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?

Accepted Answer

Sleeping later in the morning may disturb circadian rhythms and in this case is adding,rather than reducing,the stress in his life.Going to bed earlier and arising at the usual time alleviates fatigue more effectively.Sedatives may offer some benefit but are a short-term intervention with potential side effects,and other nonpharmacological interventions might work as well or better.Exercise earlier in the evening could induce tiredness and ease the process of falling asleep,but doing so right before bedtime would likely be stimulating and interfere with sleep instead.Alcohol is sedating but is also potentially addictive,and encouraging its use could increase the risk of using alcohol maladaptively as a response to stress in general.

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?

Accepted Answer

Objective measures tend to be the most reliable means of gauging progress.In this case,the patient's elevated blood pressure,an indication of the body's physiological response to stress,has diminished.The wife's observations regarding his activity level are subjective,and his sitting quietly could reflect his having given up rather than improved.Appetite,mood,and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress.The patient's report that he feels better and is not bothered as much by his circumstances could also reflect resignation rather than improvement.

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?

Accepted Answer

High-quality social support enhances mental and physical health and acts as a significant buffer against distress.Low-quality support relationships are known to affect a person's coping effectiveness negatively.Resuming dating soon after a divorce could place additional stress on the patient rather than helping her cope with existing stressors.Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable persons.

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?

Accepted Answer

The patient is responding to stress with increased arousal of the sympathetic nervous system,as evident in his elevated vital signs.These will have a negative effect on his health and increase his perception of being anxious and stressed.Stimulating the parasympathetic nervous system (i.e. ,Benson's relaxation response)will counter the sympathetic nervous system's arousal,normalizing these vital-sign changes and reducing the physiological demands stress is placing on his body.Other options do not address his physiological response pattern as directly or immediately.

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:

Accepted Answer

Many patients find that spiritual measures,including prayer,are helpful in mediating stress.Studies have shown that spiritual practices can enhance the sense of well-being.When a patient suggests a viable means of reducing stress,it should be supported by the nurse.Indicating that prayer is the patient's only hope is pessimistic and would cause further distress.Suggesting meditation or other alternatives to prayer implies that the nurse does not think prayer would be effective.

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.

Accepted Answer

The answer of A stress-laden patient has elected to learn...

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?

Accepted Answer

The patient has dysfunctional images of dyspnea and her ability to climb stairs.Guided imagery can help her replace the dysfunctional image with a positive coping image.Athletes have found that picturing successful images can enhance performance.Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen-carbon dioxide exchange and help her achieve further relaxation.Other options focus on unrealistic goals (being younger,not needing supplemental oxygen)or restrict her quality of life (sleeping downstairs rather than reducing her anxiety about stair climbing).

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?

Accepted Answer

The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present.This data would indicate whether or not his distress is placing him in danger (e.g. ,by elevating his blood pressure dangerously or via maladaptive responses such as drinking)and would help you understand how he copes and how well his coping strategies and resources are serving him.Therefore,of the choices presented,the highest priority would be to determine what he is doing to cope at present,preferably via an open-ended or broad-opening inquiry.Family history,the extent of his use of exercise,and how much sleep he is getting are all helpful but seek data that is less of a priority.Also,the manner in which such data is sought here is likely to provide only brief responses (e.g. ,how much sleep he got on one particular night is probably less important than how much he is sleeping in general).

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?

Accepted Answer

A person returning to college after losing his job is dealing with two significant stressors simultaneously.Together,these stressors total more "life change units" than any of the single stressors cited in the other options.

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:

Accepted Answer

Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being.The other options wrongly suggest that spiritual practices have little effect on the immune system.

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?

Accepted Answer

Many people from Central American cultures express distress in somatic terms.The other options are not specific to this patient's cultural background and are not more likely to be observed in persons from Central America.

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:

Accepted Answer

b-Endorphins produced during exercise result in improvement in mood and lowered anxiety.The other options are not accurate.

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?

Accepted Answer

In this case,the nurse lacks information about what stressors the patient is coping with or about what coping skills already possessed.As a result,further assessment is indicated before potential solutions can be explored.Suggesting further exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.

Question 14

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

Accepted Answer

The correct answers are all short-term physiological responses to stress.Increased risk of immune system dysfunction,cancer,cardiovascular disease,depression,and autoimmune disease are all long-term (chronic)effects of stress.

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:

Accepted Answer

When the sympathetic nervous system is operative,the individual experiences muscular tension and an elevated pulse,blood pressure,and respiratory rate.Relaxation is achieved when the sympathetic nervous system is quieted and the parasympathetic nervous system is operative.Modifying electronic signals is the basis for biofeedback,a behavioral approach to stress reduction.Altering thinking and activities from more-stressful to less-stressful reflects the cognitive approach to stress management.Reducing catecholamine production is the basis for guided imagery's effectiveness.

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.

Accepted Answer

The intent of guided imagery to assist patients manage stress is to lead the patient to envision images that are calming and health enhancing.Statements that involve the patient calming progressively with breathing,feeling increasingly relaxed,being in a calm and pleasant location,being away from stressors,and having a peaceful and calm mind are therapeutic and should be included in the script.However,items that raise stressful images or memories or that involve unrealistic expectations or elements beyond the patient's control (e.g. ,that others will treat the patient as he desires,that everything is going the patient's way,that bosses are understanding)interfere with relaxation and/or do not promote effective coping.Thus these are not health promoting and should not be included in the script.

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?

Accepted Answer

Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping.Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed,irrational,and unquestioning manner.Helping the patient to recognize and reframe (reword)such thoughts so that they are realistic and accurate promotes coping and reduces stress.Thinking about being in calming circumstances is a form of guided imagery.Instruments that give feedback about bodily functions are used in biofeedback.Journaling is effective for helping to increase self-awareness.However,none of these last three interventions is likely to alter the patient's manner of thinking.

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?

Accepted Answer

Finding contentment within one's own work,even when it does not involve success as others might define it,is likely to lead to a reduced sense of distress about achievement level.It speaks to finding satisfaction and happiness without measuring the self against another person.Focusing on salary is simply a more specific way of being as successful as her sister,which would not promote coping.Expecting others to treat her as they do her sister is beyond her control.Dismissing the sister's cleverness as unimportant indicates that the patient continues to believe that she is inferior to her sibling.

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:

Accepted Answer

Option D best explains evidence-based thinking.Research does support a link between negative emotions and/or prolonged stress and impaired immune system functioning,such as reduced white blood cell production.Activation of the immune system sends proinflammatory cytokines to the brain,and the brain in turn releases it own cytokines that signal the central nervous system to initiate myriad responses to stress.Prolonged stress suppresses the immune system and lowers resistance to infections.Although the daughter may be more aware of issues involving her mother,the pattern of illnesses described may be an increase from the mother's baseline.

Quiz 11: Understanding Responses to Stress