Chapter 55: Psychologic Responses to Illness Nursing School Test Banks

Chapter 55: Psychologic Responses to Illness
Linton: Introduction to Medical-Surgical Nursing, 6th Edition

MULTIPLE CHOICE

1. How should a nurse describe a patient who has a functional interaction of the cognitive, affective, behavioral, and social dimensions of his personality?
a. Effectively organized
b. Personally satisfied
c. Well rounded
d. Mentally healthy
ANS: D
Mental health depends on the functional integration of the four dimensions of the personality.

DIF: Cognitive Level: Comprehension REF: p. 1272 OBJ: 1
TOP: Definition of Mental Health KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

2. A nurse assesses that a 42-year-old patient lives with her parents and is dependent on them for decisions about her life. Which mental health characteristic is this patient lacking?
a. Reality orientation
b. Autonomous behavior
c. Spontaneity
d. Ethical decision making
ANS: B
Autonomy is a mark of mental health.

DIF: Cognitive Level: Comprehension REF: p. 1273 OBJ: 1
TOP: Definition of Mental Health KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

3. What is an example of a positive stressor?
a. Test anxiety
b. Loss of a job
c. Paying income tax
d. Single motherhood
ANS: A
Test anxiety can be beneficial to promote study and sharpen focus.

DIF: Cognitive Level: Knowledge REF: p. 1273 OBJ: 2
TOP: Stress KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

4. Which action is an example of a person attempting to maintain homeostasis as a newcomer in a community?
a. Joins a local church
b. Buys a new car
c. Stays in his or her apartment watching television
d. Spends hours writing e-mail messages to old friends
ANS: A
The newcomer who attempts to balance the newcomer status with belonging is an example of homeostasis.

DIF: Cognitive Level: Comprehension REF: p. 1274 OBJ: 2
TOP: Homeostasis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

5. Which behavior best exemplifies developmental activities in a 13-year-old teenager?
a. Going out with a group of friends
b. Reading an exciting book
c. Volunteering for the local hospital
d. Choosing a career
ANS: A
Interacting in peer relationships is a major developmental task of this age group.

DIF: Cognitive Level: Comprehension REF: p. 1274 OBJ: 3
TOP: Growth and Development KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

6. In which stage is introspection a major characteristic?
a. Middle-aged adult
b. Middle childhood
c. Early adulthood
d. Older-age adult
ANS: D
Introspection is properly identified as an activity of older age.

DIF: Cognitive Level: Knowledge REF: p. 1274 OBJ: 3
TOP: Growth and Development KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

7. A nurse hears a 5-year-old patient who just started kindergarten use rude vocabulary. What is the best response to this behavior?
a. Ignore it.
b. Speak to his teacher about it.
c. Praise him when he speaks properly.
d. Talk about it at the parentteachers association.
ANS: C
Learned behaviors can be unlearned with rewards for the desired behavior.

DIF: Cognitive Level: Application REF: p. 1274 OBJ: 3
TOP: Behavioral Theory KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

8. Which patient is most likely to experience the greatest cultural impact on his coping with a chronic debilitating illness?
a. A 26-year-old Latino man with a family
b. A 30-year-old divorced white man with no dependents
c. A 35-year-old Asian wife with a family
d. A 65-year-old widowed black church pastor with married children
ANS: A
The Latino man will have to deal with the loss of his culturally expected role as the head of the household.

DIF: Cognitive Level: Analysis REF: p. 1275 OBJ: 3
TOP: Coping with Illness KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

9. A patient with low back pain confesses that he drinks heavily each night to help him sleep and control pain. What does this behavior exemplify?
a. Alternate pain control methods
b. Coping with a chronic condition
c. Using a social coping mechanism
d. Using a maladaptive coping method
ANS: D
This behavior is an example of maladaptive coping. Drinking is not an appropriate means of coping with chronic pain.

DIF: Cognitive Level: Application REF: p. 1277-1278
OBJ: 6 TOP: Coping with Illness KEY: Nursing Process Step: N/A
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

10. What do a preschoolers experiences in kindergarten help the child to adapt to?
a. Sexual identity
b. Interpersonal conflicts
c. Independent decision making
d. Self-direction
ANS: B
Preschoolers adapt to interpersonal conflicts as they experience the broader world.

DIF: Cognitive Level: Comprehension REF: p. 1274 OBJ: 3
TOP: Preschooler KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

11. What information should a nurse provide to a Native American patient taking herbal remedies and nutritional supplements?
a. Herbs and vitamins are not helpful.
b. If herbs and vitamins are not harmful, then they will be integrated into the plan of care.
c. Medical research has shown that such alternative remedies are a waste of money.
d. In the hospital, no physician will prescribe anything other than accepted medical protocols.
ANS: B
Care planning for individuals with different cultural beliefs requires respect and individualization.

DIF: Cognitive Level: Application REF: p. 1275 OBJ: 7
TOP: Cultural Beliefs KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. When a patient is given a diagnosis of cancer, his first statement is, What did I ever do to deserve God punishing me? What does this exemplify?
a. Maladaptive coping
b. Behavioral emotionalism
c. Spiritual distress
d. Spiritual maladaptation
ANS: C
This is a response to spiritual distress. The patient is questioning the meaning of illness and suffering.

DIF: Cognitive Level: Comprehension REF: p. 1276 OBJ: 5
TOP: Spirituality KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

13. A star quarterback on the high school football team is injured in a motorcycle accident. He will be unable to play football again. Which nursing diagnosis is most appropriate when planning care specific to coping?
a. Impaired physical mobility
b. Situational low self-esteem
c. Impaired social interaction
d. Impaired comfort
ANS: B
Athletes who sustain injuries can have low self-esteem related to their altered body image.

DIF: Cognitive Level: Application REF: p. 1276 OBJ: 7
TOP: Self-Concept KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

14. A wife of a critically injured husband has been at his bedside constantly for 2 days. As the nurse speaks to the wife, the wife sobs, This is awful. I cant take it anymore. What is the wife experiencing?
a. Fear
b. Denial
c. Compensation
d. Stress
ANS: D
Long-term stress causes fatigue and an inability to solve problems.

DIF: Cognitive Level: Application REF: p. 1276-1278
OBJ: 5 TOP: Emotions: Stress
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

15. How does fear differ from anxiety?
a. Fear is a useless emotion.
b. Fear is an ineffective coping strategy.
c. Fear is an irrational feeling.
d. Fear is a response to a specific threat.
ANS: D
Fear is a response to a specific threat (e.g., a rattlesnake in the garden); anxiety is a response to a nonspecific threat (e.g., first day on a new job).

DIF: Cognitive Level: Comprehension REF: p. 1277 OBJ: 5
TOP: Emotions: Anxiety and Fear KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

16. An older Italian woman has an egg yolk in a bowl under her bed that she believes is absorbing the evil of her illness and making her feel better. Which action should a nurse implement?
a. Move the egg yolk out of the way to the bathroom.
b. Replace the egg yolk with a hard-boiled egg.
c. Remove the egg for sanitary purposes.
d. Include maintenance of the egg in the nursing care plan.
ANS: D
A nursing approach should help with coping, not increase the stress.

DIF: Cognitive Level: Application REF: p. 1275 OBJ: 5
TOP: Cultural Concepts KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

17. When a 25-year-old woman who had a hysterectomy 1 day earlier tearfully tells the nurse that she is grieving for the children she will never have, the nurse assesses the grief as positive. What does grief allow this patient to achieve?
a. Focus on her loss.
b. Forget about her concern.
c. Reappraise her values for the future.
d. Depend on others for grief support.
ANS: C
Grief and mourning signify an end to something. After the mourning, the patient is free to reappraise values for the future.

DIF: Cognitive Level: Comprehension REF: p. 1277 OBJ: 4
TOP: Perceived Loss and Grief KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

18. A 5-year-old patient was in an accident in which his cousin was killed. The patient starts to wet the bed at night. What question should the nurse ask the mother when she confirms that it has been several years since the patient had any difficulty with bedwetting?
a. Do you think this is related to the accident?
b. Do others in the family have this problem?
c. Does your child drink lots of fluids late at night?
d. Are there any stressful situations in your family?
ANS: A
Anxiety is the root of such defense mechanisms as regression. This behavior is an example of regression, in which the 5-year-old child has gone back to behavior more suited to a younger developmental age.

DIF: Cognitive Level: Application REF: p. 1278 OBJ: 4
TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

19. A 24-year-old man scheduled for brain surgery in the morning constantly listens to music with his headphones on. What should a nurse recognize this behavior as?
a. Conversion reaction
b. Conscious coping strategy
c. Defense mechanism of undoing
d. Reaction formation
ANS: B
The use of a conscious coping strategy can help decrease stress.

