Chapter 10: Stress Responses and Stress Management |Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

MULTIPLE CHOICE 1. The adult child of a patient diagnosed with major depressive disorder asks, ―Do you think depression and physical illness are connected? Since my father‘s death, my mother has had shingles and the flu, but she‘s usually not one who gets sick.‖ Which answer by the nurse best reflects current knowledge? a. It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system.‖ b. You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses.‖ c. So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link.‖ d. Negative emotions and prolonged stress interfere with the body‘s ability to protect itself and can increase the likelihood of illness.‖ ANS: D The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to illness. Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother‘s baseline. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-7, 8 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 2. A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize? a. Engaging in activity without using any supplemental oxygen b. Sleeping comfortably and soundly, without respiratory distress c. Feeling relaxed and taking regular deep breaths when leaving home d. Having a younger, healthier body that knows no exercise limitations ANS: C The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen–carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-16, 40 (Box 10-3) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity 3. A nurse leads a psychoeducational group for patients experiencing depression. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors. b. prevents damage from overstimulation of the sympathetic nervous system. c. detoxifies the body by removing metabolic wastes and other toxins. d. improves mood stability for patients with bipolar disorders. ANS: A β-Endorphins produced during exercise result in improvement in mood and lowered anxiety. The other options are not accurate. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 10-12, 19, 37 (Box 10-1) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 4. A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, ―The immigration to America has been very difficult.‖ Considering cultural background, which expression of stress by this patient would the nurse expect? a. Motor restlessness b. Somatic complaints c. Memory deficiencies d. Sensory perceptual alterations