Stress and Coping

1.A patient who was injured in a motor vehicle accident is taken via ambulance to the emergency department. The nurse performing the physical assessment knows that, according to the general adaptation syndrome, the patient should be expected to exhibit:

a.
increased blood flow to the intestines.
b.
increased heart rate.
c.
decreased blood pressure.
d.
decreased blood glucose levels.

ANS: B

In the early part of the twentieth century, the fight-or-flight response was described. This arousal of the sympathetic nervous system prepares a person for action by increasing heart rate; diverting blood from the intestines to the brain and striated muscles; and increasing blood pressure, heart rate, respiratory rate, and blood glucose levels.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 638 OBJ: Formulate nursing diagnoses based on assessment data.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity

2.The nurse is administering flu vaccines. One of the children who is scheduled to receive the vaccine is afraid of needles and is tearful, and his younger brother is trying to calm him down. The nurse knows that the tearful child has evaluated this event as challenging and therefore is experiencing psychological stress caused by which of the following?

a.
Primary appraisal
b.
Coping
c.
Secondary appraisal
d.
Dissociation

ANS: A

When a person encounters an event, there is an immediate process of primary appraisal or rating of the event. If this appraisal results in the event being identified as a potential harm, loss, threat, or challenge, the person has stress. Coping refers to strategies or practices that help people deal with stress. Following the recognition of stress, secondary appraisal focuses on the resources or coping strategies that can meet the stress. Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one’s surroundings.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 638 | 640 OBJ: Formulate nursing diagnoses based on assessment data.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

3.The nurse is assigned a patient who has experienced the alarm reaction and continues to recover. The nurse knows that the primary hormone impacting the stress response in the resistance stage of the general adaptation syndrome is:

a.
vasopressin.
b.
adrenaline.
c.
noradrenaline.
d.
cortisol.

ANS: D

Corticotropin stimulates the adrenal gland to increase the production of corticosteroids, including cortisol, the primary hormone impacting the stress response. Cortisol increases blood glucose, enhances the brain’s use of glucose, and increases the availability of substances for tissue repair. Vasopressin increases reabsorption of water by the kidneys and induces vasoconstriction, thereby raising blood pressure. The adrenal gland also releases catecholamines, adrenaline, and noradrenaline, which are important parts of the alarm reaction.

PTS: 1 DIF: Cognitive Level: Remembering (Knowledge)

REF: 638 | 639 OBJ: Describe the three stages of the general adaptation syndrome.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity

4.The nurse is talking to a patient who was involved in a motor vehicle accident. The patient asks the nurse why there was no sensation of pain at the time of the accident. The best explanation would be:

a.
“Vasopressin was released to decrease pain sensation.”
b.
“Endorphins are released during a time of stress to reduce pain.”
c.
“Alcohol reduces the perception of stress when injury occurs.”
d.
“You probably have chronic high levels of cortisol to help with chronic pain.”

ANS: B

Endorphins are hormones that interact with the opiate receptors in the brain to reduce our perception of pain and produce a sense of well-being. Vasopressin increases reabsorption of water by the kidneys and induces vasoconstriction, thereby raising blood pressure. It has no effect on pain sensation. Unhealthy coping choices, such as the use of alcohol or tobacco, negatively affect a person’s health as well as increasing the perception of stress. Persistent elevated cortisol levels are associated with chronic health conditions, such as obesity, heart disease, depression and anxiety, diabetes, and osteoporosis.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 638-640 OBJ: Identify how stress and coping relate to health.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity

5.The nursing student has severe test anxiety. When he receives a test in class, his heart rate increases, he feels more mentally alert, and his pupils dilate. According to the general adaptation theory, the nursing student should identify this response as what stage of the body’s reaction to stress?

a.
Alarm
b.
Resistance
c.
Adaptation
d.
Exhaustion

ANS: A

During the alarm reaction, rising hormone levels result in increased blood volume, blood glucose levels, epinephrine and norepinephrine levels, heart rate, blood flow to muscles, oxygen intake, and mental alertness. In addition, the pupils of the eyes dilate to produce a greater visual field. During the resistance stage the body stabilizes and responds in an opposite manner to the alarm reaction. In the adaptation stage, antiinflammatory adrenocortical hormones are released, and healing occurs. However, if the stressor remains and adaptation does not happen, the person enters the third stage, exhaustion. The exhaustion stage occurs when the body is no longer able to resist the effects of the stressor and the struggle to maintain adaptation drains all available energy.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 639 OBJ: Describe the three stages of the general adaptation syndrome.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity

