Deck 10: Understanding and Managing Responses to Stress

Question 1

A person with a fear of heights drives across a high bridge.Which structure will stimulate a response from the autonomic nervous system?

A) Thalamus
B) Parietal lobe
C) Hypothalamus
D) Pituitary gland

Answer 1

Hypothalamus

Question 2

A patient says,"One result of my chronic stress is that I feel so tired.I usually sleep from 11:00 PM to 6:30 AM.I started setting my alarm to give me an extra 30 minutes of sleep each morning,but I don't feel any better and I'm rushed for work." Which nursing response would best address the patient's concerns?

A) "You may need to speak to your doctor about taking a sedative to help you sleep."
B) "Perhaps going to bed a half-hour earlier would work better than sleeping later."
C) "A glass of wine in the evening might take the edge off and help you to rest."
D) "Exercising just before retiring for the night may help you to sleep better."

Answer 2

"Perhaps going to bed a half-hour earlier would work better than sleeping later."

Question 3

A patient tells the nurse,"I will 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 by the patient is most likely to promote coping?

A) "People should treat me as well as they treat my sister."
B) "I can find contentment in succeeding at my own job level."
C) "I won't be happy until I make as much money as my sister."
D) "Being as smart or clever as my sister isn't really important."

Answer 3

"I can find contentment in succeeding at my own job level."

Question 4

A patient reports,"I am overwhelmed by stress." Which question by the nurse would be most important to use in the initial assessment of this the patient?

A) "Tell me about your family history. Do you have any relatives who have problems with stress?"
B) "Tell me about your exercise. How much activity do you typically get in a day?"
C) "Tell me about the kinds of things you do to reduce or cope with your stress."
D) "Stress can interfere with sleep. How much did you sleep last night?"

Question 5

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

A) Muscular tension, blood pressure, and triglycerides increase.
B) Epinephrine is released, increasing heart and respiratory rates.
C) Corticosteroid release increases stamina and impedes digestion.
D) Cortisol is released, increasing glucogenesis and reducing fluid loss.
E) Immune system functioning decreases, and risk of cancer increases.
F) Risk of depression, autoimmune disorders, and heart disease increases.

Question 6

Which scenario best demonstrates an example of eustress? An individual:

A) loses a beloved family pet.
B) prepares to take a one-week vacation to a tropical island with a group of close friends.
C) receives a bank notice there were insufficient funds in their account for a recent rent payment.
D) receives notification their current employer is experiencing financial problems and some workers will be terminated.

Question 7

A patient tells the nurse,"I know that I should reduce the stress in my life,but I have no idea where to start." What would be the best initial nursing response?

A) "Physical exercise works to elevate mood and reduce anxiety."
B) "Reading about stress and how to manage it might be a good place to start."
C) "Why not start by learning to meditate? That technique will cover everything."
D) "Let's talk about what is going on in your life and then look at possible options."

Question 8

A person with a fear of heights drives across a high bridge.Which division of the autonomic nervous system will be stimulated in response to this experience?

A) Limbic system
B) Peripheral nervous system
C) Sympathetic nervous system
D) Parasympathetic nervous system

Question 9

The adult child of a patient diagnosed with major depression asks,"Do you think depression and physical illness are connected? Since my father's death,my mother has had shingles and the flu,but she's usually not one who gets sick." Which answer by the nurse best reflects current knowledge about psychoneuroimmunology?

A) "It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system."
B) "You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses."
C) "So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link."
D) "Negative emotions and stress may interfere with the body's ability to protect itself and can increase the likelihood of infection."

Question 10

A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises.When the patient returns to the clinic 2 weeks later,which finding most clearly shows the patient is coping more effectively with stress?

A) The patient's systolic blood pressure has changed from the 140s to the 120s mm Hg.
B) The patient reports, "I feel better, and that things are not bothering me as much."
C) The patient reports, "I spend more time napping or sitting quietly at home."
D) The patient's weight decreased by 3 pounds.

Question 11

A patient tells the nurse,"My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking." Which response by the nurse would support the recommendation?

A) Encourage the patient to imagine being in calm circumstances.
B) Provide the patient with a blank journal and guidance about journaling.
C) Teach the patient to recognize, reconsider, and reframe irrational thoughts.
D) Teach the patient to use instruments that give feedback about bodily functions.

Question 12

According to the Recent Life Changes Questionnaire,which situation would most necessitate a complete assessment of a person's stress status and coping abilities?

A) A person who has been assigned more responsibility at work
B) A parent whose job required relocation to a different city
C) A person returning to college after an employer ceased operations
D) A man who recently separated from his wife because of marital problems

Question 13

When a nurse asks a newly admitted patient to describe social supports,the patient says,"My parents died last year and I have no family.I am newly divorced,and my former in-laws blame me.I don't have many friends because most people my age just want to go out drinking." Which action will the nurse apply?

A) Advise the patient that being so particular about potential friends reduces social contact.
B) Suggest using the Internet as a way to find supportive others with similar values.
C) Encourage the patient to begin dating again, perhaps with members of the church.
D) Discuss how divorce support groups could increase coping and social support.

Question 14

A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse,"Do you think saying a prayer would help?" Select the nurse's best answer.

A) "It could be that prayer is your only hope."
B) "You may find prayer gives comfort and lowers your stress."
C) "I can help you feel calmer by teaching you meditation exercises."
D) "We do not have evidence that prayer helps, but it wouldn't hurt."

Question 15

A patient is brought to the Emergency Department after a motorcycle accident.The patient is alert,responsive,and diagnosed with a broken leg.The patient's vital signs are pulse (P)72 and respiration (R)16.After being informed surgery is required for the broken leg,which vital sign readings would be expected?

A) P 64, R 14
B) P 68, R 12
C) P 72, R 16
D) P 80, R 20

Question 16

A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home.Recently the patient has reduced activity because of fear that breathing difficulty will occur.A nurse suggests using guided imagery.Which image should the patient be encouraged to visualize?

A) Engaging in activity without using any supplemental oxygen
B) Sleeping comfortably and soundly, without respiratory distress
C) Feeling relaxed and taking regular deep breaths when leaving home
D) Having a younger, healthier body that knows no exercise limitations

Question 17

A patient nervously says,"Financial problems are stressing my marriage.I've heard rumors about cutbacks at work; I am afraid I might get laid off." The patient's pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88.Which nursing intervention will the nurse implement?

A) Advise the patient, "Go to sleep 30 to 60 minutes earlier each night to increase rest."
B) Direct the patient in slow and deep breathing via use of a positive, repeated word.
C) Suggest the patient consider that a new job might be better than the present one.
D) Tell the patient, "Relax by spending more time playing with your pet."

Question 18

A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S.resident for 10 years.The family member says,"The immigration to America has been very difficult." Considering cultural background,which expression of stress by this patient would the nurse expect?

A) Motor restlessness
B) Somatic complaints
C) Memory deficiencies
D) Sensory perceptual alterations

Question 19

A nurse leads a psychoeducational group for depressed patients.The nurse plans to implement an exercise regime for each patient.The rationale to use when presenting this plan to the treatment team is that exercise:

A) has an antidepressant effect comparable to selective serotonin reuptake inhibitors.
B) prevents damage from overstimulation of the sympathetic nervous system.
C) detoxifies the body by removing metabolic wastes and other toxins.
D) improves mood stability for patients with bipolar disorders.

Question 20

A patient newly diagnosed as HIV-positive seeks the nurse's advice on how to reduce the risk of infections.The patient says,"I used to go to church and I was in my best health then.Maybe I should start going to church again." Which response will the nurse offer?

A) "Religion does not usually affect health, but you were younger and stronger then."
B) "Contact with supportive people at church might help, but religion itself is not especially helpful."
C) "Studies show that spiritual practices can enhance immune system function and coping abilities."
D) "Going to church would expose you to many potential infections. Let's think about some other options."

Question 21

Which nursing comments are likely to help a patient to cope by addressing the mediators of stress? Select all that apply.

A) "A divorce, while stressful, can be the beginning of a new, better phase of life."
B) "You said you used to jog; getting back to aerobic exercise could be helpful."
C) "Journaling often promotes awareness of how experiences have affected people."
D) "Slowing your breathing by counting to three between breaths will calm you."
E) "Would a short-term loan make your finances less stressful?"
F) There is a support group for newly divorced persons in your neighborhood."

Question 22

An individual says to the nurse,"I feel so stressed out lately.I think the stress is affecting my body also." Which somatic complaints are most likely to accompany this feeling? Select all that apply.

A) Headache
B) Neck pain
C) Insomnia
D) Anorexia
E) Myopia

Question 23

The nurse wishes to use guided imagery to help a patient relax.Which comments would be appropriate to include in the guided imagery script? Select all that apply.

A) "Imagine others treating you the way they should, the way you want to be treated …"
B) "With each breath, you feel calmer, more relaxed, almost as if you are floating …"
C) "You are alone on a beach, the sun is warm, and you hear only the sound of the surf …"
D) "You have taken control, nothing can hurt you now. Everything is going your way…"
E) "You have grown calm, your mind is still, there is nothing to disturb your well-being …"
F) "You will feel better as work calms down, as your boss becomes more understanding …"