ATI - Stress and Coping Assessment 2.0

A nurse is caring for a client who is in crisis following the breakup of a long-term relationship. The client tells the nurse, "I might as well just die. My life is over." Which of the following actions should the nurse take first?

-Explore past positive coping strategies.

-Establish a follow-up plan of care.

-Conduct a suicidal risk evaluation.

-Display a neutral attitude.

-Conduct a suicidal risk evaluation.

The greatest risk to this client is injury to self or others; therefore, the first action the nurse should take is to conduct a suicidal and homicidal risk evaluation.

Not A, as while exploring positive coping strategies is an essential aspect of crisis intervention, it is not the first action the nurse should take.

Not B, as while establishing a follow-up plan of care is an essential aspect of crisis intervention, it is not the first action the nurse should take.

Not D, as while the nurse should establish a therapeutic environment and display a neutral, nonjudgemental attitude toward the client, it is not the first action the nurse should take.

A nurse is caring for an older adult client who reports being stressed about their health status due to problems with short-term memory, slower reaction times when driving, and urinary frequency. The nurse should recognize that the client is experiencing which of the following types of stressors?

-Developmental stressors

-Situational stressors

-Adventitious stressors

-Socioeconomic stressors

-Developmental stressors

Developmental, or maturational, stressors vary throughout the lifespan and occur as individuals move through the stages of life. Older adults may experience stressors related to health problems and changes in mobility and cognition.

Not B, as situational stressors typically stem from personal, family, and work-related issues.

Not C, as adventitious stressors typically result from events such as floods, earthquakes, war, and physical assault.

Not D, as socioeconomic stressors are typically related to factors such as poverty, low socioeconomic status, and homelessness.

A nurse is caring for a client who has been charged with partner violence against their spouse. The client is angry, pacing, and yells out, "I wouldn't lose my temper if my spouse would just leave me alone. It's their fault." The nurse should identify the client is displaying which of the following defense mechanisms?

-Projection

-Compartmentalization

-Repression

-Regression

-Projection

Projection involves attributing negative or uncomfortable thoughts, feelings, or motives onto another individual to avoid dealing with them as one's own.

Not B, as compartmentalization refers to categorizing life experiences into separate segments to avoid facing the anxieties while in that mindset.

Not C, as repression refers to concealing unpleasant or painful thoughts, memories, or beliefs in hopes of forgetting about them entirely.

Not D, as regression refers to moving back to a more comfortable developmental time in life when faced with stress or anxiety.

A nurse is talking about implementing self-care strategies to cope with the stress of caregiving with the partner of a client who has dementia. Which of the following strategies reported by the partner should the nurse identify as an example of effective coping?

-Practicing deep breathing while sitting outside

-Sitting by the client's bedside and drinking coffee

-Going out onto the patio to smoke a cigarette when feeling stressed

-Drinking a glass of wine every night before falling asleep

-Practicing deep breathing while sitting outside

Eating nutritious meals, participating in active exercise, and engaging in mindfulness activities such as deep breathing are examples of healthy coping.

Not B, as while being at the client's bedside might be calming strategy, drinking caffeine can have negative effects such as anxiety and insomnia.

Not C, as smoking cigarettes has a detrimental effect on health and is not an effective coping strategy.

Not D, as drinking alcohol can have a detrimental effect on health is not an effective coping strategy.

A nurse is caring for a client who reports experiencing stress over an upcoming surgical procedure. Which of the following statements describes the characteristics of stress?

-Stress is an easily defined phenomenon regardless of viewpoint and discipline.

-Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one's state of equilibrium.

-Stress only affects the individual and does not affect the person's family, friends, or other associates.

-The lack of definition regarding stress does not pose a problem for the client or the nurse.

-Stress is a condition in which the body responds to physical, emotional, or environmental changes affecting one's state of equilibrium.

Stress can be caused by physical, emotional, environmental, or mental changes, which can be positive or negative depending on the person's perception or appraisal of the stressor.

Not A, as defining stress is a complex and ambiguous endeavor, and definitions vary based upon the viewpoint and discipline of each individual researcher, clinician, health care provider, and members of the general public.

Not C, as stress affects the entire family as well as the individual and must be considered in the client's plan of care.

Not D, as the lack of definition regarding stress can present a problem for clients, nurses, families, and all members of the health care team.

A nurse in a community clinic is interviewing a client who is distressed and reports being unable to sleep following a neighborhood fire several days ago. The client has hypertension, tachycardia, and is diaphoretic. The nurse should identify that the client is experiencing which of the following types of stress?