6.An older adult patient in a long-term care facility recently had a stroke after experiencing a myocardial infarction. The patient is not speaking or eating. The nurse notices an adverse change in vital signs. When a patient is unable to resist the effects of a stressor, the nurse can identify this stage of the general adaptation system as:

a.
an alarm reaction.
b.
the resistance stage.
c.
the exhaustion stage.
d.
a fight-or-flight response.

ANS: C

The exhaustion stage occurs when the body is no longer able to resist the effects of the stressor and the struggle to maintain adaptation drains all available energy. The physiological response intensifies, but the person has so little energy left that adaptation to the stressor diminishes. The body can no longer defend itself against the impact of the event, and if the stress continues, it damages the heart along with other bodily organs and lowers resistance to illness. In the alarm stage, rising hormones result in an increased blood pressure, blood glucose levels, epinephrine and norepinephrine levels, heart rate, blood flow to muscles, oxygen intake, and mental alertness. This change in body systems prepares an individual for fight or flight and lasts from 1 minute to many hours. During the resistance stage, the body stabilizes and responds in an opposite manner to the alarm stage.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 639 OBJ: Describe the three stages of the general adaptation syndrome.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity

7.A 48-year-old nurse is complaining of being continually exhausted because of the workload on her unit. She states that “the patients are getting heavier and the halls are getting longer. Sometimes I just don’t think I can get through the day.” The nurse is dealing with stress caused by:

a.
situational factors.
b.
maturational factors.
c.
sociocultural factors.
d.
compassion fatigue.

ANS: A

Situational factors include work stress that happens with work overload (patient load, distractions, conflicting priorities), heavy physical work, long hour work shifts, patient concerns (dealing with death and medical treatment), and interpersonal problems with other health care professionals and staff. Coping strategies vary with the individual and the situation. Maturational factors involve stressors and coping strategies that vary with life stage. Sociocultural factors include prolonged poverty, physical handicap, and chronic illness. Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:641 | 642OBJ:Define stress and coping.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

8.A nurse works on an oncology unit and has a lot of stress in her life. Which of the following situational factors would be considered work stress?

a.
Caring for a family member who has Alzheimer’s disease
b.
Being diagnosed with a chronic back injury
c.
Finding out that a parent has lung cancer
d.
Having a disagreement with her nurse manager

ANS: D

Work stress for nurses happens with work overload, heavy physical work, shift work, patient concerns (dealing with death and medical treatment), and interpersonal problems with other health care professionals and staff. Adjusting to chronic illness can result in situational stress, but is not work related. Furthermore, the stress experienced while caring for someone with a chronic illness (such as Alzheimer’s disease) can lead to adverse health consequences but is also not work related. Another non–work-related stressor would be caring for a family member who has cancer. Those family members caring for cancer patients have been shown to display immunologic changes that can contribute to the development of inflammatory disease.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:641OBJ:Define stress and coping.

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

9.A patient and family attend a counseling session. The patient has become depressed after a job loss. The nurse leading the counseling session informs the patient and his family that this type of crisis is caused by:

a.
situational factors.
b.
maturational factors.
c.
sociocultural factors.
d.
compassion fatigue.

ANS: A

Situational factors include work-related stress. Coping strategies vary with the individual and the situation. Maturational factors involve stressors and coping strategies that vary with life stage. Sociocultural factors include prolonged poverty, physical handicap, and chronic illness. Compassion fatigue is a term used to describe a state of burnout and secondary traumatic stress.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 641 | 642 OBJ: Identify how stress and coping relate to health.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

10.A new nurse is looking for a staff nurse position. She had several instances during clinical rotations in nursing school in which she was late because she studied until the early hours of the morning. According to her circadian rhythm she would be best suited for which of the following positions?

a.
Full-time 8-hour day/evening rotation
b.
Part-time 12-hour day/night rotation position
c.
Full-time 12-hour night position
d.
Full-time 8-hour day position

