Test Bank Psychiatric Mental Health Nursing Concepts of Care in Evidence-BasedPractice 10th Edition Townsend

Test Bank Psychiatric Mental Health Nursing Concepts of Care in Evidence-BasedPractice 10th Edition TownsendChapter 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. 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. C. D. Determines the client is not at risk for significant stress-related illness. Needs further assessment of the client’s coping skills to determine susceptibility to stress-related illness. Recognizes the client may view the losses as challenges and perceive them as opportunities. ANS: C C 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 1 | P a g eA 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 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 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 2 | P a g e CON: Stress2. 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. C. D. Harm/loss. A threat. A challenge. ANS: D Chapter: Chapter 0, 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 B C D This is incorrect. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth. This is incorrect. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth. This is incorrect. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth. 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 3. Which client statement alerts the nurse that the client may be responding maladaptively to stress? A. “Avoiding contact with others helps me cope.” 3 | P a g eB. “I really enjoy journaling; it’s my private time.” C. D. “I signed up for a yoga class this week.” “I made an appointment to meet with a therapist.” ANS: A Chapter: Chapter 0, 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 Difficulty: Easy Feedback A This is correct. 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. B C D This is incorrect. Journaling is not considered a maladaptive coping method. This is incorrect. Group exercise is not considered a maladaptive coping method. This is incorrect. Seeing a therapist is not considered a maladaptive coping method. PTS: 1 4. CON: Stress A nursing student comes down with a sinus infection toward the end of every semester. Which stage of stress is the student most likely experiencing when this occurs? A. Alarm reaction B. C. D. Resistance Exhaustion Fight or flight ANS: C Chapter: Chapter 0, The Concept of Stress Adaptation Chapter learning objective: Explain the relationship between stress and diseases of adaptation. Page: 9 4 | P a g eHeading: Stress as a Biological Response > Stage of Exhaustion Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback A B This is incorrect. At the alarm reaction stage, physiological responses of the fight-or-flight syndrome are initiated. This is incorrect. At the stage of resistance, the individual uses the physiological responses of the first stage as a defense in the attempt to adapt to the stressor. Physiological symptoms may disappear. C This is correct. 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. D This is incorrect. The fight-or-flight syndrome occurs during the alarm reaction stage. PTS: 1 5. CON: Stress 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 response by the nurse is best? A. “Teenagers! They don’t know a thing about real stress.” B. C. D. “Psychological or physical stress occur only when there is a loss.” “Poor physical condition can interfere with psychological well-being.” “A threat to self-esteem can result in psychological stress.” ANS: D Chapter: Chapter 0, 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 5 | P a g eCognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A B C This is incorrect. This response is judgmental and nontherapeutic. This is incorrect. Physical and psychological stress can be precipitated by events other than loss. 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 6. 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. C. D. Problem-solving training Relaxation Journaling ANS: B Chapter: Chapter 0, 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 6 | P a g eA 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 D This is incorrect. The student must assess his or her situation and determine which coping strategy is best for him. This is incorrect. The student must assess his or her situation and determine which coping strategy is best for him. PTS: 1 7. 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. C. D. Complete the problem-solving process for her. Assist her with the problem-solving process. Encourage her to keep a daily journal of feelings. ANS: C Chapter: Chapter 0, 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. 7 | P a g eB 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 8. 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. C. D. Personally relevant. Based on immaturity. Exceeds her capacity to cope. ANS: B Chapter: Chapter 0, 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 Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback A B This is incorrect. An event becomes relevant to an individual when the outcome holds personal significance. This is correct. Determination of an event as stressful depends on the individual’s cognitive appraisal of the situation. An event becomes relevant to an individual when the outcome holds personal significance. 8 | P a g eC This is incorrect. An event becomes relevant to an individual when the outcome holds personal significance. D This is incorrect. An event becomes relevant to an individual when the outcome holds personal significance. PTS: 1 9. CON: Stress Meditation has been shown to be an effective stress management technique. Which nursing assessment indicates meditation has been effective? A. An achieved state of relaxation B. C. D. An achieved insight into one’s feelings A demonstration of appropriate role behaviors An enhanced ability to problem-solve ANS: A Chapter: Chapter 0, The Concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management > Adaptive Coping Strategies Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback A This is correct. Meditation produces relaxation by creating a special state of consciousness through focused concentration. 