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Chapter 1. The Concept of Stress Adaptation
MULTIPLE CHOICE
- A client has experienced the death of a close family member and at the same time becomes unemployed. The client’s 6-month score on the Recent Life Changes Questionnaire is 110. The nurse: A. (^) Understands the client is at risk for significant stress-related illness. B. (^) Determines the client is not at risk for significant stress-related illness. C. (^) Needs further assessment of the client’s coping skills to determine susceptibility to stress-related illness. D. (^) Recognizes the client may view the losses as challenges and perceive them as opportunities. ANS: C Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Explain the relationship between stress and diseases of adaptation. Page: 5– 6 Heading: Stress as an Environmental Event Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A (^) This is incorrect. Assessment is the first step of the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related physical and psychological illness. The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experienc es 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 and susceptibility to stress-related illnesses. B (^) This is incorrect. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining the client’s perception of the current stresses. A 6-month score of 300 or a year-score of 500 or more on the Recent Life Changes Questionnaire indicates high stress in a client’s life and susceptibility to stress-related physical and psychological illness. C (^) This is correct. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related physical and psychological illness. A 6-month score of 300 or a year-score of 500 or more indicates high stress in a client’s life and risk for significant stress-related physical and psychological illness. D (^) This is incorrect. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related illness. A 6-month score of 300 or a year-score of 500 or more on the Recent Life Changes Questionnaire indicates high stress in a client’s life is susceptible to significant stress-related physical and psychological
illness. PTS: 1 CON: Stress
- A physically and emotionally healthy client has just been fired. During a routine office visit, he tells the nurse, “Perhaps this was the best thing to happen. Maybe I’ll consider pursuing an art degree.” The nurse determines the client perceives the stressor of his job loss as: A. (^) Irrelevant. B. (^) Harm/loss. C. (^) A threat. D. (^) A challenge. ANS: D Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 7 Heading: Individual’s Perception of the Event > Primary Appraisal Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback A (^) This is incorrect. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth. B (^) This is incorrect. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth. C (^) This is incorrect. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth. D (^) This is correct. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth. PTS: 1 CON: Stress
- Which client statement alerts the nurse that the client may be responding maladaptively to stress? A. (^) “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.” ANS: A Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 8– 9 Heading: Stress Management Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress
C. (^) “Poor physical condition can interfere with psychological well-being.” D. (^) “A threat to self-esteem can result in psychological stress.” ANS: D Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Describe the core concept of stress as an environmental event. Page: 7 Heading: Stress as a Transaction Between the Individual and the Environment Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A (^) This is incorrect. This response is judgmental and nontherapeutic. B (^) This is incorrect. Physical and psychological stress can be precipitated by events other than loss. C (^) This is incorrect. Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change. D (^) This is correct. Determination of an event as stressful depends on the individual’s cognitive appraisal of the situation, which is an individual’s evaluation of the personal significance of the event or occurrence. Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change. PTS: 1 CON: Stress
- A student confides in the school nurse that he is “stressed out” about deciding whether to go to college or work to provide income the family needs. Which coping strategy is the nurse’s best recommendation? A. (^) Meditation B. (^) Problem-solving training C. (^) Relaxation D. (^) Journaling ANS: B Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A (^) This is incorrect. The student must assess his or her situation and determine which coping strategy is best for him. B (^) This is correct. The student must assess his or her situation and determine which coping strategy is best for him. Problem-solving training, by providing structure
and objectivity, can assist in decision-making. C (^) This is incorrect. The student must assess his or her situation and determine which coping strategy is best for him. D (^) This is incorrect. The student must assess his or her situation and determine which coping strategy is best for him. PTS: 1 CON: Stress
