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Stress & Adaptation

A middle-aged adult discusses with the nurse the loss of his job due to frequent illness. The nurse recognizes the patient's loss of his income as which of the following?

A: a stressor
B: homeostasis
C: adaptation
D: a coping mechanism



A: a stressor
Rationale:
A stressor is anything that is perceived as a challenging, threatening, or demanding. Loss of a job and financial insecurity are external stressors.

A nurse hears a patient yelling for help from his room. The nurse runs to the patient room, and upon arriving in the room, the nurses heart rate and oxygen demands have increased. What phase of the general adaptation syndrome is best described by the nurses physiological changes?

A: resistance
B: rest and recovery
C: alarm reaction
D: exhaustion



C: alarm reaction
rationale:
Tthe alarm reaction is initiated when the person perceives a specific stessor and the person experiences an increase in energy levels, oxygen intake, cardiac output, blood pressure, mental alertness. Resistance occurs when the body attempts to adapt to the stressor and vital signs, hormone levels, and energy production return to normal. Exhaustion results with the adaptative mechanisms are exhausted

A group of nursing students are learning about the body's response to stress. Which system is responsible for initiating the flight or fight response to stress?

A: endocrine system
B: parasympathetic nervous system
C: respiratory system
D: sympathetic nervous system



D: sympathetic nervous system
rationale:
Functions of the sympathetic nervous system under stress conditions bring out the flight or fight response.

Upon assessment of a patient being evaluated at the headache clinic, the patient informed that nurse that her headaches started when she started experiencing marital problems. The patient reports that each time she and her husband have a fight, she develops a headache and loses her appetite for several days. Which of the following best defines the physiologic symptoms?

A: fear
B: a coping mechanism
C: a psychosomatic disorder
D: anxiety




C: a psychosomatic disorder
rationale:
a psychosomatic disorder is a real illness caused by physiological influences. The patient's fight with her husband causes emotions that lead to physical symptoms. Anxiety is a vague, uneasy feeling of discomfort or dread accompanied by autonomic response. Fear is a cognitive response to a known threat. Anxiety often managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety.

Upon arrival to the emergency room, the mother of a patient involved in a motor vehicle accident becomes upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breath. What if the mother likely experiencing?

A: a panic attack
B: moderate anxiety
C: severe anxiety
D: mild anxiety





A: a panic attack
rationale:
causes the person to lose control and experience dread and terror. Panic is characterized by disorganized state, increased physical activity, difficulty communicating, agitation, trembling, dyspnea, palpitations, a choking sensation, and sensations of chest pressure or pain. Sever. E anxiety creates a narrow focus on specific details; moderate anxiety leads to a focus on immediate concern; and mild anxiety is often present in day-to-day living, and increases alertness and perceptual field.

The nurse involved in coordinating a support group for spinal cord injury patients learns that one participants in the support group was a college athlete prior to his diving accident. The patient forms the group that he earned a scholarship based upon his athletic ability and not academic performance, and after the accident, he focused his energies on his studies and has been on the Dean's list for two semesters. What defense mechanism is illustrated in this scenario?

A: compensation
B: reaction formation
C: projection
D: sublimation




A: compensation
rationale:
Compensation is overcoming a perceived weakness by emphasizing a more desirable trait or achieving in a more comfortable area. Sublimation involves a person substituting a socially acceptable goal for one whose normal channel of expression is blocked. Projection is a persons thoughts or impulses attributed to someone else. Reaction formation is the development of conscious attitudes and behavior patterns that are opposite to what he or she would really like to do.

Hurricane Katrina in 2005 with a crisis for the residents of New Orleans. What type of crisis was this event?

A: developmental
B: adventitious
C: maturational
D: situational





B: Adventitious
rationale:
there are three types of crisis; the maturational, situational, and adventitious. Adventitious crisis is our accidental and unexpected events, resulting in multiple losses and major environmental changes, such as fires, hurricanes, earthquakes, and floods. Maturational crisis occurs during developmental events that require role change. Situational crisis occurs when a life events disrupt a person's psychological equilibrium, such as loss of a job or loved one.

Which of the following nurses is likely to experience the greatest amount of stress related to his or her position as a nurse?

A: A nurse with one year of experience working on an oncology unit.
B: a nurse with 10 years of experience working as a nurse educator.
C: a graduate nurse working on a telemetry unit.
D: a nurse who is an editor of a nursing journal.




C: a graduate nurse working on a telemetry unit.
Rationale:
Stress is often greater for new graduate nurses and nurses who work in settings such as an intensive care unit and emergency care.

The parents of an infant who requires cardiac surgery inform the nurse that they are not anxious about the surgery and "will leave the outcome in God's hands." The nurse notes that the parents are likely anxious when she observes:

A: a calm, serene manner.
B: the parents speaking in a slow, deliberate manner.
C: the parents pacing around the child's hospital room.
D: euphoric attitudes and facial expressions.




C: that parents pacing around the child's hospital room.
Rationale:
objective data related to anxiety may include pacing, tremors, rapid speech, dilated pupils, lack of facial expression, and restlessness.

A nurse working on an oncology floor often sits with her patient in a calm, quiet, dimly lit environment and describes a walk along the ocean's shore. The nurse provides details of the walk and verbally painting a picture for the patient. Which of the following best defines this form of stress management?

A: biofeedback
B: anticipatory guide
C: mediation
D: guided imagery




D: guided imagery
rationale:
Guided imagery involves creating a mental image based upon a verbal description offered by another individual. Biofeedback is a method of gaining mental control of the autonomic nervous system and regulating body responses. Mediation involves relaxing major muscle groups and repeating a word silently during exhalation. Anticipatory guidance focuses on physiologically preparing a person for unfamiliar or painful event.

