Chap 32 – Stress and Coping – Flashcards
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Stress
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A demand from the internal or external environment that exceeds the person's immediately available resources or ability to respond A nonspecific response of the body to any demand made upon it
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Stress Appraisal
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The process by which the person interprets a stressor as either threat or challenge
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Stressor
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An event or stimulus that disrupts the person's sense of equilibrium
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Homeostasis
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The body's regulation of systems to maintain a steady
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Fight or Flight Response
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Physiologic response to stress, whether physical or psychological, is activation of the autonomic nervous system
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General Adaptation Syndrome (GAS)
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Physical response to stress
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Distress
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Stress that is beyond the ability of the affected person to cope with or adapt to effectively negative stress
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Eustress
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Motivational stress good stress
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Allostatsis
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Means by which homeostasis is reestablished, and the purpose is to assist the body in maintaining stability
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Local Adaptation Syndrome (LAS)
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Tissues of the body more directly affected by stress May manifest as inflammation, reflexive response to pain, or hypoxia secondary to catecholamine release
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Sense of Coherence (SOC)
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Characteristic of personality that references one's perception of the world as comprehensible manageable and meaningful
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Coping
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Defined as the dynamic cognitive and behavioral efforts to manage demands (internal and external) that are appraised as exceeding immediately available resources
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Defense Mechanisms
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Predominantly unconscious protective coping methods that people may apply in response to a perceived threat
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Anxiety
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A response to stress that causes apprehension or uncertainty
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Generalized Anxiety Disorder (GAD)
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Characterized by unrealistic levels of worry and tension with or without an identifiable cause
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Post-Traumatic Stress Disorder (PTSD)
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A very serious mental health condition characterized by flashbacks and erratic behaviors that results from exposure to a horrifying experience
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Anger
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An emotion that involves antagonism toward another person or situation
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Depression
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Is describes as "anger turned inward". Typically results from an experience of loss
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Crisis Intervention
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Short-term assistance provided at a time of physical or emotional upheaval with the goal of helping the person is distress to regain equilibrium
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Burnout
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Mental or physical exhaustion due to constant stress or activity
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Alarm Reaction Stage
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Hypothalamic-pituitary-adrenal and autonomic nervous systems are activated, successively triggering responses in the sympathetic nervous system and the endocrine and immune systems
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Resistance Stage
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The body attempts to adapt to the stressor and some of the initial responses are attenuated as the parasympathetic nervous system reverses the sympathetic stimulation and stabilization occurs. The body begins to repair damage and restore resources
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Exhaustion Stage
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When the stress is not relieved or the resources are inadequate to meet persistent demands
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The nurse has been assigned the same patients for the past 4 days. Two of the patients demand a great deal of attention, and the nurse feels anxious and angry about being given this assignment again. What action would demonstrate the most effective way for the nurse to cope with the patient care assignment? a. Share complaints about the assignment with the nurse manager. b. Prioritize the patients' needs, and identify a specific time period for care for each patient. c. Talk with the patients, and explain that they cannot expect so much personal attention. d. Trade assignments with another nurse who is unaware of the concerns regarding the patient assignment.
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B Prioritizing care and setting aside time to spend with specific patients constitute the most effective coping strategy for the nurse to use. Sharing concerns with the nurse manager does not demonstrate strong problem-solving skills; it merely shows a desire to complain. Trading assignments diminishes the continuity of care during which patient trust and nurse-patient relationships are developed. Patients are always the focus of nursing care and should not be given the impression that the nurse does not have time to care or listen to their concerns
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A patient is newly diagnosed with diabetes and requires insulin injections. He requests information about classes offered by the diabetes educator. Which type of coping technique is this patient using? a. Emotion-focused b. Problem-focused c. Avoidance d. Denial
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B Problem-focused coping techniques are aimed at altering or removing a stressor. If this patient gains the skills to administer his own injections from the diabetes educator, he will remove a major stressor associated with a new diabetes diagnosis. Emotion-focused coping techniques, avoidance, and denial are all psychological techniques, rather than a psychomotor-based activity, which is required in this situation.
