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A family member asks the nurse, 'Do you think stress 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 long term effects of stress?
- 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.'
Correct Answer: D
Rationale: 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 signals the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to infections.
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Cortisol is released in response to a patient's prolonged stress. Which initial effect would the nurse expect to result from the increased cortisol level?
- A. Diuresis and electrolyte imbalance
- B. Focused and alert mental status
- C. Drowsiness and lethargy
- D. Restlessness and anxiety
Correct Answer: B
Rationale: Cortisol is the primary stress hormone and is released in response to prolonged stress. Cortisol helps supply cells with amino acids and fatty acids for energy supply, as well as diverting glucose from muscles for use by the brain. As a result, the brain stays alert and focused. The distractors present effects that would not be expected.
A nurse talks with the caregiver of a combat veteran diagnosed with severe traumatic brain injuries. The caregiver says, 'I don't know how much longer I can do it. My whole life is consumed with taking care of my partner.' Which response best addresses the needs of the caregiver?
- A. How are you taking care of yourself?'
- B. Let's review your partner's diagnostic results.'
- C. I have some web-based programs for you to visit.'
- D. Your partner is lucky to have someone so devoted.'
Correct Answer: A
Rationale: The caregiver is the focus of the nurse's attention. The caregiver is suffering. The nurse must be empathetic and assess how the caregiver is caring for self. Reassurance and isolated computer activities do not help. The partner is already aware of the diagnostic results.
A veteran of military combat tells the nurse, 'I saw a child get blown up over a year ago, and now I keep seeing bits of flesh everywhere. I see something red and the visions race back to my mind.' Which phenomenon associated with posttraumatic stress disorder (PTSD) is this veteran describing?
- A. Re-experiencing
- B. Hyperarousal
- C. Avoidance
- D. Psychosis
Correct Answer: A
Rationale: Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events are often associated with PTSD. The veteran has described intrusive thoughts and visions associated with re-experiencing the traumatic event. This description does not indicate psychosis, hypervigilance, or avoidance.
A nurse designs a plan of exercise for a patient experiencing stress. What rationale should the nurse cite when presenting this plan to the treatment team?
- A. Exercise will stimulate endorphins and improve the patient's feelings of well-being.
- B. Exercise prevents damage from overstimulation of the sympathetic nervous system.
- C. Exercise detoxifies the body by removing metabolic wastes and other toxins.
- D. Exercise will prevent exacerbation of the stress by the limbic system.
Correct Answer: A
Rationale: Exercise is a stress reduction strategy that stimulates endorphins and improves patient's feelings of well-being. The other options are not accurate.
A soldier returned home last year after deployment to a war zone. The soldier's spouse reports, 'We were going to start a family but now he won't talk about it. He will not look at children. I wonder if we're going to make it as a couple.' What response best addresses the spouse's concerns?
- A. Posttraumatic stress disorder often changes a person's sexual functioning.'
- B. I encourage you to continue to participate in social activities where children are present.'
- C. Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior.'
- D. Posttraumatic stress disorder often strains relationships. I will suggest some community resources for help and support.'
Correct Answer: D
Rationale: Posttraumatic stress disorder (PSTD) precipitates changes that often lead to divorce. Providing support to both the veteran and spouse is important. Confrontation will not be effective. Although providing information is important, ongoing support is more effective.