role Strain to be an appropriate nursing diagnosis—especially since the child is not at home. Ineffective Denial and Fear are common reactions to this type of threat (options 1 and 3). The father demonstrates Compromised Family Coping by his difficulty in being supportive (option 4). Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Diagnosing. Learning Outcome: 42-8.
The nurse has recently changed jobs to work with young adults and recognizes that sources of stress common to that population include which of the following? Select all that apply.
1. Marriage
2. Aging parents
3. Starting a new job
4. Leaving the parental home
5. Decreased physical abilities
6. Changing body structure
- Answer: 1, 3, and 4. Rationale: Common stressors among young adults include marriage, starting a new job, and leaving the parental home. Stressors from aging parents are more common among middleaged adults (option 2); decreased physical abilities is a stressor in older adults (option 5); and changing body structure serves as a stressor in both children and older adults (option 6). Cognitive Level: Understanding. Client Need: Psychosocial Integrity. Nursing Process: Planning. Learning Outcome: 42-7.
A middle-aged male client is experiencing job-related stress associated with the fear of being laid off, resulting in his accepting projects that require a great deal of travel. Which of the following would be the most important health promotion strategy for this client?
1. Exercise
2. Sleep
3. Nutrition
4. Time management
- Answer: 2. Rationale: All four areas of health promotion strategies may be important, but for this client sleep is likely to be the most adversely affected by travel in which changing time zones and unfamiliar sleeping quarters are common. It is easier for clients to adapt to modifying exercise (option 1), nutrition (option 3), and time management (option 4) during travel than it is to control sleep. Thus, it becomes the most important area requiring intervention to avoid worsening the existing stress. Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Implementation. Learning Outcome: 42-9.
The first time the nurse enters the client’s room, the client is on the phone. Immediately, the client slams down the phone, sweeps everything off the overbed table, and demands that the nurse perform several duties “this very minute.” Which of the following would be the most appropriate response for the nurse? 1. Tell the client “I will return” and then leave the room.
2. Tell the client no care will be given until the screaming ends.
3. Begin providing needed care calmly and quietly.
4. Allow the client to complete venting, then respond calmly.
- Answer: 4. Rationale: Unless the nurse feels in physical danger, it is important to remain with the client, allow the anger to dissipate, and then begin assessing the cause. Leaving the room provides no therapeutic action (option 1). Option 2 may be considered setting limits, which can be helpful, but cannot occur until the client is calmer. All behavior is meaningful; it is inappropriate to ignore the client’s behavior (option 3). Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Implementation. Learning Outcome: 42-9.
A client newly diagnosed with a chronic condition that will significantly change the lifestyle must learn aspects of self-care. The client exhibits severe anxiety: increased blood pressure and pulse, headache, and nervousness. Based on this situation, how would the nurse appropriately plan the teaching? 1. Recognize that the client’s ability to learn is severely impaired and teach only the immediate, critical needs and plan to follow up and reinforce this teaching later.
2. Recognize that the client’s learning will be adaptive and begin immediately to implement the full teaching and learning plan.
3. Recognize that the client’s ability to learn will be slightly impaired and modify the usual teaching strategies to accommodate for this impairment.
4. Recognize that the client cannot learn at this time, that the level of anxiety must first be reduced, and then teaching can be based on this new level of anxiety.
- Answer: 1. Rationale: This client is exhibiting severe anxiety and, therefore, learning is impaired but not impossible (see Table 42–2). Therefore, it is most appropriate for the nurse to teach only those things that are critical for the client to learn at this time. The nurse also recognizes that learning may not be retained at this level of anxiety and plans to reinforce the teaching when the client is less anxious. Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Planning. Learning Outcome: 42-4.
Which of the following defense mechanisms for coping with stress could be effective and constructive? Select all that apply.
1. Compensation
2. Displacement
3. Minimization
4. Repression
5. Regression
- Answer: 1, 2, and 4. Rationale: Compensation (option 1) may allow the client to overcome a weakness. Displacement (option 2) allows the client to express feelings safely. Repression (option 4) protects the client from further emotional trauma until able to cope. Minimization (option 3) prevents the client from accepting responsibility for actions. Regression (option 5) returns the client to a lower/previous developmental level. Note: Each of these may be more or less effective defenses depending on the exact context of the situation. Cognitive Level: Understanding. Client Need: Psychosocial Integrity. Nursing Process: Assessment. Learning Outcome: 42-5.
