Deck 31: Stress and Coping

Question 1

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

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

Answer 1

Chewing on a finger nail
Tapping foot

Question 2

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 syndrome.

Answer 2

Monitor for neuroleptic syndrome.

Question 3

Which intervention would help a client who is demonstrating stress about being hospitalized and 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.

Answer 3

Ask the client if there is anyone who would be able to help with the family needs at home during recuperation.

Question 4

The nurse suspects that a healthy client could be experiencing stress because of which laboratory result?

A) Serum sodium of 142 mEq/L
B) Serum glucose of 165 mg/dL
C) Serum potassium of 4.0 mEq/L
D) Serum calcium of 10.2 mEq/L

Question 5

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) Reading self-help literature
B) Thought stopping
C) Journaling
D) Distraction
E) Practicing yoga

Question 6

Which is the priority nursing action when providing care to a client who demonstrate 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 7

A nurse on the behavioral health unit is caring for a client diagnosed with depression,who just lost a spouse in a motor-vehicle accident.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

Question 8

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 9

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) Structuring

Question 10

A client,who was recently being laid off from work,is scheduled for a biopsy to detect a 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 11

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 12

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 13

While caring for a critically ill child,the child's mother becomes distraught and begins to cry loudly while stroking the child's face.Which is the best response by the nurse?

A) Explain the procedure that will occur with the treatment.
B) Tell the mother that she needs to control herself for the benefit of her child.
C) Take the mother out of the room and comfort her.
D) Distract the mother by having her straighten the linens on the bed.

Question 14

A client,who is experiencing slight anxiety,is trembling and communicating in a manner that makes it difficult for the nurse to understand the client's needs.Based on this data,which level of anxiety is the client likely experiencing?

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

Question 15

The nurse is assessing a client who demonstrates physiologic manifestations of a stress response.Which physiologic manifestations result for the inhibition of the parasympathetic nervous system? Select all that apply.

A) Dry oral mucous membranes
B) Hypoactive bowel sounds
C) Increased heart rate
D) Increased respiratory rate
E) Increased depth of respirations

Question 16

Which nursing intervention minimizes the stress and anxiety of hospitalization for a client?

A) Explain all procedures in detail before performing them.
B) Control the environment of healing.
C) Demonstrate staff competence by using multiple nurses for care.
D) Let the client make the majority of decisions about the plan of care.

Question 17

The nurse is admitting a client with panic anxiety 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 18

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 19

After a mammogram,a client is told that she needs a fine needle aspirate of a breast mass.Which actions 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 and cries
C) Asking the nurse if she has cancer
D) Scheduling the procedure in 6 weeks, which is the earliest possible appointment

Question 20

While attempting to choose a nursing diagnosis,the nurse must decide whether a client is experiencing anxiety or fear.Which key point would allow the nurse to plan care based on the nursing diagnosis of Anxiety?

A) The source of fear is identifiable, but anxiety may be vague.
B) Anxiety is a milder form of fear.
C) Fear results in a physiologic response, whereas anxiety is psychological.
D) Anxiety is generally based in reality, whereas fear is not.

Question 21

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 22

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 a cold 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 23

A nurse is caring for a client in crisis.While providing care it is imperative that the nurse communicates 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 24

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 25

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 26

A client who has been divorced for 1 year begins to take classes at a community college and has enrolled the children in daycare.When documenting the client's actions,which phrase is the most appropriate for the nurse to use?

A) Turning point in life
B) Maturational crisis
C) Situational crisis
D) Responding to stress

Question 27

The nurse is concerned that a client is demonstrating signs of obsessive-compulsive disorder.Which clinical manifestations observed during the nursing assessment causes the nurse to come to this conclusion? 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 28

The nurse is working with a family who survived a tornado.As part of providing care to the family,the nurse is reviewing normal reaction and emotions they may experience as a result of the traumatic event.Which conclusions does the nurse make? Select all that apply.

A) All family members will process the experience at about the same pace.
B) Each member of the family has a different way of coping.
C) Each family member talks to the nurse openly and freely.
D) All family members will experience anxiety about self and family safety.
E) Some family members have difficulty accepting help.

Question 29

Which are appropriate responses by the nurse when providing care for a client who is experiencing a situational crisis? Select all that apply.

