NUR 276 FINAL UPDATED ACTUAL
Questions and CORRECT Answers
Be able to explain the relationship between the concepts of stress and coping, cellular regulation, and
oxygenation/perfusion - CORRECT ANSWER -*Respiratory*: Increased ventilatory rate and depth
of respirations, dilation of bronchioles to facilitate increased oxygenation
*Cardiac*: Increased heart rate and cardiac output to promote transport of oxygen and nutrients
throughout the body
*Integumentary*: Increased sweat production (diaphoresis) to offset increased body temperature
secondary to increased metabolism; skin pallor secondary to vasoconstrictive effects of norepinephrine
*GI*: inhibition of the parasympathetic nervous system leads to decreased motility of gastric and
intestinal contents (peristalsis) through the gastrointestinal tract, which may cause constipation and
exccess flatus (intestinal gas); dry mouth due to decreased salivation secondary to inhibition of the
parasympathetic nervous system.
*Urinary*: Increased sodium and water retention due mineralocorticoid release, which leads to decreased
urine output and increased blood volume
*Opthalmic*: Pupillary dilation to allow entrance of more light and enhanced visual perception
Neurological: Enhances awareness and alertness in response to severe threats
*Musculoskeletal*: Increased muscular tension in preparation for defense (flight) or rapid mobility
(flight)
*Endocrine*: Increased release of glucocorticoids and increased gluconeogenesis, which leads to an
increased serum glucose (blood sugar)
What lab values are affected by stress and know why (Page 1903) - CORRECT ANSWER -Stress
Response causes
research suggests that peer rejection stimulates an increase in systolic blood pressure and in the
production of saliva a-amylase (sAA), which is an enzyme that is reflective of sympathetic nervous
system activation. Additionally, stressors related to performance-based challenges were associated with
increased cortisol production and increased diastolic blood pressure
1. Release of *catecholamines* and *epinephrine* and *norepinephrine*. This causes an increase in
blood pressure and heart rate.
2. Release of *glucocorticoids* and increased gluconeogenesis
,3. Increased serum glucose-increased risk for hyperglycemia and poor glucose control in clients with
diabetes
prolonged exposure to stress may lead to significant enlargement of the adrenal glands and pronounced
shrinkage (atrophy) of the lymphatic structures, including the lymph nodes, thymus, and spleen.
Additionally, within the gastrointestinal tract, ulcers may develop.
the sympathetic nervous system triggers the body's "fight-or-flight" response, which is necessary for
survival. Activation of the sympathetic nervous system causes release of hormones such as epinephrine,
which increases the heart rate and blood pressure to assist in the delivery of oxygen to tissues and organs.
Epinephrine also causes bronchial dilation, which allows for increased oxygen uptake. This increase in
oxygen uptake and delivery is intended to meet the increased metabolic demands associated with facing a
stressor (fight) or escaping the stressor (flight).
Local Adaptation Syndrome (LAS):
1. Alarm reaction: Body prepares for cascade of physiological reactions
2. Resistance: Body attempts to move toward restoration of homeostasis
3. Exhaustion: Energy and resources become depleted, body may rebound or disease/death may occur
epinephrine- increased heart rate
Know how the nurse should interact/intervene with a client experiencing anxiety or stress (Page 1906) -
CORRECT ANSWER -Initial nursing actions that inspire client confidence and that may help calm
anxious clients:
1. Make eye contact, focusing on the person
2. Take a nonthreatening stance
3. Validate the client's feelings: "I know you are very uncomfortable; we will do everything we can to
help you feel better."
4. Determine and address the client's immediate concerns: "What can I do right away to help you?"
5. Remember to address the client by name. Some clients find terms of endearment such as "honey" or
"sweetie" impersonal or demeaning. Using the client's first name may be seen as patronizing if the client
is expected to use the nurse's last name. On the other hang, some clients respond positively to the
informality of first name use. Ask clients how they would prefer to be addressed and never use the first
name of anyone over 18 without permission.
,6. Recognize and acknowledge manifestations of stress
7. Identify health coping mechanisms, including ensuring adequate time aware from the workplace and
incorporation of recreational activities into personal life
8. Seek out support and assistance when needed
9. Interview the client regarding level of anxiety and encourage open expression of concerns and
emotions.
a. the nurse acquires information about the individual; about the individual prioritizes and appraises
stressors. The nurse critically evaluates thoughts that may be increasing the person's anxiety.
b. Levels of anxiety range from mild to panic. Because the individual is unable to take in new information
during these stages, interventions focus on reducing the anxiety level prior to providing new information.
