Adaptive Responses to Stress
An adolescent entering high school voices anxiety over changing schools. Stating anxiety is an act of
1.adaptation.
2.evaluation.
3.reaction.
4.valuation.
During a counseling session a client states, "I just try to forget about my spouse hitting me." Which defense mechanism should the nurse document on the basis of this client's statement?
reaction formation
rationalization
repression
regression
Repression
13. A nurse at the university health clinic has assessed a student reporting an inability to concentrate and a pounding heart. The student states, "my boyfriend just dumped me out of the blue. They were supposed to be my date at my sister's wedding this weekend. How can I go now?" Which response would the nurse make?
1."Can you tell me what part of this is most problematic right now?"
2. "What alternatives can you think of at this late date?"
3."You might start by evaluating your relationship."
4. "It may be best to not think about this person until after the wedding"
1."Can you tell me what part of this is most problematic right now?"
Identify the problem.
The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness.At what stage of stress is the client?alarm stage exhaustion stage or resistance stage
Exhaustion stage
A withdrawn and isolated client is most likely suffering from what type of stressors on basic human needs?1.Physiologic needs 2.Safety and security needs 3.Self-esteem needs 4.Love and belonging needs
Love and belonging needs
Which behaviors represent effective coping mechanisms? Select all that apply.
1.setting limits with family members who upset you
2.learning relaxation techniques
3.taking a vacation
4.sleeping 14 hours a night
5.sleeping 3 hours a night
6.denying responsibility for a DUI conviction
1.setting limits with family members who upset you
2.learning relaxation techniques
3.taking a vacation
Coping mechanisms can have positive or negative effects on a client's well-being. All of these examples represent coping, either effective or ineffective.
A toilet trained toddler was admitted to the hospital for dehydration. Upon returning home, the toddler becomes incontinent of urine and stool. The parent is concerned regarding this return to previous behavior and calls the pediatric clinic. What is the nurse's best response to the parent?
This behavior is sublimation.
This behavior is called regression.
This behavior is known as repression.
This behavior is reaction formation.
This behavior is called regression.
A visiting nurse is assessing a family that includes a young couple and their infant who has cerebral palsy. The nurse notes that the mother is unkempt, the house is untidy, and the mother states she is "so busy with the baby that I don't have time to do anything else." What priority intervention would the nurse set for this family?
1.Arranging to have the infant removed from the home
2.Informing other members of the family of the situation
3.Increasing the number of visits by the visiting nurse
4.Recommending respite care for the parent (s)
4.Recommending respite care for the parent (s)
A person providing care at home for a family member for long periods of time often experiences caregiver bur den, manifested by chronic fatigue, sleep disorders, and an increased incidence of stress- related illnesses, such as hypertension and heart disease. The nurse could recommend a consultation with a social worker or suggest community resources including possible respite care for the parent(s).
A nurse has been caring for a client who experienced a physical assault a year ago. The client now describes being "totally recovered from it." Which stage of stress is the client currently experiencing?
The client is in the Resistance Stage, where the body has returned to the homeostasis state. The mind or brain is normal again,
A nurse is assessing a patient who complains of migraines that have become “unbearable.” The patient tells the nurse, “I just got laid off from my job last week and I have two kids in college. I don’t know how I’m going to pay for it all.” Which physiologic effects of stress would be expected findings in this patient? Select all that apply.
1.Changes in appetite 2.Changes in elimination patterns 4.Decreased pulse and respirations 5.Use of ineffective coping mechanisms 6.Withdrawal 7.Attention-seeking behaviors
A, B. Physiologic effects of stress include changes in appetite and elimination patterns as well as increased (not decreased) pulse and respirations. Using ineffective coping mechanisms, becoming withdrawn and isolated, and exhibiting attention-seeking behaviors are psychological effects of stress.
A recently retired client reports that he has been able to sleep only 3 hours a night and that he has nausea, frequent urination, and headaches. He is asking the nurse what she thinks is going on with his health. What is the most probable cause of his symptoms?
