Chapter 6 Nursing School Test Banks

 

1.

A nurse is meeting with a young woman who has recently lost her job after moving with her husband to a new city. She describes herself as being anxious and pretty depressed. What principle of stress and adaptation should be integrated into the nurses plan of care for this patient?

A)

Adaptation often fails during stressful events and results in homeostasis.

B)

Stress is a part of all lives, and, eventually, this young woman will adapt.

C)

Acute anxiety and depression can be adaptations that alleviate stress in some individuals.

D)

An accumulation of stressors can disrupt homeostasis and result in disease.

Ans:

D

Feedback:

Four conceptsconstancy, homeostasis, stress, and adaptationare key to the understanding of steady state. Homeostasis is maintained through emotional, neurologic, and hormonal measures; stressors create pressure for adaptation. Sometimes too many stressors disrupt homeostasis, and, if adaptation fails, the result is disease. If a person is overwhelmed by stress, he or she may never adapt. Acute anxiety and depression are frequently associated with stress.

2.

You are the nurse caring for an adult patient who has just received a diagnosis of prostate cancer. The patient states that he will never be able to cope with this situation. How should you best understand the concept of coping when attempting to meet this patients needs?

A)

Coping is a physiologic measure used to deal with change, and he will physically adapt.

B)

Coping is composed of the physiologic and psychological processes that people use to adapt to change.

C)

Coping is the human need for faith and hope, both of which create change.

D)

Coping is a social strategy that is used to deal with change and loss.

Ans:

B

Feedback:

Indicators of stress and the stress response include both subjective and objective measures. They are psychological, physiologic, or behavioral and reflect social behaviors and thought processes. The physiologic and psychological processes that people use to adapt to stress are the essence of the coping process. Coping is both a physiologic and psychological process used to adapt to change. Coping is a personal process used to adapt to change.

3.

The nurse is with a patient who has learned that he has glioblastoma multiforme, a brain tumor associated with an exceptionally poor prognosis. His heart rate increases, his eyes dilate, and his blood pressure increases. The nurse recognizes these changes as being attributable to what response?

A)

Part of the limbic system response

B)

Sympathetic nervous response

C)

Hypothalamic-pituitary response

D)

Local adaptation syndrome

Ans:

B

Feedback:

The sympathetic nervous system responds rapidly to stress; norepinephrine is released at nerve ending causing the organs to respond (i.e., heart rate increases, eyes dilate, and blood pressure increases). The limbic system is a mediator of emotions and behavior that are critical to survival during times of stress. The hypothalamic-pituitary response regulates the cortisol-induced metabolic effect that results in elevated blood sugars during stressful situations. Local adaptation syndrome is a tissue-specific inflammatory reaction.

4.

You are the nurse caring for a 72-year-old woman who is recovering from a hemicolectomy on the postsurgical unit. The surgery was very stressful and prolonged, and you note on the chart that her blood sugars are elevated, yet diabetes does not appear in her previous medical history. To what do you attribute this elevation in blood sugars?

A)

It is a temporary result of increased secretion of antidiuretic hormone.

B)

She must have had diabetes prior to surgery that was undiagnosed.

C)

She has suffered pancreatic trauma during her abdominal surgery.

D)

The blood sugars are probably a result of the fight-or-flight reaction.

Ans:

D

Feedback:

During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to glucose; the result is elevated blood sugars. Antidiuretic hormone is released during stressful situations and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Assuming the patient had diabetes prior to surgery demonstrates a lack of understanding of stress-induced hyperglycemia. No evidence presented in the question other than elevated blood sugars would support a diagnosis of diabetes.

5.

A patient tells the nurse that she does not like to go to the doctor and is feeling anxious about being in this place. When the nurse checks her blood pressure, it is elevated along with her heart rate. The nurse rechecks her blood pressure about 10 minutes later and it is normal. The patient asks the nurse if she should be concerned that she may have hypertension. What statement should guide the nurses response?

A)

She should not worry; it was stress related and her regular blood pressure is good.

B)

The first blood pressure was part of a simple stress response; our long-term blood pressure is controlled by negative feedback systems.

C)

Blood pressure is only one measure of hypertension; she should review this with the doctor and plan to recheck it on a regular basis.

D)

The respiratory infection is the probably the cause of the elevated blood pressure, and, with treatment, her blood pressure should remain normal.

