Chapter 12: Understanding Responses to Stress Flashcards
The adult child of a patient diagnosed with major depression asks, “Do you think depression and physical illness are connected? Since my father’s death, my mother has had shingles and the flu, but she’s usually not one who gets sick.” Which answer by the nurse best reflects current knowledge about psychoneuroimmunology?
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 stress may interfere with the body’s ability to protect itself and can increase the likelihood of infection.”
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 infections. 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.
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.
A nurse leads a psychoeducational group for depressed patients. The nurse plans to implement an exercise regime for each patient. Which of the following rationales should the nurse use when presenting this plan to the treatment team?
a. Exercise can lead to protection from the harmful effects of stress.
b. Exercise prevents damage from overstimulation of the sympathetic nervous system.
c. Exercise detoxifies the body by removing metabolic wastes and other toxins.
d. Exercise improves mood stability for patients with bipolar disorders.
ANS: A
Physical exercise can lead to protection from the harmful effects of stress on both physical and mental states. Regular physical activity was associated with lower incidence of all psychiatric disorders except bipolar disorder. The other options are not accurate.
A recent immigrant from Honduras comes to the clinic with a family member who has been a Canadian resident for 10 years. The family member says, “The immigration to Canada 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 Asia, Africa and Central America 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 people from Central America.
A patient nervously says, “Financial problems are stressing my marriage. I’ve heard rumours about cutbacks at work; I am afraid I might get laid off.” The patient’s pulse is 112 per minute; respirations are 26 per 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 via use of a positive, repeated word.
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 evidenced 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.
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
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.
A patient newly diagnosed as HIV-positive seeks the nurse’s advice on how to reduce the risk of infections. The patient says, “I used to go to church 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 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.
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 help 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 people.
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.”
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 other alternatives to prayer implies that the nurse does not think prayer would be effective.
A patient is brought to the emergency department after a motorcycle accident. The patient is alert and responsive and is diagnosed with a broken leg. The patient’s vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected?
a. P 64, R 14
b. P 68, R 12
c. P 72, R 16
d. P 80, R 20
ANS: D
The patient would experience stress associated with anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight-or-flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs.
A patient tells the nurse, “I know that I should reduce the stress in my life, but I have no idea where to start.” What would be the best initial nursing response?
a. “Physical exercise works to elevate mood and reduce anxiety.”
b. “Reading about stress and how to manage it might be a good place to start.”
c. “Why not start by learning to meditate? That technique will cover everything.”
d. “Let’s talk about what is going on in your life and then look at possible options.”
ANS: D
In this case, the nurse lacks information about what stressors the patient is coping with and what coping skills the patient already possesses. Further assessment is indicated before potential solutions can be explored. Suggesting exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.
A patient tells the nurse, “My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking.” Which response by the nurse would support the recommendation?
a. Encourage the patient to imagine being in calm circumstances.
b. Provide the patient with a blank journal and guidance about journaling.
c. Teach the patient to recognize, reconsider, and reframe irrational thoughts.
d. Teach the patient to use instruments that give feedback about bodily functions.
ANS: C
Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient’s manner of thinking.
A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress?
a. The patient’s systolic blood pressure has changed from the 140s to the 120s mm Hg.
b. The patient reports, “I feel better, and things are not bothering me as much.”
c. The patient reports, “I spend more time napping or sitting quietly at home.”
d. The patient’s weight decreased by 3 pounds.
ANS: A
Objective measures tend to be the most reliable means of gauging progress. In this case, the patient’s elevated blood pressure, an indication of the body’s physiological response to stress, has diminished. The patient’s report regarding activity level is subjective; sitting quietly could reflect depression rather than improvement. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress. The patient’s weight change could be a positive or negative indicator; the blood pressure change is the best answer.
A patient tells the nurse, “I will never be happy until I’m as successful as my older sister.” The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping?
a. “People should treat me as well as they treat my sister.”
b. “I can find contentment in succeeding at my own job level.”
c. “I won’t be happy until I make as much money as my sister.”
d. “Being as smart or clever as my sister isn’t really important.”
ANS: B
Finding contentment within one’s own work, even when it does not involve success as others might define it, is likely to lead to a reduced sense of distress about achievement level. It speaks to finding satisfaction and happiness without measuring the self against another person. Focusing on salary is simply a more specific way of being as successful as the sister, which would not promote coping. Expecting others to treat her as they do her sister is beyond her control. Dismissing the sister’s cleverness as unimportant indicates that the patient continues to feel inferior to the sibling.
A patient says, “One result of my chronic stress is that I feel so tired. I usually sleep from 11 p.m. to 6:30 a.m. I started setting my alarm to give me an extra 30 minutes of sleep each morning, but I don’t feel any better and I’m rushed for work.” Which nursing response would best address the patient’s concerns?
a. “You may need to speak to your doctor about taking a sedative to help you sleep.”
b. “Perhaps going to bed a half-hour earlier would work better than sleeping later.”
c. “A glass of wine in the evening might take the edge off and help you to rest.”
d. “Exercising just before retiring for the night may help you to sleep better.”
ANS: B
Sleeping later in the morning may disturb circadian rhythms and in this case is adding, rather than reducing, stress. Going to bed earlier and arising at the usual time alleviates fatigue more effectively. Sedatives may offer some benefit but are a short-term intervention with potential side effects, and other nonpharmacological interventions might work as well or better. Exercise earlier in the evening could induce tiredness and ease the process of falling asleep, but doing so right before bedtime would stimulate and interfere with sleep. Alcohol is sedating but potentially addictive; encouraging its use could increase the risk of using alcohol maladaptively as a response to stress in general