9 | P a g eB This is incorrect. Meditation does not necessarily produce an achieved insight into one’s feelings. C D This is incorrect. Meditation does not help to demonstrate appropriate role behaviors. This is incorrect. Meditation does not necessarily enhance one’s ability to solve problems. PTS: 1 CON: Stress 10. 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. C. D. Formulate goals for resolution of the problem Evaluate the outcome of the implemented alternative Assess the facts of the situation ANS: D Chapter: Chapter 0, 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. 10 | P a g eC 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 11. 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. C. D. “When an individual inherits maladaptive genes.” “When an individual experiences existing conditions that exacerbate stress.” “When an individual’s physiological and psychological resources are depleted.” ANS: D Chapter: Chapter 0, 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. 11 | P a g eB 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 12. When an individual’s stress response is sustained over a long period, the nurse anticipates which physiological effect? A. B. C. D. Decreased resistance to disease Increased libido Decreased blood pressure Increased inflammatory response ANS: A Chapter: Chapter 0, 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 12 | P a g eA 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. D 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. PTS: 1 13. response? A. B. C. D. CON: Stress The nurse identifies which symptom as typical of the fight-or-flight Decreased heart rate Increased peristalsis Increased salivation Pupil constriction ANS: B Chapter: Chapter 0, 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 13 | P a g eCognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback A This is incorrect. 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. B This is correct. 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. C This is incorrect. 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. D This is incorrect. 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. PTS: 1 CON: Stress 14. A nurse is assessing a client’s response to stress. The nurse concludes that the client is performing a secondary appraisal of a stressful event when the client determines: A. The event is benign. B. C. D. The event is irrelevant. Resources are available. The event is pleasurable. ANS: C Chapter: Chapter 0, 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 > Individual’s Perception of the Event Integrated Processes: Nursing Process: Evaluation 14 | P a g eClient 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 15. 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? 15 | P a g eA. Specific physical and psychological illnesses are not identified. B. C. D. Numerical values associated with specific life events are randomly assigned. Stress is viewed as a solely physiological response. An individual’s personal perception of the event is excluded. ANS: D Chapter: Chapter 0, 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 16. 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? 16 | P a g eA. “Genetics has nothing to do with your temperament or feelings.” B. C. D. “Your reactions to past experiences influence your current feelings.” “Your stress level is lower when you are in good physical health.” “You’ll experience less stress if you use appropriate coping skills.” ANS: B Chapter: Chapter 0, 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. 17 | P a g eC 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 17. 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. C. D. Awareness of factors creating stress Relaxation exercises Identification of support systems ANS: B Chapter: Chapter 0, The Core concept of Stress Adaptation Chapter learning objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management > Adaptive Coping Strategies Integrated Processes: Teaching/Learning Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 18 | P a g eA This is incorrect. The initial step is awareness that stress is being experienced and awareness of factors that create stress. Diagnostic blood tests, identification of support systems, and relaxation exercises can be implemented after the client becomes aware of factors that create stress. B This is correct. The initial step is awareness that stress is being experienced and awareness of factors that create stress. Diagnostic blood tests, identification of support systems, and relaxation exercises can be implemented after the client becomes aware of factors that create stress. C This is incorrect. The initial step is awareness that stress is being experienced and awareness of factors that create stress. Diagnostic blood tests, identification of support systems, and relaxation exercises can be implemented after the client becomes aware of factors that create stress. D This is incorrect. The initial step is awareness that stress is being experienced and awareness of factors that create stress. Diagnostic blood tests, identification of support systems, and relaxation exercises can be implemented after the client becomes aware of factors that create stress. PTS: 1 CON: Stress 18. A 32-year-old woman is speaking to the office nurse at an initial visit. The nurse asked, “What brings you in today?” The woman replied, “I have been having headaches three to four times a week for the past month or so. I’m not sleeping well and feel tired most of the time. I work 60 hours per week and am going through a divorce.” The nurse determines the client’s symptoms represent which of the following? A. Adaptive coping B. C. D. Maladaptive coping Problem-solving Self-awareness ANS: B Chapter: Chapter 0, The Concept of Stress Adaptation Chapter learning objective: Define adaptation and maladaptation. 19 | P a g ePage: 8 Heading: Core Concepts Integrated Processes: Nursing Process Client Need: Psychosocial Integrity 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