Stress, anxiety, & Coping Therapeutic communication, and ISBAR

A nurse is teaching a client about the difference between stress and anxiety. Which statement by the client indicates a correct understanding?

A."Stress is caused by negative self-talk, while anxiety is always related to real-life events.“

B."Stress results from external events like deadlines, whereas anxiety can occur without an obvious trigger.“

C."Anxiety and stress are the same, but stress usually lasts longer.“

D."Anxiety always comes after a stressful situation."

B."Stress results from external events like deadlines, whereas anxiety can occur without an obvious trigger.“

The nurse is assessing a client who reports "feeling overwhelmed." Which of the following findings suggest the client is experiencing anxiety rather than stress?  Select all that apply.

A.Constant worry despite no immediate concerns

B.Difficulty sleeping due to an upcoming presentation

C.Feelings of worthlessness and fear of failure

D.Increased heart rate while stuck in traffic

E.Avoidance of social situations due to fear of judgment

A, C, E

What is the first stage of the general adaptation syndrome?

A.Resistance stage

B.Alarm stage

C.Exhaustion stage

D.Appraisal stage

B.Alarm stage

Which 2 hormones are released by the body in response to stress? 

Cortisol and epinephrine (elevated in the human body. that why we see elevated HR and BP)

Which of the following are acute symptoms of stress?  Select all that apply.

A.Increased heart rate

B.Decreased blood pressure

C.Decreased respiratory rate

D.Increased immune response

E.Decreased muscle tension

F.Increased blood glucose levels

A, F (everything is increase expect immune response for actue)

State one condition/disease that can result from long-term stress.

Heart attack, stroke, diabetes, constipation, obesity auto immune system

A nurse is considering screening a 45 year-old man who comes to the emergency department several times per month for chronic stress.  Which symptoms may suggest he struggles with stress?  Select all that apply.

A.Headaches

B.Indigestion

C.Earache

D.Recurrent colds

E.High blood pressure

A, B, D, E

What is one maladaptive response patients may have to stress?

nail biting, Fidgeting, drinking, drugs, sex

The patient complains of racing thoughts. The Nurse  asks the patient if something upsetting happened, and the patient’s response is not able to answer the question. The nurse assesses the level of anxiety as:

A.Mild

B.Moderate

C. Severe

C. Severe

A client experiencing moderate anxiety reports frequent headaches and a racing heart. The client is able to answer questions but appears distracted. What should the nurse do first?

A.Immediately discontinue the plan of care

B.Provide a quiet room and administer sedatives

C.Further assess the cause of the anxiety and provide support

D.Wait until the anxiety becomes severe before intervening

C.Further assess the cause of the anxiety and provide support

A client is pacing rapidly, crying uncontrollably, and states, “I feel like I’m going to die!” The nurse observes that the client is not responding to questions or commands. What is the nurse’s priority intervention?

A.Provide a safe environment and calmly acknowledge the client’s distress

B.Begin client education immediately to redirect focus

C.Tell the client to calm down and stop overreacting

D.Leave the client alone to self-soothe

A.Provide a safe environment and calmly acknowledge the client’s distress

A nurse is caring for a patient experiencing stress and is in the evaluation stage of the nursing process. Which actions will the nurse take?

A.Implement nursing interventions that promote patient’s adaptation to stress.

B.Establish short- and long-term goals with the patient experiencing stress.

C.Gather information from the patient’s medical history that could be causes of stress.

D.Reassess patient’s stress-related symptoms and compare with expected outcomes. 

D.Reassess patient’s stress-related symptoms and compare with expected outcomes. 

A trauma survivor is requesting sleep medication because of “bad dreams.” The nurse is concerned that the patient may be experiencing posttraumatic stress disorder (PTSD). Which question is a priority for the nurse to ask the patient?

“A.Are your dreams similar to your trauma?” 

B.“Are you having chest pain?”

C.“Can you describe your phobias?”

D.“I’m sure we can improve your sleep with improved sleep hygiene interventions.”

“A.Are your dreams similar to your trauma?” 

Which ego-defense mechanism does the nurse suspect in the patient who breaks objects when he experiences high levels of stress?

A.Denial

B.Regression

C.Identification

D. Displacement

D. Displacement ( taking anger out)

a previously potty trained 6 year old is admitted to the hospital after a motor vehicle accident (MVC).  She had no injuries to her bladder/kidneys, but she has been having urination accidents and needs to wear pull ups during Hospitalization.  This is an example of:

A.Regression

B.Conversion

C.Denial

Displacement

A.Regression

The nurse enters the room and notices the patient staring out the window with a flat affect. Which therapeutic communication technique is the nurse using when saying:
"You seem very quiet today."