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Which statement by a patient would indicate the use of effective coping strategies? (Select all that apply.) a. "Each month, my wife and I attend a support group for parents of children with autism." b. "Talking with my spiritual adviser may challenge my thinking on how best to handle this situation." c. "I've invited my son to join me for drinks at the bar each night on his way home from work so we can spend more time together." d. "We are looking into joining the new health club facility in our neighborhood." e. "After working all day, I eat dinner in front of the television while my family sits at the kitchen table."
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A, B, D Support groups, spiritual advisors, and health clubs all offer services that can enhance coping skills. The daily use of alcohol is not a healthy coping strategy, even if it involves spending time with family. Eating in front of the television promotes obesity and social isolation.
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When using a stress assessment tool with a patient from another culture, what factor(s) must the nurse take into consideration? (Select all that apply.) a. Specific methods of managing stress are revealed in using stress assessment tools. b. Stress assessment tools should be used only for persons living in North America. c. Stress assessment tools may not be appropriate for all people of all ages. d. Resistance resources become evident when stress assessment tools are analyzed. e. Adaptations may need to be made to the assessment tool based on circumstances.
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C, E It is not possible to use stress assessment tools in some situations. Stress assessment tools must be adapted to specific age groups, cultures, and circumstances to be most effective in gathering pertinent data. Stress assessment tools identify only stressors that the person is experiencing and not methods of managing stress or the person's resistance resources.
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Two adult siblings are caring for their ill mother, who requires 24-hour care. She needs assistance with feeding, bathing, and toileting. One of the siblings takes time to exercise after work, whereas the other goes directly to the mother's home before and after work each day. The nurse recognizes that people may react differently to the same stressors depending on which factors? (Select all that apply.) a. Individual coping skills b. Type of identified stressor c. Amount of perceived stress d. Personal appraisal of the stressor e. Hair color, gender, and skin type
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A, B, C, D The person's coping skills have an impact on how that person perceives and responds to stress. The type and amount of stress as well as the appraisal of stress also affect how the person reacts. Hair color, gender, and skin type are not recognized as factors related to stress reactions.
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A male patient is told that he may have colon cancer. Which response by the patient best indicates that his initial appraisal of the situation is primarily a challenge to be met? a. Requesting information on various treatment options b. Demanding to see another physician immediately c. Storming out of the gastroenterologist's office d. Yelling at the nurse who is scheduling his colonoscopy
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A Requesting further information regarding treatment indicates that the patient is viewing the situation primarily as a challenge to be faced. Primary and secondary appraisals determine whether the stressful situation or transaction is a threat or a challenge. A threat invokes the possibility of harm or loss, whereas a challenge holds forth the possibility of benefit. Demanding, angry behavior indicates that the patient feels threatened rather than challenged.
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A 25-year-old female patient demands that her mother or father be present during all blood testing. Which defense mechanism could the nurse document as being used by this patient? a. Sublimation b. Repression c. Projection d. Regression
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D This young adult patient is reverting back to behavior consistent with an earlier stage of development, which is the defense mechanism of regression. Sublimation is channeling unacceptable emotions into acceptable actions. Repression involves blocking unacceptable thoughts from consciousness, and projection attributes one person's desires or traits to another person.
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In the immediate postoperative period after open-heart surgery, a patient who is not a diabetic has elevated blood glucose levels. What physiologic stress response best describes the rationale for the patient's increased blood sugar? a. Release of epinephrine b. Secretion of CRH c. Circulation of endorphins d. Increase in corticosteroids
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D Corticosteroids increase serum glucose levels and inhibit the inflammatory response. Often patients who have experienced extreme physiologic stress will require short-term insulin therapy until their corticosteroid and blood glucose levels return to normal. Epinephrine, CRH, and endorphins all respond to stress; however, corticosteroids are directly responsible for the increase in this patient's blood sugar.
