Question 1

A patient who has fibromyalgia tells the nurse, &#34;My life feels very chaotic and out of my control. I will not be able to manage if anything else happens.&#34; Which response by the nurse will be helpful?&#10;A) &#34;Regular massages may help reduce your pain.&#34;&#10;B) &#34;Remember that stress can make your illness worse.&#34;&#10;C) &#34;Tell me more about how your life has been recently.&#34;&#10;D) &#34;You will find a way to cope if another crisis occurs.&#34;

Accepted Answer

The nurse's initial strategy should be further assessment of the stressors in the patient's life. Massage therapy may be of assistance to the patient, but more assessment is needed before the nurse can determine this. A reminder that stress may increase symptoms will increase the patient's stress. The response, "You will find a way to cope if another crisis occurs" offers false reassurance, since the nurse has not yet assessed the patient's coping abilities.

Question 2

An overweight patient who enjoys active outdoor activities develops arthritis in the knees. To help the patient cope with the diagnosis, the most helpful intervention by the nurse is to&#10;A) ask the patient to discuss feelings about the diagnosis.&#10;B) encourage the patient to think about how weight loss might improve symptoms.&#10;C) teach the patient how to use imagery to decrease pain and decrease stress.&#10;D) have the patient practice frequent relaxation breathing.

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 may also assist the patient in coping with the diagnosis, but they will not be as helpful as a problem-oriented strategy.

Question 3

The nurse is teaching a hospitalized patient to use imagery as a technique for stress management. Which statement by the nurse is appropriate?&#10;A) &#34;Bring what you hear and sense in your present environment into your image of the scene.&#34;&#10;B) &#34;If your scene is stressful to you, continue visualizing until you can overcome the distress.&#34;&#10;C) &#34;Pay attention to what you hear, smell, and feel at this place.&#34;&#10;D) &#34;Place your stress in the image of a form you can destroy.&#34;

Accepted Answer

Focusing on the sensory information in the imagined place assists the patient in relaxing. The patient is unlikely to relax if the sensory information from the hospital is used during imagery. The purpose of imagery is to generate calm feelings, and focusing on overcoming or destroying stresses is likely to increase stress level and the release of stress-related hormones.

Question 4

A 22-year-old patient is brought to the emergency department (ED) with multiple abrasions and bruises after being assaulted in a shopping center parking lot. The patient's initial blood pressure (BP) is 180/98. The nurse will plan to

A) treat the abrasions and discuss the risks associated with hypertension.
B) discuss the need for hospital admission to control blood pressure.
C) recheck the blood pressure prior to the patient's discharge from the ED.
D) start an intravenous (IV) line to administer antihypertensive medications.

Accepted Answer

Hypertension is a normal consequence of the activation of the "fight-or-flight" response. Because hypertension is expected when a patient has experienced an acute stressor, the nurse should plan to check the BP before discharge, which will provide a more accurate idea of the patient's usual blood pressure. Hypertension that occurs in response to acute stress does not increase risk for health problems such as stroke, indicate a need for hospitalization, or indicate a need for IV antihypertensive medications.

Question 5

A 28-year-old male patient who is diabetic is hospitalized for a gangrenous foot infection. The patient's wife visits the patient for a few minutes every other day. The patient tells the nurse that his wife is angry about being married to an invalid. The nurse identifies the nursing diagnosis of

A) ineffective denial related to inadequate knowledge about diabetes.
B) compromised family coping related to insufficient support from wife.
C) ineffective health maintenance related to expectations of family members.
D) anxiety related to lack of ability to adapt to changes in lifestyle.

Accepted Answer

The wife's visiting pattern and patient statement support the diagnosis of compromised family coping. There is no evidence indicating that the patient is in denial about his diabetes or that the ineffective health maintenance is caused by the wife's expectations. The patient's statement does not provide evidence to support anxiety for either the patient or wife.

Question 6

When assessing patients for the possible health impact of stressors, the most important information to obtain is&#10;A) the importance of religious influences for the patient.&#10;B) how long the patient has been exposed to the stressor.&#10;C) medications that the patient is taking to control anxiety.&#10;D) any family history of stress-related physical illnesses.

Accepted Answer

The length of time the patient has been exposed to the stressor is a variable that impacts on the health consequences of a stressor. Information about the type of stressor, medications the patient is taking, and family history is usually collected but will not have as much impact on the health of the patient as the length of time the patient has been stressed.

Question 7

The husband of a patient who is recovering from a heart attack tells the nurse, "My wife doesn't seem like the same person. She is so forgetful and irritable and she has always been well-organized and calm before this." Which response by the nurse is most appropriate?

A) "Mental changes after a severe illness are common and frequently permanent."
B) "I will ask the doctor about whether a psychiatric consultation should be ordered."
C) "You may need to talk to a therapist to help you cope with these mental changes."
D) "Stress frequently causes transient changes in concentration and mood."

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Accepted Answer

Behavioral responses to stress include changes in memory and irritability; these are temporary and will resolve as the stress resolves. The changes are not permanent and do not usually require psychiatric care. Because the changes are temporary, an explanation and appropriate support by the nurse are needed, but a referral to a therapist is not typically necessary.

Question 8

A hospitalized patient is very anxious about missing work and is afraid of being fired because of this illness. An appropriate nursing diagnosis for the patient is&#10;A) insomnia related to anxiety about work.&#10;B) ineffective denial related to lack of effective coping resources.&#10;C) risk for strain of the caregiver role related to lack of family support.&#10;D) complicated grieving related to prolonged stressful situation.

Accepted Answer

The information about the patient indicates that insomnia may occur as a result of the patient's stress. There is no evidence to support the diagnoses of ineffective denial, risk for caregiver role strain, or complicated grieving.

Question 9

A diabetic patient who is hospitalized 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." Which response by the nurse is appropriate?

A) "Stressors such as illness cause the release of hormones that increase blood sugar."
B) "It is probably just coincidental that your blood sugars are high when you are ill."
C) "Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times."
D) "Your diet is different here in the hospital than at home and that is the most likely cause of the increased glucose level."

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Accepted Answer

The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. The increase in blood sugar is not coincidental. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.

Deck 9: Stress and Stress Management