Chapter 30: Stress and Coping Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. A recommended intervention for a lifestyle stress indicator and reduction in the incidence of heart disease is:

a.

Regular physical exercise.

b.

Attendance at a support group.

c.

Self-awareness skill development.

d.

Time management.

ANS: a

a. A regular exercise program reduces tension and promotes relaxation, increasing ones resistance to stress, and reduces the risk of cardiovascular disease.

b. Support systems may benefit a person experiencing stress but do not reduce the incidence of heart disease.

c. Self-awareness skill development may enable persons to recognize when they are experiencing stress and need to implement stress-reducing strategies, but will not reduce the incidence of heart disease.

d. Time management, including setting priorities, helps individuals to identify tasks that are not necessary or can be delegated to someone else. Effective time management will help lower ones level of stress, but does not reduce the incidence of heart disease.

REF: Text Reference: p. 609

2. The nurse is involved in crisis intervention with a family in which the father has just lost his job and is experiencing periods of depression. The mother has a chronic debilitating illness that has put added responsibilities on the adolescent child, who is having behavioral problems. The nurse intervenes specifically to focus the family on their feelings by:

a.

Pointing out the connection between the situation and their responses

b.

Encouraging the use of the familys usual coping skills

c.

Working on time-management skills

d.

Discussing past experiences

ANS: a

a. When using a crisis-intervention approach, the nurse helps the client make the mental connection between the stressful event and the clients reaction to it.

b. Because an individuals or familys usual coping strategies are ineffective in managing the stress of the precipitating event in a crisis situation, the use of new coping mechanisms is required.

c. Time-management skills will not help reduce the stress of the precipitating event in a crisis situation.

d. What may have worked in past experiences is ineffective in managing the stress of the precipitating event in a crisis situation.

REF: Text Reference: p. 611

3. A child and his mother have gone to the playroom on the pediatric unit. His mother tells him he cannot have a toy another child is playing with. The child cries, throws a block, and runs over to kick the door. This child is using a mechanism known as:

a.

Displacement

b.

Compensation

c.

Conversion

d.

Denial

ANS: a

a. Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute.

b. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset.

c. Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms.

d. Denial is avoiding emotional conflicts by refusing consciously to acknowledge anything that might cause intolerable emotional pain.

REF: Text Reference: p. 599

4. Clients undergoing stress may undergo periods of regression. The nurse assesses this regressive behavior in the situation in which:

a.

An adult client exercises to the point of fatigue

b.

An 8-year-old child sucks his thumb and wets the bed

c.

An adult client avoids speaking about health concerns

d.

An 11-year-old child experiences stomach cramps and headaches

ANS: b

b. Regression is coping with a stressor through actions and behaviors associated with an earlier developmental period, such as an 8-year-old child sucking his thumb and wetting the bed.

a. An adult client who exercises to the point of fatigue is not demonstrating regression.

c. An adult client who avoids speaking about health concerns may be using denial as a coping mechanism.

d. An 11-year-old who develops stomach cramps and headaches is an example of conversion.

REF: Text Reference: p. 599

5. During the end-of-shift report the nurse notes that a client had been very nervous and preoccupied during the evening and that no family visited. To determine the amount of anxiety that the client is experiencing, the nurse should respond:

a.

Would you like for me to call a family member to come support you?

b.

Would you like to go down the hall and talk with another client who had the same surgery?

c.

How serious do you think your illness is?

d.

You seem worried about something. Would it help to talk about it?

ANS: d

d. The nurse learns from the client both by asking questions and by making observations of nonverbal behavior and the clients environment. To determine the amount of anxiety the client is experiencing, the nurse gathers information from the clients perspective.

a. Asking if the client desires for family to be called is not assessing the clients level of anxiety.

b. The nurse should first focus on developing a trusting relationship with the client. If the nurse takes the client to visit someone who had the same surgery, the nurse would not be able to assess the clients current level of anxiety.

c. This is not the best response. It does not assess the amount of anxiety the client is currently experiencing.

REF: Text Reference: p. 603

6. A 23-year-old who recently had a head injury from a motor vehicle accident (MVA) is in a state of unconsciousness. Which of the following physiological adaptations is primarily responsible for his level of consciousness?

a.

Medulla oblongata

b.

Reticular formation

c.

Pituitary gland

d.

External stress response

ANS: b

b. The reticular formation is primarily responsible for an individuals level of consciousness.

a. The medulla oblongata controls vital functions such as heart rate, blood pressure, and respiration.

c. The pituitary gland supplies hormones that control vital functions. The pituitary gland produces hormones necessary for adaptation to stress (e.g., adrenocorticotropic hormone).

d. The external stress response is not primarily responsible for a persons level of consciousness.

REF: Text Reference: p. 597

7. Nurses in the medical center are working with clients experiencing post-traumatic stress disorder (PTSD) after the World Trade Center bombing. An approach that is appropriate and should be incorporated into the plan of care is:

a.

Suppression of anxiety-producing memories

b.

Reinforcement that the PTSD is short term

c.

Promotion of relaxation strategies

d.

Focus on physical needs

ANS: c

c. Teaching the client relaxation strategies can help reduce the stress of anxiety-provoking thoughts and events, as seen in PTSD, and reinforces an adaptive coping strategy.

a. Suppression would be a maladaptive coping mechanism.

b. PTSD persists longer than 1 month.

d. The focus should be on developing adaptive coping mechanisms and lowering the individuals anxiety. The focus is not on physical needs for the client who is experiencing PTSD.

REF: Text Reference: p. 600

8. The nurse is working with clients in an outpatient health care setting. One of the clients is experiencing job-related stress. The nurse believes this client is dissociated as a result of observing the client:

a.

Avoiding discussion of job problems

b.

Acting like another colleague on the job

c.

Experiencing chronic headaches and stomach aches

d.

Sitting quietly and not interacting with any of the staff

ANS: d

d. Dissociation is experiencing a subjective sense of numbing and a reduced awareness of ones surroundings. The client who is sitting quietly and not interacting with any of the staff may be displaying dissociation.

a. The client who avoids discussion of the problem may be using denial as an ego-defense mechanism.

b. The client who acts like another colleague on the job is using identification as an ego-defense mechanism.

c. The client who experiences headaches and stomach aches is using the ego-defense mechanism of conversion.

REF: Text Reference: p. 599

9. A 72-year-old client is in a long-term care facility after having had a cerebrovascular accident. The client is noncommunicative, enteral feedings are not being absorbed, and respirations are becoming labored. Which of the stages of the GAS is the client experiencing?

a.

Resistance stage

b.

Exhaustion stage

c.

Reflex pain response

d.

Alarm reaction

ANS: b

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.

a. During the resistance stage, the body stabilizes.

c. Reflex pain response is not a stage of GAS.

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.

REF: Text Reference: p. 597

10. A client recently lost a child in a severe case of poisoning. The client tells the nurse, I dont want to make any new friends right now. This is an example of which of the following indicators of stress?

a.

Emotional indicator

b.

Spiritual indicator

c.

Sociocultural indicator

d.

Intellectual indicator

ANS: c

c. The client who recently experienced a loss and does not want to meet new people is an example of a sociocultural indicator of stress.

a. This is not an example of an emotional indicator of stress. The client is not displaying anger or crying.

b. This is not an example of a spiritual indicator of stress. The client is not restless or verbalizing discontent with a higher being.

d. This is not an example of an intellectual indicator of stress.

REF: Text Reference: p. 601

11. A corporate executive works 60 to 80 hours per week and is experiencing some physical signs of stress. The practitioner teaches the client to include 15 minutes of biofeedback. This is an example of which of the following health promotion interventions?

a.

Guided imagery

b.

Relaxation technique

c.

Time management

d.

Regular exercise

ANS: b

b. Biofeedback can be learned in a training program designed to develop ones ability to control the autonomic (involuntary) nervous system. The client learns to monitor functions such as heart rate, blood pressure, skin temperature, or muscle tension, and learns to relax in response to create desired changes

a. Guided imagery is a relaxed state in which a person actively uses imagination in a way that allows visualization of a soothing, peaceful setting. This is not an example of guided imagery.

c. Time-management techniques include developing lists of tasks to be performed in order of priority. This is not an example of time management.

d. This is not an example of a regular exercise program. It does not improve muscle tone and reduce the risk of cardiovascular disease.

REF: Text Reference: p. 609, Text Reference: p. 610

12. The client is assessed by the nurse as experiencing a crisis. The nurse plans to:

a.

Allow the client to work through independent problem solving

b.

Complete an in-depth evaluation of stressors and responses to the situation

c.

Focus on immediate stress reduction

d.

Recommend ongoing therapy

ANS: c

c. The nurses focus for a client experiencing a crisis is immediate stress reduction.

a. The client experiencing a crisis is unable to work through independent problem solving.

b. Completing an in-depth evaluation of stressors and responses to the situation would be inappropriate for the client who is experiencing a crisis.

d. A person who has experienced a crisis has changed, and the effects may last for years or for the rest of the persons life. If a person has successfully coped with a crisis and its consequences, he or she becomes a more mature and healthy person, and ongoing therapy may not be necessary.

REF: Text Reference: p. 610

13. While working with clients who are experiencing a significant degree of stress, the nurse is aware that a priority assessment area is:

a.

The clients primary physical needs

b.

What else is happening in the clients life

c.

How the stress has influenced the clients activities of daily living

d.

Whether the client is thinking about harming himself or others

ANS: d

d. A priority assessment is to determine if the person is suicidal or homicidal by asking directly.

a. The priority assessment for the client who is experiencing a significant degree of stress is not the clients physical needs. The nurse should first determine if the client is a danger to himself or others.

b. After determining if the client is suicidal or homicidal, the nurse can begin the problem-solving process and assess what else is happening in the clients life.

c. The nurse should first determine if the client is a danger to himself or others. Then the nurse can examine the degree of disruption in the persons life, such as in activities of daily living.

REF: Text Reference: p. 607

14. The nurse recognizes that the response to stress for older adults may be manifested differently from that in younger adults. For the older adult client, the nurse is aware that:

a.

Losses are more stress provoking

b.

Anxiety disorders are most prevalent

c.

Psychosocial factors are the greatest threats

d.

Timing of stress-inducing events is not significant

ANS: b

b. Anxiety disorders are the most prevalent disorders in later life and are continuations of life-long illnesses.

a. Losses in later life may be less stress provoking than generally assumed, partly because certain life transitions are anticipated and people prepare by coping in advance.

c. The effect of psychosocial factors on health status is not altered by age.

d. The timing of stress-inducing events can significantly influence older adults ability to cope. The fact that older adults may have several stressful events (e.g., loss of a spouse and new medical diagnosis) occur within a short period can result in detrimental effects on coping.

REF: Text Reference: p. 602

Copyright 2005 by Mosby, Inc. All rights reserved.

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