Medical Surgical Nursing 3rd Australian Edition by LeMone

Medical Surgical Nursing 3rd Australian Edition by LeMone

Chapter 8: Stress and Stress Management
Test Bank

MULTIPLE CHOICE

1. A 22-year-old patient arrives in the emergency department (ED) with multiple abrasions after a motor vehicle accident and has an initial blood pressure (BP) of 180/98. The nurse will plan to
a. discuss the need for hospital admission to control blood pressure.
b. treat the abrasions and discuss the risks associated with hypertension.
c. recheck the blood pressure before the patient’s discharge from the ED.
d. start an intravenous (IV) line to administer antihypertensive medications.

ANS: C
Because hypertension is expected when a patient has experienced an acute stressor, the nurse should plan to check the BP before discharge, which will provide a more accurate idea of the patient’s usual blood pressure. Hypertension that occurs in response to acute stress does not increase risk for health problems such as stroke, indicate a need for hospitalization, or indicate a need for IV antihypertensive medications.

DIF: Cognitive Level: Application TOP: Nursing Process: Planning
MSC: NCLEX: Physiological Integrity

2. A hospitalized patient who is usually well organized and calm is receiving diabetic teaching after being newly diagnosed with diabetes. The patient is forgetful, irritable, and has poor concentration. Which action should the nurse take?
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 patient’s family.
d. Plan to reinforce and repeat teaching about diabetes management.

ANS: D
Since 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 patient’s ability to learn the necessary information for self-management.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

3. A patient who has been hospitalized for a heart attack tells the nurse, “I didn’t sleep last night because I worried about missing work and losing my insurance coverage.” Which nursing diagnosis is appropriate to include in the plan of care?
a. Anxiety
b. Defensive coping
c. Ineffective denial
d. Risk prone health behavior

ANS: A
The information about the patient indicates that anxiety is an appropriate nursing diagnosis. The patient data do not support defensive coping, ineffective denial, or risk prone health behavior as problems for this patient.

DIF: Cognitive Level: Application TOP: Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity

4. The nurse is assisting with a breast biopsy for an alert patient who has a lump in the right breast. Which relaxation technique will be best to use at this time?
a. Massage
b. Meditation
c. Guided imagery
d. Relaxation breathing

ANS: D
Relaxation breathing is the easiest of the relaxation techniques to use. It will be difficult for the nurse to provide massage while assisting with the biopsy. Meditation and guided imagery require more time to practice and learn.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

5. A patient who has fibromyalgia tells the nurse, “My life feels very chaotic and out of my control. I will not be able to manage if anything else happens.” Which response should the nurse make initially?
a. “Regular massages may help reduce muscle pain.”
b. “Guided imagery can be helpful in regaining control.”
c. “Tell me more about how your life has been recently.”
d. “Your previous coping mechanism can help you now.”

ANS: C
The nurse’s initial strategy should be further assessment of the stressors in the patient’s life. Massage therapy, guided imagery, or previous coping mechanisms may be of assistance to the patient, but more assessment is needed before the nurse can determine this.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

6. When choosing music to help relax a patient who is having a painful dressing change, which action is best for the nurse to take?
a. Use music composed by Mozart.
b. Ask the patient about music preferences.
c. Select music that has 60 to 80 beats/minute.
d. Encourage the patient to use music without words.

ANS: B
Although music with 60 to 80 beats/minute, music without words, and music composed by Mozart are frequently recommended to reduce stress, each patient responds individually to music and personal preferences are important.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

7. The nurse is teaching a hospitalized patient to use imagery as a relaxation technique. Which statement by the nurse is appropriate?
a. “Place your stress in the image of a form you can destroy.”
b. “Think of a place where you feel peaceful and comfortable.”
c. “Bring what you hear and sense in your present environment into your image of the scene.”
d. “If your scene is stressful to you, continue visualizing until you can overcome the distress.”

ANS: B
When using imagery for relaxation, the patient should visualize a comfortable and peaceful place. The goal is to offer a relaxing retreat from the actual patient environment. Imagery may be used to target a disease or pathology, but this type of imagery will not lead to relaxation.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

8. An overweight patient who enjoys active outdoor activities develops arthritis in the knees. Which action by the nurse will be best to assist the patient in coping with the diagnosis?
a. Ask the patient to discuss feelings about the diagnosis.
b. Have the patient practice frequent relaxation breathing.
c. Educate the patient on the use of imagery to decrease pain and decrease stress.
d. Encourage the patient to think about how weight loss might improve symptoms.

ANS: D
For problems that can be changed or controlled, problem-focused coping strategies, such as encouraging the patient to lose weight, are most helpful. The other strategies also may assist the patient in coping with the diagnosis, but they will not be as helpful as a problem-oriented strategy.

DIF: Cognitive Level: Application TOP: Nursing Process: Implementation
MSC: NCLEX: Psychosocial Integrity

9. A diabetic patient who is hospitalized tells the nurse, “I don’t 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?
a. “It is probably just coincidental that your blood sugars are 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.”

ANS: B
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.

DIF: Cognitive Level: Comprehension TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. Which action should the nurse take to monitor the effects of an acute stressor on a hospitalized patient (select all that apply)?
a. Assess for bradycardia.
b. Ask about epigastric pain.
c. Observe for increased appetite.
d. Check for elevated blood glucose levels.
e. Monitor for a decrease in respiratory rate.

ANS: B, C, D
The physiologic changes associated with the acute stress response can cause changes in appetite, increased gastric-acid secretion, and elevation of blood glucose. Stress causes an increase in respiratory and heart rates.

DIF: Cognitive Level: Analysis OBJ: Special Questions: Alternate Item Format
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity