Deck 31: Stress and Coping

Question 1

Which hormone is one of the primary mediators of stress?

A)Glucagon
B)Cortisol
C)Serotonin
D)Somatostatin

Answer 1

Cortisol

Question 2

A nurse on the behavioral health unit is caring for a client diagnosed with depression who just lost a spouse in a motor vehicle crash.The client states to the nurse,"My wife would not have wanted to live if she were disabled." Based on this statement,which defense mechanism is the client using?

A)Identification
B)Denial
C)Intellectualization
D)Displacement

Answer 2

Intellectualization

Question 3

A client,who is experiencing anxiety,is trembling and complaining of dizziness and palpitations.The client is having a hard time following the nurse's instructions.Based on this data,which level of anxiety is the client likely experiencing?

A)Panic
B)Severe
C)Moderate
D)Mild

Answer 3

Severe

Question 4

The nurse is evaluating medication teaching for a client who recently started taking fluoxetine (Prozac)for anxiety.Which statement by the client indicates appropriate understanding of the information presented?

A)"My medication will take 1 week to become effective."
B)"My medication will take 4 weeks to become effective."
C)"My medication will become effective immediately after I start taking it."
D)"My medication will not begin to work for 12 weeks."

Question 5

The nurse is admitting a client suffering a panic attack to the behavioral health unit.Which clinical manifestations would indicate that the client's anxiety is at a panic level of severity? Select all that apply.

A)Inability to focus
B)Dilated pupils
C)Feelings of doom
D)Self-absorption
E)Rapid speech

Question 6

Which instruction by the nurse to a client prescribed diazepam (Valium)for anxiety and stress is appropriate?

A)"This medication will be good to take for a long time."
B)"Take this medication every time feelings of stress become overwhelming."
C)"This medication works best if taken with a meal."
D)"This medication is good to use for the short term only."

Question 7

A client states to the nurse that learning how to use the blood glucose machine will have to wait until holiday events are planned.Which cognitive indication of stress is the client demonstrating?

A)Problem solving
B)Suppression
C)Self-control
D)Cognitive structuring

Question 8

A client complains about the stress of having to work long hours and missing daily exercise routines.Which response by the nurse is appropriate?

A)"There are other ways to reduce stress,such as meditation."
B)"Exercise helps reduce the impact of stress on the body and would be a good thing."
C)"Drinking a small glass of wine each day does help reduce stress."
D)"Maybe exercising,with all of the work,would be too much for your body anyway."

Question 9

Which child would the nurse recognize as being at the highest risk of experiencing toxic stress?

A)A 15-year-old adolescent who is slightly overweight and didn't make the football team;he regularly gets teased for his weight at school.
B)A 2-week-old infant who was born at 31 weeks' gestation and has been in the neonatal intensive care unit (NICU)for the entire 2 weeks;the child's parents are at the hospital as often as possible.
C)A 12-year-old child whose father recently died and whose mother works three part-time jobs;this child is expected to care for two younger siblings after school.
D)A 4-year-old child who attends preschool or daycare each day while the parents work;the child displays signs of mild separation anxiety.

Question 10

Which is the priority nursing action when providing care to a client who demonstrates signs of escalating anxiety?

A)Isolate the client in a safe,quiet,and protective environment.
B)Leave the client alone in a room.
C)Provide a benzodiazepine.
D)Phone the physician.

Question 11

The nurse is instructing a client with an anxiety disorder on behavioral tools to help with coping.Which tools to help with coping should the nurse include in the teaching session? Select all that apply.

A)Relaxation techniques
B)Thought stopping
C)Journaling
D)Distraction
E)Practicing yoga

Question 12

Which assessment findings indicate to the nurse that a client is experiencing stress? Select all that apply.

A)Chewing on a fingernail
B)Checking cellular phone
C)Reading a magazine
D)Talking with others
E)Tapping foot

Question 13

Which intervention would help a client who is demonstrating stress about being hospitalized who is concerned about the needs of the children at home?