Ans:

B

Feedback:

A simple stress response will temporarily elevate a blood pressure and heart rate. Long-term blood pressure response is controlled by negative feedback systems.

For a science teacher, this would be an appropriate level of teaching/learning and would serve to promote health. The nurse would be incorrect in assuming the patients blood pressure is good based on only two blood pressure readings. The stress of a respiratory infection could account for the elevated blood pressure, but assuring the patient that, with treatment, her blood pressure will return to normal may not be true.

6.

A patient presents to the health center and the nurse practitioners assessment reveals an enlarged thyroid. The nurse practitioner believes the thyroid cells may be undergoing hyperplasia. How would the nurse practitioner explain this condition to the patient?

A)

Hyperplasia is the abnormal decrease in cell and organ size and is a precursor to cancer.

B)

Hyperplasia is an abnormal increase in new cells and is reversible with the stimulus for cell growth removed.

C)

Hyperplasia is the change in appearance of the thyroid due to a chronic irritation and will reverse with the stimulus removed.

D)

Hyperplasia is a cancerous growth and will be removed surgically.

Ans:

B

Feedback:

Hyperplasia is an increase in the number of new cells in an organ or tissue. This is due to increased mitotic stimulation from the additional cell division, and this, in turn, enlarges the tissue. Hyperplasia is reversible when the stimulus for cell growth is removed. Hyperplasia is the increase in the number of new cells, not a change in size or appearance. Hyperplasia is the increase in the number of new cells, which may or may not be cancerous growth.

7.

A mother has brought her young son to the emergency department (ED). The mother tells the triage nurse that the boy was stung by a bee about an hour ago. The mother explains to the nurse, It hurts him so bad and it looks swollen, red, and infected. What can the triage nurse teach the mother?

A)

The pain, redness, and swelling are part of the inflammatory process, but it is probably too early for an infection.

B)

Bee stings frequently cause infection, pain, and swelling, and, with treatment, the infection should begin to subside late today.

C)

The infection was probably caused by the stinger, which may still be in the wound.

D)

The mothers assessment is accurate and the ED doctor will probably prescribe antibiotics to fix the problem.

Ans:

A

Feedback:

Cells or tissues of the body may be injured or killed by any agent (physical, chemical, infectious). When this happens, an inflammatory response (or inflammation) naturally occurs in the healthy tissues adjacent to the injury site. Inflammation is not the same as infection. An infectious agent is only one of several agents that may trigger an inflammatory response. Although bee stings may cause infection, the signs and symptoms (very painful, looks swollen and red) result from the acute inflammatory response. If the stinger were still in the wound, it would only be creating inflammation, not infection. Antibiotics are not indicated.

8.

You are caring for an older female patient who is being treated for acute anxiety. She has a nursing diagnosis of Ineffective Coping related to a feeling of helplessness. What would be the most appropriate nursing intervention?

A)

Put the primary onus for planning care on the patient herself.

B)

Assess and provide constructive outlets for anger and hostility.

C)

Assess the patients sources of social support.

D)

Encourage an attitude of realistic hope to help her deal with helpless feelings.

Ans:

D

Feedback:

By encouraging an attitude of realistic hope, the patient will be empowered. This allows the patient to explore her feelings and bring about more effective coping patterns. The onus for care planning should not lie with the patient. The nursing diagnosis is related to feeling of helplessness, not anger and hostility. Social support is necessary, but does not directly address the feeling of helplessness.

9.

A 35-year-old woman comes to the local health center with a large mass in her right breast. She has felt the lump for about a year, but was afraid to come to the clinic because she was sure it was cancer. What is the most appropriate nursing diagnosis for this patient?

A)

Self-esteem disturbance related to late diagnosis

B)

Ineffective individual coping related to reluctance to seek care

C)

Altered family process related to inability to obtain treatment

D)

Ineffective denial related to reluctance to seek care

Ans:

B

Feedback:

Ineffective individual coping is the inability to assess our own stressors and then make choices to access appropriate resources. In this case, the patient was unable to access health care even when she was aware the disorder could be life-threatening. Self-esteem Disturbance, Altered Family Process, and Ineffective Denial are all nursing diagnoses that are often associated with breast cancer, but the patients ineffective individual coping has created a significant safety risk and is, therefore, the most appropriate nursing diagnosis.

10.

