Quiz 27: Stress

Concepts For Nursing Practice

Nursing
8
Questions
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True/False
8
Choices
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Essay
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Questions

Q1
Free

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?

Multiple Choice
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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.
Answer:
D) The patient has recently lost her spouse and needed to move in with her daughter.

Explanation:
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.
Q2
Free

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?

Multiple Choice
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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.
Answer:
D) Plan to reinforce and repeat teaching about diabetes management.

Explanation:
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.
Q3
Free

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?

Multiple Choice
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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.
Answer:
B) Stressors such as illness cause the release of hormones that increase blood sugar.

Explanation:
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.
Q4

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?

Multiple Choice
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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.
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Q5

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

Multiple Choice
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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.
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Q6

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?

Multiple Choice
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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.
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Q7

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?

Multiple Choice
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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
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Q8

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?

Multiple Choice
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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.
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