Concept 30: Stress and Coping Giddens: Concepts for Nursing Practice,3rd Edition

1. An older patient presents to the out- patient clinic with a chief complaint of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patient's chief com- plaint? a.The patient is responsible for caring for two school-age grandchildren. b.The patient's daughter works to sup- port the family. c. The patient is being treated for hyper- tension and is overweight. d. The patient has recently lost her spouse and needed to move in with her daughter 2. A patient who was recently diagnosed with diabetes is having trouble concen- trating. This patient is usually very orga- nized and laid back.Which action should the nurse take? a. Ask the healthcare provider for a psy- chiatric referral. b. Administer the PRN sedaNtive med- ication every 4 hours. c. Suggest the use of a home caregiver to the patient's family. d. Plan to reinforce and repeat teaching about diabetes management. 3. A diabetic patient who is hospitalized tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up." Which response by the nurse is appropriate? a. "It is probably just coincidental that your blood sugar is high when you are ill." ANS: D The stress of losing a loved one and having to move are important contribut- ing factors for stress-related symptoms in older people. Caring for children will increase the patient's sense of worth.Be- ing overweight and being treated for hy- pertension are not the most likely causes of insomnia or headache. The patient's daughter may have added stress due to working, but this should not directly affect the patient ANS: D Because behavioral responses to stress include temporary changes such as ir- ritability, changes in memory, and poor concentration, patient teaching will need to be repeated. Psychiatric referral or home caregiver referral will not be need- ed for these expected short-term cogni- tive changes. Sedation will decrease the patient's ability to learn the necessary information for self-management. ANS B: The release of cortisol, epinephrine, and norepinephrine increases blood glucose Concept 30: Stress and Coping Giddens: Con