c. IMMEDIATE INTERVENTIONS: reducing exposure to stimuli and providing comfort measures to
assist in reducing symptom severity. Once anxiety level has decreased additional interventions to reduce
anxiety such as med
Know nursing diagnoses related to stress and coping - CORRECT ANSWER -Client with phobia:
Anxiety, Fear, Ineffective Health maintenance, Deficient Knowledge, Ineffective Coping
Client with OCD: Anxiety, fear, ineffective coping, stress overload, disturbed sleeping pattern, insomnia,
fatigue, deficient knowledge, risk for caregiver role strain
Client in a state of crisis: Risk for self-harm, risk for injury, ineffective self-health management, anxiety,
ineffective coping, social isolation, impaired social interaction, post-trauma syndrome
Client with GAD: Anxiety, ineffective coping, disturbed sleep pattern, impaired social interaction, risk for
ineffective self-health management, ineffective coping
*Stress and Coping*:
Stress Overload
Anxiety
Ineffective coping
a. Anxiety
, b. Ineffective coping
c. Disturbed sleep pattern
d. Impaired social interaction
e. Risk for ineffective self-health management
f. Social isolation
g. Post-trauma Syndrome
h. Risk for self-harm
i. Risk for injury
Grief in children - CORRECT ANSWER -Do not generally express or show their emotions
regarding loss as openly as adults (young children are sometimes mistaken to be unable to fully recognize
the loss, but this is not always the case). May express grief through art, imaginary games, playing,
behavioral changes (decreased socialization, irritability, confusion. These behavioral changes more
common in adolescents)
Children who experience loss at an early age are at greater risk of an intense grieving period, especially
children who lose a parent or primary caregiver. This risk increases further when the remaining parent or
caregiver fails to recognize the child's grief and assumes that the child is too young to be affected by the
loss. If children do not receive support and explanation after a substantial loss, they may view the loss as
a betrayal, giving rise to feelings of guilt and anger. This reaction may result in the development of trust
issues later in life. Children's grief responses can also be more complicated if the individual lost was
physically or mentally abusive, or both. In such cases, especially young children may find it difficult to
process the loss because, while there is a considerable amount of sadness, there might also be some relief
that the abuse is over. The guilt that comes with relief at the death of a loved one is difficult to handle at
any age, but particularly for a young child, especially if the child is unable to express these feelings.
Worden and Silverman 4 tasks to help children adapt to loss:
1. Accept loss and permanence
2. Experience emotions associated with grief such as anger, fear, sadness, guilt, and loneliness
3. Adjust to daily life without the individual who has been lost
4. Come to see the relationship with the deceased as one based on memories in place of continuing
experience
Know how to calculate required intake and output based on age and body weight - CORRECT
ANSWER -Know that with continuous bladder infusion (such as with radical prostatectomy), that
CBU input must be subtracted from total output to get an accurate number for the urine output.
Questions and CORRECT Answers
Be able to explain the relationship between the concepts of stress and coping, cellular regulation, and
oxygenation/perfusion - CORRECT ANSWER -*Respiratory*: Increased ventilatory rate and depth
of respirations, dilation of bronchioles to facilitate increased oxygenation
*Cardiac*: Increased heart rate and cardiac output to promote transport of oxygen and nutrients
throughout the body
*Integumentary*: Increased sweat production (diaphoresis) to offset increased body temperature
secondary to increased metabolism; skin pallor secondary to vasoconstrictive effects of norepinephrine
*GI*: inhibition of the parasympathetic nervous system leads to decreased motility of gastric and
intestinal contents (peristalsis) through the gastrointestinal tract, which may cause constipation and
exccess flatus (intestinal gas); dry mouth due to decreased salivation secondary to inhibition of the
parasympathetic nervous system.
*Urinary*: Increased sodium and water retention due mineralocorticoid release, which leads to decreased
urine output and increased blood volume
*Opthalmic*: Pupillary dilation to allow entrance of more light and enhanced visual perception
Neurological: Enhances awareness and alertness in response to severe threats
*Musculoskeletal*: Increased muscular tension in preparation for defense (flight) or rapid mobility
(flight)
*Endocrine*: Increased release of glucocorticoids and increased gluconeogenesis, which leads to an
increased serum glucose (blood sugar)
What lab values are affected by stress and know why (Page 1903) - CORRECT ANSWER -Stress
Response causes
research suggests that peer rejection stimulates an increase in systolic blood pressure and in the
production of saliva a-amylase (sAA), which is an enzyme that is reflective of sympathetic nervous
system activation. Additionally, stressors related to performance-based challenges were associated with
increased cortisol production and increased diastolic blood pressure
1. Release of *catecholamines* and *epinephrine* and *norepinephrine*. This causes an increase in
blood pressure and heart rate.
2. Release of *glucocorticoids* and increased gluconeogenesis
,3. Increased serum glucose-increased risk for hyperglycemia and poor glucose control in clients with
diabetes
prolonged exposure to stress may lead to significant enlargement of the adrenal glands and pronounced
shrinkage (atrophy) of the lymphatic structures, including the lymph nodes, thymus, and spleen.
Additionally, within the gastrointestinal tract, ulcers may develop.
the sympathetic nervous system triggers the body's "fight-or-flight" response, which is necessary for
survival. Activation of the sympathetic nervous system causes release of hormones such as epinephrine,
which increases the heart rate and blood pressure to assist in the delivery of oxygen to tissues and organs.