Which of the following responses to the stressors result from the activation of the local adaptation syndrome?

A: Demand experiencing moderate anxiety before meeting with an important client.
B: A man has a sudden urge for a bowel movement before undergoing thoracentesis.
C: a girl quickly withdraws her hand from a stream of hot tapwater.
D: a woman's impending job interview has prompted the activation of her flight or fight response.




C: a girl quickly withdraws her hand from a stream of hot tapwater.
Rationale:
The reflex pain responses is a response to physiological stress that is a component of the local adaptation syndrome. Psychological anxiety and the activation of the flight or fight response are not considered to be manifestations of the local adaptation syndrome.

Which of the following is a physiological response experienced during the exhaustion stage of general adaptation syndrome?

A: A: increase mental alertness.
B: the initiation of the neuroendocrine activity.
C: decreased blood pressure.
D: vasoconstriction.




C: decreased blood pressure.
Rationale:
The stages of exhaustion is often accompanied by decreased blood pressure and the vasodilation. Increased mental alertness and the initiation of the neuroendocrine activity are associated with the alarm reaction of the GAS.

In contrast to anxiety, fear is characterized by which of the following?

A: the creation of an action plan to deal with a perceived threat.
B: a cognitive response to a known threat.
C: a real, rather than perceived, threat.
D: short-term resolution.




B: a cognitive response to a known threat.
Rationale:
here is a cognitive response to a known threat, while anxiety is the emotional response to that threat. Here does not necessarily result in the short term, and an action plan may or may not be formulated by the individual. The fact that you involve the identification of the known threat does not necessarily mean that the object of fear is objectively real.

The children of a 60-year-old woman are distraught at her apparent lack of recovery following a stroke several weeks earlier. The patient's daughter has frequently directed harsh criticism towards the nurses, accusing them of a substandard effort in rehabilitating her mother despite their best efforts. What defense mechanism may the patient's daughter be exhibiting?

A: denial
B: displacement
C: regression
D: sublimation




B: displacement
rationale:
the daughter may be transferring her feelings about her mother's health status to the care providers, an act that involves the displacement of the emotional reaction to another person. Denial about her mother's potential for recovery may underlie the response, but this is not demonstrated as clearly as displacement.

Family conflict around the care that recently hospitalized woman has escalated to the point that crisis intervention may be required. What should this process began with?

A: presentation of clear, achievable, and evidence-based solutions.
B: comparison of the family's situation to other similar situation.
C: careful and objective analysis of different proposed options.
D: clear identification of the relevant problem.




D: clear identification of the relevant problem
rationale:
Crisis intervention is a problem-solving technique that begins with the identification of the problem. This precedes the identification of options and assessment of proposed solutions.

Prior to the patient scheduled bone marrow biopsy, the nurse has devoted time to teaching him about the rationale and specific details of the procedure. The nurses actions constitute what stress management technique?

A: anticipatory guidance
B: guided imagery
C; normalization
D; relaxation




A: anticipatory guidance
rationale:
anticipatory guidance involves preparing a patient psychologically for an event in the knowledge that familiarity reduces anxiety. Imagery involves the creation of mental image, not education. Relaxation focuses on the control of the body's responses to stress. Normalization is not specific stress management technique.

A nurse of the four stroke that numerous overtime shifts over the past several months and unfortunately her personal financial obligations. The nurse now describes herself as "burned out," a condition that is comparable to what state of anxiety?

A: alarm
B: exhaustion
C: recovery
D: resistance



B: exhaustion
rationale:
Burnout is comparable to the exhaustion stage of anxiety; both occur following prolonged alarm the resistance, but the positive outcome of the rest and recovery is not attained.

The nurse would recognize the short-term pharmacological treatment may be appropriate if an anxious patient's nursing diagnosis includes which of the following?

A: decisional conflict
B: disturbed sleep pattern
C: social isolation
D. defensive coping




B: disturbed sleep pattern
rationale:
the nurse should recognize that diagnosis relating to conflict, coping, and decisional conflict are less amenable to pharmacologic treatment. Disturbances in sleep patterns, however, are often addressed by the appropriate use of hypnotic medication.

A first-time mother is in her second trimester, and prenatal screening has indicated the possibility of down syndrome. While awaiting the results of amniocentesis, the patient acknowledges her great anxiety. Which of the following patients statement indicates that she may be coping ineffectively with her anxiety?

A: "I phone my mom every day to debrief about what's on my mind."
B: "I am sad that there's possibility of a problem with something that's been so joyful so far."
C: "I had to rely a lot of my family and my friends from church these days."
D: "I knew all along that something was going to go terribly wrong with my pregnancy."




D: "I knew all along that something was going to go terribly wrong with my pregnancy."
Rationale:
Expressions of significant negativity and fatalism maybe suggestive to ineffective coping with the stressor. Reliance on support persons and expressions of disappointment are likely appropriate responses to a stressor.

The patient has just been diagnosed with a brain tumor after recurring headaches prompted his physician to order a CT scan. The patient may be experiencing the nursing diagnosis of an Ineffective denial if he states which of the following?

A: "I am going to do everything I can to beat this thing."
B: "I have done some online research, and there are some really promising new treatments out there."
C: "I have a coworker his wife had a brain tumor and she managed to recover."
D: "I really need to get back to my job because I'm falling behind on a lot of tasks."



D: "I really need to get back to my job because I'm falling behind on a lot of tasks."
Rationale:
Fixating on work responsibilities indicates that the patient may be making an attempt to disavow the reality of the situation at hand. Expressions of optimism and determination after effective responses to anxiety provoking situation.

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