- An unemployed college graduate confides in the clinic nurse that she is experiencing severe anxiety over not finding a teaching position and that she is having difficulty with independent problem-solving. Which nursing intervention is best? A. (^) Encourage her to use other coping mechanisms. B. Complete the problem-solving process for her. C. (^) Assist her with the problem-solving process. D. (^) Encourage her to keep a daily journal of feelings. ANS: C Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 9 Heading: Stress Management Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A (^) This is incorrect. The nurse should assist the client to problem-solve to determine the best coping strategy for her. B (^) This is incorrect. Completing the client’s problem-solving does not provide the opportunity for her to utilize this coping strategy. C (^) This is correct. Assist the client with problem-solving. During times of high anxiety and stress, clients will need more assistance in problem-solving and decision-making. D (^) This is incorrect. The nurse should assist the client to problem solve to determine the best coping strategy for her. PTS: 1 CON: Stress
- The school nurse is assessing a female high school student who is distraught because her parents can’t afford horseback riding lessons. The nurse recognizes the student’s perception is that the problem is: A. (^) Endangering her well-being. B. (^) Personally relevant. C. Based on immaturity. D. (^) Exceeds her capacity to cope. ANS: B Chapter: Chapter 1, The Concept of Stress Adaptation
PTS: 1 CON: Stress
- A first-time mother is crying and asks the nurse, “How can I go to work if I can’t afford child care?” Which is the nurse’s initial action to assist the client with problem-solving? 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 ANS: D Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 9 Heading: Stress Management >Adaptive Coping Strategies Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback A (^) This is incorrect. Assessment is the first step of the nursing process. Before any other steps can be taken, accurate information about the situation must be gathered. B (^) This is incorrect. Assessment is the first step of the nursing process. Before any other steps can be taken, accurate information about the situation must be gathered. C (^) This is incorrect. Assessment is the first step of the nursing process. Before any other steps can be taken, accurate information about the situation must be gathered. D (^) This is correct. Assessment is the first step of the nursing process. Before any other steps can be taken, accurate information about the situation must be gathered. PTS: 1 CON: Stress
- A nursing instructor asks students when diseases of adaptation are likely to occur. Which student response indicates that teaching is effective? 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 are depleted.” ANS: D Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Explain the relationship between stress and diseases of adaptation. Page: 4 Heading: Stress as a Biological Response Integrated Processes: Nursing Process: Evaluation Client Need: Psychological Integrity
Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback A (^) This is incorrect. Diseases of adaptation occur when the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is referred to as the stage of exhaustion. B (^) This is incorrect. Diseases of adaptation occur when the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is referred to as the stage of exhaustion. C (^) This is incorrect. Diseases of adaptation occur when the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is referred to as the stage of exhaustion. D (^) This is correct. Diseases of adaptation occur when the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is referred to as the stage of exhaustion. PTS: 1 CON: Stress
- When an individual’s stress response is sustained over a long period, the nurse anticipates which physiological effect? A. (^) Decreased resistance to disease B. (^) Increased libido C. (^) Decreased blood pressure D. (^) Increased inflammatory response ANS: A Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Identify physiological responses to stress. Page: 4 Heading: Stress as a Biological Response Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Moderate Feedback A (^) This is correct. Selye’s general adaptation syndrome identified prolonged exposure to stress leads to a decreased immune response and resistance to disease. During the stage of exhaustion, the body’s compensatory mechanisms no longer function effectively and diseases of adaptation occur. B (^) This is incorrect. Selye’s general adaptation syndrome identified prolonged exposure to stress leads to a decreased immune response and resistance to disease. During the stage of exhaustion, the body’s compensatory mechanisms no longer function effectively and diseases of adaptation occur. C (^) This is incorrect. Selye’s general adaptation syndrome identified prolonged exposure to stress leads to a decreased immune response and resistance to disease. During the stage of exhaustion, the body’s compensatory mechanisms no longer function effectively and diseases of adaptation occur.
