ATI LPN
Fundamentals of Nursing: The Art and Science of Person-Centered Care Tenth, North American Edition
Chapter 43 Questions
Question 1 of 5
A nurse is assessing a patient who reports their migraines have become "unbearable." The patient states, "I got laid off from my job last week, and I have two kids in college. I don't know how I'm going to pay for it all." Which effects of physiologic effects of stress would the nurse expect to find in this patient? Select all that apply.
Correct Answer: A,B
Rationale: Physiologic effects of stress include changes in appetite and elimination patterns as well as increased pulse and respirations. Using ineffective coping mechanisms, becoming withdrawn and isolated, and exhibiting attention-seeking behaviors are psychological effects of stress.
Question 2 of 5
A nurse who performs preoperative assessments and teaching prepares patients for postoperative discomfort using anticipatory guidance. What interventions would this nurse use to decrease postoperative stress?
Correct Answer: C
Rationale: Anticipatory guidance focuses on psychologically preparing a person for an unfamiliar or painful event. When the patient knows what to expect through advanced explanation about discomfort, nausea, or pain and available relief measures, the patient's anxiety can be reduced. Rhythmic breathing is a relaxation technique, focusing on a pleasant place and breathing slowly in and out is a meditation technique, and focusing on a mental image to reduce responses to stimuli is a guided imagery technique.
Question 3 of 5
A nurse in a medical practice has assessed a patient reporting abdominal pain, diarrhea, and anxiety. When the health care provider finds no identifiable cause for the symptoms, which actions would the nurse recommend? Select all that apply.
Correct Answer: A,C,D
Rationale: Keeping a diary of sources of stress can help identify the problem, which is the first step in stress management. The nurse can help the patient identify supports and their strengths. The nurse should recommend sleeping 7 to 9 hours nightly. The nurse would not infer there is a problem of abuse or a psychiatric condition as a cause of their symptoms.
Question 4 of 5
A nurse is assessing the developmental levels of patients in a pediatric office. Which person would a nurse document as experiencing developmental stress?
Correct Answer: C
Rationale: The adolescent who is a loner is not meeting a major task (being a part of a peer group) for that level of growth and development.
Question 5 of 5
A nurse in a long-term care facility is caring for patient with a spinal cord injury affecting their sensory and motor reflexes below the waist. Based on the patient's condition, what would be a priority intervention for this patient?
Correct Answer: A
Rationale: A patient with a damaged neurologic reflex arc has a diminished pain reflex response. This diminished sensation and motor response places the patient at risk for burns. All patients should be provided adequate pain relief, but this is not a priority.