The nurse at the student health center is seeing a group of students who are interested in reducing their stress level. The nurse identifies guided imagery as an appropriate intervention. What will be included in the nurses intervention?

A)

The use of progressive tensing and relaxing of muscles to release tension in each muscle group

B)

Using a positive self-image to increase and intensify physical exercise, which decreases stress

C)

The mindful use of a word, phrase, or visual, which allows oneself to be distracted and temporarily escape from stressful situations

D)

The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations

Ans:

C

Feedback:

Guided imagery is the mindful use of a word, phrase, or visual image to distract oneself from distressing situations or consciously taking time to relax or reenergize. Guided imagery does not involve muscle relaxation, positive self-image, or humor.

11.

The nurse is assessing a patient and finds two enlarged supraclavicular lymph nodes. The nurse asks the patient how long these nodes have noticeably enlarged. The patient states, I cant remember. A long time I think. Do I have cancer? Which of the following is an immediate physiologic response to stress the nurse would expect this patient to experience?

A)

Vasodilation of peripheral blood vessels

B)

Increased blood pressure

C)

Decrease in blood glucose levels

D)

Pupil constriction

Ans:

B

Feedback:

An initial response to stress, as seen by the fight-or-flight response, is an increase in the patients heart rate and blood pressure. Vasoconstriction leads to the increase in blood pressure. Blood glucose levels increase, supplying more readily available energy, and pupils dilate.

12.

Your patient tells you that he has just been told that his computed tomography results were abnormal. You can expect that his sympathetic nervous system has stimulated his adrenal gland to release what?

A)

Endorphins

B)

Dopamine

C)

Epinephrine

D)

Testosterone

Ans:

C

Feedback:

In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous system stimulates the adrenal gland to release epinephrine and norepinephrine.

13.

You walk into your patients room and find her sobbing uncontrollably. When you ask what the problem is, your patient responds, I am so scared. I have never known anyone who goes into a hospital and comes out alive. On this patients care plan you note a pre-existing nursing diagnosis of Ineffective Coping related to stress. What is the best outcome you can expect for this patient?

A)

Patient will adopt coping mechanisms to reduce stress.

B)

Patient will be stress free for the duration of treatment.

C)

Patient will avoid all stressful situations.

D)

Patient will be treated with an antianxiety agent.

Ans:

A

Feedback:

Stress management is directed toward reducing and controlling stress and improving coping. The outcome for this diagnosis is that the patient needs to adopt coping mechanisms that are effective for dealing with stress, such as relaxation techniques. The other options are incorrect because it is unrealistic to expect a patient to be stress free; avoiding stressful situations and starting an antianxiety agent are not the best answers as outcomes for ineffective coping.

14.

The nurse is assessing a patient and learns that the patient and his wife were married just 3 weeks earlier. Which of the following statements should underlie the nurses care planning for this patient?

A)

The patient and spouse should seek counseling to ease their transition.

B)

The patient will have better coping skills being in a stable relationship.

C)

Happy events do not normally cause stress.

D)

Marriage causes transition, which has the potential to cause stress.

Ans:

D

Feedback:

Transition can contribute to stress, even if the transition is a positive change. The third group of stressors has been studied most extensively and concerns relatively infrequent situations that directly affect people. This category includes the influence of life events such as death, birth, marriage, divorce, and retirement. Counseling is not necessarily indicated.

15.

The nurse is assessing a newly admitted patient who is an 84-year-old woman. The nurse learns that the patient has simultaneously experienced a hip fracture and the exacerbation of her chronic heart failure. What is an example of a bodily function that restores homeostasis by negative feedback when conditions shift out of normal range?

A)

Body temperature

B)

Pupil dilation

C)

Diuresis

D)

Blood clotting

Ans:

A

Feedback:

Negative feedback mechanisms throughout the body monitor the internal environment and restore homeostasis when conditions shift out of normal range. Body temperature, blood pressure, and acid-base balances are examples of functions regulated by these compensatory mechanisms. Blood clotting in the body involves positive feedback mechanisms. Pupil dilation and diuresis are not modulated by negative feedback mechanisms.

16.

A patient who has a 40 pack-year history of smoking may have dysplasia of the epithelial cells in her bronchi. What would the nurse tell the patient about dysplastic cells in the bronchi?

A)

This is a benign process that occurs as lung tissue regenerates.

B)

Dysplastic cells have a high potential to become malignant.

C)

This process involves a rapid increase in number of cells.

