Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 05: Adaptation to Stress Test an! M"#T$P#E CH%$CE 1. Although stress may result from either a positive or a negative event, the physical effects are similar. Which statement best describes the long term effects of stress? a Eustress is likely to result in short term stress. . b Chronic distress can take a toll on the individual. . c Stress usually manifests in physical symptoms first. . d istress generally results in more effective coping skills. . A!S" # istress is damaging to an individual $hether it is a result of either positive or negative stress. %his stressor can become chronic if the conflict is not resolved. istress can take a toll on an individual&s body as $ell as on his or her emotional state. Eustress occurs as a result of a positive stress such as from anticipation of a child&s birth but such stress is not necessarily short term and can result in the same symptoms as distress. istress is less likely to occur if previous stress has brought about good coping skills. '(" Cognitive )evel" Application *E(" +ages ,-.-/ %0+" !ursing +rocess" Assessment 1SC" !C)E2" +sychosocial 'ntegrity, +hysiological 'ntegrity 3. When e4plaining the fight.or.flight response to stress, the nurse identifies that the role of the pituitary gland is to" a 1inimi5e the secretion of cortisol. . b (acilitate the conservation of energy. . c Secrete adrenocorticotropic hormone. . d Encourage fleeing from the stressor. . A!S" C %he pituitary gland secretes adrenocorticotropic hormone, $hich stimulates the adrenal corte4 to release cortisol. Cortisol is involved in helping the entire body to react to the stress by mobili5ing the energy reserves so that the body can rapidly respond to the stressors by either fighting or fleeing.
Copyright 6 3/13, 3//7 1osby, 'nc., an affiliate of Elsevier 'nc. All rights reserved.

%est #ank '(" Cognitive )evel" Comprehension *E(" +age -/ %0+" !ursing +rocess" 'mplementation 1SC" !C)E2" +sychosocial 'ntegrity, +hysiological 'ntegrity

>.3

8. 't is believed that an individual&s locus of control has a ma9or role to play in ho$ stress $ill be handled. Which statement characteri5es an internal locus of control? a :'&ll need to manage my money better in order to get out of debt.; . b :%he economy has really caused my finances to be in a real mess.; . c :' don&t think '&ll ever be able to save enough to pay off my bills.; . d :<aving a family makes being able to stay out of debt really difficult.; . A!S" A 'ndividuals $ho demonstrate an internal locus of control vie$ their capability to have personal success or failure as having to do $ith their o$n efforts and their ability to complete a task. An individual $ith an e4ternal locus of control vie$s task completion as having to do $ith circumstances beyond his or her control. %he options involving the economy, never being able to pay off the bills, and having a family e4hibit e4ternal control locus. '(" Cognitive )evel" Application %0+" !ursing +rocess" Assessment *E(" +age -1 1SC" !C)E2" +sychosocial 'ntegrity

=. A nurse manager is attempting to address issues of $ork.related stress and dissatisfaction on the unit. Which administrative intervention has been identified through research as providing the most positive impact on staff morale even $hen 9ob demands are high? a Scheduling so that all staff gets t$o $eekends off a month . b Arranging for e4tra staff $hen patient activity is above the unit average . c 0ffering a paid vacation day to anyone $ho has no absents for si4 months . d Assuring that no staff $ill be mandated overtime more than t$ice monthly . A!S" C Workplaces $ith positive social interactions involve less stress, even $hen the 9ob demands are high. When there is competition among $orkers, negative interactions among staff members, and no assistance $hen the $orkload becomes over$helming, 9ob dissatisfaction and stress is evident. %he nurse manager $ill best impact the stress and resulting dissatisfaction by arranging for help $ith patient care $hen the need e4ists. Although the other options are not inappropriate, they do not address the issue research has identified as the primary cause of stress in the $orkplace.

Copyright 6 3/13, 3//7 1osby, 'nc., an affiliate of Elsevier 'nc. All rights reserved.

