A patient has not been sleeping well because he is worried about ...

[ENagel]

A patient has not been sleeping well because he is worried about losing his job and not being able to support his family.
 
  The nurse takes the patient's vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths/min, and his blood pressure is 166/88 instead his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first?
  a. Go to sleep 30 to 60 minutes earlier each night to increase rest.
  b. Relax by spending more time playing with his pet dog.
  c. Slow and deepen breathing via use of a positive, repeated word.
  d. Consider that a new job might be better than his present one.

Question 2

A patient tells the nurse, I'm told that I should reduce the stress in my life, but I have no idea where to start. Which would be the best initial nursing response?
 
  a. Why not start by learning to meditate? That technique will cover everything.
  b. In cases like yours, physical exercise works to elevate mood and reduce anxiety.
  c. Reading about stress and how to manage it might be a good place to start.
  d. Let's talk about what is going on in your life and then look at possible options.

[brittanywood]

Answer to Question 1

ANS: C
The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident in his elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system (i.e., Benson's relaxation response) will counter the sympathetic nervous system's arousal, normalizing these vital-sign changes and reducing the physiologic demands stress is placing on his body. Other options do not address his physiologic response pattern as directly or immediately.

Answer to Question 2

ANS: D
In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. As a result, further assessment is indicated before potential solutions can be explored. Suggesting further exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention.

[ENagel]

TYSM

[kusterl]

Excellent