A.Paraphrasing

B.Sharing observations

C.Focusing

D. Seeking clarification

B.Sharing observations

A patient appears tearful and overwhelmed. The nurse sits quietly and maintains eye contact without speaking. This is an example of which technique?

A.Focusing

B.Sharing observations

C.Using silence

D.Seeking clarification

C.Using silence

Which response by the nurse demonstrates the therapeutic technique of clarifying?

A."I'm not sure what you mean by ‘feeling off.’ Please tell me more.“

B."You should try to calm down.“

C."I know exactly how you feel.“

D."That's nothing to worry about."

A."I'm not sure what you mean by ‘feeling off.’ Please tell me more.“

A patient says, "I'm so scared about my upcoming surgery." Which response shows the nurse is using empathy?

A.“Many patients feel scared before surgery. Surgery can be a big deal.“

B."Don’t worry. It’ll be fine.“

C."I know someone who had that surgery and did great.“

D. "You should focus on the positives."

A.“Many patients feel scared before surgery. Surgery can be a big deal.“

A patient says, "I'm tired of being in pain all the time." Which nurse response is an example of paraphrasing?

A."Pain is something you’ll have to get used to.“

B.“Try not think about the pain right now.“

C."Have you told your doctor about this?“

D."It sounds like you’re really worn out from dealing with constant pain.”

D."It sounds like you’re really worn out from dealing with constant pain.”

A patient tells the nurse, "I’m following my diet," but the nurse sees a fast food bag in the trash. Which is the best therapeutic response?

A."You’re not telling the truth about your diet.“

B."Why did you lie to me about your diet?“

C."I noticed a fast food bag in the trash, but you said you're following your diet. Tell me more about that.”

D.“I am so happy you have been able to follow your diet."

C."I noticed a fast food bag in the trash, but you said you're following your diet. Tell me more about that.”

At the end of a conversation, the nurse says, "So today we talked about your trouble sleeping, your concerns about medication, and your plan to speak with the doctor. Did I get that right?" What technique is being used?

A.Sharing observations

B.Summarizing

C.Focusing

D.Validating

B.Summarizing

A patient who is scheduled for a cardiac stress test says, "I’m really nervous. I don’t know what to expect.“  Which response by the nurse demonstrates the use of the therapeutic communication technique of providing information?

A.“Let me have the doctor come back and describe the stress test to you."

B."You’ll be fine—there’s nothing to worry about.“

C."Why are you feeling nervous about the test?“

D."During the stress test, you’ll walk on a treadmill while we monitor your heart rate and rhythm. It usually takes about 30 minutes.“

D."During the stress test, you’ll walk on a treadmill while we monitor your heart rate and rhythm. It usually takes about 30 minutes.“

A patient says, “I’m really scared about what the doctor will say.”  Which of the following nurse responses is nontherapeutic?

A.“Tell me more about what you’re worried the doctor might say.”

B.“It’s okay—there’s nothing to be afraid of.”

C.“It sounds like you’re feeling very anxious about the results.”

D.“I would like to hear more about your concerns?”

B.“It’s okay—there’s nothing to be afraid of.”

A patient recently diagnosed with diabetes says, "I don’t know how I’m going to manage all of this.“  Which response by the nurse is considered nontherapeutic?

A."Are you worried about giving yourself insulin?“

B."Can you tell me more about what feels overwhelming right now?“

C."It sounds like this diagnosis is really affecting you—what concerns you most?“

D."What part of your care would you like help understanding better?"

A."Are you worried about giving yourself insulin?“

A nurse is communicating with a client.  The client moves closer and invades the nurse’s personal space, making the nurse uncomfortable.  Which is the appropriate nursing intervention?

A.The nurse ignores this behavior because it shows the client is progressing.

B.The nurse understands that clients require various amounts of personal space and accepts the behavior.

C.The nurse expresses a sense of discomfort and sets boundaries for personal space.

D.The nurse confronts and informs the client that the client will be secluded if this behavior continues.

C.The nurse expresses a sense of discomfort and sets boundaries for personal space.

Which of the following patient characteristics may affect how you communicate with them?   Select all that apply.

A.The patient is diagnosed with autism spectrum disorder

B.The patient is 5 years old

C.The patient has hearing aids

D.The patient needs to go to the bathroom

E.The patient uses a communication device on the iPad

F. The room you are in is quite dark

all correct