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15. A patient says, “One result of my chronic stress is that I feel so tired. I usually sleep from 11:00 PM to 6:30 AM. I started setting my alarm to give me an extra 30 minutes of sleep each morning, but I don’t feel any better and I’m rushed for work.” Which nursing response would best address the patient’s concerns?

a. “You may need to speak to your doctor about taking a sedative to help you sleep.” b. “Perhaps going to bed a half-hour earlier would work better than sleeping later.” c. “A glass of wine in the evening might take the edge off and help you to rest.” d. “Exercising just before retiring for the night may help you to sleep better.”

ANS: B

Sleeping later in the morning may disturb circadian rhythms and in this case is adding, rather than reducing, stress. Going to bed earlier and arising at the usual time alleviates fatigue more effectively. Sedatives may offer some benefit but are a short-term intervention with potential side effects, and other nonpharmacological interventions might work as well or better. Exercise earlier in the evening could induce tiredness and ease the process of falling asleep, but doing so right before bedtime would stimulate and interfere with sleep. Alcohol is sedating but potentially addictive; encouraging its use could increase the risk of using alcohol maladaptively as a response to stress in general.

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

REF: Page 10-37 (Box 10-1) TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. “Tell me about your family history. Do you have any relatives who have problems with stress?” b. “Tell me about your exercise. How much activity do you typically get in a day?” c. “Tell me about the kinds of things you do to reduce or cope with your stress.” d. “Stress can interfere with sleep. How much did you sleep last night?”

16. A patient reports, “I am overwhelmed by stress.” Which question by the nurse would be most important to use in the initial assessment of this patient?

ANS: C

The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether or not his distress is placing him in danger (e.g., by elevating his blood pressure dangerously or via maladaptive responses, such as drinking) and would help the nurse understand how he copes and how well his coping strategies and resources serve him. Of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful but seek data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general).

PTS: 1

DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 10-12 to 14 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

17. Which scenario best demonstrates an example of eustress? An individual a. loses a beloved family pet. b. prepares to take a vacation to a tropical island with a group of close friends. c. receives a bank notice that there were insufficient funds in his/her account for a recent rent payment. d. receives notification that his/her current employer is experiencing financial problems and some workers will be terminated.

ANS: B

Eustress is beneficial stress; it motivates people to develop skills they need to solve problems and meet personal goals. Positive life experiences produce eustress. Going on a tropical vacation is an exciting, relaxing experience and is an example of eustress. Losing the family pet, worrying about employment security, and having financial problems are examples of distress, a negative experience that drains energy and can lead to significant emotional problems. See related audience response question.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 10-6 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Thalamus b. Parietal lobe c. Hypothalamus d. Pituitary gland

18. A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system?

ANS: C

The individual will find this experience stressful. The hypothalamus functions as the command-and-control center when receiving stressful signals. The hypothalamus responds to signals of stress by engaging the autonomic nervous system. The parietal lobe is responsible for interpretation of other sensations. The thalamus processes messages associated with pain and wakefulness. The pituitary gland may be involved in other aspects of the person’s response but would not stimulate the autonomic nervous system.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 10-4 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. Limbic system b. Peripheral nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

19. A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience?

ANS: C