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Which short-term goal would be most appropriate for a patient with the nursing diagnosis Anxiety related to upcoming diagnostic tests, as evidenced by expressions of concern and pacing around the room? a. Patient will discuss specific aspects of concern. b. Nurse will administer prescribed antianxiety medication. c. Patient will understand diagnostic test procedures. d. Nurse will describe test procedures in detail to allay concerns.
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A Having the patient discuss specific aspects of concern allows the nurse the opportunity to assess the patient's level of anxiety and what interventions might be most appropriate to help allay the stated concerns. Goals must be patient-centered, measurable, and realistic. None of the other three goals meet these criteria. Two of the goals are nurse-focused. The action "understand" is not measurable.
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Which intervention would be most appropriate for the nurse to include in the care plan for a patient who is experiencing constipation and increased heart and respiratory rates? a. Time management b. Decreased grain intake c. Relaxation therapy d. Regimented exercise
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C Relaxation therapy typically lowers the person's heart and respiratory rates while increasing gastric motility. Not enough information is provided to indicate the need for time management. Both decreased grain intake and regimented exercise may exacerbate the patient's problems.
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The nurse knows that one theory explaining the variation in response to stress among individuals is called: a. stress appraisal. b. sense of coherence. c. allostasis. d. homeostasis.
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ANS: B Sense of coherence (SOC) is a characteristic of personality that references one's perception of the world as comprehensible, meaningful, and manageable. Stress appraisal is the automatic, often unconscious assessment of a demand or stressor. Allostasis is an alternative term for the stress response. Homeostasis is the tendency of the body to seek and maintain a condition of balance or equilibrium.
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The nurse is caring for a patient with a new diagnosis of diabetes type 2. Which of the following statements indicates a negative coping response? a. "I will look up information on the Internet about diabetes." b. "I will join a support group." c. "I will only focus on learning to manage my medication first." d. "I will make changes slowly so I can adapt to each change."
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ANS: C When the patient puts limits on learning by stating he/she will only learn about medication, he/she is using avoidance strategies to alleviate stress. Using strategies such as information gathering (seeking information about diabetes) is positive. Joining support groups and making changes slowly to adapt is also taking direct action by moving forward.
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The nurse is caring for a patient who is undergoing a major cardiac procedure. The patient tells you her heart is racing and she feels nauseated. You know this is part of hormone response known as: a. sense of coherence. b. stress appraisal. c. fight or flight. d. sympathoadrenal response.
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ANS: C In the "fight or flight" response, the corticotropin-releasing hormone (CRH) released by the hypothalamus stimulates the pituitary to release adrenocorticotropic hormone (ACTH). These hormones increase the heart rate, resulting in increased cardiac output, and the motility of the digestive tract is decreased, slowing digestive processes that could result in abdominal distress. Sense of coherence (SOC) is a characteristic of personality that references one's perception of the world as comprehensible, meaningful, and manageable. Stress appraisal is the automatic, often unconscious, assessment of a demand or stressor. The sympathoadrenal response is a consequence of hypothalamic activation in sympathetic stimulation, which triggers epinephrine and norepinephrine release from the adrenal medulla.
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The nurse is measuring her patient's blood glucose levels after an acute myocardial infarction (MI). She knows the rationale for doing this is: a. damaged muscle tissue releases glucose. b. corticosteroids increase glucose. c. myocardial infarctions are often seen in diabetics. d. all patients should have their blood glucose checked.
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ANS: B The endocrine system responds to stress on the body such as what happens during an acute MI. Corticosteroids are important in the stress response because they increase serum glucose levels and inhibit the inflammatory response. Although MIs can be seen in diabetics, there is nothing to indicate this patient is diabetic. All patients do not routinely have their blood glucose checked regularly.
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The nurse is teaching her patient about the difference between mild anxiety and moderate anxiety. Which statement by the patient indicates a need for further education? a. "Mild anxiety can help me remember things." b. "Moderate anxiety will narrow my focus." c. "Mild anxiety will help me be creative." d. "Moderate anxiety will increase my perception."
