Question 1

When working in a highly stressful nursing unit and accepting additional shifts,a new nursing graduate should develop a strategy to prevent burnout.What would the best strategy for the new nurse be?

Accepted Answer

An important step in preventing burnout is acknowledging one's own limitations,as well as what one's scope of work is while on the job.By doing this,the nurse will help to prevent emotional exhaustion and will limit the effects of chronic stress.Journalling and muscle relaxation are good stress-relieving techniques but are not directed at the cause of the workplace stress.Delegating,if not applicable,is an inappropriate coping mechanism.

Question 2

A 72-year-old patient is in a long-term care facility after having had a cerebrovascular accident.The patient is noncommunicative,enteral feedings are not being absorbed,and respirations are becoming laboured.What stage of the general adaptation syndrome is this patient experiencing?

Accepted Answer

The exhaustion stage occurs when the body can no longer resist the effects of the stressor and when the energy necessary to maintain adaptation is depleted.During the resistance or adaptation stage,the body stabilizes.Reflex pain response is not a stage of the general adaptation syndrome.During the alarm reaction,increasing hormone levels result in increased blood volume,epinephrine and norepinephrine amounts,heart rate,blood flow to muscles,oxygen intake,and mental alertness.

Question 3

The nurse is involved in crisis intervention with a family in which the father has just lost his job and is experiencing periods of depression.The mother has a chronic debilitating illness that has put added responsibilities on the adolescent child,who is having behavioural problems.How does the nurse help the family focus on their feelings?

Accepted Answer

When using a crisis intervention approach,the nurse helps the patient make the mental connection between the stressful event and the patient's reaction to it.Because an individual's or family's usual coping strategies are ineffective in managing the stress of the precipitating event in a crisis situation,the use of new coping mechanisms is required.Time management skills will not help reduce the stress of the precipitating event in a crisis situation.Past experiences may not be helpful in managing the stress of the precipitating event in a crisis situation.

Question 4

A woman who was sexually assaulted more than a month ago presents to the emergency department with complaints of recurrent nightmares,fear of going to sleep,repeated vivid memories of the sexual assault,and inability to feel much emotion.The nurse recognizes the signs and symptoms of which medical problem?

Accepted Answer

PTSD is characterized by vivid recollections of the traumatic event and emotional numbing and often is accompanied by nightmares.Symptoms of PTSD are more persistent than those of acute stress disorder,having lasted at least 1 month.General adaptation syndrome is the expected reaction to a major stressor.Developmental crisis occurs as a person moves through life stages rather than in response to a trauma.Alarm reaction involves physiological events such as increased activation of the sympathetic nervous system,which would have occurred at the time of the sexual assault.

Question 5

An adult who was in a motor vehicle accident is brought into the emergency department by paramedics,who report the following in-transit vital signs:
• Oral temperature: 37.2°C (99.0°F)
• Pulse: 102 beats per minute
• Respiratory rate: 26 breaths per minute
• Blood pressure: 140/106
The nurse can identify that which hormones are the likely causes of the abnormal vital signs?

Accepted Answer

Epinephrine and norepinephrine are catecholamine hormones secreted by the adrenal medulla that rapidly elevate heart rate and blood pressure.ACTH originates from the anterior pituitary gland and stimulates cortisol release;ADH originates from the posterior pituitary gland and increases renal reabsorption of water.ACTH,cortisol,and ADH do not increase heart rate.

Question 6

During the evaluation stage of the critical thinking model applied to a patient coping with stress,what will the nurse do?

Accepted Answer

During the evaluation stage,the nurse compares current stress-related symptoms against established measurable outcomes to evaluate the effectiveness of the intervention.Selecting appropriate interventions and establishing goals are part of the planning process.

Question 7

While giving a lecture on attention-deficit-hyperactivity disorder,the nurse encourages which of the following to reduce children's stress regarding homework assignments?

Accepted Answer

Time management skills are most helpful in reducing homework-related stress.Anemia prevention will improve energy levels but not alleviate stress.Routine health visits are important but do not directly affect ability to complete homework.Speech and other developmental aspects need to be developed if the child is to be successful,but skill development will not directly reduce homework-related stress.

Question 8

A senior university student contacts the campus health clinic about a first-year student living on the same dormitory floor.The senior student reports that the first-year student is crying and is not adjusting to university life.The clinic nurse recognizes this as a combination of situational and maturational stress factors.The best comment to the senior student would be which of the following?

Accepted Answer

A health care provider can help to reduce situational stress factors for individuals.Providing the student with a list of resources is one way to begin this process,as part of secondary prevention strategies.This is not a medical or psychiatric emergency,so calling 911 is not necessary.Not everyone who has sadness needs medications;some need counselling only.Not enough information is given to indicate whether leaving the university is the best solution for the student.

Question 9

The nursing student gave a wellness lecture on the importance of accurate assessment and intervention from a personal,family,and community perspective.The other nursing students enjoyed the lecture about which nursing theory?

Accepted Answer

Neuman's systems model is based on an individual's/family's/community's relationship to stress and the reaction to stress.This model promotes wellness on primary,secondary,and tertiary levels.The other items listed as models are not nursing theories.Ego defence mechanisms are unconscious coping mechanisms.Situational factors include stressors such as relocation or family job changes.Evidence-informed practice consists of relying on data or other reputable information sources to guide nursing care.

Question 10

Nurses in the medical centre are working with patients experiencing PTSD after losing family members from severe acute respiratory syndrome.Which of the following approaches would be appropriate to incorporate into the plan of care?

Accepted Answer

Teaching the patient relaxation strategies can help reduce the stress of anxiety-provoking thoughts and events,as seen in PTSD,and reinforces an adaptive coping strategy.In the presence of anxiety-provoking thoughts and events,a common physiological symptom is muscle tension.Physiological tension is diminished through a systematic approach to releasing tension in major muscle groups.Suppression would be a maladaptive coping mechanism.PTSD is not a short-term problem but a long-term one;the focus should be on developing adaptive coping mechanisms and lowering the individual's anxiety level.The primary focus for the patient who is experiencing PTSD is not on physical needs.

Question 11

A teenager with celiac disease continues to eat food she knows will make her ill several hours after ingestion.In view of appropriate tertiary level interventions,what would be the nursing intervention?

Accepted Answer

Tertiary interventions help the patient adapt to life with an illness.By adjusting the diet to meet dietary guidelines and also addressing adolescent emotional needs,the nurse will help the teenager to follow an appropriate diet without health complications and see herself as a "typical and normal" teenager.Teaching about Canada's Food Guide to Healthy Eating will not address the real issue,which is that the teen is still eating what she knows will make her ill.Administering antidiarrheal medications may help but is not a tertiary intervention.Admonishing the teenager and parents is not a tertiary intervention,and because this approach is nontherapeutic,it may cause communication problems.

Question 12

Pediatric stressors related to self-esteem and changes in family structure reflect which maturational school age category?

Accepted Answer

Children of preadolescent age experience stress related to self-esteem issues,changing family structure due to divorce or death of a parent,or hospitalization.Adolescent stressors include identity issues with peer groups and separation from parents.Elementary school age stressors include friends,family,and school relations.Adult stressors centre on life events.

Question 13

In a natural disaster relief facility,the nurse observes that an elderly man has a recovery plan,whereas a 25-year-old man is still overwhelmed by the disaster situation.These different reactions to the same situation would be explained best by which of the following?

Accepted Answer

Maturational factors and sociocultural factors can affect people differently,depending on their life experiences.An older individual would have had more life experiences to draw from and to determine which strategies were successful,whereas a younger individual would have had fewer such experiences.Nothing in the scenario implies that either man is in restorative care,has strong financial resources,or is immature or intelligent.

Question 14

A 23-year-old patient who recently suffered a head injury in a motor vehicle accident is unconscious.The physiological component that is primarily responsible for the patient's level of consciousness is

Accepted Answer

The reticular formation is primarily responsible for an individual's level of consciousness.The medulla oblongata controls vital functions such as heart rate,blood pressure,and respiration.The pituitary gland supplies hormones that control vital functions.The pituitary gland produces hormones necessary for adaptation to stress.The external stress response is not primarily responsible for a person's level of consciousness.

Question 15

After a natural disaster occurred,an emergency worker referred a family for crisis intervention services.One family member refused to attend the services,stating,"No way,I'm not crazy." The best response the nurse can give is which of the following?

Accepted Answer

Crisis intervention is a type of brief therapy that is more directive than typical psychotherapy or counselling.It focuses on problem solving and involves only the problem created by the crisis.The goal of crisis intervention is to create stability for the person involved in the crisis while promoting self-reliance.The other options do not properly reassure the patient and build trust.

Question 16

The nurse teaches stress reduction and relaxation training to a health education group of patients after cardiac bypass surgery.The nurse is performing which level of intervention?

Accepted Answer

Tertiary interventions assist patients in adapting to life with an illness.Tertiary prevention focuses on the person who already has the disease and is recovering or rehabilitating,and the goals are to slow down the disease process,prevent further damage or pain from the disease,and prevent the current disease from creating other health problems.Primary interventions include stress prevention,promotion of wellness,and risk factor reduction before illness occurs.Secondary interventions are implemented after symptoms appear and help the person develop resources to manage illness and stress."Quad level" interventions do not exist.

Question 17

The nurse is working with patients in an outpatient health care setting.One of the patients is experiencing job-related stress.Which of the following is a factor that may indicate chronic stress?

Accepted Answer

Chronic pain disorders,irritable bowel syndrome,somatization disorder,and clinical depression have all been linked to chronic stress.A patient's avoiding discussion of the problem,negative comments about his or her colleagues,and blaming of the boss may not be related to chronic stress.

Question 18

A trauma survivor is requesting sleep medication because of "bad dreams." Concerned about PTSD,the nurse would ask which of the following?

Accepted Answer

People who have PTSD often have flashbacks,re-experiencing the trauma.The other answers involve assessment of problems not specific to PTSD.

Question 19

A nurse is teaching guided imagery to a prenatal class.Which of the following is an example of guided imagery?

Accepted Answer

Guided imagery is used as a means to create a relaxed state through the person's imagination,often with the use of sensory words.Imagination allows the person to create a soothing and peaceful environment.Singing,back massage,and listening to music are other types of stress management techniques.

Question 20

An example of an assessment finding of caregiver strain would be which of the following?

Accepted Answer

A nurse will identify a caregiver's lack of self-care as a potential example of caregiver role strain.Sacrificing their own health to care for the identified patient places caregivers at risk for becoming ill themselves.If caregivers jeopardize their own health,they may not be able to care for the actual patient.In all of the other options,the caregiver is handling caregiver stress appropriately.

Quiz 29: Stress and Adaptation