Exam 4 Practice Flashcards – Stress, Coping, Psychosocial Health, Communication, Elimination, Fluids & Electrolytes

A comprehensive set of question-and-answer flashcards covering key concepts from Modules 11 & 12: stress and adaptation, psychosocial health, therapeutic communication, urinary and bowel elimination, and fluid/electrolyte balance.

What is stress in the context of health?

The body’s physical, emotional, or psychological response to any demand or change.

What are stressors?

External or internal events/conditions that threaten physical or emotional well-being.

Which type of stress is positive and motivating?

Eustress.

Which type of stress is negative and potentially harmful?

Distress.

Give an example of developmental stress.

Adolescence, parenthood, or aging (any life-stage change).

Give an example of situational stress.

Illness, natural disaster, or sudden death of a loved one.

Differentiate external vs. internal stressors.

External arise from environment (noise, finances); internal arise from thoughts, feelings, expectations, illness.

Name the three stages of the General Adaptation Syndrome (GAS).

Alarm, Resistance, Exhaustion/Recovery.

Which nervous system is activated in the Alarm stage of GAS?

Sympathetic nervous system.

List three physiologic signs of the Alarm stage.

↑Heart rate, dilated pupils, bronchiole dilation (also ↑ glucose, diaphoresis, etc.).

What occurs during the Resistance stage of GAS?

The body attempts to return to homeostasis while coping and adapting to the stressor.

What happens if stress continues beyond the body’s resources?

The Exhaustion stage occurs, leading to illness or burnout.

Name two long-term effects of chronic stress on the cardiovascular system.

Hypertension and heart disease.

Define adaptive coping and provide one example.

Constructive methods that manage stress effectively, e.g., exercise or journaling.

Define maladaptive coping and provide one example.

Destructive methods that harm health, e.g., smoking or aggression.

State two common non-pharmacologic stress interventions.

Meditation and cognitive-behavioral therapy (CBT).

Which medication class reduces the physiologic response to stress (e.g., palpitations)?

Beta-blockers.

How should a nurse communicate with a patient in a stressful situation?

Use therapeutic techniques: active listening, reflection, validation; avoid false reassurance.

List the four components of self-concept.

Body image, role performance, personal identity, self-esteem.

Mild anxiety has what effect on focus?

Sharpens focus.

What is the key feature that distinguishes delirium from dementia?

Delirium is sudden and often reversible; dementia is chronic and progressive.

During which phase of the nurse-patient relationship are goals set?

Orientation phase.

Name two therapeutic communication techniques.

Restating and clarifying (others: reflecting, silence, summarizing).

Why should a nurse avoid asking "Why" questions?

They can feel judgmental and place the patient on the defensive.

List the five basic elements of the communication process.

Sender, message, channel, receiver, feedback.

What is intrapersonal communication?

Self-talk occurring within an individual.

Give one cultural consideration when assessing stress.

Some cultures express stress physically (somatization) or prefer prayer/community support.

Function of the kidneys in urinary elimination.

Filter blood, form urine, regulate BP, produce erythropoietin, maintain acid-base balance.

Normal adult urine output per day.

1,200–1,500 mL (about 5–6 voids).

Define polyuria.

Excessive urination.

Define oliguria and the daily value that indicates it.

<400 mL urine per day

List two causes of urinary retention.

Benign prostatic hyperplasia (BPH) and postoperative anticholinergic medications.

Give two nursing interventions to promote urination in a patient with retention.

Provide privacy/warm water; use bladder scanner and possibly straight catheterization.

Name three classic symptoms of a urinary tract infection (UTI).

Frequency, urgency, and dysuria (burning).

Stress incontinence occurs under what circumstances?

Leakage with increased abdominal pressure such as coughing or laughing.

What is the priority infection-control rule for indwelling catheters?

Maintain a closed drainage system—never disconnect tubing unnecessarily.

How often should a Foley catheter drainage bag be emptied?

When ½–⅔ full or at least every 8 hours.

Describe an ileal conduit urinary diversion.

Ureters attached to a segment of ileum that exits via an abdominal stoma with continuous urine drainage to a pouch.

What does a healthy stoma look like?

Pink, moist, and round.

What should the nurse do if a stoma appears pale or black?

Report it immediately—may indicate compromised circulation.

Normal frequency range for bowel movements.

Anywhere from twice daily to three times per week.

List two common causes of constipation.

Opioid use and low-fiber diet (also immobility, dehydration).

First-line non-pharmacologic interventions for constipation.

Increase fluids to 2–3 L/day, high-fiber diet, and ambulation.

Describe signs of fecal impaction.

Hardened stool in rectum with possible oozing liquid stool around impaction.

Position for administering most enemas.

Left lateral (Sim’s) with right knee flexed.

What is a return-flow (Harris flush) enema used for?

Relieving gas (flatulence).

Output expected from an ileostomy.

Liquid, continuous stool with high fluid and electrolyte loss.

How full should an ostomy pouch be before emptying?

1/3 to 1/2 full.

Define fluid volume deficit (FVD).

Dehydration—loss of extracellular or total body fluid.

Name two common causes of FVD.

Vomiting and diuretics (also diarrhea, burns, hemorrhage).

List three assessment findings for fluid volume deficit.

Dry mucous membranes, hypotension, tachycardia (also poor skin turgor, dark urine, weight loss).

Why might BUN and hematocrit be elevated in FVD?

Hemoconcentration from loss of plasma volume.

Define fluid volume excess (FVE).

Overhydration—excess fluid in extracellular compartments.

Which disease processes commonly cause FVE?

Heart failure and renal failure.

Name two signs of FVE.

Edema and crackles in lungs (also JVD, weight gain, hypertension).

Normal serum sodium range.

135–145 mEq/L.

Significant symptom of hyponatremia.

Confusion or seizures.

ECG change often seen with hyperkalemia.

Peaked T waves (risk of ventricular fibrillation).

Normal serum potassium range.

3.5–5.0 mEq/L.

Classic signs of hypocalcemia.

Tetany, positive Chvostek’s or Trousseau’s sign.

What electrolyte is inversely related to calcium levels?

Phosphate (PO₄³⁻).

Define osmosis.

Movement of water across a semipermeable membrane from low to high solute concentration.

Which hormone causes the kidneys to retain water only?

Antidiuretic hormone (ADH).

Which hormone promotes both sodium and water retention?

Aldosterone.

Isotonic IV solutions are used for what purpose?

Fluid resuscitation and dehydration without causing fluid shifts (e.g., 0.9% NS, LR).

When is a hypotonic IV solution (0.45% NS) indicated?

To treat intracellular dehydration, such as with hypernatremia or DKA (after initial isotonic fluids).

Give one nursing consideration for hypertonic IV fluids like D5NS.

Monitor for fluid overload and pulmonary edema; use cautiously in heart/renal failure.

What is the purpose of ANP (atrial natriuretic peptide)?

Promotes excretion of sodium and water to lower blood volume.

Define diffusion.

Movement of particles from high to low concentration until equilibrium is reached.

Define active transport and give an example.

Movement of substances against the concentration gradient using energy; example: sodium-potassium pump.

What is filtration in the context of fluid balance?

Movement of fluid through a membrane due to hydrostatic pressure.

Name two nursing interventions for edema (FVE).

Fluid/sodium restriction and administration of diuretics.

Normal adult urine output that signals adequate renal perfusion (mL/hr).

At least 30 mL per hour.

Why is it important to secure catheter tubing to the thigh?

Prevents urethral traction and decreases infection risk.

Describe overflow incontinence.

Loss of small amounts of urine from an over-distended bladder that cannot empty fully.

Key nursing measure to prevent CAUTI.

Remove indwelling catheter as soon as medically possible.

What is functional incontinence?

Incontinence caused by physical or cognitive barriers to toileting.

Name one pharmacologic and one non-pharmacologic treatment of anxiety.

Pharmacologic: benzodiazepines; Non-pharmacologic: mindfulness meditation.

Which coping strategy uses humor to relieve stress?

Adaptive coping through humor and laughter.

Describe personal identity as part of self-concept.

An internal sense of individuality, wholeness, and uniqueness.

In which phase of the nurse-patient relationship is rapport established?

Orientation phase.

Why is touch considered a therapeutic communication technique?

Conveys support, empathy, and presence when culturally appropriate.

Explain why false reassurance is non-therapeutic.

It dismisses the patient’s feelings and can erode trust.

What is the main goal of bladder training for incontinence?

Increase bladder capacity and control by scheduled voiding.

List two signs a patient with diarrhea is becoming dehydrated.

Dry mucous membranes and decreased urine output.

Which electrolyte imbalance is characterized by decreased deep tendon reflexes (DTRs)?

Hypermagnesemia.

What precaution should the nurse take during a digital disimpaction?

Monitor for vagal response causing bradycardia.

Why are Kegel exercises recommended for stress incontinence?

They strengthen pelvic floor muscles to improve sphincter control.

What is the recommended height of an enema bag above the rectum?

12–18 inches (30–45 cm).

Identify one risk factor for UTIs unique to females.

Shorter urethra allowing easier bacterial entry.

Which electrolyte imbalance shows tremors and increased DTRs?

Hypomagnesemia.

Describe the function of erythropoietin produced by the kidneys.

Stimulates bone marrow to produce red blood cells.

When teaching catheter care, how often should perineal hygiene be performed?

At least once daily and after bowel movements.

What is the primary buffer system for acid-base balance in the body?

Bicarbonate (HCO₃⁻).

Which electrolyte directly affects neuromuscular excitability and clotting?

Calcium.

State two nursing priorities when caring for a patient with severe anxiety.

Ensure safety and use clear, simple communication.

What does anuria indicate and what is its daily urine output threshold?

Kidney failure or blockage; <100 mL/24 hr.

Define active listening.

Giving full attention with eye contact, nodding, and verbal cues to show understanding.

What lab values typically decrease in fluid volume excess due to hemodilution?

BUN and hematocrit.

List three signs of severe (panic-level) anxiety.

Inability to function, sense of terror, physical symptoms such as palpitations.