Deck 11: Understanding Responses to Stress

Question 1

A patient tells the nurse that one result of his chronic stress is that he has considerable fatigue.He usually sleeps from 11:00 PM to 6:30 AM.He reports he now sets his alarm to give himself an extra 30 minutes of sleep each morning but feels no better and is rushed for work.Which nursing response would best address the patient's concerns?

A) "You may need to speak to your doctor about taking a sedative to help you sleep."
B) "Exercising just before retiring for the night may help you to sleep better."
C) "Perhaps going to bed a half hour earlier would work better than sleeping later."
D) "A glass of wine in the evening might take the edge off and help you to rest."

Answer 1

"Perhaps going to bed a half hour earlier would work better than sleeping later."

Question 2

A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques.He will return to the clinic for follow-up evaluation in 2 weeks.Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress?

A) The patient's wife reports that he spends more time sitting quietly at home.
B) He reports that his appetite,mood,and energy levels are all good.
C) His systolic blood pressure has gone from the 140s to the 120s (mm Hg).
D) He reports that he feels better and that things are not bothering him as much.

Answer 2

His systolic blood pressure has gone from the 140s to the 120s (mm Hg).

Question 3

When the inpatient psychiatric nurse asks the newly-admitted patient to describe her social supports,the patient reports that she is newly divorced,has no siblings,her parents died last year,and she has little contact with her former in-laws,who subtly blame her for the divorce.She has few friends because most of her peers are not nearly as religiously conservative as she is.Which response related to social support would be most therapeutic?

A) Encourage the patient to begin dating again,perhaps with members of her church.
B) Discuss how divorce support groups could increase coping and social support.
C) Note that being so particular about potential friends reduces social contact.
D) Discuss using the internet as a way to find supportive others with similar values.

Answer 3

Discuss how divorce support groups could increase coping and social support.

Question 4

A patient reports that financial problems are stressing his marriage.Today he heard rumors about impending cutbacks at work,and he fears he will be laid off.He is wringing his hands,has a pulse rate of 112/minute,respirations are 26/minute,and his blood pressure is 166/88 instead of being in his usual 110-120/76-84 range.Which nursing intervention or recommendation should be used first?

A) Go to sleep 30 to 60 minutes earlier each night to increase rest.
B) Relax by spending more time playing with his pet dog.
C) Slow and deepen breathing via use of a positive,repeated word.
D) Consider that a new job might be better than his present one.

Question 5

A patient who is experiencing great stress associated with a disturbing new diagnosis asks the nurse,"Do you think saying a prayer would help?" The answer the nurse should give is:

A) "To be honest,it could be that prayer may be your only hope."
B) "You may find prayer gives comfort and lowers your stress."
C) "I could help you feel calmer by teaching you to meditate."
D) "We don't have evidence that prayer helps,but it wouldn't hurt."

Question 6

A stress-laden patient has elected to learn deep breathing as a means of reducing stress.Rank the order the nurse should give the following information when teaching this technique.

A) Focus on your breathing;repeat the exercise for 2 to 5 minutes.
B) With each breath,pay attention to muscular sensations that accompany abdominal expansion.
C) Hold the breath for 3 seconds.
D) Find a comfortable position.Relax the shoulders and chest;let the body relax.
E) Take a deep breath through the nose,expanding the abdomen.
F) Exhale slowly through the nose,telling the body to relax.

Question 7

A patient with emphysema who has severe shortness of breath and frequent hospitalizations often depends on her portable oxygen tank when she leaves her home.Recently she has not been able to go upstairs to her bedroom at night because of shortness of breath and fear of developing severe breathing difficulty if she continues up the stairs.A support group leader suggests the use of guided imagery.What image would the patient be encouraged to visualize?

A) Having a younger,healthier body that knows no exercise limitations
B) Walking up the stairs in a steady,relaxed manner,taking regular deep breaths
C) Walking up stairs slowly and steadily without using any supplemental oxygen
D) Sleeping comfortably and soundly downstairs,without respiratory distress

Question 8

A patient reports that he is overwhelmed by stress.Which question would be most important to use in assessing the patient during your first meeting?

A) "Tell me about the kinds of things you do to reduce or cope with your stress."
B) "Tell me about your family history-do any relatives have problems with stress?"
C) "Tell me about exercise-how far do you typically run when you go jogging?"
D) "Stress can interfere with sleep.How much did you sleep last night?"

Question 9

According to the Life Changing Event Questionnaire,which situation would most merit a complete assessment of a person's stress status and coping abilities?