ANS: C

In general, people doing shift work need to maintain as consistent a sleep and mealtime schedule as possible. Some nurses often ease their coping with shift work by knowing their own circadian rhythms. A nurse who typically thinks well at night and tends to sleep late in the morning will adapt better to night shift than to day shift. Rotating shifts prevent establishment of a consistent sleep and mealtime schedule.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF: 641 OBJ: Identify how stress and coping relate to health.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

11.A patient complains of pain. The nursing order calls for pain medication via injection. The patient is afraid of needles. The nurse can assist the patient through this stressful incident by encouraging the patient to think of a relaxing situation. The nurse’s actions can be identified as:

a.
restorative care.
b.
cognitive therapy.
c.
assertiveness training.
d.
progressive muscle relaxation.

ANS: B

Cognitive therapy teaches patients how certain thinking patterns cause symptoms of stress or depression. Cognitive therapy focuses on changing ways of thinking so that a patient feels empowered and in control of his or her own life. Restorative care occurs when a person has recovered from a stressful situation, and is taught stress management skills to reduce the number and intensity of stress responses in future situations. Assertiveness training teaches individuals to communicate effectively regarding their needs and desires. The ability to resolve conflict with others through assertiveness training reduces stress. When a group leader teaches assertiveness, the effects of interacting with other people increase the benefits of the experience. Progressive muscle relaxation diminishes physiological tension through a systematic approach to releasing tension in major muscle groups.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:648 | 649

OBJ:Identify stress management techniques used in coping with stress.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

12.The patient, a busy executive who works 80 hours a week, is admitted for angina. The patient is demonstrating physical signs of stress related to the work environment. An appropriate nursing intervention for this patient includes releasing muscle tension every 2 hours. This type of intervention is best known as:

a.
regular exercise.
b.
assertiveness training.
c.
cognitive therapy.
d.
progressive muscle relaxation.

ANS: D

Muscles tense in the presence of anxiety-provoking thoughts and events. With progressive muscle relaxation physiological tension diminishes through a systematic approach to releasing tension in major muscle groups. A regular exercise program improves muscle tone and posture, controls weight, reduces tension, improves circulation, triggers release of endorphins, and promotes relaxation. Assertiveness training teaches individuals to communicate effectively regarding their needs and desires. The ability to resolve conflict with others through assertiveness training reduces stress.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:648 | 649

OBJ:Identify stress management techniques used in coping with stress.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

13.A nurse has been working overtime because of high hospital census and a decreased work force. The nurse is concerned about the danger of work-related burnout or compassion fatigue. To combat this risk, the nurse should:

a.
increase nursing responsibilities at work.
b.
take control over new areas at work to reduce stress.
c.
strengthen relationships outside of the hospital.
d.
hang out with co-workers when not at work.

ANS: C

Compassion fatigue occurs as a result of chronic stress and is often associated with the human service professions. Make a clear separation between work and home life. Strengthening friendships outside of the workplace, socially isolating oneself for personal “recharging” of emotional energy, and spending off-duty hours in interesting activities all help reduce burnout. Identify the limits and scope of your responsibilities at work. Recognize the areas over which you have control and the ability to change and those for which you do not have responsibility.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 642 | 650 OBJ: Discuss the relevance of compassion fatigue for healthcare.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

14.A patient telephones a crisis intervention hotline. The nurse assigned to this center assesses that the patient is experiencing a crisis. What is the most appropriate action for the nurse to take?

a.
Take control of the situation and tell the patient what needs to be done.
b.
Define the problem at hand and ensure that the patient is safe.
c.
Ask the patient how he would like to handle the crisis and follow through.
d.
Ask the patient to list all of his problems and prioritize which to deal with first.

