Test Bank: Psychiatric Mental Health Nursing 7th edition Townsend 978-0803627673

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  • Test Bank: Psychiatric Mental Health Nursing 7th edition Townsend 978-0803627673
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  • Published: 2011
  • ISBN-13: 978-0803627673
  • ISBN-10: 080362767X
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Test Bank: Psychiatric Mental Health Nursing 7th edition Townsend 978-0803627673

Chapter 1: The Concept of Stress Adaptation

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Miller and Rahe Recent Life Changes Questionnaire. How should the nurse evaluate this client data?

A. The client is experiencing severe distress and is at risk for physical and psychological illness.
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness.
C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports.
D. The client may view these losses as challenges and perceive them as opportunities.

____ 2. A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: “Perhaps this was the best thing to happen. Maybe I’ll look into pursuing an art degree.” How should the nurse characterize the client’s appraisal of the job loss stressor?

A. Irrelevant
B. Harm/loss
C. Threatening
D. Challenging

____ 3. Which client statement should alert a nurse that a client may be responding maladaptively to stress?

A. “I’ve found that avoiding contact with others helps me cope.”
B. “I really enjoy journaling; it’s my private time.”
C. “I signed up for a yoga class this week.”
D. “I made an appointment to meet with a therapist.”

____ 4. A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs which stage of stress is the student most likely experiencing?

A. Alarm reaction stage
B. Stage of resistance
C. Stage of exhaustion
D. Fight-or-flight stage

____ 5. A school nurse is assessing a female high school student who is overly concerned about her appearance. The client’s mother states, “That’s not something to be stressed about!” Which is the most appropriate nursing response?

A. “Teenagers! They don’t know a thing about real stress.”
B. “Stress occurs only when there is a loss.”
C. “When you are in poor physical condition, you can’t experience psychological well-being.”
D. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”

____ 6. A bright student confides in the school nurse about conflicts related to attending college, or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time?

A. Meditation
B. Problem-solving training
C. Relaxation
D. Journaling

____ 7. An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?

A. Encourage the student to use the alternative coping mechanism of relaxation exercises.
B. Complete the problem-solving process for the client.
C. Work through the problem-solving process with the client.
D. Encourage the client to keep a journal.

____ 8. A school nurse is assessing a distraught female high school student who is overly concerned because her parents can’t afford horseback riding lessons. How should the nurse interpret the student’s reaction to her perceived problem?

A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.

____ 9. Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess?

A. An achieved state of relaxation
B. An achieved insight into one’s feelings
C. A demonstration of appropriate role behaviors
D. An enhanced ability to problem solve

____ 10. A distraught, single, first-time mother cries and says to a nurse, “How can I go to work if I can’t afford childcare!” What is the nurse’s initial action in assisting the client with the problem-solving process?

A. Determine the risks and benefits for each alternative
B. Formulate goals for resolution of the problem
C. Evaluate the outcome of the implemented alternative
D. Assess the facts of the situation

____ 11. A nursing instructor is teaching about diseases of adaptation and when they are likely to occur. When questioned about situations that precipitate these diseases, which student statement indicates that learning has occurred?

A. “When an individual has limited experience dealing with stress”
B. “When an individual inherits maladaptive genes”
C. “When an individual experiences existing conditions that exacerbate stress”
D. “When an individual’s physiological and psychological resources have become depleted”

____ 12. When an individual’s stress response is sustained over a long period of time, which physiological effect of the endocrine system should a nurse anticipate?

A. Decreased resistance to disease
B. Increased libido
C. Decreased blood pressure
D. Increased inflammatory response

____ 13. Which symptom should a nurse identify as typical of the “fight-or-flight” response?

A. Pupil constriction
B. Increased heart rate
C. Increased salivation
D. Increased peristalsis

____ 14. A nurse is evaluating a client’s response to stress. What would indicate to the nurse that the client is experiencing a secondary appraisal of the stressful event?

A. When the individual judges the event to be benign
B. When the individual judges the event to be irrelevant
C. When the individual judges the resources and skills needed to deal with the event
D. When the individual judges the event to be pleasurable

____ 15. Research undertaken by Miller and Rahe in 1997 demonstrated a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool?

A. Specific illnesses are not identified.
B. Individual coping abilities are not assessed.
C. Stress is viewed as only a physiological response.
D. Personal perception of the event is excluded.

____ 16. A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is the most appropriate nursing response?

A. “Genetics have nothing to do with your temperament.”
B. “How you reacted to past experiences influences how you feel now.”
C. “If you’re in good health physically, your stress level will be low.”
D. “Stress can always be avoided if appropriate coping mechanisms are employed.”

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 17. A nurse is interviewing a distressed client who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the client’s appraisal of the situation? (Select all that apply.)

A. “What resources have you used previously in stressful situations?”
B. “Have you ever experienced a similar stressful situation?”
C. “Who do you think is to blame for this situation?”
D. “Why do you think you were fired from your job?”
E. “What skills do you possess that might lead to gainful employment?”

____ 18. A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful when assisting the client in coping with stress? (Select all that apply.)

A. “Enjoy a pet.”
B. “Spend time with a loved one.”
C. “Listen to music.”
D. “Focus on the stressors.”
E. “Journal your feelings.”

Chapter 1: The Concept of Stress Adaptation

Answer Section

MULTIPLE CHOICE

1.ANS:C

The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500 or more, indicates high stress in a client’s life. However, positive coping mechanisms and strong social support can limit susceptibility to stress-related illnesses.

PTS:1REF:6

KEY:Cognitive Level: Application | Integrated Process: Evaluation

2.ANS:D

The client perceives the situation of job loss as a challenge and an opportunity for growth.

PTS:1REF:7

KEY:Cognitive Level: Application | Integrated Process: Assessment

3.ANS:A

Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learning appropriate coping skills and can prevent access to needed support systems.

PTS:1REF:8

KEY:Cognitive Level: Application | Integrated Process: Evaluation

4.ANS:C

At the stage of exhaustion, the student’s exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage.

PTS:1REF:4

KEY:Cognitive Level: Application | Integrated Process: Assessment

5.ANS:D

Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change.

PTS:1REF:2

KEY:Cognitive Level: Application | Integrated Process: Implementation

6.ANS:B

The student must assess his situation and determine the best course of action. Problem-solving training, by providing structure and objectivity, can assist in his decision making.

PTS:1REF:8-9

KEY:Cognitive Level: Application | Integrated Process: Implementation

7.ANS:C

During times of high anxiety and stress, clients will need more assistance in problem solving and decision making.

PTS:1REF:8-9

KEY:Cognitive Level: Application | Integrated Process: Implementation

8.ANS:B

Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation or event. Self-image is particularly important to adolescents who feel entitled to have all the advantages that other adolescents experience.

PTS:1REF:7

KEY:Cognitive Level: Application | Integrated Process: Evaluation

9.ANS:A

Meditation produces relaxation by creating a special state of consciousness through focused concentration.

PTS:1REF:8

KEY:Cognitive Level: Application | Integrated Process: Evaluation

10.ANS:D

Before any other steps can be taken, accurate information about the situation must be gathered and assessed.

PTS:1REF:9

KEY:Cognitive Level: Application | Integrated Process: Implementation

11.ANS:D

During the stage of exhaustion of the general adaptation syndrome, the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is the time when diseases of adaptation may occur.

PTS:1REF:4

KEY:Cognitive Level: Application | Integrated Process: Evaluation

12.ANS:A

In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion, at which time diseases of adaptation occur. A decreased immune response is seen at this stage.

PTS:1REF:5

KEY:Cognitive Level: Application | Integrated Process: Assessment

13.ANS:B

During the “fight-or-flight” response, the heart rate increases in response to the release of epinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slows unessential functions.

PTS:1REF:3

KEY:Cognitive Level: Comprehension | Integrated Process: Assessment

14.ANS:C

When the individual judges the resources and skills needed to deal with the event, the individual is conducting a secondary appraisal. There are three types of primary appraisals: irrelevant, benign-positive, and stressful.

PTS:1REF:7

KEY:Cognitive Level: Application | Integrated Process: Evaluation

15.ANS:D

Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration.

PTS:1REF:6

KEY:Cognitive Level: Application | Integrated Process: Evaluation

16.ANS:B

Past experiences are occurrences that result in learned patterns that can influence an individual’s current adaptation response. They include previous exposure to the stressor or other stressors in general, learned coping responses, and degree of adaptation to previous stressors.

PTS:1REF:7

KEY:Cognitive Level: Application | Integrated Process: Implementation

MULTIPLE RESPONSE

17.ANS:A, B, E

These questions specifically address the client’s coping resources and encourage the client to apply learning from past experiences. These questions also encourage the client to consider alternative methods for dealing with stress. Asking who is to blame does not assess coping abilities but, rather, encourages maladaptive behavior. Requesting an explanation is a nontherapeutic block to communication.

PTS:1REF:7

KEY:Cognitive Level: Application | Integrated Process: Assessment

18.ANS:A, B, C, E

Focusing on the stressors is more likely to increase stress in the client’s life. However, pets, healthy relationships, music, and, journaling feelings, and  have all been shown to decrease amounts of stress.

PTS:1REF:8-9

KEY:Cognitive Level: Application | Integrated Process: Implementation

Test Bank: Psychiatric Mental Health Nursing 7th edition Townsend 978-0803627673