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What is the best outcome you can expect for this patient?
- A. Patient will adopt coping mechanisms to reduce stress.
- B. Patient will be stress free for the duration of treatment.
- C. Patient will avoid all stressful situations.
- D. Patient will be treated with an antianxiety agent.
Correct Answer: A
Rationale: Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the patient needs to adopt coping mechanisms that are effective for dealing with stress, such as relaxation techniques. The other options are incorrect because it is unrealistic to expect a patient to be stress free; avoiding stressful situations and starting an antianxiety agent are not the best answers as outcomes for ineffective coping.
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What will be included in the nurses intervention?
- A. The use of progressive tensing and relaxing of muscles to release tension in each muscle group
- B. Using a positive self-image to increase and intensify physical exercise, which decreases stress
- C. The mindful use of a word, phrase, or visual, which allows oneself to be distracted and temporarily escape from stressful situations
- D. The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations
Correct Answer: C
Rationale: Guided imagery is the mindful use of a word, phrase, or visual image to distract oneself from distressing situations or consciously taking time to relax or reenergize. Guided imagery does not involve muscle relaxation, positive self-image, or humor.
To what type of stressor has this patient been exposed?
- A. Physiologic
- B. Psychosocial
- C. Physical
- D. Psychiatric
Correct Answer: C
Rationale: Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. A chemical spill is neither a psychiatric nor a psychosocial phenomenon.
What would be the most appropriate nursing intervention?
- A. Put the primary onus for planning care on the patient herself.
- B. Assess and provide constructive outlets for anger and hostility.
- C. Assess the patients sources of social support.
- D. Encourage an attitude of realistic hope to help her deal with helpless feelings.
Correct Answer: D
Rationale: By encouraging an attitude of realistic hope, the patient will be empowered. This allows the patient to explore her feelings and bring about more effective coping patterns. The onus for care planning should not lie with the patient. The nursing diagnosis is related to feeling of helplessness, not anger and hostility. Social support is necessary, but does not directly address the feeling of helplessness.
When planning this patients care, which of the following statements regarding acute inflammation should you recognize?
- A. Inflammation is essentially synonymous with infection.
- B. Inflammation may impair the healing process.
- C. Inflammation is a defensive reaction intended to remove an offending agent.
- D. Inflammation inhibits the release of histamines in the tissues.
Correct Answer: C
Rationale: Inflammation is a defensive reaction intended to remove an offending agent and prepare the site for repair. Inflammation is not the same as infection, it does not impair the healing process, and it does not inhibit the release of histamines in the tissues.
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.