A) "I know just how you feel."
B) "I am sorry this happened to you."
C) "It's best to stay busy."
D) "Things will get better and you will feel better."
E) "It could have been worse."

Question 30

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 31

A parent says to the nurse,"I think my son is showing signs of obsessive-compulsive disorder,just like my 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 32

The son of an older adult client with obsessive-compulsive disorder states to the nurse,"I want to contact the fire department about the situation; the house is nothing but boxes and bags of saved items." Which is the most appropriate nursing diagnosis for this situation?

A) Ineffective Coping
B) Deficient Knowledge
C) Risk for Caregiver Role Strain
D) Anxiety

Question 33

Which nursing diagnoses would be applicable for a client who is experiencing a situational crisis? Select all that apply.

A) Ineffective Coping
B) Risk for Self-Directed Violence
C) Spiritual Distress
D) Risk for Loneliness

Question 34

The nurse is beginning crisis counseling with a client.What actions will the nurse utilize 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 contact.
E) Assess physiologic status.

Question 35

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.

Question 36

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 37

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 38

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 vomits during cleaning
C) How frequently the client cleans the house
D) The impact of symptoms on the family system

Question 39

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 40

When planning interventions to address a client's crisis,which actions by the nurse are 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 41

The nurse is evaluating the care plan for a client diagnosed with agoraphobia.Which client statement indicates the goals of treatment have been met?

A) "I will be able to make it to my outpatient appointments as long as I can find someone to go with me. It is just easier if I ride with someone."
B) "I can't participate in counseling once I get discharged because I hate to leave the house if I don't have to. Other people hate to leave their house for no reason."
C) "It is not going to be easy but I will be making it to my appointments even if I have to leave the house by myself. I have been practicing and deep breathing exercises are helping."
D) "Every time I try to leave the house I panic and I feel like passing out. I just don't know how this is going to get any better."

Question 42

During the assessment,the nurse observes a client who was a victim of a home invasion abruptly stand up and begin to run out of the room in response to hearing a loud bang.Which should the nurse assume regarding the client's behavior?

A) The client thought there was an earthquake.
B) The client was reacting to the loud noise as a form of a flashback.
C) The client wanted to check the cause for the loud noise.
D) The client thought the assessment was concluded.

Question 43

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 44

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 phobia
C) Pathophobia
D) Agoraphobia

Question 45

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 46

The nurse suspects a client is experiencing posttraumatic stress disorder when which are noted during the assessment process? Select all that apply.

A) Observed family member be raped and murdered
B) Restores antique automobiles as a hobby
C) Lives with spouse and has a garden
D) Has a history of anxiety disorder
E) Recently terminated from employment

Question 47

A client wants to visit family members who live in Asia but has a fear of flying.Which strategy is an appropriate treatment option for this client?

A) Cognitive restructuring
B) The use of antianxiety medication
C) Meditation
D) Physical exercise

Question 48

The nurse is providing care to several clients at an outpatient clinic.Which client is at the greatest risk for developing a social anxiety disorder?

A) 11-year-old boy
B) 14-year-old girl
C) 26-year-old female
D) 30-year-old male

Question 49

A client witnessed a violent bank robbery.Which assessment findings would indicate that the client is experiencing posttraumatic stress disorder? Select all that apply.

A) Fear of returning to sleep
B) Excessive sleeping
C) Terrifying nightmares
D) Aggressive behavior
E) Hair pulling

Question 50

The nurse is caring for a client who was diagnosed with posttraumatic stress disorder 4 months ago.Which should the nurse include in the client's plan of care?

A) Guidelines on conducting activities of daily living
B) Information on the treatments available
C) Referral to local employment agency
D) Information on the need for adequate exercise

Question 51

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 52

Which nursing diagnosis would be appropriate for a client with a fear of doctors and hospitals?

A) Ineffective Health Maintenance
B) Depression
C) Anxiety
D) Ineffective Coping

Question 53

A client tells the nurse about continually reliving a situation of being robbed and shot by a gunman.Which nursing diagnosis is most appropriate for this client?