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ANS: D Moderate anxiety narrows a person's focus, dulls perception, and may challenge a person to pay attention or use appropriate problem-solving skills. Mild anxiety can be motivational, foster creativity, and actually increase a person's ability to think clearly.
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The nurse is providing discharge instructions for a patient with multiple sclerosis (an autoimmune disease). Which discharge instruction is aimed at preventing a future exacerbation? a. Engage in some form of exercise as tolerated. b. Avoid highly stressful situations. c. Check your skin regularly for pressure sores. d. Eat a diet with lots of fiber.
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ANS: B High stress levels are known to exacerbate multiple sclerosis and other autoimmune diseases. Exercise helps keep muscles loose and helps with balance, and assessing skin for pressure sores and eating a diet with high fiber prevents complications from multiple sclerosis.
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The nurse is assessing level of stress in a patient from another culture. Which question is the most appropriate in helping the nurse understand the impact of the patient's belief system? a. "Do you engage in prayer to help you during times of stress?" b. "Do you go to church or other form of organized worship?" c. "Do you have certain beliefs that are helpful during times of stress?" d. "Do you want spiritual counseling while you are here?"
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ANS: C The nurse needs to obtain a knowledge base of the patient's culture as well as identify health beliefs and cultural values from the patient's worldview. Asking the patient specific questions about prayer or church or spiritual counseling is inappropriate until the nurse first understands what the patient's own beliefs and practices are.
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The nurse is performing a physical assessment of patient who is undergoing a bone marrow biopsy. What finding by the nurse indicates the patient is experiencing stress? a. Blood pressure of 120/84 b. Temperature of 37.5° C c. Heart rate of 110 beats/min d. Respiratory rate of 10 breaths/min
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ANS: C The release of hormones increase the heart rate, resulting in increased cardiac output and elevated blood pressure. A reading of 120/84 is a normal blood pressure, and temperature is elevated is indicative of an infection. The respiratory rate increases in stress not decreases.
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The nurse is assessing the patient's use of coping skills in response to stressful situations. Which of the following questions is the most useful? a. "Have you been evaluated for stress?" b. "Do you have someone you can go to for help when you are stressed?" c. "How have you managed stressful situations in the past?" d. "Does stress cause you to experience muscle tension or headaches?"
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ANS: C The use of open-ended questions assists in obtaining accurate information regarding the patient's stressors and coping skills. Questions that elicit yes/no answers will not allow the patient to provide as much information. Asking the patient about headaches and tension is asking about physical symptoms, not coping skills.
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The nurse is caring for a patient on a medical-surgical inpatient unit. The patient tells the nurse he is very sad and is considering suicide. What is the first thing the nurse should do? a. Notify the health care provider. b. Make a referral to psychiatric services. c. Implement one-on-one observations. d. Document in the electronic medical record.
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ANS: C Verbalization of suicidal ideation or a suicide plan must be taken seriously. In the case of a hospitalized patient, one-on-one observation should be implemented to ensure patient safety. Once the patient is under observation, the health care provider is notified to put in the referral; nurses generally do not put in the referral. Documentation is always done after the patient's safety is ensured.
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The nurse knows an appropriate goal for the nursing diagnosis of Ineffective coping would be: a. The patient will report an ability to remember discharge instructions. b. The patient's family will understand how to access respite care services. c. The patient will discuss possible coping strategies during weekly counseling sessions. d. The patient will attend an online support group weekly.
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ANS: C An appropriate goal for Ineffective coping would be to discuss coping strategies. Remembering discharge instructions is an appropriate goal for Anxiety. Understanding how to access respite care services is an appropriate goal for Caregiver role strain, and attending a support group is an appropriate goal for Readiness for enhanced coping.
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The nurse knows an appropriate goal for Stress overload is: a. The patient will attend a weekly support group. b. The patient will discuss possible coping strategies during weekly office visits. c. The patient will discuss strategies for coping with relationship violence within 24 hours. d. The patient's family will use respite care once a week for the next month.
