Chapter 10Stress, Coping, and Adaptation My Nursing Test Banks

Chapter 10Stress, Coping, and Adaptation

MULTIPLE CHOICE

1.A client tells the nurse that he feels stressed out. The nurse realizes which of the following regarding stress?

1.

Stress can be caused by a variety of situations.

2.

Stressors do not cause a need for change.

3.

Positive events do not increase stress.

4.

All events are regarded as threatening to self.

ANS: 1

Stress can be caused by both positive and negative situations. These situations produce changes in the individual. Not all situations (e.g., positive stress) are regarded as threatening to the self. A certain level of stress produces changes that are needed for growth and survival.

PTS: 1 DIF: Analyze REF: Stress Stimulus-Response Theory

2.A clients symptoms are consistent with those seen in the first stage of the general adaptation syndrome (GAS). Which of the following symptoms did the nurse most likely assess in this client?

1.

Mental exhaustion, cool skin, and decreased senses

2.

Elevation of blood pressure, dilated pupils, and tachycardia

3.

Hyperventilation, nausea, and vomiting

4.

Physical illness, hypertension, and shortness of breath

ANS: 2

The first stage of the GAS is characterized by elevated blood pressure, tachycardia, constriction of blood vessels, and diversion of blood from nonessential organs, increased muscle tone, increased blood sugar levels, dilated pupils, and increased alertness. Mental exhaustion, cool skin, decreased senses, hyperventilation, nausea, vomiting, hypertension, and shortness of breath occur in different stages of the general adaptation syndrome.

PTS: 1 DIF: Analyze REF: Table 10-1 Fight or Flight Responses to Stress

3.The nurse is concerned that a client is in the third stage of the general adaptation syndrome (GAS) when which of the following is assessed?

1.

Increased energy

2.

Fluid retention

3.

Prolonged stress

4.

Numbing effect

ANS: 4

A numbing effect is part of the third stage of GAS, the stage of exhaustion. Increased energy, fluid retention, and prolonged stress are part of the second stage of GAS.

PTS: 1 DIF: Analyze REF: Stress Stimulus-Response Theory

4.The nurse determines that a client is utilizing a maladaptive method to cope with a new illness. Which of the following is the client most likely demonstrating?

1.

Crying

2.

Exercising

3.

Reading

4.

Sleeping

ANS: 4

Maladaptive techniques include sleeping, withdrawal from social contacts, overeating, smoking, drug and alcohol abuse, and excessive involvement in any activity. Adaptive methods of coping include exercising, social support, reading, writing in a journal, crying, relaxation techniques, and meditation or prayer.

PTS: 1 DIF: Analyze REF: Coping

5.A client diagnosed with heart failure is experiencing feeling of helplessness and is uncertain about how her heart failure has been progressing. These feelings are referred to as:

1.

dysfunctional.

2.

dysphagia.

3.

dysrhythmia.

4.

dysthymia.

ANS: 4

Dysthymia is a low-level depression that can last at least 2 years and can lead to more severe depression. Dysphagia is difficulty in swallowing and/or speech. Dysrhythmia is an irregular heart rate and/or rhythm. Dysfunctional is to fail to function as normally expected.

PTS: 1 DIF: Analyze REF: Stress of Chronic Illness

6.A client tells the nurse that he believes he will learn to manage his illness and will continue to live a productive life. The nurse realizes that this clients positive self-esteem is evidence of:

1.

external locus of control.

2.

self-efficacy.

3.

pity.

4.

hopelessness.

ANS: 2

Effective coping is linked to positive self-esteem and perceived self-efficacy or an internal locus of control, which is defined as the mastery of difficult situations and the ability to actively control ones own destiny. Ineffective coping is associated with an external locus of control, pity, and feelings of hopelessness.

PTS: 1 DIF: Analyze REF: Life Changes and Illness Theory

7.A client tells the nurse that she uses herbal remedies to help control the symptoms of a chronic illness but does not want her physician to know. Which of the following should the nurse respond to this client?

1.

I would not tell my doctor either.

2.

Herbal remedies dont work anyway.

3.