A)Ask the client if there is anything that is needed once discharged to home.
B)Ask the client if there is anyone who would be able to help with the family needs at home during recuperation.
C)Find out if the children can be sent to a grandparent's home until the client fully recovers.
D)Suggest the client be transferred to a long-term care facility to ensure a full recovery.

Question 14

The nurse is assessing a 68-year-old client who appears disheveled.At previous appointments,the client was well kept with good hygiene practices.Today,the client's clothes do not match,the client's hair is unkempt,and the client has intense body odor.The nurse is concerned about this change in self-care.When conducting the assessment,what is the primary factor the nurse should consider?

A)Whether the changes are due to a lack of understanding of technology
B)Whether the changes are due to stress or dementia
C)Whether the client is taking all medications as prescribed
D)Whether the client is living independently

Question 15

A client,who was recently laid off from work,is scheduled for a biopsy to evaluate a site for malignancy.When planning this client's care,which does the nurse include?

A)Reasons to delay the biopsy
B)Medicate around the clock for pain
C)Interventions to address anxiety
D)Social services to aid with financial planning

Question 16

A client is recently prescribed risperidone (Risperdal)by the healthcare provider.Which would be a priority nursing consideration for this client?

A)Assess blood pressure and heart rate.
B)Monitor for increased agitation.
C)Assess for drowsiness.
D)Monitor for neuroleptic malignant syndrome.

Question 17

A client worries every day about personal health and states,"I may not have enough medication if the weather takes a turn for the worse." This client is exhibiting a sign of which alteration in stress and coping?

A)Generalized anxiety disorder
B)Phobia
C)Obsessive-compulsive disorder
D)Panic disorder

Question 18

Occupation-specific stressors that are ongoing and unmanaged can lead to what extreme form of stress?

A)Distress
B)Eustress
C)Allostasis
D)Burnout

Question 19

After a mammogram,a client is told that she needs a fine needle aspirate of a breast mass.Which action by the client demonstrates engagement in a primary appraisal of the stressful situation?

A)Holding her breath while the nurse is talking
B)Sitting in the dressing room crying
C)Asking the nurse if she has cancer
D)Scheduling the procedure in 6 weeks,which is the earliest possible appointment

Question 20

Which intervention can the nurse implement independently when caring for a client with alterations in stress and coping?

A)Therapeutic communication
B)Cognitive-behavioral therapy
C)Psychotherapy
D)Administration of medications

Question 21

A nurse is caring for a client in crisis.While providing care it is imperative that the nurse communicate effectively with this client.Which is true when communicating with clients in crisis? Select all that apply.

A)Communication should be frequent.
B)Communication should be brief.
C)Communication should be simple.
D)Communication should be detailed.
E)Communication should be directive.

Question 22

A nurse is providing care to a woman who recently got married and would like to try to become pregnant.The woman has been on an antianxiety medication,paroxetine (Paxil),for the past year.The woman feels that she needs to continue receiving treatment for anxiety,especially if she gets pregnant.What information should the nurse provide regarding treatment options during pregnancy?

A)The woman should consider switching to a different SSRI such as fluoxetine (Prozac).
B)The woman should consider switching to cognitive-behavioral therapy (CBT)rather than medication.
C)The woman should consider stopping all medications immediately.
D)The woman should consider gradually decreasing medication until she finds out she is pregnant.

Question 23

Free-floating anxiety is often connected to what stimulus?

A)Elevators
B)Airplanes
C)No specific stimulus
D)Water

Question 24

A client with what level of anxiety would be most receptive to learning tools that would help the client recognize triggers?

A)Mild
B)Moderate
C)Severe
D)Panic

Question 25

Which nursing diagnosis would be a priority for a client who is experiencing a situational crisis?