Page: 7 Heading: Stress as a Transaction Between the Individual and the Environment > Individual’s Perception of the Event Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback A (^) This is incorrect. 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. B (^) This is incorrect. 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. C (^) This is correct. 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. D (^) This is incorrect. 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: 1 CON: Stress
- Miller and Rahe (1997) identified 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 physical and psychological illnesses are not identified. B. (^) Numerical values associated with specific life events are randomly assigned. C. (^) Stress is viewed as a solely physiological response. D. (^) An individual’s personal perception of the event is excluded. ANS: D Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Explain the relationship between stress and diseases of adaptation. Page: 5– 6 Heading: Stress as an Environmental Event Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback A (^) This is incorrect. Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration. B (^) This is incorrect. Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration. C (^) This is incorrect. Individuals differ in response to life events. The RLCQ uses a
scale that does not take these differences into consideration. D (^) This is correct. Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration. PTS: 1 CON: Stress
- A client tells the nurse, “I experience stress on a regular basis. Why do I feel this way?” Which is the nurse’s most appropriate response? A. (^) “Genetics has nothing to do with your temperament or feelings.” B. (^) “Your reactions to past experiences influence your current feelings.” C. (^) “Your stress level is lower when you are in good physical health.” D. (^) “You’ll experience less stress if you use appropriate coping skills.” ANS: B Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Explain the concept of stress as a transaction between the individual and the environment. Page: 7 Heading: Stress as a Transaction Between the Individual and the Environment > Predisposing Factors Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A (^) This is incorrect. 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. B (^) This is correct. 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. C (^) This is incorrect. 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. D (^) This is incorrect. 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: 1 CON: Stress
- A nurse is providing 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? A. (^) Diagnostic blood tests B. (^) Awareness of factors creating stress
Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback A (^) This is incorrect. When behavior disrupts the integrity of the individual, it is perceived as maladaptive. Maladaptive responses are considered negative or unhealthy. An adaptive response to stress is a behavior that maintains the integrity of the individual. B (^) This is correct. When behavior disrupts the integrity of the individual, it is perceived as maladaptive. Maladaptive responses are considered negative or unhealthy. C (^) This is incorrect. The client demonstrates a maladaptive response to stress. When behavior disrupts the integrity of the individual, it is perceived as maladaptive. Maladaptive responses are considered to be negative or unhealthy D (^) This is incorrect. When behavior disrupts the integrity of the individual, it is perceived as maladaptive. Maladaptive responses are considered negative or unhealthy. An adaptive response to stress is a behavior that maintains the integrity of the individual. PTS: 1 CON: Stress
- The emergency department nurse is providing discharge instructions to a 23-year-old man who was injured in a motor vehicle crash. The client stated, “My heart was racing when I saw the car coming through the red light was going to hit me. I didn’t know my heart could go that fast!” Which is the nurse’s best response? A. “Don’t worry, your heart is strong because you are young and in good health.” B. (^) “Everyone gets scared when they realize another car is going to hit them.” C. (^) “You had a panic attack when you saw the car that hit you was not going to stop.” D. (^) “Your body responded to the stress of knowing the car was going to hit you.” ANS: D Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Identify physiological responses to stress. Page: 3– 4 Heading: Stress as a Biological Response Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A (^) This is incorrect. The nurse’s response in this example is nontherapeutic. B (^) This is incorrect. The nurse’s response does not explain the reason for the client’s rapid heart rate. C (^) This is incorrect. The client experienced a physical reaction to the stressor of the impending car crash. A stressor is a biological, psychological, social, or chemical factor that causes physical or emotional tension. The client’s increased heart rate was a physical response during the alarm reaction stage of the fight-or-flight syndrome.
D (^) This is correct. The client experienced a physical reaction to the stressor of the impending car crash. A stressor is a biological, psychological, social, or chemical factor that causes physical or emotional tension. The client’s increased heart rate was a physical response during the alarm reaction stage of the fight-or-flight syndrome. PTS: 1 CON: Stress
- The nurse in the intensive care unit (ICU) is giving report to the nurse on the cardiac step-down unit. The nurse states, “The patient is a 48-year-old woman admitted 3 days ago for chest pain and a stent placement. Vital signs are stable, but I am worried about her stress level. She said she just moved here due to a job transfer and her husband stayed behind to sell the house. She told me they have a high insurance deductible and she is worried about the hospital bill.” Which factor has the most significant influence on the client’s health? A. (^) Coping skills B. (^) Existing conditions C. (^) Individual vulnerability D. (^) Perceived threat ANS: B Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Identify physiological responses to stress. Page: 7 Heading: Stress as a Transaction between the Individual and the Environment > Predisposing Factors Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Stress Difficulty: Moderate Feedback A (^) This is incorrect. Predisposing factors influence how an individual responds to a stressful event. Existing conditions incorporate vulnerabilities that influence the adequacy of an individual’s resources to deal with adaptive demands. Existing stressors are the recent move, loss of the support system, and financial concerns. B (^) This is correct. Predisposing factors influence how an individual responds to a stressful event. Existing conditions incorporate vulnerabilities that influence the adequacy of an individual’s resources to deal with adaptive demands. Existing stressors are the recent move, loss of the support system, and financial concerns. C (^) This is incorrect. Predisposing factors influence how an individual responds to a stressful event. Existing conditions incorporate vulnerabilities that influence the adequacy of an individual’s resources to deal with adaptive demands. Existing stressors are the recent move, loss of the support system, and financial concerns. D (^) This is incorrect. Predisposing factors influence how an individual responds to a stressful event. Existing conditions incorporate vulnerabilities that influence the adequacy of an individual’s resources to deal with adaptive demands. Existing stressors are the recent move, loss of the support system, and financial concerns.
Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 8– 9 Heading: Stress Management > Adaptive Coping Strategies Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback
- This is correct. Pets have been shown to decrease stress.
- This is correct. Healthy relationships have been shown to decrease stress.
- This is correct. Music has been shown to decrease stress.
- This is incorrect. Focusing on the stressors is more likely to increase stress.
- This is correct. Journaling feelings has been shown to decrease stress. PTS: 1 CON: Stress
- 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 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 ANS: B, D, E Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Identify physiological responses to stress. Page: 3– 4 Heading: Stress as a Biological Response Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity Cognitive Level: Analysis [Analyzing] Concept: Stress Difficulty: Moderate Feedback
- This is incorrect. Dilated pupils, rather than constricted pupils, are related to the fight-or-flight syndrome.
- This is correct. Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress.
- This is incorrect. Unusual food cravings have not been identified as a typical biological response to stress.
- This is correct. Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress.
- This is correct. Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress. PTS: 1 CON: Stress
- Which concepts are included in Hobfoll’s Conservation of Resources theory? Select all that apply. A. (^) Availability of resources B. (^) Disequilibrium C. (^) Genetics D. (^) Past experiences E. (^) Resilience ANS: A, C, D Chapter: Chapter 1, The Concept of Stress Adaptation Chapter learning objective: Explain the concept of stress as a transaction between the individual and the environment. Page: 7– 8 Heading: Stress as a Transaction Between the Individual and the Environment Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback
- This is correct. Hobfoll’s Conservation of Resources theory asserts a variety of elements influence an individual’s perception and response to a stressful event. Predisposing factors strongly influence whether the response is adaptive or maladaptive. These include genetic influences, past experiences, and existing conditions. Available resources also affect an individual’s perception of adaptive capabilities. An individual who experiences stress in the present becomes more vulnerable to future stress when there is a loss or lack of resources.
- This is incorrect. Disequilibrium is not included as part of Hobfoll’s theory.
- This is correct. Hobfoll’s Conservation of Resources theory asserts a variety of elements influence an individual’s perception and response to a stressful event. Predisposing factors strongly influence whether the response is adaptive or maladaptive. These include genetic influences, past experiences, and existing conditions. Available resources also affect an individual’s perception of adaptive capabilities. An individual who experiences stress in the present becomes more vulnerable to future stress when there is a loss or lack of resources.
- This is correct. Hobfoll’s Conservation of Resources theory asserts a variety of elements influence an individual’s perception and response to a stressful event. Predisposing factors strongly influence whether the response is adaptive or maladaptive. These include genetic influences, past experiences, and existing conditions. Available resources also affect an individual’s perception of adaptive capabilities. An individual who experiences stress in the present
