Deck 31: Stress and Coping

Question 1

A 23-year-old man who recently had a head injury from a motor vehicle accident (MVA)is in a state of unconsciousness.Which of the following physiological adaptations is primarily responsible for his level of consciousness?
1) Pituitary gland
2) Medulla oblongata
3) Reticular formation
4) External stress response

Answer 1

3
The reticular formation is primarily responsible for an individual's level of consciousness.The pituitary gland supplies hormones that control vital functions.The pituitary gland produces hormones necessary for adaptation to stress (e.g. ,adrenocorticotropic hormone).The medulla oblongata controls vital functions such as heart rate,blood pressure,and respiration.The external stress response is not primarily responsible for a person's level of consciousness.

Question 2

Which of the following clients shows the greatest risk factor for stress coping related to situational stressors?
1) An 18-year-old high school athlete who breaks his leg just before college football tryouts
2) A 75-year-old widow whose only son is severely injured in an automobile accident
3) A 36-year-old who loses his job days after his marriage to his high school sweetheart
4) A 60-year-old who is diagnosed with prostate cancer after deciding to retire from his job of 26 years

Answer 2

2
The timing of stress-inducing events significantly influences older adults' ability to cope.The fact that older adults have several stressful events (i.e. ,loss of a spouse and new medical diagnosis)occur within a short period of time often results in negative effects on coping ability.The remaining options reflect stressful situations but to lesser degrees.

Question 3

Which of the following client behaviors best reflects Neuman Systems Model of primary prevention? The client who:
1) Swims daily to strengthen muscles weakened as a result of shoulder surgery
2) Follows a low-fat diet in order to bring her high-density lipids to under 200 mg/dL
3) Walks 1 mile daily to keep her blood pressure from rising higher than 130/70 mm Hg
4) Attends a survivor support group after the loss of a spouse in an automobile accident

Answer 3

3
According to Neuman's theory,the goal of primary prevention is to promote client wellness by stress prevention and reduction of risk factors.Secondary prevention occurs after symptoms appear.At the tertiary level of prevention,the nurse supports rehabilitation processes involved in healing,moving the client back to wellness and the primary level of disease prevention.

Question 4

A corporate executive works 60 to 80 hours/week.The client is experiencing some physical signs of stress.The practitioner teaches the client to "include 15 minutes of biofeedback." This is an example of which of the following health promotion interventions?
1) Guided imagery
2) Regular exercise
3) Time management
4) Relaxation technique

Question 5

A client recently lost a child in a severe case of poisoning.The client tells the nurse,"I don't want to make any new friends right now." This is an example of which of the following indicators of stress?
1) Spiritual indicator
2) Emotional indicator
3) Intellectual indicator
4) Sociocultural indicator

Question 6

It appears to the nurse the client is experiencing a crisis.The nurse plans to:
1) Allow the client to work through independent problem-solving
2) Complete an in-depth evaluation of stressors and responses
3) Focus on immediate stress reduction
4) Recommend ongoing therapy

Question 7

A client who has experienced massive soft tissue trauma is handling both the physical and emotional stressors via the generalized adaptation syndrome (GAS).The major benefit of this defense mechanism is through the:
1) Identification of foreign antigens on invading bacteria
2) Production of endorphins that decrease awareness of pain
3) Increased epinephrine,resulting in improved cardiac output
4) Increased norepinephrine directed towards sustaining blood pressure

Question 8

For a lifestyle stress indicator and reduction in the incidence of heart disease a recommended intervention would be:
1) Regular physical exercise
2) Attendance at a support group
3) Self-awareness skill development
4) Effective time management techniques

Question 9

A client is experiencing job-related stress.The nurse is working with the client in an outpatient health care setting.The nurse believes this client is dissociated as a result of observing the client:
1) Avoid discussion of job problems
2) Act like another colleague on the job
3) Experience chronic headaches and stomach aches
4) Sit quietly and not interacting with any of the staff

Question 10

A mother and her child sit in a playroom on the pediatric unit.The boy wants to play with a toy that another child has but the mother says no.The child cries,throws a block,and runs over to kick the door.This child is using a mechanism known as:
1) Displacement
2) Compensation
3) Conversion
4) Denial

Question 11

Which of the following statements reflects the correct interpretation of the effect of age on coping strategies?
1) "The young adult client generally handles stress more effectively than does the elder adult."
2) "Life provides the older adult with more opportunities to effectively manage their stressful events."
3) "Children appear to be less aware of stressors in their lives and so are less negatively affected by it."
4) "Stress is evident in everyone's life and we all learn to cope with it regardless of our age or life experiences."