1.type 2 diabetes
2.obstructive sleep apnea
3.moderate anxiety
4.herniated lumbar disc
Moderate Anxiety
This client may have increased anxiety from adjusting to retirement, a significant life stressor. There are not enough data to identify any of the other disorders as being present.
The nurse involved in coordinating a support group for spinal cord injury clients learns that one of the participants in the support group was a college athlete prior to his diving accident. The client informs the group that he earned a scholarship based upon his athletic abilities and not his academic performance, and after the injury, he focused his energies on his studies. He has been on the dean's list for two semesters. What defense mechanism is illustrated in this scenario?
1.compensation
2.sublimation
3.projection
4.reaction formation
Compensation
Compensation is overcoming a perceived weakness by emphasizing a more desirable trait or achieving in a more comfortable area.
A client was at home alone when a tornado struck and damaged the structure. What type of crisis does the nurse address in the care of this client?
Adventitious
Developmental
Situational
Maturational
Adventitious
There are three types of crises: maturational, situational, and adventitious. Adventitious crises are accidental and unexpected events, resulting in multiple losses and major environmental changes, such as fires, hurricanes, earthquakes, and floods. Maturational crises occur during developmental events that require role change. Situational crises occur when a life event disrupts a person's psychological equilibrium, such as loss of a job or loved one. Developmental crisis does not exist.
A client with cancer has recovered from tumor removal surgery and is now stable while undergoing a chemotherapy treatment schedule. She is not having any symptoms at this time and is continuing to work and enjoy social events. What stage of the general adaptation syndrome (GAS) would the nurse place her in?
Resistance
This client's situation is an example of the resistance stage of the GAS. Stress is continuing, but the client is maintaining homeostasis.
An occupational health nurse at an oil refinery on the Gulf Coast of Texas performs client education with an adult client. The client is being seen after having suffering a chemical burn in an accident at the refinery. Which type of stressor has this client been exposed to?
1.physiologic
2.psychosocial
3.maturational
4.socioeconomic
Physiologic
Physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders.
Which client would the nurse expect to have negative coping skills?
1.a 19-year-old diagnosed with schizophrenia who is heading off to college
2.a 13-year-old diabetic who joins a softball league
3.a 37-year-old factory worker who is laid off for the summer
4.a 72-year-old retiree who needs to take an expensive new chemotherapeutic agent
A 19-year-old diagnosed with schizophrenia who is heading off to college
All of these clients will be facing stressors and need to develop adaptation skills. The client with schizophrenia, a chronic but manageable psychiatric illness, is most at risk for reacting negatively to the new life stressor. Clients with mental illness may have decreased physiologic reserve with which to effectively cope and adapt.
A new graduate is having difficulty coping with the role transition from student to registered nurse (RN). Which defense mechanism is being exhibited when the nurse states, "I hate going in to work on weekends. The aides are lazy, the clients are all complaining, and the families are all crazy!"
1.denial
2.projection
3.displacement
4.reaction formation
Reaction Formation- Developing attitudes that are opposite to what the nurse really would prefer to do (or needs to do) in the situation.
A patient admitted through the emergency department for a severe infection is receiving intravenous (IV) antibiotics. The patient, who has been oriented, demands the nurse remove the IV because the patient is leaving now. What action will the nurse take?
1.Apply soft wrist restraints
2.Perform a neurologic assessment
3.Explain that after signing an “against medical order form,” the patient may leave
4.Call the patient’s family to encourage the patient to stay
3.Explain that after signing an “against medical order form,” the patient may leave
A person cannot be legally forced to remain in a health facility, such as a hospital, if that person is of sound mind. The patient signs an “against medical orders” form when insisting on being discharged, to indicate not holding the facility responsible for harm from leaving. Applying soft wrist restraints when the patient has expressed wanting to leave constitutes battery, which includes willful, angry, and violent or negligent touching of another person’s body or clothes or anything attached to or held by that other person. The patient has been oriented, so another assessment is not indicated. The patient, not the family, has autonomy.
Which response to stressors results from the activation of the local adaptation syndrome (LAS)?
1.A girl quickly withdraws her hand from a stream of hot tap water.
2.A woman's impending job interview has prompted the activation of her fight-or-flight response.
3.A man is experiencing moderate anxiety before meeting with an important client.
4.A man has a sudden urge for a bowel movement before undergoing thoracentesis.
A girl quickly withdraws her hand from a stream of hot tap water.
The local adaptation syndrome (LAS) is a localized response of the body to stress. It involves only a specific body part (such as a tissue or organ) instead of the whole body.
A patient has just been told by the physician that she has stage III uterine cancer. The patient says to the nurse, “I don’t know what to do. How do I tell my husband?” and begins to cry. Which of the following responses by the nurse is the MOST therapeutic?
1.“How do you think would be best to tell your husband?”
2.“I think this will all be easier to deal with than you think.”
3. “Why do you think this is happening to you?”
4.“It seems to me that this is a lot to handle. I’ll stay here with you.”
4.“It seems to me that this is a lot to handle. I’ll stay here with you.”Example of dealing with psychosocial event
Reflection (observing how the patient feels/what they say) is most therapeutic and staying with the patient is a plus. Never ask why or refer back to yourself immediately.
A client informs the nurse that they have a well-paying job but that it is demanding and causes a great deal of anxiety. What statement made by the client indicates that the client has a coping mechanism to deal with anxiety produced by this situation?
" Everyone feels sorry for me, and I find comfort in that."
"I am going to tell my manager that I just can't deal with the stress."
"I am going to have to start taking medication for this anxiety."
"I am actively seeking job opportunities in a less stressful environment."
"I am actively seeking job opportunities in a less stressful environment."
The person may respond by limiting his emotional response, taking direct action to solve a problem, or using defense mechanisms. Medications are not considered to be coping mechanisms.
The parents of an infant who requires cardiac surgery inform the nurse they are not anxious about the surgery and "will leave the outcome in God's hands." Which intervention(s) will the nurse use to support the parents' spiritual beliefs? Select all that apply.
1.Give the parents directions to the hospital chapel
2.Give the parents a pamphlet for the nurse's church
3.Tell the parents denial is a common coping 4.mechanism
5.Ask the parents if they would like to speak to the chaplain
6.Ask the parents if they have been praying on a regular basis
1.Give the parents directions to the hospital chapel
5.Ask the parents if they would like to speak to the chaplain
Giving the parents directions to the hospital chapel provides an opportunity for them to be alone and practice spiritual beliefs in a quiet place. Offering the chaplain's assistance is appropriate because talking to another person is an emotion-focused coping mechanism. It is inappropriate for the nurse to offer his or her beliefs or religion to the parents. It is inappropriate and demeaning for the nurse to tell the parents they are in denial. Asking the parents about specific religious practices is inappropriate and prying.
A nurse in a long-term care facility is caring for patient with a spinal cord injury affecting their sensory and motor reflexes below the waist. based on the patient's condition, what would be a priority intervention for this patient?
1.Taking care with hot beverages to prevent burns
2.Providing adequate pain relief measures to reduce stress
3.Monitoring for depression related to social isolation
4.Offering meals high in carbohydrates to promote healing
1.Taking care with hot beverages to prevent burns
A patient with a damaged neurologic reflex arc has a diminished pain reflex response. This diminished sensation and motor response places the patient at risk for burns. All patients should be provided adequate pain relief, but this is not a prior-ity. Monitoring for depression would be an intervention for this patient but is not related to the damaged neurologic reflex arc. A patient who is immobile should eat a well-balanced diet.
The nurse provides education about physiological stressors. The nurse recognizes the education to be effective when the client identifies which of the following as physiological stressors? (Select all that apply.)
a) Outside temperature of 100 degrees
b) Accidental death of a child
c) Excessive protein in the diet
d) Upper respiratory infection
e) Rheumatoid arthritis
a, c, d, e
A physiological stressor can include excessive temperatures, infections, illness, and imbalances in nutrition. The death of a child would be a psychological stressor.