Medical-Surgical Nursing- Assessment And Management Of Clinical Problems, 10th Edition By, Exams of Nursing

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Start an IV line to administer antihypertensive medications. Recheck the blood pressure after the patient has been assessed. Discuss the need for hospital admission to control blood pressure. Teach the patient about the stroke risk associated with uncontrolled hypertension.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

Medical-Surgical Nursing- Assessment and Management of Clinical Problems, 10th Edition by Sharon L. Lewis, Shannon Ruff Dirksen, Margaret McLean Heitkemper Test Bank Chapter 06: Stress and Stress Management Lewis: Medical-Surgical Nursing, 10th Edition

1. An adult patient who arrived at the triage desk in the emergency department (ED) with minor facial lacerations after a motor vehicle accident has a blood pressure (BP) of 182/94. Which action by the nurse is appropriate?

Ask the health care provider for a psychiatric referral. Focus teaching on preventing postoperative complications.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: B

When a patient experiences an acute stressor, the BP increases. The nurse should plan to recheck the BP after the patient has stabilized and received treatment. This will provide a more accurate indication of the patient’s usual blood pressure. Elevated BP that occurs in response to acute stress does not increase the risk for health problems such as stroke, indicate a need for hospitalization, or indicate a need for IV antihypertensive medications. DIF: Cognitive Level: Apply (application) REF: 80 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity

2. A female patient who initially came to the clinic with incontinence was recently diagnosed with endometrial cancer. She is usually well organized and calm, but the nurse who is giving her preoperative instructions observes that the patient is irritable, has difficulty concentrating, and yells at her husband. Which action should the nurse take?

Encourage the patient to combine the hysterectomy with surgery for bladder repair.

Medical-Surgical Nursing- Assessment

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: C

Because behavioral responses to stress include temporary changes such as irritability, changes in memory, and poor concentration, patient teaching will need to be repeated. It is also important to try to calm the patient by listening to her concerns and fears. Psychiatric referral will not necessarily be needed for her but that can better be evaluated after surgery. Focusing on postoperative care does not address the need for preoperative instruction such as the procedure, NPO instructions before surgery, date and time of surgery, medications to be taken or discontinued before surgery, and so on. The issue of incontinence is not immediately relevant in the discussion of preoperative teaching for her hysterectomy. DIF: Cognitive Level: Apply (application) REF: 81 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

b.Defensive coping d.Risk prone health behavior

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

3. An adult patient who is hospitalized after a motorcycle crash tells the nurse, “I didn’t sleep last night because I worried about missing work at my new job and losing my insurance coverage.” Which nursing diagnosis is appropriate to include in the plan of care? a. Anxiety c. Ineffective denial

b.Guided imagery d.Mindfulness meditation

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: A

The information about the patient indicates that anxiety is an appropriate nursing diagnosis. The patient data do not support defensive coping, ineffective denial, or risk prone health behavior as problems for this patient. DIF: Cognitive Level: Apply (application) REF: 78 TOP: Nursing Process: Diagnosis MSC: NCLEX: Psychosocial Integrity

4. A patient is extremely anxious about having a biopsy on a femoral lymph node. Which relaxation technique would be the best choice for the nurse to facilitate during the procedure?

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

a. Yoga stretching c. Relaxation breathing ANS: C Relaxation breathing is an easy relaxation technique to teach and use. The patient should remain still during the biopsy and not move or stretch any of his extremities. Meditation and guided imagery require more time to practice and learn. DIF: Cognitive Level: Apply (application) REF: 83 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

“Regular exercise may get your mind off the pain.” “Guided imagery can be helpful in regaining control.” “Tell me more about how your life has been recently.” “Your previous coping resources can be helpful to you now.”

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

5. A patient who has frequent migraines tells the nurse, “My life feels chaotic and out of my control. I could not manage if anything else happens.” Which response should the nurse make initially?

Use music composed by Mozart. Play music that does not have words. Ask the patient about music preferences. Select music that has 60 to 80 beats/minute.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: C

The nurse’s initial strategy should be further assessment of the stressors in the patient’s life. Exercise, guided imagery, or understanding how to use coping strategies that worked in the past may be of assistance to the patient, but more assessment is needed before the nurse can determine this. DIF: Cognitive Level: Apply (application) REF: 86 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

6. A nurse prepares an adult patient with a severe burn injury for a dressing change. The nurse knows that this is a painful procedure and wants to try providing music to help the patient relax. Which action is best for the nurse to take?

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: C

Although music with 60 to 80 beats/min, music without words, and music composed by Mozart are frequently recommended to reduce stress, each patient responds individually to music and personal preferences are important. DIF: Cognitive Level: Analyze (analysis) REF: 85 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. The nurse teaches a patient who is experiencing stress at work how to use imagery as a relaxation technique. Which statement by the nurse would be appropriate?