%est #ank

>.8

'(" Cognitive )evel" Application *E(" +age -3 %0+" !ursing +rocess" 'mplementation 1SC" !C)E2" +sychosocial 'ntegrity >. %he nurse suggests that a patient help manage the stressors that are triggering generali5ed an4iety by implementing compartmentali5ation. Which activity provides proof that the patient is employing this healthy defense mechanism? a Attends a meditation class 8 times a $eek right after $ork . b ?ses chocolate as a re$ard $hen keeping stress under control . c Counts to 1/ before responding to a co$orker $ho is a source of stress . d Shares $ith the office manager the situations that regularly cause increased stress . A!S" A %he person $ho uses compartmentali5ation learns to leave the stressor in a designated space. An e4ample of this mechanism $ould be regularly attending a class that serves to separate the stressful $ork environment from one&s private life. ?sing food as a re$ard may not be healthy and as $ith the remaining options, it is not e4amples of compartmentali5ation. '(" Cognitive )evel" Application *E(" +age -8 Evaluation 1SC" !C)E2" +sychosocial 'ntegrity %0+" !ursing +rocess"

@. %he spouse of a patient e4hibiting symptoms of chronic stress asks ho$ they can help their spouse. Which suggestion by the nurse sho$s an understanding of a family member&s role in the management of stress? a 0ffer to discuss the problem $ith the person $ho is most responsible for causing . their spouse&s stress. b )isten attentively $hen their spouse talks about the stressors and provide hugs to . sho$ your support. c <elp the spouse limit the amount of time each day they devote to discussing and . other$ise d$elling on the stress. d +rovide the spouse $ith a variety of options and techniAues for dealing $ith the . stressors and the resulting physical symptoms. A!S" #

Copyright 6 3/13, 3//7 1osby, 'nc., an affiliate of Elsevier 'nc. All rights reserved.

%est #ank

>.=

+eople need people to prevent isolation to promote their ability to deal $ith stress. 'n a study, it $as found that individuals $ho had significant relationships that involved an e4pression of affection had a reduction in the fight.or.flight response $hen stressed. %hose $ho regularly received hugs from their romantic partners had a decrease in resting heart rate and a healthy functioning limbic.hypothalamic.pituitary.adrenal a4is. Conversely, individuals $ho lacked such support sho$ed a higher level of stress and an increased possibility of developing an illness. 0ffering to confront the source of the stress is not supporting the spouse in learning to manage stress. )imiting time to d$ell on obsessive thoughts may be therapeutic, but $hen a spouse implements this techniAue too often, it suggests a lack of patience and understanding of the problem. %he spouse may not be Aualified to provide such therapeutic optionsB that is the role of a mental health professional. '(" Cognitive )evel" Application *E(" +age -8 %0+" !ursing +rocess" 'mplementation 1SC" !C)E2" +sychosocial 'ntegrity 7. %he patient is being introduced to mindfulness.based stress reduction to help manage chronic stress. %he patient is first taught to focus on" a What is causing the stress . b #oth inhaling and e4haling . c *ela4ing each ma9or muscle group . d Cisuali5ing their life $ithout the stress . A!S" # 't is helpful to teach individuals a generic method of rela4ation by first concentrating on the rhythm of breathing. +aying attention to each breath as one takes in a respiration and releases an e4piration provides a focus for the meditation. %he remaining options are not steps included in mindful mediation. '(" Cognitive )evel" Application *E(" +age -= %0+" !ursing +rocess" 'mplementation 1SC" !C)E2" +sychosocial 'ntegrity M"#T$P#E &ESP%NSE 1. What is the role of the brain in producing the fight.or.flight stress response? Select all that apply. a %he medulla oblongata increases heart rate. . b #lood flo$ is increased by the medulla oblongata. . c %he hypothalamus is stimulated via the limbic area. . d %he reticular formation coordinates the brain&s sensory and motor tracks.

Copyright 6 3/13, 3//7 1osby, 'nc., an affiliate of Elsevier 'nc. All rights reserved.

%est #ank . e Adrenocorticotropic hormone production is increased in the hypothalamus. .