-Acute stress

-Post-traumatic stress disorder (PTSD)

-Episodic acute stress

-Chronic stress

-Acute stress

The nurse should identify that the client is experiencing acute stress. Most episodes of acute stress do not have lingering health effects; however, if an individual experiences severe or prolonged stress levels, this condition could lead to mental health issues.

Not B, as symptoms of PTSD include recurring and intrusive memories or flashbacks of the trauma, nightmares, and an exaggerated startle response or certain noises or experiences that remind them of the trauma.

Not C, as episodic acute stress occurs when someone experiences frequent and recurring episodes of acute stress.

Not D, as chronic stress is a disabling condition that occurs when stress levels are heightened, constant, and prolonged.

A nurse is caring for a client who has migraine headaches and reports that they are "getting worse." Which of the following questions should the nurse ask the client to determine if the headaches are a stress-related disorder? Select all that apply.

-"What is the intensity of your migraine headaches?"

-"How often do the migraine headaches occur?"

-"Are you eligible for workers' compensation due to the migraine headaches?"

-"What type of support is available to you when you have a migraine headache?"

-"What coping strategies do you use when you experience a migraine headache?"

-"What is the intensity of your migraine headaches?"

-"How often do the migraine headaches occur?"

-"What type of support is available to you when you have a migraine headache?"

-"What coping strategies do you use when you experience a migraine headache?"

How an individual appraises a stressor determines how they will respond to the stressor. The onset and severity of stress-related disorders is affected by the type, frequency, and intensity of the stressor, perception of the stressor, access to support systems, and the individual's ability to effectively cope with the stressor.

Not C, as eligibility of workers' compensation is not a factor when appraising a stress-related disorder.

A nurse is caring for a client whose partner was recently hospitalized with COVID-19. The client is experiencing manifestations related to the alarm stage of general adaptation syndrome (GAS). For which of the following manifestations should the nurse monitor? Select all that apply.

-Hypertension

-Dilated pupils

-Increased state of arousal

-Bradycardia

-Lethargy

-Hypertension

During the alarm stage of GAS, the client's fight-or-flight response is mobilized to meet the threat. The nurse should expect rising hormone levels during this phase to cause hypertension.

-Dilated pupils

During the alarm stage of GAS, the nurse should expect rising hormone levels during this phase to cause dilated pupils.

-Increased state of arousal

During the alarm stage of GAS, the nurse should expect rising hormone levels during this phase to cause an increased state of arousal.

Not D, as during the alarm stage of GAS, the nurse should expect that rising hormone levels during this phase can cause an increase in heart rate.

Not E, as during the alarm stage of GAS, the nurse should expect that rising hormone levels during this phase can cause a heightened state of alertness.

A nurse is caring for a client who has pancreatic cancer that is unresponsive to treatment. The client is experiencing significant weight loss and fatigue, but when the nurse asks how they are feeling, they respond with, "Great! I'm going to beat this cancer." Which of the following defense mechanisms is the client using?

-Regression

-Projection

-Repression

-Denial

-Denial

Denial refers to the refusal to acknowledge or accept reality about a situation, despite what might be obvious to others, to avoid the emotional impact.

Not A, as regression refers to the movement back to a more comfortable time in life when faced with stress and anxiety.

Not B, as projection refers to attributing negative or uncomfortable thoughts, feelings, or motives to another individual to avoid dealing with them as their own.

Not C, as repression refers to concealing unpleasant or painful thoughts, memories, or beliefs in hopes of forgetting about them entirely.

A nurse is planning care for a client who is recently divorced with two young children. The client reports difficulty sleeping, feeling hopeless, and being estranged from family. The nurse should plan to monitor the client for which of the following potential manifestations of chronic stress?

-Systemic infection

-Exaggerated startle response

-Recurring nightmares

-Suicide

-Suicide

Chronic stress can cause or exacerbate serious health problems such as depression, anxiety, cancer, and suicide.

Not A, as chronic stress can exacerbate many serious health problems such as cardiovascular disease; however, it does not result in a systemic infection.

Not B, as an exaggerated startle response is a manifestation commonly associated with PTSD, not with chronic stress.

Not C, as recurring nightmares are a manifestation commonly associated with PTSD, not with chronic stress.

A nurse is interviewing a client who recently experienced an act of workplace violence when an armed person held the workers at gunpoint before police intervened. The client now reports being anxious and fears the gunman might return. The nurse should identify that the client is experiencing which of the following types of crisis?

-Situational

-Cultural

-Maturational

-Adventitious

-Adventitious

Adventitious crises occur from natural disasters such as floods, hurricanes, or fire; or from acts of war, criminal activity, or terrorism.

Not A, as a situational crisis commonly stems from events such as divorce, job loss, an unexpected event, or a change in circumstance.

Not B, as cultural crises or stressors occur when one is living within a society in which they have different cultural practices and/or receive care that ignores their cultural beliefs.

Not C, as maturational crisis occurs when a person experiences a new stage of development and is challenged to adapt to the new experience.

A nurse in a health clinic is interviewing a client who is upset and reports that their stress "is too much to handle." The client is unemployed, a single guardian to young children, and has periodic asthma attacks. Which of the following stress-related conditions is the client experiencing?

-Post-traumatic stress disorder (PTSD)

-Allostatic load

-Chronic illness

-Alarm stage

-Allostatic load

Chronic exposure to elevated or fluctuating endocrine or neural responses causes excessive wear and tear on the body organs, resulting in allostatic load. The nurse should identify that the client's constant stress may be manifesting itself in physical ailments such as periodic asthma attacks.

Not A, as symptoms of PTSD include recurring and intrusive memories or flashbacks of the trauma, nightmares, sweating, increased heart rate, and an exaggerated startle response to certain noises or experiences that remind them of the trauma.

Not C, as the client has periodic episodes of asthma, which are not chronic in nature.

Not D, as the alarm stage is associated with the "fight-or-flight" response. The response is mobilized to meet the threat.

A nurse is caring for a college student admitted for acute alcohol intoxication. The client reports feeling overwhelmed and expresses an inability to cope with stressors at school. Which of the following statements should the nurse make?

-"Drinking too much alcohol is not the best choice. I suggest you stop drinking."

-"I can see why you're using alcohol to cope; you've got a lot going on."

-"Let's talk about the coping methods that have worked for you in the past."

-"I've been stressed before too, but I tell myself that I can handle it."

-"Let's talk about the coping methods that have worked for you in the past."

The nurse is using therapeutic communication techniques and building on the client's strengths to improve coping skills. Nurses use several therapeutic communication techniques to build a trusting relationship including active listening, asking open-ended questions, seeking clarification, and offering observations.

Not A, as this is a judgmental response by the nurse and therefore nontherapeutic in helping the client manage their stress.

Not B, as drinking alcohol is a maladaptive response to stress. The nurse should not condone the client's abuse of alcohol as a coping mechanism.

Not D, as the nurse is using nontherapeutic communication and focusing on self, rather than the client.

A nurse is caring for a client who has delivered a healthy newborn. The client tells the nurse that while they are somewhat stressed about being a new parent, they are thrilled by the birth of their child. The nurse should identify that the client is experiencing which of the following types of stress?

-Allostatic load

-Distress

-Eustress

-Fight-or-flight response

-Eustress

Positive stress, or eustress, is often associated with accomplishment or achievement and generally produces feelings of well-being, inspiration, and motivation.

Not A, as allostatic load refers to chronic exposure to elevated or fluctuating endocrine or neural responses, causing excessive wear and tear on the body organs.

Not B, as distress refers to negative or unhealthy stress.

Not D, as the fight-or-flight response is a physiological response to a threatening situation, which readies one either to forcibly engage or retreat.

A nurse is assessing a client who was sexually assaulted 6 months ago and has been diagnosed with post-traumatic stress disorder (PTSD). Which of the following manifestations should the nurse expect? Select all that apply.

-Intrusive memories of the event

-Flashbacks of the event

-Poor work relationships

-Exaggerated startle response when reminded of the event

-Frequent episodes of diarrhea

-Intrusive memories of the event

A client who has PTSD can experience intrusive memories of the event.

-Flashbacks of the event

A client who has PTSD can experience flashbacks of the event.

-Exaggerated startle response when reminded of the event

A client who has PTSD can experience an exaggerated startle response when reminded of the event.

Not C, as having poor work relationships is not a manifestation associated with PTSD.

Not E, as diarrhea is not a manifestation associated with PTSD.

A nurse is caring for a client who has delivered a healthy newborn. The client is tense, refuses to hold the baby, and tells the nurse, "I have no idea how to handle having a baby. I wish this pregnancy had never happened." Which of the following statements should the nurse make?

-"Becoming a parent is a new experience for you. Let's talk about your concerns."

