Chapter 10: Stress Responses and Stress Management Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition(Complete Answers)

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1. The adult child of a patient diagnosed with major depressive disorder asks, ―Do you think depression and physical illness are connected? Since my father‘s death, my mother has had shingles an... d the flu, but she‘s usually not one who gets sick.‖ Which answer by the nurse best reflects current knowledge? 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 prolonged stress interfere with the body‘s ability to protect itself and can increase the likelihood of illness.‖ ANS: D The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to illness. 124 Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother‘s baseline. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-7, 8 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 2. 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 ANS: C The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen–carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-16, 40 (Box 10-3) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 3. A nurse leads a psychoeducational group for patients experiencing depression. 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. ANS: A -Endorphins produced during exercise result in improvement in mood and lowered anxiety. The other options are not accurate. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 10-12, 19, 37 (Box 10-1) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 125 4. 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 ANS: B Honduras is in Central America. Many people from Central American cultures express distress in somatic terms. The other options are not specific to this patient‘s cultural background and are less likely to be observed in persons from Central America. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 10-11 TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 5. 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 using abdominal muscles. 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.‖ ANS: B The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident by elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system will counter the sympathetic nervous system‘s arousal, normalizing these vital sign changes and reducing the physiological demands stress is placing on his body. Other options do not address his physiological response pattern as directly or immediately. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-3, 4, 15, 16, 39 (Box 10-2) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity 6. 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 126 ANS: C A person returning to college after losing a job is dealing with two significant stressors simultaneously. Together, these stressors total more life change units than any of the single stressors cited in the other options. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 10-12, 13, 31 (Table 10-3) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity 7. A patient newly diagnosed as HIV-positive seeks the nurse‘s advice on how to reduce the risk of infections. The patient says, ―I went to church years ago 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 a 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.‖ ANS: C Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being. The other options wrongly suggest that spiritual practices have little effect on the immune system or reject the patient‘s preferences regarding health management. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-11, 12 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 8. 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. ANS: D High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships affect a person‘s coping negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than helping her cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable persons. 127 PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-10, 11 TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity 9. 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.‖ ANS: B Many patients find that spiritual measures, including prayer, are helpful in mediating stress. Studies have shown that spiritual practices can enhance the sense of well-being. When a patient suggests a viable means of reducing stress, it should be supported by the nurse. Indicating that prayer is the patient‘s only hope is pessimistic and would cause further distress. Suggesting meditation or o [Show More]

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