A) Fear
B) Anxiety
C) Post-Trauma Syndrome
D) Ineffective Coping

Question 54

A client asks for a hospital bed near the door because of a fear of being trapped in a room and not being able to get out.When planning care for this client,which does the nurse include as a possible cause for this client's fear?

A) Genetic predisposition
B) A traumatic event
C) Observing others
D) Informational transmission

Question 55

A nurse educator is teaching a group of new staff members recently hired on a behavioral health unit.Which examples of cognitive-behavioral therapy (CBT)does the educator include as expected when providing care to clients on the unit? Select all that apply.

A) Cognitive restructuring
B) Relaxation techniques
C) Systematic desensitization
D) Reciprocal inhibition
E) Benzodiazepine administration

Question 56

The nurse is providing teaching to a client diagnosed with a social phobia.Which client statement indicates appropriate understanding of the information presented?

A) "I try to avoid all situations where I am expected to talk in front of other people."
B) "I can control anxiety by deep breathing and relaxing before talking in front of other people."
C) "I take an antianxiety pill before I have to do anything in front of other people."
D) "I can have a drink before I speak in front of other people."

Question 57

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 58

Which is the role of the nurse when providing care to a client diagnosed with a phobia?

A) Providing comfort and alleviating emotional distress
B) Encouraging the client to confront fears
C) Providing medication to help reduce the symptoms of the disorder
D) Telling the client that the hospital is a safe place

Question 59

A client is experiencing severe anxiety associated with a phobia.Which nursing actions are appropriate when providing care to the client? Select all that apply.

A) Explain why the reaction to the phobia is unrealistic.
B) Make sure the client understands that she is safe.
C) Teach why the phobia is imagined.
D) Coach the client to deep breathe.
E) Ensure a quiet and calm environment.

Question 60

The nurse is reviewing the effectiveness of care provided to a client diagnosed with posttraumatic stress disorder.Which outcomes would indicate the interventions in the plan of care have been effective? Select all that apply.

A) The client takes a sedative at least 4 times a day.
B) The client has been sleeping throughout the night.
C) The client keeps all of the lights on at home.
D) The client verbalizes future plans with family and friends.
E) The client will not enter a car with fewer than three people.

Question 61

A nurse is developing a plan of care for a client diagnosed with post-traumatic stress disorder (PTSD)who was admitted to the hospital for suicide ideations and sleep disturbance due to frequent nightmares.Which is the priority nursing diagnosis for this client?

A) Disturbed Sleep Pattern
B) Post-Trauma Syndrome
C) Risk for Other-Directed Violence
D) Risk for Self-Directed Violence

Question 62

Which nursing interventions would be appropriate for a client demonstrating acute anxiety related to posttraumatic stress disorder? Select all that apply.

A) Encourage the client to discuss what caused the syndrome to develop.
B) Provide a calm, quiet environment.
C) Give the client paperwork to complete while waiting to be assessed.
D) Ask the client what is causing the anxiety.
E) Reassure the client that the environment is safe.

Question 63

A client diagnosed with posttraumatic stress disorder is experiencing insomnia.Which interventions would be beneficial for this client? Select all that apply.

A) Discuss the importance of exercise before sleep.
B) Instruct in relaxation techniques.
C) Encourage the use of sedatives.
D) Suggest daytime naps.
E) Coach in the use of guided imagery.

Question 64

A client is admitted with a diagnosis of post-traumatic stress disorder (PTSD).During a review of the client's history,the nurse is made aware that the client suffers from depression and suicidal thoughts.While interviewing the client,the client tells the nurse he is feeling extremely irritable and that the main reason he is there is because he has been having frequent nightmares.Based on the assessment findings,which medication prescription does the nurse anticipate for this client?

A) Propanolol (Inderal)
B) Prazosin (Minipress)
C) Risperidone (Risperdal)
D) Fluvoxamine (Luvox)

Question 65

A nurse is developing a plan of care for a client diagnosed with post-traumatic stress disorder (PTSD).The client was recently admitted to the hospital for suicide ideations and sleep disturbance due to frequent nightmares.Which is the priority goal to include in the client's plan of care?

A) The client will report a reduction in or cessation of nightmares.
B) The client will report a decreased perception of anxiety.
C) The client will discuss emotions related to traumatic experiences.
D) The client will remain free from injury or harm.