-"You should be thrilled about having a healthy newborn. I would be."

-"Why don't you hold the baby? I'm sure it will make you feel better."

-"How can you think that way? This is a joyous occasion and should be celebrated."

-"Becoming a parent is a new experience for you. Let's talk about your concerns."

An individual's perceptions of and responses to the stressor determine whether the stressor is positive (eustress) or negative (distress). By using therapeutic communication skills, the nurse creates a safe environment for the client to express thoughts and feelings.

Not B, as as how an individual appraises the stressor determines how they will respond to the stressor. This is a judgmental and nontherapeutic response by the nurse.

Not C, as how an individual appraises the stressor determines how they will respond to the stressor. This is a nontherapeutic response by the nurse because the client's stress is being disregarded.

Not D, as as how an individual appraises the stressor determines how they will respond to the stressor. This is a confrontational and nontherapeutic response by the nurse.

A nurse is interviewing a client who is in distress and tells the nurse, "My ex-partner is suing for full custody of my children. I am so worried and don't know what to do." Which of the following questions should the nurse ask to evaluate the client's coping skills?

-"Can you describe your relationship with your ex-partner?"

-"What happens when you feel worried like this?"

-"What do you believe was your contribution to the relationship breakup?"

-"What strategies have you used in the past to deal with stress?"

-"What strategies have you used in the past to deal with stress?"

This question is appropriate because it focuses on investigating the client's ability to cope with and manage stressful situations.

Not A, as this question is focused on perception of the relationship rather than the client's ability to cope with and manage the current issue.

Not B, as this question is focused on expression of feelings rather than the client's ability to cope with and manage the current issue.

Not C, as this question is focused on perception of the relationship rather than the client's ability to cope with and manage the current issue.

A nurse is providing discharge teaching about health promotion to a client who has a new diagnosis of type 2 diabetes mellitus. Which of the following instructions should the nurse include? Select all that apply.

-Practice mindful breathing.

-Start each day with a to-do list.

-Include simple carbohydrates in the diet.

-Develop habits to mitigate stress.

-Preserve energy by reducing physical activity.

-Practice mindful breathing.

The nurse should instruct the client to practice mindful breathing. Health promotion includes practicing mindfulness activities that build resilience. Mindful breathing includes clearing the mind and relaxing while taking in slow, deep breaths.

-Start each day with a to-do list.

The nurse should instruct the client to start each day with a to-do list. Health promotion includes prioritizing daily tasks from high to low to help lower stress levels.

-Develop habits to mitigate stress.

The nurse should instruct the client to develop habits to mitigate stress. Health promotion includes building resilience to bounce back from life's various challenges.

Not C, as the nurse should instruct the client to include complex carbohydrates in their diet. Health promotion includes consuming a healthy diet that stabilizes blood sugar levels.

Not E, as the nurse should instruct the client to increase physical activity because exercise increases overall health and provide a sense of well-being while reducing stress.

A nurse is assessing a client who is working at home due to COVID-19 restrictions. The client reports abdominal cramping and bloating with diarrhea and states, "I am completely stressed out from working at home." The nurse should identify that the client is experiencing manifestations of which of the following stress-related conditions?

-Irritable bowel syndrome

-Food poisoning

-Panic disorder

-Major depressive disorder

-Irritable bowel syndrome

Irritable bowel sounds is a condition often triggered by stress and characterized by abdominal discomfort, cramping, bloating, and diarrhea.

Not B, as some of the symptoms the client is describing might mimic food poisoning; however, food poisoning is not a stress-related condition.

Not C, as panic disorder is a type of anxiety disorder characterized by sudden feelings of terror.

Not D, as major depressive disorder is a mental health disorder characterized by persistently depressed mood and loss of interest in activities.

A nurse is conducting an educational session for clients who report experiencing stress-related disorders. A client asks the nurse which part of the body activates the stress response. Which of the following responses should the nurse provide?

-Sympathetic nervous system (SNS)

-Adrenal glands

-Hypothalamus

-Adrenocorticotropic hormone

-Hypothalamus

The hypothalamus activates the stress response. When a stress response is triggered, the hypothalamus sends signals to the pituitary and adrenal glands.

Not A, as the SNS is involved in the stress response; however, the hypothalamus activates the stress response.

Not B, as the adrenal glands are involved in the stress response; however, the hypothalamus activates the stress response.

Not D, as the adrenocorticotropic hormone is involved in the stress response; however, the hypothalamus activates the stress response.