Unit 8: Ch.32 Stress and Coping Flashcards
The nurse has been assigned the same patients for the past 4 days. Two of the patients demand a great deal of attention, and the nurse feels anxious and angry about being given this assignment again. What action would demonstrate the most effective way for the nurse to cope with the patient care assignment?
a. Share complaints about the assignment with the nurse manager.
b. Prioritize the patients’ needs and identify a specific time period to care for each patient.
c. Talk with the patients and explain that they cannot expect so much personal attention.
d. Trade assignments with another nurse who is unaware of the concerns regarding the patient assignment.
Answer: b
Prioritizing care and setting aside time to spend with specific patients constitute the most effective coping strategy for the nurse to use. Sharing concerns with the nurse manager does not demonstrate strong problem-solving skills; it merely shows a desire to complain. Trading assignments diminishes the continuity of care during which patient trust and nurse–patient relationships are developed. Patients are always the focus of nursing care and should not be given the impression that the nurse does not have time to care or listen to their concerns.
A patient is newly diagnosed with diabetes and requires insulin injections. He requests information about classes offered by the diabetes educator. Which type of coping technique is this patient using?
a. Emotion-focused
b. Problem-focused
c. Avoidance
d. Denial
Answer: b
Problem-focused coping techniques are aimed at altering or removing a stressor. If this patient gains the skills to administer his own injections from the diabetes educator, he will remove a major stressor associated with a new diabetes diagnosis. Emotion-focused coping techniques, avoidance, and denial are all psychological techniques, rather than a psychomotor-based activity, which is required in this situation.
Which statements by a patient would indicate the use of effective coping strategies? (Select all that apply.)
a. “Each month, my wife and I attend a support group for parents of children with autism.”
b. “Talking with my spiritual adviser may challenge my thinking on how best to handle this situation.”
c. “I’ve invited my son to join me for drinks at the bar each night on his way home from work so that we can spend more time together.”
d. “We are looking into joining the new health club facility in our neighborhood.”
e. “After working all day, I eat dinner in front of the television while my family sits at the kitchen table.”
Answer: a, b, d
Support groups, spiritual advisors, and health clubs all offer services that can enhance coping skills. The daily use of alcohol is not a healthy coping strategy, even if it involves spending time with family. Eating in front of the television promotes obesity and social isolation.
When using a stress assessment tool with a patient from another culture, what factors must the nurse take into consideration? (Select all that apply.)
a. Specific methods of managing stress are revealed in using stress assessment tools.
b. Stress assessment tools should be used only for persons living in North America.
c. Stress assessment tools may not be appropriate for all people of all ages.
d. Resistance resources become evident when stress assessment tools are analyzed.
e. Adaptations may need to be made to the assessment tool based on circumstances.
Answer: c, e
It is not possible to use stress assessment tools in some situations. Stress assessment tools must be adapted to specific age groups, cultures, and circumstances to be most effective in gathering pertinent data. Stress assessment tools identify only stressors that the person is experiencing and not methods of managing stress or the person’s resistance resources.
Two adult siblings are caring for their ill mother, who requires 24-hour care. She needs assistance with feeding, bathing, and toileting. One of the siblings takes time to exercise after work, whereas the other goes directly to the mother’s home before and after work each day. The nurse recognizes that people may react differently to the same stressors depending on which factors? (Select all that apply.)
a. Individual coping skills
b. Type of identified stressor
c. Amount of perceived stress
d. Personal appraisal of the stressor
e. Hair color, gender, and skin type
Answer: a, b, c, d
The person’s coping skills have an impact on how that person perceives and responds to stress. The type and amount of stress as well as the appraisal of stress also affect how the person reacts. Hair color, gender, and skin type are not recognized as factors related to stress reactions.
A male patient is told that he may have colon cancer. Which response by the patient best indicates that his initial appraisal of the situation is that it is primarily a challenge to be met?
a. Requesting information on various treatment options
b. Demanding to see another physician immediately
c. Storming out of the gastroenterologist’s office
d. Yelling at the nurse who is scheduling his colonoscopy
Answer: a
Requesting further information regarding treatment indicates that the patient is viewing the situation primarily as a challenge to be faced. Primary and secondary appraisals determine whether the stressful situation or transaction is a threat or a challenge. A threat invokes the possibility of harm or loss, whereas a challenge holds the possibility of benefit. Demanding, angry behavior indicates that the patient feels threatened rather than challenged.
A 25-year-old female patient demands that her mother or father be present during all blood testing. Which defense mechanism could the nurse document as being used by this patient?
a. Sublimation
b. Repression
c. Projection
d. Regression
Answer: d
This young adult patient is reverting back to behavior consistent with an earlier stage of development, which is the defense mechanism of regression. Sublimation is channeling unacceptable emotions into acceptable actions. Repression involves blocking unacceptable thoughts from consciousness, and projection attributes one person’s desires or traits to another person.
In the immediate postoperative period after open-heart surgery, a patient who is not a diabetic has elevated blood glucose levels. What physiologic stress response would the nurse recognize as being directly responsible for the patient’s increased blood sugar?
a. Release of epinephrine
b. Circulation of endorphins
c. Increase in corticosteroids
d. Secretion of corticotropin-releasing hormone (CRH)
Answer: c
Corticosteroids increase serum glucose levels and inhibit the inflammatory response. Patients who have experienced extreme physiologic stress will often require short-term insulin therapy until their corticosteroid and blood glucose levels return to normal. Epinephrine, CRH, and endorphins all respond to stress; however, corticosteroids are directly responsible for the increase in this patient’s blood sugar.
Which short-term goal would be most appropriate for a patient with the nursing diagnosis Anxiety with supporting data, including upcoming diagnostic tests, expressions of concern, and pacing around the room?
a. Patient will discuss specific aspects of concern.
b. Nurse will administer prescribed antianxiety medication.
c. Patient will understand diagnostic test procedures.
d. Nurse will describe test procedures in detail to allay concerns.
Answer: a
Having the patient discuss specific aspects of concern allows the nurse the opportunity to assess the patient’s level of anxiety and what interventions might be most appropriate to help allay the stated concerns. Goals must be patient centered, measurable, and realistic. None of the other three goals meet these criteria. Two of the goals are nurse focused. The action “understand” is not measurable.
Which intervention would be most appropriate for the nurse to include in the care plan for a patient who is experiencing constipation and increased heart and respiratory rates?
a. Time management
b. Decreased grain intake
c. Relaxation therapy
d. Regimented exercise
Answer: c
Relaxation therapy typically lowers the person’s heart and respiratory rates while increasing gastric motility. Not enough information is provided to indicate the need for time management. Both decreased grain intake and regimented exercise may exacerbate the patient’s problems.