ANS: B

Crisis intervention begins with defining the problem, ensuring patient safety, and providing support. First determine that a patient is safe and is not at risk for injury to self or others, and then use crisis intervention to examine alternatives, make plans, and obtain a commitment to positive action from the patient. Ideally these last three steps are completed collaboratively with a patient, but a patient in crisis may be unable to participate actively and may need a very directive approach or a crisis interventionist. Emphasize focusing on the specific problem, and help a patient to avoid all-encompassing, catastrophic interpretations.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 650 OBJ: Develop a care plan for a patient experiencing stress.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15.The student nurse was late for clinical rounds because she had to change the tire on her car. She is in the process of preparing pain medication for her patient when her nursing instructor asks her to identify the drug classification of the medication that she is preparing. The student nurse is very frustrated, becomes tearful, and states, “I can’t seem to crush this tablet correctly.” This reaction to the instructor is most likely a result of what ego-defense mechanism?

a.
Compensation
b.
Displacement
c.
Denial
d.
Dissociation

ANS: B

Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one’s surroundings.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 640 OBJ: Formulate nursing diagnoses based on assessment data.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

16.The nurse works in a small clinic with two other nurses and a nurse practitioner. Recently the nurse has been staying at work longer than usual. His neighbor, a patient at the clinic, asks one of the other employees at the clinic how the nurse is coping since his wife left him. The nurse had not shared this information with his co-workers. The nurse may be coping with his loss with which of the following?

a.
Compensation
b.
Conversion
c.
Denial
d.
Dissociation

ANS: C

Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite). Dissociation is experiencing a subjective sense of numbing and a reduced awareness of one’s surroundings.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 640 OBJ: Formulate nursing diagnoses based on assessment data.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

17.A 4-year-old boy has been admitted to the hospital with pneumonia. He has been in the hospital for 3 days and has suddenly started to become incontinent of urine. The nurse knows that this is most likely a result of what ego-defense mechanism?

a.
Compensation
b.
Conversion
c.
Denial
d.
Regression

ANS: D

Regression is coping with a stressor through actions and behaviors associated with an earlier developmental period. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite). Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 640 OBJ: Formulate nursing diagnoses based on assessment data.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

18.The nurse has recently been promoted to a new management position in her hospital. She is concerned about her new responsibilities and has found that she is having difficulty sleeping at night. This is an example of what ego-defense mechanism?

a.
Compensation
b.
Denial
c.
Conversion
d.
Displacement

ANS: C

Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms (e.g., difficulty sleeping, loss of appetite). Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that causes intolerable emotional pain. Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute. (Example: A person transfers anger over a job conflict to a malfunctioning computer.)

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 640 OBJ: Formulate nursing diagnoses based on assessment data.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1.The patient has severe injuries. The nurse knows that the general adaptation syndrome (GAS) was viewed as a reaction to stress consisting of: (Select all that apply.)

a.
a pattern of alarm.
b.
deleterious consequences.
c.
a stage of resistance.
d.
developmental impairment.
e.
a state of exhaustion.

ANS: A, C, E

The GAS was viewed as a reaction to stress consisting of three distinct stages; a pattern of alarm, followed by a stage of resistance as a person attempts to compensate for changes induced by the alarm stage. A state of exhaustion follows if the person cannot successfully adapt during the stage of resistance or if stress remains unrelieved. When stress reaches chronic, harmful levels, deleterious consequences follow, from compromised immune function to weight gain to developmental impairment. Deleterious consequences and developmental consequences, then, are a product of unsuccessful GAS, not a part of the syndrome.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF: 638 OBJ: Describe the three stages of the general adaptation syndrome.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity

2.The nurse is interviewing a patient who claims to be in the middle of a crisis situation. The nurse should: (Select all that apply.)

a.
determine the patient’s view of the situation.
b.
be aware that denial is never a coping mechanism for people in crisis.
c.
point out that the patient is repeating information and ask him to stop.
d.
assess for the potential for suicide/homicide.
e.
assess coping mechanisms and support systems.

ANS: A, D, E

Use the interview to determine a patient’s view of the situation that provoked stress, assess safety issues, coping resources, any possible maladaptive coping, and adherence to prescribed medical recommendations, such as medication or diet. If your patient is experiencing a crisis, assess safety concerns such as potential for suicide or homicide and ability to care for one’s own activities of daily living. Finally, assess alternatives, coping mechanisms, and support systems. If the patient uses denial as a coping mechanism, be alert to whether the person overlooks necessary information. Listen for any recurrent themes in the patient’s conversation.

PTS:1DIF:Cognitive Level: Applying (Application)

REF: 643 | 644 OBJ: Develop a care plan for a patient experiencing stress.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity