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10. A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient’s vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected?

a. P 64, R 14 b. P 68, R 12 c. P 72, R 16 d. P 80, R 20

ANS: D

The patient would experience stress associated with anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight or flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 10-3, 4

MSC: Client Needs: Physiological Integrity

TOP: Nursing Process: Assessment a. “Physical exercise works to elevate mood and reduce anxiety.” b. “Reading about stress and how to manage it might be a good place to start.” c. “Why not start by learning to meditate? That technique will cover everything.” d. “Let’s talk about what is going on in your life and then look at possible options.”

11. A patient tells the nurse, “I know that I should reduce the stress in my life, but I have no idea where to start.” What would be the best initial nursing response?

ANS: D

In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. Further assessment is indicated before potential solutions can be explored. Suggesting exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 10-12 to 14

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment a. Encourage the patient to imagine being in calm circumstances. b. Provide the patient with a blank journal and guidance about journaling. c. Teach the patient to recognize, reconsider, and reframe irrational thoughts. d. Teach the patient to use instruments that give feedback about bodily functions.

12. A patient tells the nurse, “My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking.” Which response by the nurse would support the recommendation?

ANS: C