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ANS: C Strategies for coping with relationship violence within 24 hours (short timeframe) is an appropriate goal for Stress overload. Attending a weekly support group is an appropriate goal for Readiness for enhanced coping. An appropriate goal for Ineffective coping would be to discuss possible coping strategies during weekly visits. Using respite care once a week for the next month is an appropriate goal for Caregiver role strain.
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The nurse knows that an appropriate goal for Readiness for enhanced coping would be: a. The patient will report an ability to focus on discharge instructions. b. The patient will attend a coping skills class on a weekly basis. c. The patient will discuss possible coping strategies during weekly office visits. d. The patient will discuss strategies for coping with relationship violence within 24 hours.
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ANS: C The patient will discuss possible coping strategies during weekly office visits is an appropriate goal for Readiness for enhanced coping. The patient will report an ability to focus on discharge instructions is an appropriate goal for Anxiety. An appropriate goal for Ineffective coping would be to discuss possible coping strategies during weekly visits. Strategies for coping with relationship violence within 24 hours (short timeframe) is an appropriate goal for Stress overload.
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The nurse knows that when coordination between multiple health care disciplines is needed, the following role is used: a. Pastoral care b. Case manager c. Social worker d. Dietitian
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ANS: B If coordination of care between multiple health care disciplines is needed, a case manager is used. Pastoral care plays a significant role in addressing stress and anxiety issues when the patient has a preferred religion or strong faith background. A social worker identifies appropriate services and resources. A dietician can provide education regarding dietary needs and food choices.
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The nurse is providing education to a patient around anger management strategies. Which statement indicates a need for further education by the patient? a. "Exercise can help me deal with the anger." b. "I can use humor." c. "I can punch things." d. "I can take a time out."
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ANS: C Strategies should focus on non-violent methods. Some anger management interventions include expressing feelings in a calm, non-confrontational manner; exercising; identifying potential solutions; taking a time out; forgiving; diffusing the situation with humor; owning one's feelings; and breathing deeply.
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The nurse is educating the patient about alternative therapies. Which statement by the patient indicates a need for more information? a. Alternative therapies can include relaxation techniques. b. Alternative therapies are used in conjunction with medical therapies. c. Alternative therapies can be used when patients are experiencing stress. d. Some alternative therapists require certification.
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ANS: B Alternative therapies are used in place of medical treatment. These types of interventions are useful when patients are experiencing physiologic and psychological responses to stress. Some complementary and alternative therapies such as therapeutic touch, Reiki, biofeedback, and massage therapy require additional certification and training, whereas muscle relaxation and guided imagery do not.
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The nurse is educating the patient on the use of relaxing therapy. Which statement by the patient indicates a need for further education? a. "I should relax my muscles from head to toe." b. "I visual the relaxed muscle." c. "I should do this three times a week." d. "I focus on muscles that are tense."
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ANS: C This technique should be done daily. Typically, relaxation progresses from head to toe. With practice, the patient visualizes an image of the relaxed muscles and will be able to relax muscles from the mental image. Progressive relaxation is implemented by having patients focus on muscles that are tensed and then intentionally relax those muscle groups.
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The nurse is seeing a patient during a follow-up visit after discharge in which the patient had a nursing diagnosis of Ineffective coping. Which statement by the patient would be a cause for concern? a. "I am sleeping better most nights." b. "I feel less anxious." c. "I do not need to do the relaxation exercises anymore." d. "I am continuing my exercises every day."
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ANS: C Patients should continue using the stress-reduction techniques to maintain a feeling of well-being. Once stress decreases, patients typically report feeling better, sleeping more soundly, and feeling less anxious. Continuing their positive activities such as exercising is good.