DIF: Cognitive Level: Comprehension REF: p. 1278-1279
OBJ: 6 TOP: Conscious Coping Strategies
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

20. When a patient is asked whether he wants his pain medication, he says to you, I dont know; whatever you think is best. What should the nurse recognize this maladaptive coping mechanism as?
a. Powerlessness
b. Helplessness
c. Denial
d. Depression
ANS: A
The patient feels that he has lost control of his situation and has started to defer decisions about his care to others.

DIF: Cognitive Level: Application REF: p. 1279 OBJ: 6
TOP: Maladaptive Coping Mechanisms KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

21. Which patient diagnosis and behavior should lead a nurse to conclude the patient is using the defense mechanism of denial?
a. A patient with emphysema continues to smoke.
b. A patient with diabetes mellitus uses a sugar substitute.
c. A patient with a drug problem blames his mother for his habit.
d. A patient with osteoarthritis angrily kicks the steps that he cannot climb.
ANS: A
The patient with emphysema is an example of denial, the patient with diabetes is an example of an adaptive response, the patient with a drug problem is an example of projection, and the patient with osteoarthritis is an example of regression.

DIF: Cognitive Level: Comprehension REF: p. 1278 OBJ: 6
TOP: Maladaptive Coping KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

22. What is the goal of nursing care for the patient with a chronic illness?
a. Find the cause of the illness.
b. Tell the patient that he or she will learn to live with the illness.
c. Help the patient manage the illness.
d. Give the patient websites that have information about the illness.
ANS: C
The goal of caring for patients with a chronic illness is to help them manage the illness and to develop coping skills.

DIF: Cognitive Level: Comprehension REF: p. 1274 OBJ: 7
TOP: Nursing Goals KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

23. What nursing action should be implemented when dealing with a patient who is an alcoholic in denial and claims to only drink in social situations?
a. Insist that he stop drinking entirely.
b. Point out that the patient is using denial.
c. Help the patient investigate ways to reduce drinking.
d. Provide information on Alcoholics Anonymous.
ANS: C
In dealing with patients in denial, the nurse may have to accept the denial while still getting cooperation.

DIF: Cognitive Level: Application REF: p. 1278 OBJ: 4
TOP: Denial KEY: Nursing Process Step: Planning
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

MULTIPLE RESPONSE

24. What factors are known to influence coping strategies? (Select all that apply.)
a. Age
b. Financial status
c. Role expectations
d. Personal values
e. Cultural expectations
ANS: A, C, D, E
Financial status is not a basic part of building coping strategies. All the other options, however, play integral parts in the patients ability to cope or design new coping strategies or both.

DIF: Cognitive Level: Knowledge REF: p. 1274 OBJ: 6
TOP: Coping Strategies KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

25. What should a nurse evaluate to assess the social dimension of a patients persona? (Select all that apply.)
a. Interaction with family
b. Formulation of thoughts
c. Presentation of self to community
d. Problem solving
e. Processing of information
ANS: A, C
Interacting with family and presenting oneself to the community are elements of the social component. The other options belong to the element of the cognitive component.

DIF: Cognitive Level: Application REF: p. 1272 OBJ: 1
TOP: Aspects of Personality KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

26. What are characteristics of a healthy person according to Maslow? (Select all that apply.)
a. Acceptance of self
b. Reality orientation
c. Spontaneity
d. Effective problem-solving skills
e. No need for privacy
ANS: A, B, C, D
Mentally healthy people require some element of privacy. All other options are characteristics of self-actualization.

DIF: Cognitive Level: Knowledge REF: p. 1273 OBJ: 1
TOP: Characteristics of Mental Health KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

COMPLETION

27. A student nurse who was terrified of giving an injection now gives many injections every shift. The change in the nurse is the result of _____.

ANS:
adaptation
Adaptation refers to a persons efforts to respond to stressors in such a way as to overcome the stress.

DIF: Cognitive Level: Comprehension REF: p. 1273 OBJ: 2
TOP: Adaptation KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

28. A nurse recognizes that mild stress can be a positive force that stimulates the patient to _____ a problem.

ANS:
solve
Mild stress can cause a person to focus and be able to solve a problem.

DIF: Cognitive Level: Comprehension REF: p. 1273 OBJ: 2
TOP: Mild Stress KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

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