C HAPTER 10: S TRESS R ESPONSES AND S TRESS
M ANAGEMENT
Varcarolis’ Foundations of Psychiatric -Mental Health Nursing: 8th Ed ition
MULTIPLE CHOICE
1. A patient tells the nurse, I know that I should reduce the stress in m y life,
but I have no idea where to start. What would be the best initial nursing
response?
a. Physical exercise works to elevate mood and reduce anxiet y.
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. Lets talk about what is going on in your life and then look at
possible options.
ANS: D
In this case, the nur se 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 onl y option that involves further assessment rather than
suggesting a particular intervention.
, PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 162 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y
2. A patient tells the nurse, My doctor thinks m y 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?
a. Encourage the patient to imagine being in calm circum stances.
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 bodil y
functions.
ANS: C
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 unquestioni ng 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 feed back about bodil y functions are
used in biofeedback. Journaling is effective for helping to increase
self-awareness. However, none of these last three interventions is
likel y to alter the patients manner of thinking.
, PTS: 1 DIF: Cognitive Level: Appl y (A pplication)
REF: 167 TOP: Nursing Process: Planning MSC:
Client Needs: Psychosocial Integrit y
3. 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 clearl y
shows the patient is coping more effectivel y with stress?
a. The patients 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 bot hering
me as much.
c. The patient reports, I spend more time napping or sitting quietly at
home.
d. The patients weight decreased by 3 pounds.
ANS: A
Objective measures tend to be the most reliable means of gauging
progress. In this case, the patients elevated blood pressure, an
indication of the bodys physiological response to stress, has
diminished. The patients report regarding activit y level is subjective;
sitting quietl y could reflect depression rather than improvement.
Appetite, mood, and energy levels ar e also subjective reports that do
not necessaril y reflect physiological changes from stress and may not
reflect improved coping with stress. The patients weight change could
be a positive or negative indicator; the blood pressure change is the
best answer.
M ANAGEMENT
Varcarolis’ Foundations of Psychiatric -Mental Health Nursing: 8th Ed ition
MULTIPLE CHOICE
1. A patient tells the nurse, I know that I should reduce the stress in m y life,
but I have no idea where to start. What would be the best initial nursing
response?
a. Physical exercise works to elevate mood and reduce anxiet y.
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. Lets talk about what is going on in your life and then look at
possible options.
ANS: D
In this case, the nur se 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 onl y option that involves further assessment rather than
suggesting a particular intervention.
, PTS: 1 DIF: Cognitive Level: Appl y (Application)
REF: 162 TOP: Nursing Process: Assessment MSC:
Client Needs: Psychosocial Integrit y
2. A patient tells the nurse, My doctor thinks m y 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?
a. Encourage the patient to imagine being in calm circum stances.
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 bodil y
functions.
ANS: C
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 unquestioni ng 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 feed back about bodil y functions are
used in biofeedback. Journaling is effective for helping to increase
self-awareness. However, none of these last three interventions is
likel y to alter the patients manner of thinking.
, PTS: 1 DIF: Cognitive Level: Appl y (A pplication)
REF: 167 TOP: Nursing Process: Planning MSC:
Client Needs: Psychosocial Integrit y
3. 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 clearl y
shows the patient is coping more effectivel y with stress?
a. The patients 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 bot hering
me as much.
c. The patient reports, I spend more time napping or sitting quietly at
home.
d. The patients weight decreased by 3 pounds.
ANS: A
Objective measures tend to be the most reliable means of gauging
progress. In this case, the patients elevated blood pressure, an
indication of the bodys physiological response to stress, has
diminished. The patients report regarding activit y level is subjective;
sitting quietl y could reflect depression rather than improvement.
Appetite, mood, and energy levels ar e also subjective reports that do
not necessaril y reflect physiological changes from stress and may not
reflect improved coping with stress. The patients weight change could
be a positive or negative indicator; the blood pressure change is the
best answer.