D)

Dysplasia may cause uncontrolled growth of scar tissue.

Ans:

B

Feedback:

Dysplasia is bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same tissue type. Dysplastic cells have a tendency to become malignant; dysplasia is seen commonly in epithelial cells in the bronchi of people who smoke. This may not be a harmless condition and dysplasia does not cause scar tissue. Hyperplasia is an increase in the number of new cells.

17.

A teenage boy who was the victim of a near drowning has been admitted to the emergency department. The patient was submerged for several minutes and remains unconscious. What pathophysiological process has occurred as a result of the submersion?

A)

Atrophy of brain cells

B)

Cellular lysis

C)

Hypoxia to the brain

D)

Necrosis to the brain

Ans:

C

Feedback:

The length of time different tissues can survive without oxygen varies. The brain will become hypoxic in 3 to 6 minutes. The other options are incorrect because submersion injuries do not cause atrophy to brain cells right away; submersion injuries also do not cause cellular lysis or necrosis to the brain.

18.

Your older adult patient has been diagnosed with urosepsis and has a temperature of 103.4F. You should be aware that the oxygen demands of the patients body would change in which direction and why?

A)

Increase due to an increase in metabolism

B)

Decrease due to a decrease in metabolism

C)

Increase due to a decrease in metabolism

D)

Decrease due to an increase in metabolism

Ans:

A

Feedback:

When a persons temperature is elevated, hypermetabolism occurs, and the respiratory rate, heart rate, and basal metabolic rate increase. The other options are incorrect because oxygen demands would not decrease and they would not increase due to a decrease in metabolism.

19.

You are admitting a patient who presents with inflammation of his right ankle. When planning this patients care, which of the following statements regarding acute inflammation should you recognize?

A)

Inflammation is essentially synonymous with infection.

B)

Inflammation may impair the healing process.

C)

Inflammation is a defensive reaction intended to remove an offending agent.

D)

Inflammation inhibits the release of histamines in the tissues.

Ans:

C

Feedback:

Inflammation is a defensive reaction intended to remove an offending agent and prepare the site for repair. Inflammation is not the same as infection, it does not impair the healing process, and it does not inhibit the release of histamines in the tissues.

20.

An elderly man tells you that his wife died 14 months ago and that he cannot stop grieving over his loss. What should you encourage the patient to consider?

A)

Improve his nutritional intake.

B)

Make an appointment at a wellness clinic.

C)

Walk on a daily basis.

D)

Increase his interaction with his social network.

Ans:

D

Feedback:

Social networks can reduce stress by providing the individual with a positive social identity, emotional support, material aide, information, and new social contacts. Changes to diet and activity may be beneficial, but social interaction is known to be of particular benefit. Attendance at a wellness clinic may or may not be beneficial, and does not involve social interaction.

21.

You are caring for a 65-year-old widower whose wife died 4 months ago. He tells you that he is not doing well and that his friends and family seem hesitant to talk with him about his wife. What could the nurse do to help the patient?

A)

Refer him to a consciousness-raising group.

B)

Refer him to a psychiatrist.

C)

Refer him to a support group.

D)

Refer him to a church or temple.

Ans:

C

Feedback:

Being a member of a group with similar problems or goals has a releasing effect on a person that promotes freedom of expression and exchange of ideas. Psychiatry may or may not be necessary. Spiritual assessment would necessarily precede any referral to a specific religious setting. Consciousness-raising groups are not known to be a common source of social support.

22.

A 44-year-old woman will undergo a bilateral mastectomy later today and the nurse in surgical admitting has begun the process of patient education. What positive outcome of providing the patient with information should the nurse expect?

A)

Increased concentration

B)

Decreased depression levels

C)

Sharing of personal details

D)

Building interdependent relationships

Ans:

A

Feedback:

Giving patients information also reduces the emotional response so that they can concentrate and solve problems more effectively. Educating the patient does not decrease depression levels or build interpersonal relationships. Educating the patient does not mean sharing of personal details.

23.

You are the nurse caring for a 51-year-old man who has just been told in a family meeting that he has stage IV colon cancer. You expect that the patient now has an increase in blood pressure, heart rate and respiratory rate. You spend time talking with this patient and his vital signs become closer to normal range. To what would you attribute this phenomenon?

A)

Cortisol levels are decreasing.

B)

Endocrine activity has increased.

