A nurse is collecting data from a client who is experiencing stress. Which of the following findings should indicate to the nurse ineffective coping?

The client takes a 20-min nap each afternoon.

The client has gained 4.5 kg (10 lb) in the past month.

The client takes a walk for 1 hr each day.

The client is taking a poetry class.

Answer and Explanation

The Correct Answer is B

A. The client takes a 20-min nap each afternoon. Taking a short nap is a healthy coping mechanism and does not indicate ineffective coping.

B. The client has gained 4.5 kg (10 lb) in the past month. Sudden weight gain can indicate emotional eating or stress-related metabolic changes, which are signs of ineffective coping.

C. The client takes a walk for 1 hr each day. Walking is a positive coping strategy that helps manage stress.

D. The client is taking a poetry class. Engaging in creative activities is a healthy coping mechanism that can reduce stress.

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Correct Answer is D

Explanation

A. Nausea – Not a primary manifestation of hypoxia. Hypoxia primarily affects oxygen delivery to tissues, leading to respiratory and neurological changes.

B. Dysphagia – Difficulty swallowing is not a common sign of hypoxia. It is more often associated with neurological conditions or structural abnormalities.

C. Warm, dry skin – Hypoxia typically causes cool, clammy skin due to vasoconstriction and poor oxygenation, not warm, dry skin.

D. Cyanosis – Correct. Cyanosis (bluish discoloration of the skin, lips, or nail beds) occurs due to inadequate oxygenation of the blood, making it a key sign of hypoxia.

A. Allow the perineal area to air dry after each stool. B. Administer a soap-suds enema to cleanse the colon. C. Provide the client with a high fiber diet. D. Apply a zinc-oxide barrier to the perineal area after each stool.

Correct Answer is D

Explanation

A. Allow the perineal area to air dry after each stool. While drying is important, leaving the skin unprotected can lead to skin breakdown and irritation from continued exposure to stool.

B. Administer a soap-suds enema to cleanse the colon. Soap-suds enemas are contraindicated in diarrhea because they can cause further irritation and electrolyte imbalances.

C. Provide the client with a high-fiber diet. A high-fiber diet is recommended for constipation, not diarrhea, as fiber can increase stool frequency.

D. Apply a zinc-oxide barrier to the perineal area after each stool. Zinc-oxide protects the skin from moisture and irritation, helping prevent dermatitis and skin breakdown.

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A nurse is collecting data from a client who is experiencing stress. Which of the following findings should indicate to the nurse ineffective coping?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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