Question 1

A female patient who initially came to the clinic with incontinence was recently diagnosed with endometrial cancer. She is usually well organized and calm,but the nurse who is giving her preoperative instructions observes that the patient is irritable,has difficulty concentrating,and yells at her husband. Which action should the nurse take?

Accepted Answer

Because behavioral responses to stress include temporary changes such as irritability,changes in memory,and poor concentration,patient teaching will need to be repeated. It is also important to try to calm the patient by listening to her concerns and fears. Psychiatric referral will not necessarily be needed for her but that can better be evaluated after surgery. Focusing on postoperative care does not address the need for preoperative instruction such as the procedure,NPO instructions before surgery,date and time of surgery,medications to be taken or discontinued before surgery,and so on. The issue of incontinence is not immediately relevant in the discussion of preoperative teaching for her hysterectomy.

Question 2

A patient who is taking antiretroviral medication to control human immunodeficiency virus (HIV)infection tells the nurse about feeling mildly depressed and anxious. Which additional information about the patient is most important to communicate to the health care provider?

Accepted Answer

St. John's wort interferes with metabolism of medications that use the cytochrome P450 enzyme system,including many HIV medications. The health care provider will need to check for toxicity caused by the drug interactions. Teaching is needed about drug interactions. The other information will also be reported but does not have immediate serious implications for the patient's health.

Question 3

An adult patient who is hospitalized after a motorcycle crash tells the nurse,"I didn't sleep last night because I worried about missing work at my new job and losing my insurance coverage." Which nursing diagnosis is appropriate to include in the plan of care?

Accepted Answer

The information about the patient indicates that anxiety is an appropriate nursing diagnosis. The patient data do not support defensive coping,ineffective denial,or risk prone health behavior as problems for this patient.

Question 4

A hospitalized patient with diabetes 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. This is so frustrating." Which response by the nurse is accurate?

Accepted Answer

The release of cortisol,epinephrine,and norepinephrine increase blood glucose levels. The increase in blood glucose is not coincidental. The liver does not control blood glucose. A patient with diabetes who is hospitalized will be on an appropriate diet to help control blood glucose.

Question 5

An obese female patient who had enjoyed active outdoor activities is stressed because osteoarthritis in her hips now limits her activity. Which action by the nurse will best assist the patient to cope with this situation?

Accepted Answer

For problems that can be changed or controlled,problem-focused coping strategies,such as encouraging the patient to lose weight,are most helpful. The other strategies also may assist the patient in coping with her problem,but they will not be as helpful as a problem-focused strategy.

Question 6

A patient who is hospitalized with a pelvic fracture after a motor vehicle accident just received news that the driver of the car died from multiple injuries. What actions should the nurse take based on knowledge of the physiologic stress reactions that may occur in this patient ?

Accepted Answer

The physiologic changes associated with the acute stress response can cause changes in appetite,increased gastric acid secretion,and increase blood glucose levels. In addition,stress causes an increase in respiratory and heart rates.

Question 7

A patient who has frequent migraines tells the nurse,"My life feels chaotic and out of my control. I could not manage if anything else happens." Which response should the nurse make initially?

Accepted Answer

The nurse's initial strategy should be further assessment of the stressors in the patient's life. Exercise,guided imagery,or understanding how to use coping strategies that worked in the past may be of assistance to the patient,but more assessment is needed before the nurse can determine this.

Question 8

An adult patient who arrived at the triage desk in the emergency department (ED)with minor facial lacerations after a motor vehicle accident has a blood pressure (BP)of 182/94. Which action by the nurse is appropriate?

Accepted Answer

When a patient experiences an acute stressor,the BP increases. The nurse should plan to recheck the BP after the patient has stabilized and received treatment. This will provide a more accurate indication of the patient's usual blood pressure. Elevated BP that occurs in response to acute stress does not increase the risk for health problems such as stroke,indicate a need for hospitalization,or indicate a need for IV antihypertensive medications.

Question 9

A nurse prepares an adult patient with a severe burn injury for a dressing change. The nurse knows that this is a painful procedure and wants to try providing music to help the patient relax. Which action is best for the nurse to take?

Accepted Answer

Although music with 60 to 80 beats/min,music without words,and music composed by Mozart are frequently recommended to reduce stress,each patient responds individually to music and personal preferences are important.

Question 10

A patient is extremely anxious about having a biopsy on a femoral lymph node. Which relaxation technique would be the best choice for the nurse to facilitate during the procedure?

Accepted Answer

Relaxation breathing is an easy relaxation technique to teach and use. The patient should remain still during the biopsy and not move or stretch any of his extremities. Meditation and guided imagery require more time to practice and learn.

Question 11

A middle-aged male patient with usually well-controlled hypertension and diabetes visits the clinic. Today he has a blood pressure of 174/94 mm Hg and a blood glucose level of 190 mg/dL. What patient information may indicate that additional intervention by the nurse is needed?

Accepted Answer

The increase in blood pressure and glucose levels possibly suggests that stress caused by his divorce and custody battle may be adversely affecting his health. The nurse should assess this further and develop an appropriate plan to assist the patient in decreasing his stress. Although he has been very compliant with his treatment plan in the past,the nurse should assess whether the stress in his life is interfering with his management of his health problems. The family history will not necessarily explain why he has had changes in his blood pressure and glucose levels.

Question 12

The nurse teaches a patient who is experiencing stress at work how to use imagery as a relaxation technique. Which statement by the nurse would be appropriate?

Accepted Answer

Imagery is the use of one's mind to generate images that have a calming effect on the body. When using imagery for relaxation,the patient should visualize a comfortable and peaceful place. The goal is to offer a relaxing retreat from the actual work environment. Imagery that is not intended for relaxation purposes can target a disease,problem,or stressor.

Quiz 6: Stress and Stress Management

A patient who is taking antiretroviral medication to control human immunodeficiency virus (HIV) infection tells the nurse about feeling mildly depressed and anxious. Which additional information about the patient is most important to communicate to the health care provider?