Question 1

Ayoung adult arrives in the emergency department (ED) with multiple abrasions after a motor vehicle accident and has an initial blood pressure (BP) of 180/98. Which of the following interventions should the nurse implement?

A)Discuss the need for hospital admission to control blood pressure.
B)Change the dressing on the abrasions and discuss the risks associated with hypertension.
C)Recheck the blood pressure before the client's discharge from the ED.
D)Start an intravenous (IV) line to administer antihypertensive medications.

Accepted Answer

Because hypertension is expected when a client has experienced an acute stressor, the nurse should plan to check the BP before discharge, which will provide a more accurate idea of the client'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 2

When choosing music to help relax a client who is having a painful dressing change, which action is best for the nurse to take?&#10;A)Use music composed by Mozart.&#10;B)Ask the client about music preferences.&#10;C)Select music that has 60-80 beats/minute.&#10;D)Encourage the client to use music without words.

Accepted Answer

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

Question 3

The nurse is caring for a client who has been hospitalized following a heart attack and tells the nurse, "I didn't sleep last night because I worried about missing work and losing my insurance coverage." Which nursing diagnosis is appropriate to includeintheplan of care?

A)Anxiety
B)Defensive coping
C)Ineffective denial
D)Risk prone-health behaviour

Anxiety

Accepted Answer

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

Question 4

The nurse is caring for a hospitalized client with diabetes who states to 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)"It is probably just coincidental that your blood sugars are high when you are ill."
B)"Stressors such as illness cause the release of hormones that increase blood sugar."
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 client who is hospitalized will be on an appropriate diet to help control blood glucose.

Question 5

The nurse is assisting with a breast biopsy for an alert client who has a lump in the right breast. Which relaxation technique will be best to use at this time?&#10;A)Massage&#10;B)Meditation&#10;C)Guided imagery&#10;D)Relaxation breathing

Accepted Answer

Relaxation breathing is the easiest of the relaxation techniques to use. It will be difficult for the nurse to provide massage while assisting with the biopsy. Meditation and guided imagery require more time to practise and learn.

Question 6

Ahospitalized client who is usually well organized and calm is receiving diabetic teaching after being newly diagnosed with diabetes. The client is forgetful, irritable, and has poor concentration. Which action should the nurse take?

A)Ask the health care provider for a psychiatric referral.
B)Administer the PRN sedative medication every 4 hours.
C)Suggest the use of a home caregiver to the client's family.
D)Plan to reinforce and repeat teaching about diabetes management.

Accepted Answer

Since behavioural responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, client teaching will need to be repeated. Psychiatric referral or home caregiver referral will not be needed for these expected short-term cognitive changes. Sedation will decrease the client's ability to learn the necessary information for self-management.

Question 7

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

Accepted Answer

When using imagery for relaxation, the client should visualize a comfortable and peaceful place. The goal is to offer a relaxing retreat from the actual client environment. Imagery may be used to target a disease or pathology, but this type of imagery will not lead to relaxation.

Question 8

The nurse is preparing a health-promotion session on meditation for older adults at a community centre. Which of the following points should the nurse include in the session?&#10;A)Have clients bring earphones to the session.&#10;B)Breathing pattern to slowly increase speed.&#10;C)Allow a 10-20 minute time frame for meditation.&#10;D)Practise two to three times per week.

Accepted Answer

Guidelines for basic mediation include continuing it for 10-20 minutes, although even 5 minutes can be helpful. Clients won't bring earphones as the guideline is to find a quiet place with no distractions. The breathing pattern is to breathe slowly and consistently, relaxation breathing, not to speed up the rate. Meditation guidelines suggest that this be done once or twice a day.

Question 9

Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized client? (Select all that apply.)&#10;A)Assess for bradycardia.&#10;B)Ask about gastrointestinal pain.&#10;C)Observe for decreased appetite.&#10;D)Check for elevated blood glucose levels.&#10;E)Monitor for a decrease in respiratory rate.

Accepted Answer

The physiological changes associated with the acute stress response can cause changes in appetite, increased gastrointestinal upset, and elevation of blood glucose. Stress causes an increase in respiratory and heart rates.

Question 10

An overweight client who enjoys active outdoor activities develops arthritis in the knees. Which action by the nurse is most appropriate to assist the client in coping with the diagnosis?&#10;A)Ask the client to discuss feelings about the diagnosis.&#10;B)Have the client practise frequent relaxation breathing.&#10;C)Educate the client on the use of imagery to decrease pain and decrease stress.&#10;D)Encourage the client to think about how weight loss might improve symptoms.

Accepted Answer

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

Deck 8: Stress and Stress Management