“Think of a place where you feel peaceful and comfortable.” “Place the stress in your life into an image that you can destroy.”

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

“Repeatedly visualize yourself experiencing the distress in your workplace.” “Bring what you hear and sense in your work environment into your image.”

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: A

Imagery is the use of one’s mind to generate images that have a calming effect on the body. When using imagery for relaxation, the patient should visualize a comfortable and peaceful place. The goal is to offer a relaxing retreat from the actual work environment. Imagery that is not intended for relaxation purposes can target a disease, problem, or stressor. DIF: Cognitive Level: Apply (application) REF: 84 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. An obese female patient who had enjoyed active outdoor activities is stressed because osteoarthritis in her hips now

Have the patient practice frequent relaxation breathing. Ask the patient what outdoor activities she misses the most. Teach the patient to use imagery for reducing pain and stress. Encourage the patient to consider weight loss to improve symptoms.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

limits her activity. Which action by the nurse will bestassist the patient to cope with this situation? ANS: D For problems that can be changed or controlled, problem-focused coping strategies, such as encouraging the patient to lose weight, are most helpful. The other strategies also may assist the patient in coping with her problem, but they will not be as helpful as a problem- focused strategy. DIF: Cognitive Level: Analyze (analysis) REF: 86 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

9. A hospitalized patient with diabetes 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. This is so frustrating.” Which response by the nurse is accurate?

“The liver is not able to metabolize glucose as well during stressful times.” “Your diet at the hospital is the most likely cause of the increased glucose.” “The stress of illness causes release of hormones that increase blood glucose.” “It is probably coincidental that your blood glucose is higher when you are ill.”

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: C

The release of cortisol, epinephrine, and norepinephrine increase blood glucose levels. The increase in blood glucose is not coincidental. The liver does not control blood glucose. A patient with diabetes who is hospitalized will be on an appropriate diet to help control blood glucose. DIF: Cognitive Level: Apply (application) REF: 79 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity

10. A middle-aged male patient with usually well-controlled

The patient states that he takes his prescribed antihypertensive medications daily. The patient states that both of his parents have high blood pressure and diabetes. The patient indicates that he does blood glucose monitoring several times each day. The patient reports that he and his wife are disputing custody of their 8-yr-old son.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

hypertension and diabetes visits the clinic. Today he has a blood pressure of 174/94 mm Hg and a blood glucose level of 190 mg/dL. What patient information may indicate that additional intervention by the nurse is needed? ANS: D The increase in blood pressure and glucose levels possibly suggests that stress caused by his divorce and custody battle may be adversely affecting his health. The nurse should assess this further and develop an appropriate plan to assist the patient in decreasing his stress. Although he has been very compliant with his treatment plan in the past, the nurse should assess whether the stress in his life is interfering with his management of his health problems. The family history will not necessarily explain why he has had changes in his blood pressure and glucose levels.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

DIF: Cognitive Level: Apply (application) REF: 79 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

The patient takes vitamin supplements and St. John’s wort. The patient recently experienced the death of a close friend. The patient’s blood pressure has increased to 152/88 mm Hg. The patient expresses anxiety about whether the drugs are effective.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

11. A patient who is taking antiretroviral medication to control human immunodeficiency virus (HIV) infection tells the nurse about feeling mildly depressed and anxious. Which additional information about the patient is most important to communicate to the health care provider? ANS: A St. John’s wort interferes with metabolism of medications that use the cytochrome P 450 enzyme system, including many HIV medications. The health care provider will need to check for toxicity caused by the drug interactions. Teaching is needed about drug interactions. The other information will also be reported but does not have immediate serious implications for the patient’s health. DIF: Cognitive Level: Analyze (analysis) REF: 80

Assess for bradycardia. Observe for decreased appetite. Ask about epigastric discomfort. Monitor for decreased respiratory rate. Check for elevated blood glucose levels.

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

TOP: Nursing Process: AssessmentMSC: NCLEX: Safe and Effective Care Environment MULTIPLE RESPONSE

1. A patient who is hospitalized with a pelvic fracture after a motor vehicle accident just received news that the driver of the car died from multiple injuries. What actions should the nurse take based on knowledge of the physiologic stress reactions that may occur in this patient (select all that apply)?

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

ANS: B, C, E

And Management Of Clinical Problems,

10th Edition By Sharon L. Lewis,

Shannon Ruff Dirksen, Margaret Mclean

Heitkemper Test Bank

The physiologic changes associated with the acute stress response can cause changes in appetite, increased gastric acid secretion, and increase blood glucose levels. In addition, stress causes an increase in respiratory and heart rates. DIF: Cognitive Level: Analyze (analysis) REF: 78 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity