Chapter 31: Stress and Coping Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank

MULTIPLE CHOICE

1. For a lifestyle stress indicator and reduction in the incidence of heart disease a recommended intervention would be:

1.

Regular physical exercise

2.

Attendance at a support group

3.

Self-awareness skill development

4.

Effective time management techniques

ANS: 1

A regular exercise program reduces tension, promotes relaxation, increases ones resistance to stress, and reduces the risk of cardiovascular disease. Support systems may benefit a person experiencing stress but do not reduce the incidence of heart disease. Self-awareness skill development may enable a person to recognize when they are experiencing stress and need to implement stress-reducing strategies, but they will not reduce the incidence of heart disease. Time management, including setting priorities, helps individuals 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.

DIF: A REF: 494 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

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

1.

Pointing out the connection between the situation and their responses

2.

Encouraging the use of the familys usual coping skills

3.

Working on time management skills

4.

Discussing past experiences

ANS: 1

When using a crisis intervention approach, pointing out the connections between situation and responses, the nurse helps the client make the mental connection between the stressful event and the clients reaction to it. 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. Time management skills will not help reduce the stress of the precipitating event in a crisis situation. What may have worked in past experiences is ineffective in managing the stress of the precipitating event in a crisis situation.

DIF: A REF: 498 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

3. A mother and her child sit in a playroom on the pediatric unit. The boy wants to play with a toy that another child has but the mother says no. The child cries, throws a block, and runs over to kick the door. This child is using a mechanism known as:

1.

Displacement

2.

Compensation

3.

Conversion

4.

Denial

ANS: 1

Displacement is transferring emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute. Compensation is making up for a deficiency in one aspect of self-image by strongly emphasizing a feature considered an asset. Conversion is unconsciously repressing an anxiety-producing emotional conflict and transforming it into nonorganic symptoms. Denial is avoiding emotional conflicts by refusing to consciously acknowledge anything that might cause intolerable emotional pain.

DIF: A REF: 488 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

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

1.

An adult client exercises to the point of fatigue

2.

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

3.

An adult client avoids speaking about health concerns

4.

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

ANS: 2

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. An adult client who exercises to the point of fatigue is not demonstrating regression. An adult client who avoids speaking about health concerns may be using denial as a coping mechanism. An 11-year-old who develops stomach cramps and headaches is an example of conversion.

DIF: A REF: 488 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

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:

1.

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

2.

Would you like to talk with another client who had the same surgery?

3.

How serious do you think the illness you are experiencing really is?

4.

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

ANS: 4

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. Noting that he seems worried and offering to discuss it is the correct response. Asking if the client desires for family to be called is not assessing the clients level of anxiety. 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. Asking the client about how serious he deems the illness to be is not the best response. It does not assess the amount of anxiety the client is currently experiencing.

DIF: A REF: 491 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

6. A 23-year-old man 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?

1.

Pituitary gland

2.

Medulla oblongata

3.

Reticular formation

4.

External stress response

ANS: 3

The reticular formation is primarily responsible for an individuals level of consciousness. The pituitary gland supplies hormones that control vital functions. The pituitary gland produces hormones necessary for adaptation to stress (e.g., adrenocorticotropic hormone). The medulla oblongata controls vital functions such as heart rate, blood pressure, and respiration. The external stress response is not primarily responsible for a persons level of consciousness.

DIF: A REF: 486 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

7. Clients experiencing post-traumatic stress disorder (PTSD) following the World Trade Tower bombing work with nurses in the medical center. An approach that is appropriate and should be incorporated into the plan of care is:

1.

Suppression of anxiety-producing memories

2.

Reinforcement that the PTSD is short term

3.

Promotion of relaxation strategies

4.

Focus on physical needs

ANS: 3

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. Suppression would be a maladaptive coping mechanism. PSTD persists longer than 1 month. 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.

DIF: A REF: 489 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

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

1.

Avoid discussion of job problems

2.

Act like another colleague on the job

3.

Experience chronic headaches and stomach aches

4.

Sit quietly and not interacting with any of the staff

ANS: 4

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. The client who avoids discussion of the problem may be using denial as an ego-defense mechanism. The client who acts like another colleague on the job is using identification as an ego-defense mechanism. The client who experiences headaches and stomach aches is using the ego-defense mechanism of conversion.

DIF: A REF: 488 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

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?

1.

Alarm reaction

2.

Resistance stage

3.

Exhaustion stage

4.

Reflex pain response

ANS: 3

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. During the alarm reaction, rising hormone levels result in increased blood volume, epinephrine and norepinephrine amounts, heart rate, blood flow to muscles, oxygen intake, and mental alertness. During the resistance stage, the body stabilizes. Reflex pain response is not a stage of GAS.

DIF: A REF: 487 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

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?

1.

Spiritual indicator

2.

Emotional indicator

3.

Intellectual indicator

4.