Epinephrine also causes bronchial dilation, which allows for increased oxygen uptake. This increase in
oxygen uptake and delivery is intended to meet the increased metabolic demands associated with facing a
stressor (fight) or escaping the stressor (flight).
Local Adaptation Syndrome (LAS):
1. Alarm reaction: Body prepares for cascade of physiological reactions
2. Resistance: Body attempts to move toward restoration of homeostasis
3. Exhaustion: Energy and resources become depleted, body may rebound or disease/death may occur
epinephrine- increased heart rate
Know how the nurse should interact/intervene with a client experiencing anxiety or stress (Page 1906) -
CORRECT ANSWER -Initial nursing actions that inspire client confidence and that may help calm
anxious clients:
1. Make eye contact, focusing on the person
2. Take a nonthreatening stance
3. Validate the client's feelings: "I know you are very uncomfortable; we will do everything we can to
help you feel better."
4. Determine and address the client's immediate concerns: "What can I do right away to help you?"
5. Remember to address the client by name. Some clients find terms of endearment such as "honey" or
"sweetie" impersonal or demeaning. Using the client's first name may be seen as patronizing if the client
is expected to use the nurse's last name. On the other hang, some clients respond positively to the
informality of first name use. Ask clients how they would prefer to be addressed and never use the first
name of anyone over 18 without permission.
,6. Recognize and acknowledge manifestations of stress
7. Identify health coping mechanisms, including ensuring adequate time aware from the workplace and
incorporation of recreational activities into personal life
8. Seek out support and assistance when needed
9. Interview the client regarding level of anxiety and encourage open expression of concerns and
emotions.
a. the nurse acquires information about the individual; about the individual prioritizes and appraises
stressors. The nurse critically evaluates thoughts that may be increasing the person's anxiety.
b. Levels of anxiety range from mild to panic. Because the individual is unable to take in new information
during these stages, interventions focus on reducing the anxiety level prior to providing new information.
c. IMMEDIATE INTERVENTIONS: reducing exposure to stimuli and providing comfort measures to
assist in reducing symptom severity. Once anxiety level has decreased additional interventions to reduce
anxiety such as med
Know nursing diagnoses related to stress and coping - CORRECT ANSWER -Client with phobia:
Anxiety, Fear, Ineffective Health maintenance, Deficient Knowledge, Ineffective Coping
Client with OCD: Anxiety, fear, ineffective coping, stress overload, disturbed sleeping pattern, insomnia,
fatigue, deficient knowledge, risk for caregiver role strain
Client in a state of crisis: Risk for self-harm, risk for injury, ineffective self-health management, anxiety,
ineffective coping, social isolation, impaired social interaction, post-trauma syndrome
Client with GAD: Anxiety, ineffective coping, disturbed sleep pattern, impaired social interaction, risk for
ineffective self-health management, ineffective coping
*Stress and Coping*:
Stress Overload
Anxiety
Ineffective coping
a. Anxiety
, b. Ineffective coping
c. Disturbed sleep pattern
d. Impaired social interaction
e. Risk for ineffective self-health management
f. Social isolation
g. Post-trauma Syndrome
h. Risk for self-harm
i. Risk for injury
Grief in children - CORRECT ANSWER -Do not generally express or show their emotions
regarding loss as openly as adults (young children are sometimes mistaken to be unable to fully recognize
the loss, but this is not always the case). May express grief through art, imaginary games, playing,
behavioral changes (decreased socialization, irritability, confusion. These behavioral changes more
common in adolescents)
Children who experience loss at an early age are at greater risk of an intense grieving period, especially
children who lose a parent or primary caregiver. This risk increases further when the remaining parent or
caregiver fails to recognize the child's grief and assumes that the child is too young to be affected by the
loss. If children do not receive support and explanation after a substantial loss, they may view the loss as
a betrayal, giving rise to feelings of guilt and anger. This reaction may result in the development of trust
issues later in life. Children's grief responses can also be more complicated if the individual lost was
physically or mentally abusive, or both. In such cases, especially young children may find it difficult to
process the loss because, while there is a considerable amount of sadness, there might also be some relief
that the abuse is over. The guilt that comes with relief at the death of a loved one is difficult to handle at
any age, but particularly for a young child, especially if the child is unable to express these feelings.
Worden and Silverman 4 tasks to help children adapt to loss:
1. Accept loss and permanence
2. Experience emotions associated with grief such as anger, fear, sadness, guilt, and loneliness
3. Adjust to daily life without the individual who has been lost
4. Come to see the relationship with the deceased as one based on memories in place of continuing
experience
Know how to calculate required intake and output based on age and body weight - CORRECT
ANSWER -Know that with continuous bladder infusion (such as with radical prostatectomy), that
CBU input must be subtracted from total output to get an accurate number for the urine output.
