Nokea
What do you know is occurring with this young woman?
- A. The mediating process is occurring.
- B. The patient is experiencing an expected level of denial.
- C. The patients awareness of her stress makes it more acute.
- D. The patient is emotionally overwhelmed.
Correct Answer: A
Rationale: After recognizing a stressor, a person consciously or unconsciously reacts to manage the situation. This is termed the mediating process. Nothing in the scenario indicates the patient is either in denial or feeling overwhelmed. Awareness of stress does not necessarily exacerbate it.
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What would be the most complete statement by the students about the concept of steady state?
- A. The concept of steady state preserves life.
- B. The mechanisms of steady state work to maintain balance in the body.
- C. This concept compensates for biologic and environmental attacks on the body.
- D. Steady state is the same as adaptation.
Correct Answer: B
Rationale: Mechanisms for adjusting internal conditions promote the normal steady state of the organism and its survival. These mechanisms are compensatory in nature and work to restore balance in the body. Adaptation is a part of the concept of steady state; it is not the concept itself.
You should be aware that the oxygen demands of the patients body would change in which direction and why?
- A. Increase due to an increase in metabolism
- B. Decrease due to a decrease in metabolism
- C. Increase due to a decrease in metabolism
- D. Decrease due to an increase in metabolism
Correct Answer: A
Rationale: When a persons temperature is elevated, hypermetabolism occurs, and the respiratory rate, heart rate, and basal metabolic rate increase. The other options are incorrect because oxygen demands would not decrease and they would not increase due to a decrease in metabolism.
What should you encourage the patient to consider?
- A. Improve his nutritional intake.
- B. Make an appointment at a wellness clinic.
- C. Walk on a daily basis.
- D. Increase his interaction with his social network.
Correct Answer: D
Rationale: Social networks can reduce stress by providing the individual with a positive social identity, emotional support, material aide, information, and new social contacts. Changes to diet and activity may be beneficial, but social interaction is known to be of particular benefit. Attendance at a wellness clinic may or may not be beneficial, and does not involve social interaction.
What is the most appropriate nursing diagnosis for this patient?
- A. Self-esteem disturbance related to late diagnosis
- B. Ineffective individual coping related to reluctance to seek care
- C. Altered family process related to inability to obtain treatment
- D. Ineffective denial related to reluctance to seek care
Correct Answer: B
Rationale: Ineffective individual coping is the inability to assess our own stressors and then make choices to access appropriate resources. In this case, the patient was unable to access health care even when she was aware the disorder could be life-threatening. Self-esteem Disturbance, Altered Family Process, and Ineffective Denial are all nursing diagnoses that are often associated with breast cancer, but the patients ineffective individual coping has created a significant safety risk and is, therefore, the most appropriate nursing diagnosis.
To what would you attribute this phenomenon?
- A. Cortisol levels are decreasing.
- B. Endocrine activity has increased.
- C. The patient is adapting to noxious stressors.
- D. The sympathetic response has been activated.
Correct Answer: C
Rationale: Selye developed a theory of adaptation to biologic stress that he named the general adaptation syndrome (GAS), which has three phases: alarm, resistance, and exhaustion. During the alarm phase, the sympathetic fight-or-flight response is activated with release of catecholamines and the onset of the adrenocorticotropic hormone (ACTH) adrenal cortical response. The alarm reaction is defensive and anti-inflammatory but self-limited. Because living in a continuous state of alarm would result in death, people move into the second stage, resistance. During the resistance stage, adaptation to the noxious stressor occurs, and cortisol activity is still increased.