Chapter 1

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 Recent Life Changes Questionnaire. How should the nurse evaluate this client data?

Answer 1

C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports.

Question 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?

Answer 2

D. Challenging

Question 3

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

Answer 3

A. “I’ve found that avoiding contact with others helps me cope.”

Question 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?

Answer 4

C. Stage of exhaustion

Question 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?

Answer 5

D. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”

Question 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?

Answer 6

B. Problem-solving training

Question 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?

Answer 7

C. Work through the problem-solving process with the client.

Question 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?

Answer 8

B. The problem is personally relevant to her.

Question 9

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

Answer 9

A. An achieved state of relaxation

Question 10

A distraught, single, first-time mother cries and asks 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?

Answer 10

D. Assess the facts of the situation.

Question 11

A nursing instructor is asking students about diseases of adaptation and when they are likely to occur. Which student response indicates that learning has occurred?

Answer 11

D. “When an individual’s physiological and psychological resources have become depleted”

Question 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?

Answer 12

A. Decreased resistance to disease

Question 13

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

Answer 13

B. Increased heart rate

Question 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?

Answer 14

C. When the individual judges the resources and skills needed to deal with the event

Question 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?

Answer 15

D. Personal perception of the event is excluded.

Question 16

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

Answer 16

B. “How you reacted to past experiences influences how you feel now.”

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?”

Answer 17

A, B, E

Question 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.”

Answer 18

A, B, C, E

Question 19

A nurse is conducting education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety?

Answer 19

B. Awareness of factors creating stress

Question 20

A patient presents in the Emergency Department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physical injury, but she appears very hyperactive and talkative. Which of these symptoms manifested by the patient are common initial biological responses to stress? Select all that apply.

A. Constricted pupils
B. Watery eyes
C. Unusual food cravings
D. Increased heart rate
E. Increased respirations

Answer 20

B, D, E