Question 12

The response to stress for older adults may be manifested differently than in younger adults.The nurse recognizes that.For the older adult client,the nurse is aware that:
1) Losses are more stress-provoking
2) Anxiety disorders are most prevalent
3) Psychosocial factors are the greatest threats
4) Timing of stress-inducing events is not significant

Question 13

An adolescent child,who is having behavioral problems has had added responsibilities put upon her because the father has just loss his job and is experiencing periods of depression and the mother has a chronic debilitating illness.The nurse is involved in crisis intervention and intervenes to specifically focus the family on their feelings by:
1) Pointing out the connection between the situation and their responses
2) Encouraging the use of the family's usual coping skills
3) Working on time management skills
4) Discussing past experiences

Question 14

Clients undergoing stress may have periods of regression.The nurse assesses this regressive behavior in the situation where:
1) An adult client exercises to the point of fatigue
2) An 8-year-old child sucks his thumb and wets the bed
3) An adult client avoids speaking about health concerns
4) An 11-year-old child experiences stomach cramps and headaches

Question 15

What priority assessment area has been noticed by a nurse while working with clients who are experiencing a significant degree of stress?
1) The client's primary physical needs
2) What else is happening in the client's life
3) How the stress has influenced the client's activities of daily living
4) Determining whether the client is thinking about harming self or others

Question 16

The nurse is caring for a client who was admitted with various physical traumas resulting from an assault by a stranger attempting to steal her purse.Which of the following statements made by the nurse is most therapeutic in assessing the degree of stress the event has caused the client?
1) "Would you like to talk about the attack?"
2) "What may I do to help you emotionally?"
3) "Has being attacked been traumatic for you?"
4) "How has this experience affected your life?"

Question 17

Clients experiencing post-traumatic stress disorder (PTSD)following the World Trade Tower bombing work with nurses in the medical center.An approach that is appropriate and should be incorporated into the plan of care is:
1) Suppression of anxiety-producing memories
2) Reinforcement that the PTSD is short term
3) Promotion of relaxation strategies
4) Focus on physical needs

Question 18

A 72-year-old client is in a long-term care facility after having had a cerebrovascular accident.The client is noncommunicative,enteral feedings are not being absorbed,and respirations are becoming labored.Which of the stages of the GAS is the client experiencing?
1) Alarm reaction
2) Resistance stage
3) Exhaustion stage
4) Reflex pain response

Question 19

The son of a client diagnosed with moderately advanced Alzheimer's disease shows concern over the care his mother will receive after making the decision to institutionalize her.Which of the following statements made by the admitting nurse is most therapeutic in addressing the son's concerns?
1) "We care deeply for all our clients and take great pride in the care and attention we give each one of them."
2) "Please feel free to talk to our staff and to the other clients about the care and attention we give to each of our clients."
3) "I hope that you will be able to visit your mother often and offer us suggestions on how best to meet her physical and emotional needs."
4) "I know it has been a difficult decision,and you must have concerns about leaving her,but rest assured we have her best interest at heart."

Question 20

During the end-of-shift report the nurse notes that a client had been very nervous and preoccupied during the evening and that no family visited.To determine the amount of anxiety that the client is experiencing,the nurse should respond:
1) "Would you like for me to call a family member to come support you?"
2) "Would you like to talk with another client who had the same surgery?"
3) "How serious do you think the illness you are experiencing really is?"
4) "You seem worried about something.Would it help to talk about it?"

Question 21

Which of the following client behaviors best reflects Neuman Systems Model of tertiary prevention? The client who:
1) Swims daily to strengthen muscles weakened as a result of hip surgery
2) Follows a low-fat diet in order to bring her high-density lipids to under 200 mg/dL
3) Walks 1 mile daily to keep her blood pressure from rising higher than 130/70 mm Hg
4) Attends a survivor support group after the loss of a spouse in an automobile accident

Question 22

The husband of a client with terminal cancer has expressed a high degree of stress over his role as caregiver.When asked whether he has suicidal or homicidal thoughts he answered,"Sometimes." Which of the following nursing statements is most therapeutic initially?
1) "What is the hardest part about your wife's impending death?"
2) "Can you describe your plan for killing yourself and your wife?"
3) "What can I do to help make caring for your wife less stressful?"
4) "Can you tell me how caring for your wife has affected you personally?"

Question 23

Which of the following statements made by the nurse shows the best understanding of the therapeutic value of a support system for a client experiencing stress?
1) "They will be there when you need them and make sure you will have your needs met."
2) "They will provide you with someone to talk with about your problems and support your decisions."
3) "When you are experiencing stress,it is always comforting to have people who care about you nearby."
4) "These individuals have experienced what you are going though and can offer you effective suggestions."