Sociocultural indicator

ANS: 4

The client who recently experienced a loss and does not want to meet new people is an example of a sociocultural indicator of stress. Spiritual indicator is not an example of a spiritual indicator of stress. The client is not restless or verbalizing discontent with a higher being. Emotional indicator is not an example of an emotional indicator of stress. The client is not displaying anger or crying. Intellectual indicator is not an example of an intellectual indicator of stress.

DIF: A REF: 490 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

11. A corporate executive works 60 to 80 hours/week. The client 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?

1.

Guided imagery

2.

Regular exercise

3.

Time management

4.

Relaxation technique

ANS: 4

Relaxation technique is correct. Biofeedback is a training program designed to develop ones ability to control the autonomic (involuntary) nervous system. Clients learn to monitor their functioning such as heart rate, blood pressure, skin temperature, or muscle tension, and learn to relax in response in order to create desired changes. 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. Regular exercise is not an example of a regular exercise program. It does not improve muscle tone and reduce the risk of cardiovascular disease. Time management techniques include developing lists of tasks to be performed in order of priority. This is not an example of time management.

DIF: A REF: 497 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

12. It appears to the nurse the client is experiencing a crisis. The nurse plans to:

1.

Allow the client to work through independent problem-solving

2.

Complete an in-depth evaluation of stressors and responses

3.

Focus on immediate stress reduction

4.

Recommend ongoing therapy

ANS: 3

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

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

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

DIF: A REF: 498 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

13. What priority assessment area has been noticed by a nurse while working with clients who are experiencing a significant degree of stress?

1.

The clients primary physical needs

2.

What else is happening in the clients life

3.

How the stress has influenced the clients activities of daily living

4.

Determining whether the client is thinking about harming self or others

ANS: 4

A priority assessment is to determine if the person is suicidal or homicidal by asking directly. 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 self or others. 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. The nurse should first determine if the client is a danger to self or others. Then the nurse can examine the degree of disruption in the persons life, such as in activities of daily living.

DIF: A REF: 494 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

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

1.

Losses are more stress-provoking

2.

Anxiety disorders are most prevalent

3.

Psychosocial factors are the greatest threats

4.

Timing of stress-inducing events is not significant

ANS: 2

Anxiety disorders are the most prevalent disorders in later life and are continuations of life-long illnesses. 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. The effect of psychosocial factors on health status is not altered by age. 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 with a short period of time can result in detrimental effects on coping.

DIF: A REF: 491 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

15. A client who has experienced massive soft tissue trauma is handling both the physical and emotional stressors via the generalized adaptation syndrome (GAS). The major benefit of this defense mechanism is through the:

1.

Identification of foreign antigens on invading bacteria

2.

Production of endorphins that decrease awareness of pain

3.

Increased epinephrine, resulting in improved cardiac output

4.

Increased norepinephrine directed towards sustaining blood pressure

ANS: 2

Endorphins, hormones that act on the mind like morphine and opiates, produce a sense of well-being and reduce pain. It is the bodys immune system that recognizes antigens on the surface of the bacteria cells and thus identifies bacteria as invaders. During the alarm reaction stage of the GAS process, rising epinephrine and norepinephrine levels result in increased heart rate and blood flow.

DIF: A REF: 486-487 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

16. The nurse is caring for a client who was admitted with various physical traumas resulting from an assault by a stranger attempting to steal her purse. Which of the following statements made by the nurse is most therapeutic in assessing the degree of stress the event has caused the client?

1.

Would you like to talk about the attack?

2.

What may I do to help you emotionally?

3.

Has being attacked been traumatic for you?

4.

How has this experience affected your life?

ANS: 4

The vital question for a person in crisis is, What does this mean to you; how is it going to affect your life? What causes extreme stress for one person is not always stressful to another. The perception of the event, the situational supports, and the coping mechanisms all influence return of equilibrium or homeostasis. The other options are not as effective at opening up client-directed communication concerning the effects of the event.

DIF: C REF: 488 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

17. Which of the following clients shows the greatest risk factor for stress coping related to situational stressors?

1.

An 18-year-old high school athlete who breaks his leg just before college football tryouts

2.

A 75-year-old widow whose only son is severely injured in an automobile accident

3.

A 36-year-old who loses his job days after his marriage to his high school sweetheart

4.

A 60-year-old who is diagnosed with prostate cancer after deciding to retire from his job of 26 years

ANS: 2

The timing of stress-inducing events significantly influences older adults ability to cope. The fact that older adults have several stressful events (i.e., loss of a spouse and new medical diagnosis) occur within a short period of time often results in negative effects on coping ability. The remaining options reflect stressful situations but to lesser degrees.

DIF: C REF: 489 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

18. Which of the following client behaviors best reflects Neuman Systems Model of primary prevention? The client who:

1.

Swims daily to strengthen muscles weakened as a result of shoulder surgery

2.

Follows a low-fat diet in order to bring her high-density lipids to under 200 mg/dL

3.

Walks 1 mile daily to keep her blood pressure from rising higher than 130/70 mm Hg

4.

Attends a survivor support group after the loss of a spouse in an automobile accident

ANS: 3

According to Neumans theory, the goal of primary prevention is to promote client wellness by stress prevention and reduction of risk factors. Secondary prevention occurs after symptoms appear. At the tertiary level of prevention, the nurse supports rehabilitation processes involved in healing, moving the client back to wellness and the primary level of disease prevention.

DIF: C REF: 489 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

19. The son of a client diagnosed with moderately advanced Alzheimers disease shows concern over the care his mother will receive after making the decision to institutionalize her. Which of the following statements made by the admitting nurse is most therapeutic in addressing the sons concerns?

1.

We care deeply for all our clients and take great pride in the care and attention we give each one of them.

2.

Please feel free to talk to our staff and to the other clients about the care and attention we give to each of our clients.

3.

I hope that you will be able to visit your mother often and offer us suggestions on how best to meet her physical and emotional needs.

4.

I know it has been a difficult decision, and you must have concerns about leaving her, but rest assured we have her best interest at heart.

ANS: 3

The decision to institutionalize a family member and the aftermath of that decision cause emotional distress and are a threat to family members psychological well-being. When their role shifted from primary caregiver to advocate for the patient, the family members felt empowered. Previous studies showed that institutionalized residents have a better quality of life when family members are involved. By encouraging frequent visits and including them in the clients care, the familys concerns will be best managed.

DIF: C REF: 490 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

20. Which of the following statements reflects the correct interpretation of the effect of age on coping strategies?

1.

The young adult client generally handles stress more effectively than does the elder adult.

2.

Life provides the older adult with more opportunities to effectively manage their stressful events.

3.

Children appear to be less aware of stressors in their lives and so are less negatively affected by it.

4.

Stress is evident in everyones life and we all learn to cope with it regardless of our age or life experiences.

ANS: 4

There are very few age-related differences in coping strategies, and older adults are just as effective at coping as younger adults (Varcarolis and others, 2006).

DIF: A REF: 489 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

21. Which of the following client behaviors best reflects Neuman Systems Model of tertiary prevention? The client who:

1.

Swims daily to strengthen muscles weakened as a result of hip surgery

2.

Follows a low-fat diet in order to bring her high-density lipids to under 200 mg/dL

3.

Walks 1 mile daily to keep her blood pressure from rising higher than 130/70 mm Hg

4.

Attends a survivor support group after the loss of a spouse in an automobile accident

ANS: 1

According to Neumans theory, the goal of primary prevention is to promote client wellness by stress prevention and reduction of risk factors. Secondary prevention occurs after symptoms appear such as muscle strengthening post surgery. At the tertiary level of prevention, the nurse supports rehabilitation processes involved in healing, moving the client back to wellness and the primary level of disease prevention.

DIF: C REF: 494 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

22. The husband of a client with terminal cancer has expressed a high degree of stress over his role as caregiver. When asked whether he has suicidal or homicidal thoughts he answered, Sometimes. Which of the following nursing statements is most therapeutic initially?

1.

What is the hardest part about your wifes impending death?

2.

Can you describe your plan for killing yourself and your wife?

3.

What can I do to help make caring for your wife less stressful?

4.

Can you tell me how caring for your wife has affected you personally?

ANS: 2

If a client indicates suicidal or homicidal ideations, the nurse should first determine in a caring and concerned manner if the person has a plan and determine how lethal the means are. The remaining options represent appropriate questions but only after the safety issues have been addressed.

DIF: C REF: 497 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

23. Which of the following statements made by the nurse shows the best understanding of the therapeutic value of a support system for a client experiencing stress?

1.

They will be there when you need them and make sure you will have your needs met.

2.

They will provide you with someone to talk with about your problems and support your decisions.

3.

When you are experiencing stress, it is always comforting to have people who care about you nearby.

4.

These individuals have experienced what you are going though and can offer you effective suggestions.

ANS: 2

A support system of family, friends, and colleagues who will listen, offer advice, and provide emotional support benefits a client experiencing stress. The individuals need not have actually experienced the same stressors nor is it necessary or reasonable to expect that they will meet all your needs.

DIF: C REF: 486 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

MULTIPLE RESPONSE

1. The nurse recognizes that a client experiencing anxiety related to a traumatic injury and the resulting pain is likely to experience the fight or flight response, which would cause which of the following assessment findings? (Select all that apply.)

1.

Rectal temperature of 102.2 F

2.

Pulse Ox of 97% on room air

3.

Respirations of 30 breaths per minute

4.

Heart rate greater than 100 beats per minute

5.

Fasting glucose level of 118 mg/dL

6.

Systolic blood pressure 26 mm Hg above baseline

ANS: 3, 4, 5, 6

This reaction prepares a person for action by increasing heart rate; diverting blood from the intestines to the brain and striated muscles; and increasing blood pressure, respiratory rate, and blood sugar levels. Body temperature and oxygen saturation are not typically affected by fight or flight.

DIF: C REF: 487 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Psychosocial Integrity/Coping Mechanisms/Stress Management

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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