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Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient’s manner of thinking.

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

REF: Pages 10-19, 20, 36 (Table 10-4) TOP: Nursing Process: Planning

MSC: Client Needs: Psychosocial Integrity eBay: testbanks_and_xanax a. The patient’s systolic blood pressure has changed from the 140s to the 120s mm Hg. b. The patient reports, “I feel better, and that things are not bothering me as much.” c. The patient reports, “I spend more time napping or sitting quietly at home.” d. The patient’s weight decreased by 3 pounds.

13. A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress?

ANS: A

Objective measures tend to be the most reliable means of gauging progress. In this case, the patient’s elevated blood pressure, an indication of the body’s physiological response to stress, has diminished. The patient’s report regarding activity level is subjective; sitting quietly could reflect depression rather than improvement. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress. The patient’s weight change could be a positive or negative indicator; the blood pressure change is the best answer.

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

REF: Pages 10-15, 16, 39 (Box 10-4) TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity a. “People should treat me as well as they treat my sister.” b. “I can find contentment in succeeding at my own job level.” c. “I won’t be happy until I make as much money as my sister.” d. “Being as smart or clever as my sister isn’t really important.”

14. A patient tells the nurse, “I will never be happy until I’m as successful as my older sister.” The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping?

ANS: B

Finding contentment within one’s own work, even when it does not involve success as others might define it, is likely to lead to a reduced sense of distress about achievement level. It speaks to finding satisfaction and happiness without measuring the self against another person. Focusing on salary is simply a more specific way of being as successful as the sister, which would not promote coping. Expecting others to treat her as they do her sister is beyond her control. Dismissing the sister’s cleverness as unimportant indicates that the patient continues to feel inferior to the sibling.

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

REF: Pages 10-19, 20, 36 (Table 10-4) TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity