Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
TEST BANK
Psychiatric Mental Health Nursing
Concepts of Care in Evidence-Based Practice
Mary C. Townsend
8th Edition
, Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Table of Contents
I. BASIC CONCEPTS IN PSYCHIATRIC/MENTAL HEALTH NURSING
1. The Concept of Stress Adaptation
2 . Mental Health/Mental Illness: Historical and Theoretical Concepts
II. FOUNDATIONS FOR PSYCHIATRIC/MENTAL HEALTH NURSING
3. Theoretical Models of Personality Development
4. Concepts of Psychobiology
5. Ethical and Legal Issues in Psychiatric/Mental Health Nursing
6. Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing
III. THERAPEUTIC APPROACHES IN PSYCHIATRIC NURSING CARE
7. Relationship Development
8. Therapeutic Communication
9. The Nursing Process in Psychiatric/Mental Health Nursing
10. Therapeutic Groups
11. Intervention with Families
12. Milieu Therapy—The Therapeutic Community
13. Crisis Intervention
14. Assertiveness Training
15. Promoting Self Esteem
16. Anger/Aggression Management
17. The Suicidal Client
18. Behavior Therapy
19. Cognitive Therapy
20. Electroconvulsive Therapy
21. The Recovery Model
IV. NURSING CARE OF CLIENTS WITH ALTERATIONS IN PSYCHOSOCIAL ADAPTATION
22. Neurocognitive Disorders
23. Substance-Related and Addictive Disorders
24. Schizophrenia Spectrum and Other Psychotic Disorders
25. Depressive Disorders
26. Bipolar and Related Disorders
27. Anxiety, Obsessive-Compulsive, and Related Disorders
28. Trauma and Stressor-Related Disorders
29. Somatic Symptom and Dissociative Disorders
30. Issues Related to Human Sexuality and Gender Dysphoria
31. Eating Disorders
32. Personality Disorders
V. PSYCHIATRIC/MENTAL HEALTH NURSING OF SPECIAL POPULATIONS
33. Children and Adolescents
34. The Aging Individual
35. Survivors of Abuse or Neglect
36. Community Mental Health Nursing
37. The Bereaved Individual
38. Military Families
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-1
Chapter 1. The Concept of Stress Adaptation
Multiple Choice
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?
A. The client is experiencing severe distress and is at risk for physical and psychological illness.
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no
significant threat of stress-related illness.
C. Susceptibility to stress-related physical or psychological illness cannot be estimated without
knowledge of coping resources and available supports.
D. The client may view these losses as challenges and perceive them as opportunities.
ANS: C
The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent
Experiences 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. However,
positive coping mechanisms and strong social support can limit susceptibility to stress-related
illnesses.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
A. Irrelevant
B. Harm/loss
C. Threatening
D. Challenging
ANS: D
The client perceives the situation of job loss as a challenge and an opportunity for growth.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Psychosocial Integrity
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-2
3. Which client statement should alert a nurse that a client may be responding maladaptively to
stress?
A. “I’ve found that 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
Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It
can prevent learning appropriate coping skills and can prevent access to needed support systems.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
A. Alarm reaction stage
B. Stage of resistance
C. Stage of exhaustion
D. Fight-or-flight stage
ANS: C
At the stage of exhaustion, the student’s exposure to stress has been prolonged and adaptive
energy has been depleted. Diseases of adaptation occur more frequently in this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Psychosocial Integrity
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?
A. “Teenagers! They don’t know a thing about real stress.”
B. “Stress occurs only when there is a loss.”
C. “When you are in poor physical condition, you can’t experience psychological well-being.”
D. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”
ANS: D
Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as
stressful as a physiological change.
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-3
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. Meditation
B. Problem-solving training
C. Relaxation
D. Journaling
ANS: B
The student must assess his or her situation and determine the best course of action. Problem-
solving training, by providing structure and objectivity, can assist in decision making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. Encourage the student to use the alternative coping mechanism of relaxation exercises.
B. Complete the problem-solving process for the client.
C. Work through the problem-solving process with the client.
D. Encourage the client to keep a journal.
ANS: C
During times of high anxiety and stress, clients will need more assistance in problem-solving and
decision making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-4
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.
ANS: B
Psychological stressors to self-esteem and self-image are related to how the individual perceives
the situation or event. Self-image is of particular importance to adolescents, who feel entitled to
have all the advantages that other adolescents experience.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
9. Meditation has been shown to be an effective stress management technique. When meditation
is effective, what should a nurse expect to assess?
A. An achieved state of relaxation
B. An achieved insight into one’s feelings
C. A demonstration of appropriate role behaviors
D. An enhanced ability to problem-solve
ANS: A
Meditation produces relaxation by creating a special state of consciousness through focused
concentration.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
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
Before any other steps can be taken, accurate information about the situation must be gathered
and assessed.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-5
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?
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 have become depleted”
ANS: D
During the stage of exhaustion of the general adaptation syndrome, the individual loses the
capacity to adapt effectively because physiological and psychological resources have become
depleted. This is the time when diseases of adaptation may occur.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Health Promotion and Maintenance
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?
A. Decreased resistance to disease
B. Increased libido
C. Decreased blood pressure
D. Increased inflammatory response
ANS: A
In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at
which time the body’s compensatory mechanisms no longer function effectively and diseases of
adaptation occur. A decreased immune response is seen at this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Physiological Integrity
13. Which symptom should a nurse identify as typical of the “fight-or-flight” response?
A. Pupil constriction
B. Increased heart rate
C. Increased salivation
D. Increased peristalsis
ANS: B
During the “fight-or-flight” response, the heart rate increases in response to the release of
epinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slows
unessential functions. OK
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-6
KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment |
Client Need: Physiological Integrity
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?
A. When the individual judges the event to be benign
B. When the individual judges the event to be irrelevant
C. When the individual judges the resources and skills needed to deal with the event
D. When the individual judges the event to be pleasurable
ANS: C
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.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
A. Specific illnesses are not identified.
B. The numerical values associated with specific life events are randomly assigned
C. Stress is viewed as only a physiological response.
D. Personal perception of the event is excluded.
ANS: D
Individuals differ in response to life events. The RLCQ uses a scale that does not take these
differences into consideration.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Health Promotion and Maintenance
16. A client who experiences stress on a regular basis asks a nurse what causes these feelings.
Which is the most appropriate nursing response?
A. “Genetics have nothing to do with your temperament.”
B. “How you reacted to past experiences influences how you feel now.”
C. “If you’re in good physical health, your stress level will be low.”
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-7
D. “Stress can always be avoided if appropriate coping mechanisms are employed.”
ANS: B
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.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
Multiple Response
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?”
ANS: A, B, E
These questions specifically address the client’s coping resources and encourage the client to
apply learning from past experiences. These questions also encourage the client to consider
alternative methods for dealing with stress. Asking who is to blame does not assess coping
abilities but, rather, encourages maladaptive behavior. Requesting an explanation is a
nontherapeutic block to communication.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Psychosocial Integrity
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.”
, Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-8
ANS: A, B, C, E
Focusing on the stressors is more likely to increase stress in the client’s life. However,
pets, music, journaling feelings, and healthy relationships have all been shown to
decrease amounts of stress.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. Diagnostic blood tests
B. Awareness of factors creating stress
C. Relaxation exercises
D. Identifying support systems
ANS: B
Although all of the above answers may be useful in the comprehensive management of stress, the
initial step is awareness that stress is being experienced and awareness of factors that create
stress.
KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need:
Psychosocial Integrity
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
ANS: B, D, E
Increased lacrimal secretions, increased heart rate, and increased respirations are identified as
initial biological responses to stress. Since dilated pupils rather than constricted pupils are related
TEST BANK
Psychiatric Mental Health Nursing
Concepts of Care in Evidence-Based Practice
Mary C. Townsend
8th Edition
, Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Table of Contents
I. BASIC CONCEPTS IN PSYCHIATRIC/MENTAL HEALTH NURSING
1. The Concept of Stress Adaptation
2 . Mental Health/Mental Illness: Historical and Theoretical Concepts
II. FOUNDATIONS FOR PSYCHIATRIC/MENTAL HEALTH NURSING
3. Theoretical Models of Personality Development
4. Concepts of Psychobiology
5. Ethical and Legal Issues in Psychiatric/Mental Health Nursing
6. Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing
III. THERAPEUTIC APPROACHES IN PSYCHIATRIC NURSING CARE
7. Relationship Development
8. Therapeutic Communication
9. The Nursing Process in Psychiatric/Mental Health Nursing
10. Therapeutic Groups
11. Intervention with Families
12. Milieu Therapy—The Therapeutic Community
13. Crisis Intervention
14. Assertiveness Training
15. Promoting Self Esteem
16. Anger/Aggression Management
17. The Suicidal Client
18. Behavior Therapy
19. Cognitive Therapy
20. Electroconvulsive Therapy
21. The Recovery Model
IV. NURSING CARE OF CLIENTS WITH ALTERATIONS IN PSYCHOSOCIAL ADAPTATION
22. Neurocognitive Disorders
23. Substance-Related and Addictive Disorders
24. Schizophrenia Spectrum and Other Psychotic Disorders
25. Depressive Disorders
26. Bipolar and Related Disorders
27. Anxiety, Obsessive-Compulsive, and Related Disorders
28. Trauma and Stressor-Related Disorders
29. Somatic Symptom and Dissociative Disorders
30. Issues Related to Human Sexuality and Gender Dysphoria
31. Eating Disorders
32. Personality Disorders
V. PSYCHIATRIC/MENTAL HEALTH NURSING OF SPECIAL POPULATIONS
33. Children and Adolescents
34. The Aging Individual
35. Survivors of Abuse or Neglect
36. Community Mental Health Nursing
37. The Bereaved Individual
38. Military Families
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-1
Chapter 1. The Concept of Stress Adaptation
Multiple Choice
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?
A. The client is experiencing severe distress and is at risk for physical and psychological illness.
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no
significant threat of stress-related illness.
C. Susceptibility to stress-related physical or psychological illness cannot be estimated without
knowledge of coping resources and available supports.
D. The client may view these losses as challenges and perceive them as opportunities.
ANS: C
The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent
Experiences 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. However,
positive coping mechanisms and strong social support can limit susceptibility to stress-related
illnesses.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
A. Irrelevant
B. Harm/loss
C. Threatening
D. Challenging
ANS: D
The client perceives the situation of job loss as a challenge and an opportunity for growth.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Psychosocial Integrity
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-2
3. Which client statement should alert a nurse that a client may be responding maladaptively to
stress?
A. “I’ve found that 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
Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It
can prevent learning appropriate coping skills and can prevent access to needed support systems.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
A. Alarm reaction stage
B. Stage of resistance
C. Stage of exhaustion
D. Fight-or-flight stage
ANS: C
At the stage of exhaustion, the student’s exposure to stress has been prolonged and adaptive
energy has been depleted. Diseases of adaptation occur more frequently in this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Psychosocial Integrity
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?
A. “Teenagers! They don’t know a thing about real stress.”
B. “Stress occurs only when there is a loss.”
C. “When you are in poor physical condition, you can’t experience psychological well-being.”
D. “Stress can be psychological. A threat to self-esteem may result in high stress levels.”
ANS: D
Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as
stressful as a physiological change.
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-3
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. Meditation
B. Problem-solving training
C. Relaxation
D. Journaling
ANS: B
The student must assess his or her situation and determine the best course of action. Problem-
solving training, by providing structure and objectivity, can assist in decision making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. Encourage the student to use the alternative coping mechanism of relaxation exercises.
B. Complete the problem-solving process for the client.
C. Work through the problem-solving process with the client.
D. Encourage the client to keep a journal.
ANS: C
During times of high anxiety and stress, clients will need more assistance in problem-solving and
decision making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-4
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.
ANS: B
Psychological stressors to self-esteem and self-image are related to how the individual perceives
the situation or event. Self-image is of particular importance to adolescents, who feel entitled to
have all the advantages that other adolescents experience.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
9. Meditation has been shown to be an effective stress management technique. When meditation
is effective, what should a nurse expect to assess?
A. An achieved state of relaxation
B. An achieved insight into one’s feelings
C. A demonstration of appropriate role behaviors
D. An enhanced ability to problem-solve
ANS: A
Meditation produces relaxation by creating a special state of consciousness through focused
concentration.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
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
Before any other steps can be taken, accurate information about the situation must be gathered
and assessed.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-5
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?
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 have become depleted”
ANS: D
During the stage of exhaustion of the general adaptation syndrome, the individual loses the
capacity to adapt effectively because physiological and psychological resources have become
depleted. This is the time when diseases of adaptation may occur.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Health Promotion and Maintenance
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?
A. Decreased resistance to disease
B. Increased libido
C. Decreased blood pressure
D. Increased inflammatory response
ANS: A
In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at
which time the body’s compensatory mechanisms no longer function effectively and diseases of
adaptation occur. A decreased immune response is seen at this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Physiological Integrity
13. Which symptom should a nurse identify as typical of the “fight-or-flight” response?
A. Pupil constriction
B. Increased heart rate
C. Increased salivation
D. Increased peristalsis
ANS: B
During the “fight-or-flight” response, the heart rate increases in response to the release of
epinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slows
unessential functions. OK
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-6
KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Assessment |
Client Need: Physiological Integrity
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?
A. When the individual judges the event to be benign
B. When the individual judges the event to be irrelevant
C. When the individual judges the resources and skills needed to deal with the event
D. When the individual judges the event to be pleasurable
ANS: C
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.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Psychosocial Integrity
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?
A. Specific illnesses are not identified.
B. The numerical values associated with specific life events are randomly assigned
C. Stress is viewed as only a physiological response.
D. Personal perception of the event is excluded.
ANS: D
Individuals differ in response to life events. The RLCQ uses a scale that does not take these
differences into consideration.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation |
Client Need: Health Promotion and Maintenance
16. A client who experiences stress on a regular basis asks a nurse what causes these feelings.
Which is the most appropriate nursing response?
A. “Genetics have nothing to do with your temperament.”
B. “How you reacted to past experiences influences how you feel now.”
C. “If you’re in good physical health, your stress level will be low.”
,Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-7
D. “Stress can always be avoided if appropriate coping mechanisms are employed.”
ANS: B
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.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
Multiple Response
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?”
ANS: A, B, E
These questions specifically address the client’s coping resources and encourage the client to
apply learning from past experiences. These questions also encourage the client to consider
alternative methods for dealing with stress. Asking who is to blame does not assess coping
abilities but, rather, encourages maladaptive behavior. Requesting an explanation is a
nontherapeutic block to communication.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment |
Client Need: Psychosocial Integrity
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.”
, Test Bank - Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice 8th Edition
Chapter 1-8
ANS: A, B, C, E
Focusing on the stressors is more likely to increase stress in the client’s life. However,
pets, music, journaling feelings, and healthy relationships have all been shown to
decrease amounts of stress.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation |
Client Need: Psychosocial Integrity
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?
A. Diagnostic blood tests
B. Awareness of factors creating stress
C. Relaxation exercises
D. Identifying support systems
ANS: B
Although all of the above answers may be useful in the comprehensive management of stress, the
initial step is awareness that stress is being experienced and awareness of factors that create
stress.
KEY: Cognitive Level: Analysis | Integrated Processes: Teaching/Learning | Client Need:
Psychosocial Integrity
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
ANS: B, D, E
Increased lacrimal secretions, increased heart rate, and increased respirations are identified as
initial biological responses to stress. Since dilated pupils rather than constricted pupils are related
