Author Question: A 72-year-old patient is in a long-term care facility after having had a cerebrovascular accident. ... (Read 72 times)

asd123 · **on:** Jul 22, 2018

A 72-year-old patient is in a long-term care facility after having had a cerebrovascular accident. The patient is noncommunicative, enteral feedings are not being absorbed, and respirations are becoming laboured.

Which of the stages of the general adaptation syndrome is the patient experiencing? a. Resistance stage
b. Exhaustion stage
c. Reflex pain response
d. Alarm reaction

Question 2

A young mother has been hospitalized for an irregular heartbeat (arrhythmia). The night nurse comes in to see the patient awake. What would be the most appropriate nursing intervention?

a. Inform the patient that it is late and time to go to sleep.
b. Ask the patient if she would like medication to help her sleep.
c. Recommend the great movie that is on television tonight.
d. Take time to sit and talk with the patient about her inability to sleep.

rekilledagain · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

B

Feedback
A During the resistance or adaptation stage, the body stabilizes.
B The exhaustion stage occurs when the body can no longer resist the effects of the stressor and when the energy necessary to maintain adaptation is depleted.
C Reflex pain response is not a stage of the general adaptation syndrome.
D During the alarm reaction, increasing hormone levels result in increased blood volume, epinephrine and norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake, and mental alertness.

Answer to Question 2

D
Assessment is the first step of the nursing process; therefore assessment needs to be done first and involves ascertaining the cause of the patient's inability to sleep. Patients who are admitted to the hospital for uncertain diagnoses can be stressed and worried about the testing and outcomes. In addition, a young mother can be worried about the care of the children and those caring for the children. This uncertainty and change in routine can cause difficulty in resting or falling asleep. Take the time to talk with the patient to determine the cause of the inability to sleep. A distraction such as a television may or may not work for the patient. After assessment is completed, a sedative may or may not be in order. Telling the patient that it is late and time to go to sleep is not a therapeutic response for an adult who is under stress.