A)Ineffective Coping
B)Ineffective Activity Planning
C)Readiness for Enhanced Communication
D)Chronic Low Self-Esteem

Question 26

A 72-year-old client presents to the clinic with complaints of restlessness,muscle tension,and increased perspiration.Her vital signs are P 112,R 23,BP 131/85,and T 97.8°F.The nurse recognizes these manifestations as signs and symptoms of moderate anxiety.However,the client reports that she does not feel anxious about anything and has never before been diagnosed with an anxiety disorder.What other factor must the nurse consider based on this client's age?

A)These manifestations could instead be related to a medical illness.
B)These manifestations could be related to an overdose of antianxiety medications.
C)These manifestations could indicate a change in the client's cognitive functioning.
D)These manifestations could be related to drug-drug interactions between selective serotonin reuptake inhibitors (SSRIs)and other medications.

Question 27

The nurse is discharging a client diagnosed with general anxiety disorder (GAD).The client is prescribed a selective serotonin reuptake inhibitor (SSRI).Which statement made by the client would indicate to the nurse a need for further education?

A)"This medicine could make me feel like I have the jitters."
B)"I may experience some nausea while on this medication."
C)"My doctor will start me off on a high dose and then decrease the dose."
D)"This medicine alters the levels of the neurotransmitter serotonin in the brain."

Question 28

The nurse is beginning crisis counseling with a client.What actions will the nurse use when counseling the client? Select all that apply.

A)Assist in coping with the problem.
B)Conduct follow-up assessments.
C)Boil down the problem.
D)Achieve rapport.
E)Assess physiologic status.

Question 29

The nurse is providing care to a client who is "in crisis." The client recently lost a job,was served with divorce papers,and has been sick with back-to-back colds for 1 month.Which nursing statement demonstrates understanding of the care of a client in crisis?

A)"Experiencing a crisis is never positive,so we must work to relieve your anxiety as soon as possible."
B)"People generally find it easier to work through a crisis if someone is working with them."
C)"Men often handle crisis better individually,whereas women do better with a counselor."
D)"Once you reach the crisis state,you may remain there for several months until you recover."

Question 30

A client tells a nurse that he believes he has an anxiety disorder because his mom and sister both have anxiety disorders.The nurse recognizes that the client believes in which theory related to the etiology of anxiety disorders?

A)Neurochemical theories
B)Neurobiological theories
C)Genetic theories
D)Humanistic theories

Question 31

What characteristic is essential for individuals to adapt to crisis in a positive way?

A)Security
B)Strength
C)Resilience
D)Independence

Question 32

After an assessment,the nurse determines that an older adolescent client is experiencing a maturational crisis because of which findings? Select all that apply.

A)Relationship with significant other ended
B)Inability to focus on school studies
C)Cannot sleep at night and skips classes
D)Recent death of a friend
E)Graduating from high school in 2 months

Question 33

The nurse is providing care to a client who is experiencing a crisis.Which statement by the client indicates that the goals of care have not been met?

A)"I came up with some ideas on how to cope when I am in this position."
B)"I feel like I am in control and can begin managing things now."
C)"I am not sure whom I am going to call when I start feeling like this again."
D)"I can deal with this,I am a strong person,and I have a lot of friends and family."

Question 34

The nurse needs to plan interventions to address a client's crisis.Which action by the nurse is appropriate?

A)Develop the plan prior to meeting with the client.
B)Conduct a complete assessment.
C)Determine follow-up.
D)Focus on long-term problems.

Question 35

A client states to the nurse,"I experience shortness of breath and dizziness every time I get into an elevator." Which actions by the nurse are appropriate based on this data? Select all that apply.

A)Assist the client to rethink the degree of anxiety associated with elevators.
B)Ask the client how he has survived in life so far with elevators.
C)Instruct the client in deep breathing exercises.
D)Suggest that the client should avoid elevators.
E)Tell the client that elevators are completely safe.

Question 36

A client who has just experienced a crisis is likely to present to the emergency department with which clinical manifestation?

A)Depression
B)Disorientation
C)Fatigue
D)Sleeplessness

Question 37

Which of these is an accurate description of a crisis?

