Chapter 10: Understanding and Managing Responses to Stress

Chapter 10: Understanding and Managing Responses to Stress

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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.

 

PTS:   1                    DIF:    Cognitive Level: Apply (Application)

REF:   Page 169-170                                  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:   Page 176-177 (Box 10-6)                 TOP:   Nursing Process: Planning

MSC:  Client Needs: Psychosocial Integrity

 

3. A nurse leads a psychoeducational group for depressed patients. 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

b-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:   Page 177-178                                  TOP:   Nursing Process: Implementation

MSC:  Client Needs: Physiological Integrity

 

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	c.	Memory deficiencies
b.	Somatic complaints	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 170-171                                  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 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 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:   Page 174-176 (Box 10-4)                 TOP:   Nursing Process: Planning

MSC:   Client Needs: Physiological Integrity