Concept 27: Stress My Nursing Test Banks

Concept 27: Stress

Test Bank

MULTIPLE CHOICE

1. An older patient presents to the outpatient clinic with a chief complaint of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patients chief complaint?

a.

The patient is responsible for caring for two school-age grandchildren.

b.

The patients daughter works to support the family.

c.

The patient is being treated for hypertension and is overweight.

d.

The patient has recently lost her spouse and needed to move in with her daughter.

ANS: D

The stress of losing a loved one and having to move are important contributing factors for stress-related symptoms in older people. Caring for children will increase the patients sense of worth. Being overweight and being treated for hypertension are not the most likely causes of insomnia or headache. The patients daughter may have added stress due to working, but this should not directly affect the patient.

REF: 284 OBJ: NCLEX Client Needs Category: Physiological Integrity

2. A patient who was recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. Which action should the nurse take?

a.

Ask the health care provider for a psychiatric referral.

b.

Administer the PRN sedative medication every 4 hours.

c.

Suggest the use of a home caregiver to the patients family.

d.

Plan to reinforce and repeat teaching about diabetes management.

ANS: D

Because behavioral responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, patient teaching will need to be repeated. Psychiatric referral or home caregiver referral will not be needed for these expected short-term cognitive changes. Sedation will decrease the patients ability to learn the necessary information for self-management.

REF: 285 OBJ: NCLEX Client Needs Category: Psychosocial Integrity

3. A diabetic patient who is hospitalized tells the nurse, I dont understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up. Which response by the nurse is appropriate?

a.

It is probably just coincidental that your blood sugar is high when you are ill.

b.

Stressors such as illness cause the release of hormones that increase blood sugar.

c.

Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times.

d.

Your diet is different here in the hospital than at home, and that is the most likely cause of the increased glucose level.

ANS: B

The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. The increase in blood sugar is not coincidental. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.

REF: 282 OBJ: NCLEX Client Needs Category: Physiological Integrity

4. A patient has not been sleeping well because he is worried about losing his job and not being able to support his family. The nurse takes the patients vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths/min, and his blood pressure is 166/88 instead 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.

ANS: C

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., Bensons relaxation response) will counter the sympathetic nervous systems arousal, normalizing these vital-sign changes and reducing the physiologic demands stress is placing on his body. Other options do not address his physiologic response pattern as directly or immediately.

REF: 285

OBJ: NCLEX Client Needs Category: Psychosocial Integrity and Physiological Integrity

5. The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is 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 physiologic 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.

ANS: A

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 imagerys effectiveness.

REF: 283 OBJ: NCLEX Client Needs Category: Physiological Integrity

6. A patient tells the nurse, Im 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.

Lets talk about what is going on in your life and then look at possible options.

ANS: D

In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are 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.

REF: 284 OBJ: NCLEX Client Needs Category: Psychosocial Integrity

7. 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 doctors 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

ANS: A

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 patients manner of thinking.

REF: 286 OBJ: NCLEX Client Needs Category: Psychosocial Integrity

8. 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 patients 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.

ANS: C

Objective measures tend to be the most reliable means of gauging progress. In this case, the patients elevated blood pressure, an indication of the bodys physiologic response to stress, has diminished. The wifes 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 physiologic changes from stress and may not reflect improved coping with stress. The patients report that he feels better and is not bothered as much by his circumstances could also reflect resignation rather than improvement.

REF: 285

OBJ: NCLEX Client Needs Category: Psychosocial Integrity and Physiological Integrity

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