chapter 37 : stress and coping Flashcards
In a natural disaster relief facility, the nurse observes that an older-adult male has a recovery plan, while a 25-year-old male is still overwhelmed by the disaster situation. A nurse is planning care for both patients. Which factors will the nurse consider about the different coping reactions?
a. Restorative care factors
b. Strong financial resource factors
c. Maturational and situational factors
d. Immaturity and intelligence factors
c. Maturational and situational factors
Maturational factors and situational factors can affect people differently depending on their life experiences. An older individual would have more life experiences to draw from and to analyze on why he was successful, whereas a younger individual would have fewer life experiences based on chronological age to analyze for patterns of previous success. Nothing in the scenario implies that either man is in restorative care, has strong financial resources, or is immature or intelligent.
A woman who was sexually assaulted a month ago presents to the emergency department with reports of recurrent nightmares, fear of going to sleep, repeated vivid memories of the sexual assault, and inability to feel much emotion. Which medical problem will the nurse expect to see documented in the chart?
a. General adaptation syndrome (GAS)
b. Posttraumatic stress disorder (PTSD)
c. Acute stress disorder
d. Alarm reaction
b. Posttraumatic stress disorder (PTSD)
Posttraumatic stress disorder is characterized by vivid recollections of the traumatic event and emotional detachment and often is accompanied by nightmares. General adaptation syndrome is the expected reaction to a major stressor. Acute stress disorder is a similar diagnosis that differs from PTSD in duration of symptoms. Alarm reaction involves physiological events such as increased activation of the sympathetic nervous system that would have occurred at the time of the sexual assault.
The nurse teaches stress-reduction and relaxation training to a health education group of patients after cardiac bypass surgery. Which level of intervention is the nurse using?
a. Primary
b. Secondary
c. Tertiary
d. Quad
c. Tertiary
Tertiary-level interventions assist the patient in readapting and can include relaxation training and time-management training. At the primary level of prevention, you direct nursing activities to identifying individuals and populations who are possibly at risk for stress. Nursing interventions at the secondary level include actions directed at symptoms such as protecting the patient from self-harm. Quad level does not exist.
A nurse is teaching guided imagery to a prenatal class. Which technique did the nurse describe?
a. Singing
b. Massaging back
c. Listening to music
d. Visualizing peaceful settings
d. Visualizing peaceful settings
Guided imagery is used as a means to create a relaxed state through the person’s imagination. Imagination allows the person to create a soothing and peaceful environment. Singing, back massage, and listening to music are other types of stress management techniques.
After a natural disaster occurred, an emergency worker referred a family for crisis intervention services. One family member refused to attend the services, stating, ―No way, I’m not crazy.‖ What is the nurse’s best response?
a. Many times, disasters can create mental health problems, so you really should participate with your family.
b. Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique.
c. Don’t worry now. The psychiatrists are well trained to help.
d. This will help your family communicate better.
b. Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique.
Crisis intervention is a type of brief therapy that is more directive than traditional psychotherapy or counseling. It focuses on problem solving and involves only the problem created by the crisis. The other options do not properly reassure the patient and build trust. Giving advice in the form of ―you really should participate‖ is inappropriate. ―Don’t worry now‖ is false reassurance. While crisis intervention may help families communicate better, the goal is to return to precrisis level of functioning; family therapy will focus on helping families communicate better.
A preadolescent patient is experiencing maturational stress. Which area will the nurse focus on when planning care?
a. Identity issues
b. Self-esteem issues
c. Physical appearance
d. Major changing life events
b. Self-esteem issues
Preadolescents experience stress related to self-esteem issues, changing family structure as a result of divorce or death of a parent, or hospitalizations. Adolescent stressors include identity issues with peer groups and separation from their families. Children identify stressors related to physical appearance, families, friends, and school. Adult stressors centralize around major changes in life circumstances.
A nurse is caring for a patient experiencing stress and is in the evaluation stage of the critical thinking model. Which actions will the nurse take?
a. Select nursing interventions and promote patient’s adaptation to stress.
b. Establish short-and long-term goals with the patient experiencing stress.
c. Identify stress management interventions and achieve expected outcomes.
d. Reassess patient’s stress-related symptoms and compare with expected outcomes.
d. Reassess patient’s stress-related symptoms and compare with expected outcomes.
During the evaluation stage, the nurse compares current stress-related symptoms against established measurable outcomes to evaluate the effectiveness of the intervention. Selecting appropriate interventions and establishing goals are part of the planning process.
An adult male reports new-onset, seizure-like activity. An EEG and a neurology consultant’s report rule out a seizure disorder. It is determined the patient is using conversion. Which action should the nurse take next?
a. Suggest acupuncture.
b. Confront the patient on malingering.
c. Obtain history of any recent life stressors.
d. Recommend a regular exercise program
c. Obtain history of any recent life stressors.
Unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite) describes conversion defense mechanism. The nurse must assess the patient fully for emotional conflict and stress before implementing any nursing interventions (acupuncture or exercise program). Although the patient may be malingering, confrontation is nontherapeutic because the patient is using this type of defense mechanism in response to some type of stressor.
A senior college student visits the college health clinic about a freshman student living on the same dormitory floor. The senior student reports that the freshman is crying and is not adjusting to college life. The clinic nurse recognizes this as a combination of situational and maturational stress factors. Which is the best response by the nurse?
a. Let’s call 9-1-1 because this freshman student is suicidal.
b. Give the freshman student this list of university and community resources.
c. I recommend that you help the freshman student start packing bags to go home.
d. You must make an appointment for the freshman student to obtain medications
b. Give the freshman student this list of university and community resources.
A nurse can help reduce situational stress factors for individuals. Inform the patient about potential resources. Providing the student with a list of resources is one way to begin this process, as part of secondary prevention strategies. This is not a medical or psychiatric emergency, so calling 9-1-1 is not necessary. Not everyone who has sadness needs medications; some need counseling only. Not enough information is given to know whether the student would be best suited to leave college.
Despite working in a highly stressful nursing unit and accepting additional shifts, a new nurse has a strategy to prevent burnout. Which strategy will be best for the nurse to use?
a. Delegate complex nursing tasks to nursing assistive personnel.
b. Strengthen friendships outside the workplace.
c. Write for 10 minutes in a journal every day.
d. Use progressive muscle relaxation.
b. Strengthen friendships outside the workplace.
Strengthening friendships outside of the workplace, arranging for temporary social isolation for personal ―recharging‖ of emotional energy, and spending off-duty hours in interesting activities all help reduce burnout. Journaling and muscle relaxation are good stress-relieving techniques but are not directed at the cause of the workplace stress. Delegating complex nursing tasks to nursing assistive personnel is a strategy that is both illegal and unsafe.
A female teen diagnosed with celiac disease continues to eat food she knows will make her ill several hours after ingestion. While planning care, the nurse considers maturational and tertiary-level interventions. Which intervention will the nurse add to the care plan?
a. Teach the teen about the food pyramid.
b. Administer antidiarrheal medications with meals.
c. Gently admonish the teen and her parents regarding the consistently poor diet choices.
d. Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends.
d. Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends.
Tertiary-level interventions assist the patient in readapting to life with an illness. By adjusting the diet to meet dietary guidelines and also addressing adolescent maturational needs, the nurse will help the teen to eat an appropriate diet without health complications and see herself as a ―typical and normal‖ teenager. Teaching about the food pyramid will not address the real issue, which is that the teen is still eating what she knows will make her ill and the food pyramid is usually a primary intervention. Administering antidiarrheal medications may help but is not a tertiary-level or maturational intervention. Admonishing the teen and parents is not a tertiary-level intervention, and because this approach is nontherapeutic, it may cause communication problems.
A trauma survivor is requesting sleep medication because of ―bad dreams.‖ The nurse is concerned that the patient may be experiencing posttraumatic stress disorder (PTSD). Which question is a priority for the nurse to ask the patient?
a. Are you reliving your trauma?
b. Are you having chest pain?
c. Can you describe your phobias?
d. Can you tell me when you wake up?
a. Are you reliving your trauma?
People who have PTSD often have flashbacks, recurrent and intrusive recollections of the event. The other answers involve assessment of problems not specific to PTSD.
A patient in a motor vehicle accident states, ―I did not run the red light,‖ despite very clear evidence on the street surveillance tape. Which defense mechanism is the patient using?
a. Denial
b. Conversion
c. Dissociation
d. Compensation
a. Denial
Denial consists of avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Dissociation involves creating subjective numbness and less awareness of surroundings. Conversion involves repressing anxiety and manifesting it into nonorganic symptoms. Compensation occurs when an individual makes up for a deficit by strongly emphasizing another feature
A nurse is teaching the staff about the general adaptation syndrome. In which order will the nurse list the stages, beginning with the first stage? 1.Resistance
2.Exhaustion
3.Alarm
a. 3, 1, 2
b. 3, 2, 1
c. 1, 3, 2
d. 1, 2, 3
a. 3, 1, 2
The general adaptation syndrome (GAS), a three-stage reaction to stress, describes how the body responds physiologically to stressors through stages of alarm, resistance, and exhaustion
A young male patient is diagnosed with testicular cancer. Which action will the nurse take first?
a. Provide information to the patient.
b. Allow time for the patient’s friends.
c. Ask about the patient’s priority needs.
d. Find support for the family and patient.
c. Ask about the patient’s priority needs.
Take time to understand a patient’s meaning of the precipitating event and the ways in which stress is affecting his life. For example, in the case of a woman who has just been told that a breast mass was identified on a routine mammogram, it is important to know what the patient wants (priority needs) and needs most from the nurse. Providing information, allowing time with friends, and finding support may be implemented after finding out what the patient wants or needs.