A) A person returning to college after his employer ceased operations.
B) A man who whose job is requiring him to relocate to a different city.
C) A person who has been assigned more responsibilities at work.
D) A man who recently separated from his wife because of marital problems.

Question 10

A patient newly diagnosed as being HIV-positive seeks the nurse's advice on how to reduce the risk of infections.The patient states "I used to go to church,and it seems like I was in my best health then.Maybe I should start going to church again." The reply that shows the best understanding of psychoimmunology is:

A) "Religion doesn't usually affect health,but you were younger and stronger then."
B) "Contact with friends at church might help,but probably not religion itself."
C) "Studies show that spiritual practices can enhance immune system function."
D) "If it calms you,it might help,but spiritual practices themselves do not help."

Question 11

A recent immigrant from Central America is brought to the clinic by her daughter,who has been a U.S.resident for 10 years.The daughter says the stress of immigration has made her mother unwell.For which expression of stress should the nurse be alert during the assessment interview?

A) Motor restlessness
B) Somatic complaints
C) Memory deficiencies
D) Sensory perceptual alterations

Question 12

A nurse who leads group therapy for a group of depressed patients plans to implement a plan of exercise for each patient.The rationale to use when presenting this plan to the treatment team is that exercise:

A) has an antidepressant effect comparable to selective serotonin reuptake inhibitors.
B) prevents damage from overstimulation of the sympathetic nervous system.
C) improves circulation and oxygenation to the brain and other organs.
D) detoxifies the body by ridding it of metabolic wastes and other toxins.

Question 13

A patient tells the nurse,"I'm told that I should reduce the stress in my life,but I have no idea where to start." Which would be the best initial nursing response?

A) "Why not start by learning to meditate? That technique will cover everything."
B) "In cases like yours,physical exercise works to elevate mood and reduce anxiety."
C) "Reading about stress and how to manage it might be a good place to start."
D) "Let's talk about what is going on in your life and then look at possible options."

Question 14

Which changes reflect the short-term physiological response to stress? Select all that apply.

A) Cortisol is released,increasing glucogenesis and reducing fluid loss.
B) Immune system functioning decreases,and risk of cancer increases.
C) Corticosteroid release increases stamina and impedes digestion.
D) Muscular tension,blood pressure,and triglycerides increase.
E) Epinephrine is released,increasing heart and respiratory rates.

Question 15

The nurse planning to teach a patient how to use Benson's relaxation techniques to treat hypertension is essentially teaching the patient to:

A) switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode.
B) alter the internal state by modifying electronic signals related to physiological processes.
C) replace stress-producing thoughts and activities with daily stress-reducing thoughts and activities.
D) reduce catecholamine production and promote the production of additional beta-endorphins.

Question 16

The nurse wishes to use guided imagery to help her patient relax.Which comment would be appropriate to include in the guided imagery script? Select all that apply.

A) "Imagine others treating you the way they should,the way you want to be treated…"
B) "With each breath,you are feeling calmer,more relaxed,almost as if you are floating…"
C) "You are alone on a beach,the sun is warm,and you hear only the sound of the surf…"
D) "You have taken control,nothing can hurt you now,everything is going your way…"
E) "You have grown calm,your mind is still,there is nothing to disturb your well-being…"

Question 17

A patient tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things,and he wants me to learn a new way of thinking." Which response would be in keeping with the doctor's recommendations?

A) Teaching the patient to recognize,reconsider,and reframe irrational thoughts
B) Encouraging the patient to imagine being in calming circumstances
C) Teaching the patient to use instruments that give feedback about bodily functions
D) Provide the patient with a blank journal and guidance about journaling

Question 18

The patient tells the nurse,"I'll never be happy until I'm as successful as my older sister." The nurse asks the patient to reassess this statement and reframe it.Which reframed statement is most likely to promote coping?

A) "I won't be happy until I make as much money as my sister."
B) "People should treat me as well as they treat my sister."
C) "I can find contentment in succeeding at my own job level."
D) "Being as smart or clever as my sister isn't really important."

Question 19

The daughter of a severely depressed patient asks the nurse "What do you think about the relationship between depression and physical illness? Since my mother has been grieving over my father's death,she has had colds,shingles,and the flu,and she's usually not one to get sick." The answer that best reflects the current thinking about psychoimmunology is:

A) "It is probably a coincidence.Not much evidence is available that emotions like grieving make one prone to physical illnesses."
B) "You might be paying more attention to your mother since your father died,and you are noticing more things such as minor illnesses."
C) "So far,the research on emotions or stress and becoming ill more easily is unclear-we just do not know for sure if there is a link."
D) "Emotions and stress are believed to interfere with white blood cell production and can increase the likelihood of infectious diseases."