Some herbal remedies could interact with prescribed medications. Be sure to let your doctor know what you are taking.

4.

Your doctor doesnt believe in herbal remedies so dont tell him.

ANS: 3

Many clients do not inform their health care providers about their use of alternative medicines. This could have a disastrous effect because of interactions between the herbal supplements and medications. The nurse should encourage the client to inform her physician of all herbal remedies she is taking. The other choices could cause the client harm and should not be done.

PTS: 1 DIF: Apply REF: Psychoneuroimmunoendocrinology

8.A client diagnosed with a terminal illness tells the nurse that he will do whatever it takes to work through the illness and be as healthy as he can. The nurse recognizes this clients inner strength is a characteristic of:

1.

emotion-focused coping.

2.

resilience.

3.

compliance.

4.

adherence.

ANS: 2

Resilience is a process that involves protective factors against stress, having an internal locus of control, having a personal responsibility in managing life, as is synonymous with inner strength. Emotion-focused coping includes the behaviors of avoidance, wishful thinking, and self-blame. Compliance and adherence are terms used to describe a client following a prescribed medical or treatment regime.

PTS: 1 DIF: Analyze REF: Resilience

9.The nurse is planning interventions for a client with a chronic illness who is experiencing stress. Which of the following would be appropriate for this client?

1.

Inform the client that others have the responsibility for addressing her stress.

2.

Inform the client about diet, exercise, and medications to help with her stress.

3.

Remind the client that keeping a journal is not a good use of time.

4.

Encourage the client to remain isolated until the stress passes.

ANS: 2

Interventions to assist a client with a chronic illness who is experiencing stress include informing the client she has the responsibility for addressing her stress; informing the client about diet, exercise, and medications to help with her stress; encouraging the client to keep a journal to monitor progress; and encouraging the client to seek social support and avoid isolation.

PTS:1DIF:Apply

REF: Nursing Strategy: Patient Education for Managing Stress of Severe Chronic Disease

10.A client from a non-English-speaking culture refuses to accept one prescribed treatment for an acute illness. Which of the following should the nurse do to support this clients refusal of care?

1.

Suggest the client be discharged since care is being refused.

2.

Talk with the client about the treatment and why it is not being accepted.

3.

Ask the physician to prescribe an equally effective treatment so that the client may agree.

4.

Transfer the client to another care area.

ANS: 2

The client from a non-English-speaking culture could have cultural limitations on the prescribed treatment. The best approach would be for the nurse to talk with the client about the treatment to find out why it is not being accepted. Discharging or transferring the client would not meet the clients health care or cultural needs. Asking the physician to prescribe a different treatment also does not meet the clients cultural needs.

PTS:1DIF:ApplyREF:Cultural Factors

11.The family of a client in the critical care unit are complaining about the care their family member is receiving. Which of the following can the nurse do to reduce the familys stress?

1.

Inform the family about procedures and address their concerns.

2.

Encourage the family to not visit as frequently.

3.

Explain why the monitor volume is high and why it is necessary for the nurses to hear.

4.

Suggest they discuss their issues with the nursing supervisor.

ANS: 1

Clients in the critical care area are subjected to environmental stressors. The best intervention would be for the nurse to inform the family about procedures and address the familys concerns. The family should not be encouraged to reduce visits. The nurse should adjust the volume on the monitor to reduce environmental stimuli. The nurse should address the familys issues and not delegate this conversation to the nursing supervisor.

PTS:1DIF:Apply

REF: Nursing Strategy: Reducing Environmental Stress for Critically Ill Patients and Their Families

12.The nurse is feeling overworked, tired, and irritable. Which of the following should the nurse do to combat these feelings of burnout?

1.

Take a weekend off and party with friends to blow off steam.

2.

Spend one entire day in bed.

3.

Have a drink and social cigarette with friends.

4.

Exercise regularly, eat a well-balanced diet, and get adequate sleep.

ANS: 4

The nurse who is experiencing burnout needs to apply self-care principles to her own life. These would include exercise, well-balanced diet, and adequate sleep. Partying with friends, staying in bed, drinking, and smoking are not appropriate self-care principles and may not help with the feelings of burnout.

PTS:1DIF:ApplyREF:Occupational Stress

13.The nurse, working as a case manager, is designing a program to help clients meet their health promotion needs. Which of the following activities would be appropriate to include in this program?

1.

Ways to cut down on medication costs

2.

Reasons to limit visits to the primary care provider

3.

Provide education to support a healthy lifestyle

4.

Why the physician should be contacted with issues related to client nonadherence

ANS: 3

The role of the nurse case manager includes providing education to support a healthy lifestyle. The nurse case manager would not provide a client with ways to reduce medication costs, reasons to limit visits to the primary care provider, nor inform a client as to why a physician would be notified with issues related to client nonadherence.

PTS: 1 DIF: Apply REF: Box 10-4 Roles of the Nurse Case Manager

MULTIPLE RESPONSE

1.The nurse is determining in which stage a client is experiencing the biological effects of the general adaptation syndrome (GAS). This syndrome includes which three stages? (Select all that apply.)

1.

Resistance stage

2.

Exhaustion stage

3.

Paralyzing stage

4.

Alarm reaction stage

5.

Anxiety stage

6.

Possum response

ANS: 1, 2, 4

The three stages of GAS are the alarm reaction stage, the stage of resistance, and the exhaustion stage. Anxiety is a symptom of stage one, and a paralyzing effect is a part of stage three. The possum response is an activity that can occur during the exhaustion stage of the syndrome.

PTS: 1 DIF: Apply REF: Table 10-1 Fight or Flight Responses to Stress

2.A client is utilizing a problem-focused approach to cope with a new illness. Which of the following behaviors is this client most likely demonstrating? (Select all that apply.)

1.

Taking direct action to solve a problem

2.

Avoiding

3.

Identifying personal strengths

4.

Wishful thinking

5.

Accepting support when needed

6.

Self-blame

ANS: 1, 3, 5

Problem-focused coping is identified as taking direct action to solve a problem, identifying personal strengths, and accepting support when needed. Avoiding, wishful thinking, and self-blame are emotional-focused coping behaviors.

PTS: 1 DIF: Analyze REF: Coping

3.A client tells the nurse that as long as he is alive, he is going to hope that his chronic illness will improve. The nurse recognizes that this client is demonstrating which of the following qualities? (Select all that apply.)

1.

Future-oriented goals

2.

Despair

3.

Determining strategies

4.

Helplessness

5.

Being in control

6.

Confusion

ANS: 1, 3, 5

Hope is the ability to cherish a desire with an expectation of fulfillment. Hope is future-oriented and allows the person to set goals, devise strategies to achieve those goals, and have a sense of being in control. Despair, helplessness, and confusion are not qualities of hope.

PTS: 1 DIF: Analyze REF: Hope

4.The nurse suspects a client is experiencing acute stress disorder when which of the following symptoms are assessed? (Select all that apply.)

1.

Sense of detachment

2.

Internal locus of control

3.

Depersonalization

4.

Setting goals

5.

Inability to cope

6.

Hoping for a positive outcome

ANS: 1, 3, 5

The following are symptoms associated with acute stress disorder: a sense of detachment or reduced awareness of surroundings; depersonalization or feelings of unreality, alienation, or amnesia; and the inability to cope effectively. Internal locus of control, setting goals, and hoping for a positive outcome are responses to positively cope with stress.

PTS:1DIF:AnalyzeREF:Acute Stress Disorder

5.A client diagnosed with post-traumatic stress disorder is demonstrating signs of increased arousal. Which of the following did the nurse most likely assess in this client?

1.

Sleep disturbance

2.

Crying

3.

Irritability

4.

Angry outbursts

5.

Exaggerated startle response

6.

Sleeping

ANS: 1, 3, 4, 5

Signs of increased arousal include sleep disturbances, irritability, angry outbursts, difficulty concentrating, hypervigilance, and exaggerated startle response. Crying and sleeping are not signs of increased arousal.

PTS: 1 DIF: Apply REF: Table 10-2 Post-Traumatic Stress Disorder (PTSD)

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