A)An acute event that is detrimental
B)A chronic event that is intermittent
C)A chronic event that is consistent and ongoing
D)An acute event that will resolve

Question 38

A nurse on the behavioral health unit is leading a group regarding risk factors for anxiety.At the completion of group work,which comment made by a client would indicate the need for further teaching?

A)"A lack of social interaction places me at risk for anxiety."
B)"My personality could place me at risk for anxiety because I am shy."
C)"Chronic illness is not a risk factor unless I am also unemployed."
D)"I experienced a traumatic event that placed me at risk for having this anxiety disorder."

Question 39

A client states,"I haven't left my house for 6 years." Based on this data,which diagnosis does the nurse anticipate for this client?

A)Hematophobia
B)Social anxiety disorder
C)Pathophobia
D)Agoraphobia

Question 40

A clinic nurse is assessing a client who is experiencing crisis.The nurse needs to determine the client's immediate needs.Which is the priority action by the nurse?

A)Scan for physical distress.
B)Explore perceptions of the crisis.
C)Develop a follow-up plan.
D)Assess for immediate safety needs.

Question 41

A nurse is evaluating the plan of care for a client diagnosed with obsessive-compulsive disorder (OCD).Which client statement indicates a positive outcome for the plan of care?

A)"Instead of washing my hands several times a day I use hand sanitizer several times a day."
B)"I am still hand washing frequently,and even though it is less than before I am a failure."
C)"I am still hand washing frequently but it is less often than before.I think I am improving."
D)"I don't know why I can't wash my hands several times a day;I have nothing else to do anyway."

Question 42

A malfunction in what system is thought to contribute to the development of obsessive-compulsive disorder?

A)Frontal-subcortical circuit
B)Hypothalamic-pituitary-adrenal axis
C)Cortico-striato-thalamo-cortical circuit
D)Microbiome-gut-brain axis

Question 43

A pregnant woman has just been informed that her baby will be born with spina bifida.The woman begins to cry,stating "Why is this happening to me? I can't take care of a baby with a disability.I can't afford to pay for all the treatments the baby will need.What am I going to do?" What is the best response by the nurse?

A)"If you calm down,we can talk about it.It's not as bad as it sounds."
B)"The first step is to learn more about what to expect.Let me help you."
C)"I know this is overwhelming,but everything will work out OK."
D)"Your love for your baby will outweigh all of the difficulties."

Question 44

Which finding would indicate that treatment for a client with obsessive-compulsive disorder is effective?

A)The client watches television while eating meals and engages in conversation with a roommate.
B)The client conducts ritualistic hand washing every hour.
C)While walking,the client counts 13 steps and then reverses the direction and repeats the process.
D)The client folds and refolds clothing in a drawer before each meal.

Question 45

A client is prescribed fluoxetine (Prozac)for treatment of obsessive-compulsive disorder.During the latest office visit,the client washes the hands while counting to 10 and repeats the process every 5 minutes.Which is the priority assessment for the nurse to complete for this client?

A)The amount of medication the client is taking
B)Side effects from the medication the client is experiencing
C)Whether the client is taking the medication as prescribed
D)Foods that may be interacting with the client's medication

Question 46

The home care nurse observes a client scrubbing areas throughout the house over and over,especially areas where the family gathers.Prior to planning care for this client,which must the nurse assess?

A)If the client is forgetful
B)If the client does not clean thoroughly
C)How frequently the client cleans the house
D)The impact of symptoms on the family system

Question 47

A 68-year-old female client was recently diagnosed with depression and subclinical obsessive-compulsive symptoms.What does the nurse need to consider when planning care for this client?

A)This client will not need treatment for the OCD symptoms because they are subclinical.
B)This client may take longer to meet goals than a younger client with similar symptoms.
C)This client will need to be assessed frequently for signs of dementia.
D)This client may need a higher dose of medication than a younger client.

Question 48

The nurse is concerned that a client is demonstrating signs of obsessive-compulsive disorder.Which clinical manifestations and risk factors identified during the nursing assessment caused the nurse's concern? Select all that apply.

A)Not making eye contact with the nurse
B)Female age 25
C)Client checking the contents of a purse several times within minutes
D)Client repeating the words "third floor"
E)Client asking to use the bathroom in the middle of the assessment

Question 49

For a client with obsessive-compulsive disorder with contamination obsessions,what nursing assessment is essential to development of an effective client care plan?

A)Assessment for skin integrity
B)Assessment for sexual activity
C)Assessment for tics
D)Assessment for religious beliefs

Question 50

A nurse is providing discharge instructions to a client recently diagnosed with obsessive-compulsive disorder (OCD)and prescribed fluvoxamine (Luvox).Which statement made by the client indicates to the nurse that the client understands the instructions?

A)"I am glad the physician chose this medication because it does not have any side effects."
B)"I should continue taking this medication and in 1-2 years I can stop taking it."
C)"I should continue taking this medication and in 1-2 years my physician may taper me off gradually."
D)"Even though I don't think this medication is for my OCD,I will take it because the physician wants me to."

Question 51

The nurse is part of a disaster response team caring for individuals after a metro bus collided with a building.What must the nurse consider when assessing the emotional state of each individual?

A)The individual's previous healthcare experiences will make them more open to sharing emotions.
B)The individual's race or ethnicity will be a predictor of their resiliency.
C)The individual's emotional state is not as important as their physical injuries.
D)The individual's culture will influence their expression of emotions.

Question 52

The mother of a 12-year-old child with obsessive-compulsive disorder (OCD)tells the nurse that the child tends to get angry and throw a fit when the parents prevent him from performing compulsions in public.She tells the nurse that they don't have this problem at home because they just let him perform his rituals.The mother asks the nurse why he has these.What is the best response by the nurse?

A)"It would be best if you don't take your child out in public until he can learn to control himself."
B)"Rage attacks by children with OCD are often made worse if the parents accommodate the OCD behaviors."
C)"The best way to prevent the rage attacks is to reinforce the OCD behaviors,especially when in public."
D)"When he has rage attacks,you need to discipline him immediately and remove him from the area."

Question 53

A mother says to the nurse,"I think my teenage son is showing signs of obsessive-compulsive disorder,just like his father." Which risk factors in the client's medical history would support this diagnosis? Select all that apply.

A)Lives with parents
B)Male gender
C)Unemployed
D)History of chronic illnesses
E)Family history

Question 54

What important fact should the nurse relay to the young adult who was just diagnosed with obsessive-compulsive disorder?

A)Not acting on compulsions is the best cure.
B)Treatment is essential to remission.
C)Recognizing the obsessions as false will lessen their impact.
D)The disorder will gradually get better over time.

Question 55

A client diagnosed with obsessive-compulsive disorder (OCD)is being admitted as an inpatient.The client is obsessed with thoughts of symmetry.Which compulsive behaviors does the nurse anticipate when performing the admission assessment? Select all that apply.

A)The client repeatedly washes his hands.
B)The client repeatedly taps both wrists on the bedside table.
C)The client avoids shaking the nurse's hand
D)The client begins counting the floor tiles.
E)The client repeatedly cleans the top of the bedside table.

Question 56

The nurse is providing care to a client who is diagnosed with obsessive-compulsive disorder.Which nursing intervention is most appropriate when providing care to this client?

A)Confront the client and ask what purpose the behavior serves.
B)Tell the client that the behavior is unacceptable and must end.
C)Interrupt the ritualistic behavior when observed.
D)Discuss the need to incorporate the behavior with other hospital routines.

Question 57

When caring for a client newly diagnosed with obsessive-compulsive disorder,which action by the nurse is appropriate?

A)Do not interrupt the ritual.
B)Interrupt the ritual.
C)Teach about antianxiety foods.
D)Teach ritual interruption skills.