Nursing interventions appropriate to the generalized adaptation syndrome (GAS) exhaus-tion state include which of the following? Select all that apply
a. Planning care to best conserve the patient's energy
b. Assessment for respiratory disorders such as asthma
c. Monitoring of exacerbation of compulsive ritual behaviors
d. Frequent assessment of pain management related to headaches
e. Planned periods to reinforce effective relaxation techniques
ANS: A, B, D, E
If the individual's body does not adapt and the stressor continues to be prominent, then the third stage, called the exhaustion stage, occurs. The exhaustion stage can manifest itself in the form of illnesses such as infections, headaches, hypertension, asthma attacks, chronic fatigue syndrome, depression, anxiety disorders, and many other chronic conditions.
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The parent of 16-month-old Chris asks, "What is the best way to keep Chris from getting into our medicines at home?" The nurse should advise that
a. "All medicines should be locked away securely." b. "The medicines should be placed in high cabinets." c. "Chris just needs to be taught not to touch medicines." d. "Medicines should not be kept in the homes of small children."
An instructor explains factors that can influence the body's ability to defend itself against infection. A student shows a need for additional instruction by saying:
1. "In elderly individuals, the immune system gradually decreases in effectiveness, leaving them more vulnerable to invading pathogens." 2. "Toxicity from chemicals can impair the body's ability to fight infection." 3. "A diet that is lacking in fruits and vegetables can negatively affect the body's defenses." 4. "Mucous membranes can provide a portal for microorganisms to bypass the body's defenses and enter the body."
When can the researcher omit informed consent, when existing data from records and/or specimens are used?
A) The study does not involve an intervention. B) The researcher is gathering data anonymously. C) Health professional students are used as subjects. D) The study is gathering data from records over 10 years old.
The client experienced abdominal surgery the previous day and has just received an opioid medication for report of pain. The client is sitting in a chair next to the bed. An additional activity that the nurse uses to relieve pain is
a) apply ice to the incision site for 30 minutes b) have the client deep breathe and hold c) encourage the client to watch television d) assist the client to ambulate on the nursing unit