C)

The patient is adapting to noxious stressors.

D)

The sympathetic response has been activated.

Ans:

C

Feedback:

Selye developed a theory of adaptation to biologic stress that he named the general adaptation syndrome (GAS), which has three phases: alarm, resistance, and exhaustion. During the alarm phase, the sympathetic fight-or-flight response is activated with release of catecholamines and the onset of the adrenocorticotropic hormone (ACTH) adrenal cortical response. The alarm reaction is defensive and anti-inflammatory but self-limited. Because living in a continuous state of alarm would result in death, people move into the second stage, resistance. During the resistance stage, adaptation to the noxious stressor occurs, and cortisol activity is still increased. If exposure to the stressor is prolonged, the third stage, exhaustion, occurs. During the exhaustion stage, endocrine activity increases, and this has negative effects on the body systems (especially the circulatory, digestive, and immune systems) that can lead to death.

24.

While talking with the parents of conjoined twins who are medically unstable, you note that the father of the babies has an aggressive stance, is speaking in a loud voice, and makes several hostile statements such as, Id sure like to have words with that doctor who told us our babies would be okay. You know that this fathers cognitive appraisal has led to what?

A)

Harm/loss feelings

B)

Feelings of challenge

C)

A positive adjustment to the possible loss of his children

D)

The development of negative emotions

Ans:

D

Feedback:

The appraisal process contributes to the development of an emotion. Negative emotions, such as fear and anger, accompany harm/loss appraisals, and positive emotions accompany challenge. Harm and challenge are not feelings, so the corresponding options are incorrect. There is nothing in the scenario that indicates that the father is making a positive adjustment to the possible loss of his children.

25.

The nurse is caring for a patient who was widowed 2 years prior to this current hospitalization, her fifth since the death of her husband. The woman says to the nurse, The doctor says my blood pressure is dangerously high. What is making my blood pressure so high? What does the nurse know about the probable cause of this patients hypertension?

A)

Prolonged or unrelenting suffering can cause physical illness.

B)

Physical illness is always caused by prolonged stress.

C)

The elderly are at increased risk for hypertension due to stress.

D)

Stress always exacerbates the physiologic processes of the elderly.

Ans:

A

Feedback:

When a person endures prolonged or unrelenting suffering, the outcome is frequently the development of a stress-related illness. Physical illness is not always caused by prolonged stress. The elderly population is not the only population at increased risk for hypertension due to stress. Stress does not always exacerbate the physiologic processes of the elderly. This is an absolute statement, and true absolutes are rare.

26.

You are the psychiatric-mental health nurse caring for a young, recently married woman, whose sister and niece were recently killed in a motor vehicle accident. This young woman is making arrangements for the funerals, and you know that your patient has insight into her current stressors. What do you know is occurring with this young woman?

A)

The mediating process is occurring.

B)

The patient is experiencing an expected level of denial.

C)

The patients awareness of her stress makes it more acute.

D)

The patient is emotionally overwhelmed.

Ans:

A

Feedback:

After recognizing a stressor, a person consciously or unconsciously reacts to manage the situation. This is termed the mediating process. Nothing in the scenario indicates the patient is either in denial or feeling overwhelmed. Awareness of stress does not necessarily exacerbate it.

27.

As an occupational health nurse at a large industrial plant, you are planning the return to work of an employee who was exposed to a chemical spill. To what type of stressor has this patient been exposed?

A)

Physiologic

B)

Psychosocial

C)

Physical

D)

Psychiatric

Ans:

C

Feedback:

Physical stressors include cold, heat, and chemical agents; physiologic stressors include pain and fatigue. A chemical spill is neither a psychiatric nor a psychosocial phenomenon.

28.

You are caring for a patient in the urgent care center who presented with complaints of lethargy, malaise, aching, weakness, and loss of appetite. During the assessment, you note an area on the patients right posterior calf that is warm to touch, edematous, and tender to touch. You know the most probable cause of this patients symptoms is what?

A)

Local inflammatory response

B)

Systemic shock response

C)

Local infectious response

D)

Systemic inflammatory response

Ans:

D

Feedback:

The inflammatory response is often confined to the site, causing only local signs and symptoms. However, systemic responses can also occur. During this process, general, nonspecific symptoms develop, including malaise, loss of appetite, aching, and weakness. The fact that the patient is experiencing systemic effects such as lethargy, malaise, aching, weakness, and loss of appetite suggests that inflammation is not limited to one specific site.

29.

You are discharging a 4-year-old boy from the emergency department. The boy was seen for an insect bite that became swollen and reddened and warm and painful to touch. The patients vital signs are all within normal range for age. While giving discharge instructions to the patients father, he asks why the child is not going to get antibiotics for the infected insect bite. What would be your best response?

A)

This is a local inflammatory response to the insect bite; it is not an infection so antibiotics will not help.

B)

In children who are previously healthy, inflammation and infections usually resolve without the need for drugs.

C)

Ill make sure the doctor is made aware that youd like your son to have a course of antibiotics.

D)

Infection is not the same as inflammation. What your son has is inflammation.

Ans:

A

Feedback:

Regardless of the cause, a general sequence of events occurs in the local inflammatory response. This sequence involves changes in the microcirculation, including vasodilation, increased vascular permeability, and leukocytic cellular infiltration. As these changes take place, five cardinal signs of inflammation are produced: redness, heat, swelling, pain, and loss of function. Infections do not always resolve spontaneously. The nurse should teach the patients father about the reasons that antibiotics are unnecessary rather than simply deferring to the physician.

30.

A group of nursing students are applying the concept of steady state to the nursing care plan of a patient who is undergoing chemotherapy and radiotherapy for the treatment of lung cancer. What would be the most complete statement by the students about the concept of steady state?

A)

The concept of steady state preserves life.

B)

The mechanisms of steady state work to maintain balance in the body.

C)

This concept compensates for biologic and environmental attacks on the body.

D)

Steady state is the same as adaptation.

Ans:

B

Feedback:

Mechanisms for adjusting internal conditions promote the normal steady state of the organism and its survival. These mechanisms are compensatory in nature and work to restore balance in the body. Adaptation is a part of the concept of steady state; it is not the concept itself.

31.

A nursing student has presented a concept map of a medical patients health that demonstrates the maintenance of a steady state. The student has elaborated on the relationship of individual cells to compensatory mechanisms. When do compensatory mechanisms occur in the human body?

A)

According to a diurnal cycle

B)

When needed

C)

Continuously

D)

Sporadically

Ans:

C

Feedback:

The concept of the cell as existing on a continuum of function and structure includes the relationship of the cell to compensatory mechanisms, which occur continuously in the body to maintain the steady state.

32.

A nurse is planning the care of a woman who has been admitted to the medical unit following an ischemic cerebrovascular accident. What would the nurse recognize as the longest-acting phase of the womans physiologic response to stress and its cause?

A)

Sympathetic-adrenal-medullary response caused by persistent stress

B)

Hypothalamic-pituitary response caused by acute stress

C)

Sympathetic-adrenal-medullary response caused by acute stress

D)

Hypothalamic-pituitary response caused by persistent stress

Ans:

D

Feedback:

The longest-acting phase of the physiologic response, which is more likely to occur in persistent stress, involves the hypothalamic-pituitary pathway, not the sympathetic-adrenal-medullary pathway.

33.

Selyes general adaptation syndrome (GAS) is a theory of adaption to biologic stress. Selye compared the GAS with the life process: childhood, adulthood, and later years. What would occur during adulthood in the GAS?

A)

Stressful events occur and resistance or adaption occurs.

B)

Successful avoidance of stressful life events leaves the body vulnerable.

C)

The accumulation of lifes stressors causes resistance to fall.

D)

Vulnerability leads to eventual death.

Ans:

A

Feedback:

Selye compared the general adaptation syndrome with the life process. During childhood, too few encounters with stress occur to promote the development of adaptive functioning, and children are vulnerable. During adulthood, a number of stressful events occur, and people develop resistance or adaptation. During the later years, the accumulation of lifes stressors and wear and tear on the organism again decrease peoples ability to adapt, so resistance falls, and, eventually, death occurs. Based on this comparison, options B, C, and D are incorrect.

34.

You are auditing the electronic health record of a 33-year-old patient who was treated for a postpartum hemorrhage. When reviewing the patients records, you can see various demonstrations of negative feedback loops. Which of the following constitute negative feedback loops? Select all that apply.

A)

Serum glucose levels

B)

Acid-base balance

C)

Temperature

D)

Blood clotting

E)

Labor onset

Ans:

A, B, C

Feedback:

These mechanisms work by sensing deviations from a predetermined set point or range of adaptability and triggering a response aimed at offsetting the deviation. Blood pressure, acidbase balance, blood glucose level, body temperature, and fluid and electrolyte balance are examples of functions regulated through such compensatory mechanisms. Coagulation and labor onset are results of positive feedback loops.

35.

A group of nurses are planning the care of an older adult who is being rehabilitated following a stroke. A nurse notes that hypertension and cardiovascular disease could have occurred over time if the patient previously experienced a state of chronic arousal. In a state of chronic arousal, what can happen within the body?

A)

Blood pressure decreases.

B)

Serum glucose levels drop.

C)

Arteriosclerosis may develop.

D)

Tissue necrosis may occur.

Ans:

C

Feedback:

If the sympathetic-adrenal-medullary response is prolonged or excessive, a state of chronic arousal develops that may lead to high (not low) blood pressure, arteriosclerotic changes, and cardiovascular disease. If the production of ACTH is prolonged or excessive, behavior patterns of withdrawal and depression are seen. In addition, the immune response is decreased, and infections and tumors may develop.

36.

A group of nurses are attending an educational inservice on adaptive and maladaptive responses to stress. When talking about the assessment of coping strategies in patients, the nurses discuss the use of drugs and alcohol to reduce stress. What is most important for the nurses to know about these coping behaviors?

A)

They are effective, but alternative, coping behaviors.

B)

They do not directly influence stress in the body.

C)

They are adaptive behaviors.

D)

They increase the risk of illness.

Ans:

D

Feedback:

Coping processes that include the use of alcohol or drugs to reduce stress increase the risk of illness. The use of drugs and alcohol as a means to reduce stress are not effective coping behaviors. They are maladaptive behaviors, even though they have a short-term effect on stress.

37.

You are assessing an older adult patient post-myocardial infarction. You attempt to identify your patients health patterns and to assess if these health patterns are achieving the patients goals. How should you best respond if it is found that the patients health patterns are not achieving their goals?

A)

Seek ways to promote balance in the patient.

B)

Refer the patient to social work.

C)

Identify alternative models of health care.

D)

Provide insight into the patients physiological failings.

Ans:

A

Feedback:

The nurse has a significant role and responsibility in identifying the health patterns of the patient receiving care. If those patterns are not achieving physiologic, psychological, and social balance, the nurse is obligated, with the assistance and agreement of the patient, to seek ways to promote balance. The nurse is not obligated to refer to social work, identify alternative forms of care, or provide insight into the physiologic failings of the system if the patients health patterns are not achieving their goals.

38.

A patient is experiencing intense stress during his current hospital admission for the exacerbation of chronic obstructive pulmonary disease (COPD). Which of the patients actions best demonstrates adaptively coping?

A)

Becoming controlling

B)

Reprioritizing needs and roles

C)

Using benzodiazepines as ordered

D)

Withdrawing

Ans:

B

Feedback:

Adaptive ways of coping included seeking information, reprioritizing needs and roles, lowering expectations, making compromises, comparing oneself to others, planning activities to conserve energy, taking things one step at a time, listening to ones body, and using self-talk for encouragement. Becoming controlling or withdrawing are not ways to cope adaptively. Benzodiazepines are sometimes indicated, but these are not considered to be an adaptive coping behavior.

39.

The nurse is performing discharge planning for a patient who has numerous chronic health problems. The nurse recognizes that lifestyle changes would likely benefit the patients health status. Which factor would the nurse identify as most important in determining health status?

A)

Gender

B)

Ethnicity

C)

Social class

D)

Interfamilial relationships

Ans:

C

Feedback:

The single most important factor for determining health status is social class and, within a social class, the research suggests that the major factor influencing health is level of education. This factor supersedes the importance of ethnicity, gender, or interfamilial relationships.

40.

The nurse is admitting a 51-year-old patient to the medical-surgical unit after a diagnosis of cellulitis of the calf. What factors does the nurse know impact the processes of inflammation, repair, and replacement? Select all that apply.

A)

Severity of the injury

B)

Social relationships

C)

Condition of the host

D)

Familial support

E)

Nature of the injury

Ans:

A, C, E

Feedback:

The condition of the host, the environment, and the nature and severity of the injury affect the processes of inflammation, repair, and replacement. The patients social relationships and familial support do not directly affect the processes of inflammation, repair, and replacement.

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