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The nurse knows that when patients are experiencing stress, the following change can be seen in their signs and symptoms: (Select all that apply.) a. Increase in heart rate b. Increase in gastric motility c. Pupil dilation d. Decrease in blood pressure e. Increase in respiratory rate
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ANS: A, C, E The physiologic response to stress, whether physical or psychological, is activation of the autonomic nervous system, resulting in an increase in heart rate, blood pressure, and respirations along with pupil dilation and a decrease in gastric motility and blood flow to the skin.
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The nurse knows that the body's response to the release of hormones in the "fight or flight" response is which of the following? (Select all that apply.) a. Decreased respiratory rate b. Slowing of the digestive process c. Glucose being mobilized from the liver d. Pupils dilating e. Smooth muscles in the bronchi constricting
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ANS: B, C, D The release of hormones increases the heart rate, resulting in increased cardiac output and elevated blood pressure. There is an increase in the flow of blood to muscles at the expense of the digestive and other systems not immediately needed in the fight-or-flight response. Smooth muscles in the bronchi relax and dilate the bronchi and smaller airways, and the respiratory rate increases, allowing for an enhanced flow of well-oxygenated blood to muscles and other organs. The motility of the digestive tract is decreased, slowing digestive processes, but glucose and fatty acids are mobilized from the liver and other stores to support increased mental activities (alertness) and skeletal muscle function. Pupillary dilation produces a larger visual field.
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The nurse knows that certain personality factors have been shown to buffer the impact of stress. These factors are: (Select all that apply.) a. resilience. b. sense of coherence. c. gender. d. hardiness. e. coping style.
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ANS: A, B, D Personality factors such as resilience, hardiness, and sense of coherence can buffer the impact of stress, reducing the negative consequences. Gender is not a personality factor. Coping style refers to a pattern of measures taken to relieve stress but is not a personality factor.
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The nurse knows that childhood stress related to the school experience centers on: (Select all that apply.) a. goal achievement. b. family dissolution. c. life changes. d. test anxiety. e. competition.
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ANS: A, D, E Childhood stress related to the school experience centers on competition, goal achievement, and test anxiety. Family dissolution and life changes are not related to the school experience.
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The nurse knows that the coping strategies that are more frequently seen in older adults are: (Select all that apply.) a. anger. b. withdrawal. c. information gathering. d. avoidance. e. problem focused.
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ANS: A, B Cognitive changes may affect an older adult's ability to cope. Anger or withdrawal as coping strategies may be used more frequently than in the past.
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The nurse manager of a busy oncology unit is concerned about compassion fatigue among her nursing staff. Which of the following signs and symptoms would alter her to this problem? (Select all that apply.) a. Nurses become very emotionally upset without an apparent cause. b. Nurses start to avoid caring for certain patients. c. Nurses start to call in sick more often. d. Nurses begin working more overtime. e. Nurses have difficulty showing empathy for patients.
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ANS: A, B, C, E Compassion fatigue occurs when deeply caring and empathetic nurses become overwhelmed by the constant needs of patients and families. Symptoms include mood swings, avoidance of working with some patients, frequent sick days, irritability, reduced memory, poor concentration, and a decreased ability to show empathy.
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The nurse manager of the unit is implementing a program to assist the nursing staff in managing compassion fatigue. Which intervention will be the most successful? (Select all that apply.) a. Support group that nurses can participate in that meets on the unit b. Exercise completion to encourage nurse to exercise and log their time c. Organized break times so nurses can get off the unit for breaks and lunches d. Quiet area on the unit where the nurses can go during break e. Promotion of work-life balance
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ANS: A, B, C, D, E To care most effectively for others, nurses must first take time to care for themselves. Many of the stress reduction interventions incorporated into patient care plans can be effective in addressing the stressors faced by nurses. Exercise, balanced nutrition, and mindfulness therapy have been shown to help health care professionals in coping with the demands of patient care. Interventions designed specifically to prevent nurse burnout and address compassion fatigue include mentoring programs, quiet areas on a nursing unit for relaxation, availability of pastoral care, the sharing of feelings with trusted colleagues, and promotion of work-life balance.