>.>

A!S" A, #, C, %he brain Dspecifically the medulla oblongataE is responsible for the heart rate, the blood pressure rate, and the respiration rate. When a stressor is detected, the autonomic nervous system tells the medulla oblongata to increase the blood flo$ to certain organs De.g., the musclesE to allo$ the individual to prepare for fight.or.flight. %he brain receives an increase in o4ygenated blood to increase a$areness and the ability to think and respond to the stressor. %he blood in the brain has an increase in glucose, epinephrine, and norepinephrine to assist the individual $ith reacting to the stressor. %he reticular formation supports the coordination of the sensory and motor tract of the individual&s brain. %his provides the individual $ith the ability to fight or flee. %he limbic area of the brain communicates $ith the hypothalamus that the stress is occurring. %he pituitary gland secretes adrenocorticotropic hormone $hich stimulates the adrenal corte4 to release cortisol. '(" Cognitive )evel" Application *E(" +age -/ %0+" !ursing +rocess" 'mplementation 1SC" !C)E2" +sychosocial 'ntegrity 3. !ursing interventions appropriate to the generali5ed adaptation syndrome DFASE e4haustion state include $hich of the follo$ing? Select all that apply. a +lanning care to best conserve the patient&s energy . b Assessment for respiratory disorders such as asthma . c 1onitoring of e4acerbation of compulsive ritual behaviors . d (reAuent assessment of pain management related to headaches . e +lanned periods to reinforce effective rela4ation techniAues . A!S" A, #, , E 'f the individual&s body does not adapt and the stressor continues to be prominent, then the third stage, called the exhaustion stage, occurs. %he e4haustion stage can manifest itself in the form of illnesses such as infections, headaches, hypertension, asthma attacks, chronic fatigue syndrome, depression, an4iety disorders, and many other chronic conditions. '(" Cognitive )evel" Application *E(" +age -/ %0+" !ursing +rocess" 'mplementation 1SC" !C)E2" +sychosocial 'ntegrity 8. Which are e4pected outcomes for a patient $ho is effectively implementing a decision tree to enhance their problem.solving abilities? Select all that apply. a A large, comple4 problem $ill be turned into a series of smaller, manageable . problems.

Copyright 6 3/13, 3//7 1osby, 'nc., an affiliate of Elsevier 'nc. All rights reserved.

%est #ank b . c . d . e . %he patient $ill not be over$helmed and made to feel po$erless by the problem. %he problem and the resulting stress $ill be clearly and concisely defined. All resulting stress $ill be eliminated and the patient $ill feel empo$ered. Several different options for resolving the problem $ill be formulated.

>.@

A!S" A, #, C, E A decision tree enhances the person&s ability to think through a problem $ithout getting stuck in a pattern of feeling over$helmed and therefore unable to determine $ays to reduce the effect of the stressful situation. %he decision tree provides individuals $ith opportunities to problem solve by breaking do$n a problem or a stressor into smaller increments. efining a problem clearly and determining options for solving it can help a person to think about more than one $ay to $ork on the problem or stressor. %he use of a decision tree $ill not remove all stress but rather empo$er the individual to strive to solve the problem causing the stress. '(" Cognitive )evel" Application *E(" +age -3 %0+" !ursing +rocess" 'mplementation 1SC" !C)E2" +sychosocial 'ntegrity =. %he patient has been taught to use the stop, divert, and reframe method to deal $ith stress. Which responses indicate that the patient can affective utili5e the techniAue $hen preparing to take a $ritten e4amination? Select all that apply. a 's heard declaring that, :'t&s only a testB if ' fail this one ' $ill 9ust study harder . for the ne4t one.. b 's observed opening a notebook and focusing on a family picture taken during a . recent vacation c 's heard stating, :Stop thinking that you can&t correctly ans$er the Auestion. Gou . can and you $ill.; d 's observed asking the test monitor to be allo$ to sit some$here :Auiet and a$ay . from other people e 's heard saying, :' $ill read the Auestion thoroughly, find the key $ord, and then . look at the options '&m given.; A!S" #, C, E Stop interrupts the negative train of thought. ivert allo$s focus on something that $ill rapidly reduce the stress. *eframe reinforces $hat you can do to reduce the stressor. %he remaining options do not address any of the identified steps in this stress management method. '(" Cognitive )evel" Application *E(" +age -= Evaluation 1SC" !C)E2" +sychosocial 'ntegrity %0+" !ursing +rocess"

Copyright 6 3/13, 3//7 1osby, 'nc., an affiliate of Elsevier 'nc. All rights reserved.