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. The client’s 6-month score on the Recent Life Changes Questionnaire is 110. The
nurse:
1. Understands the client is at risk for significant stress-related illness.
2. Determines the client is not at risk for significant stress-related illness.
3. Needs further assessment of the client’s coping skills to determine susceptibility to stress-re-
lated illness.
4. Recognizes the client may view the losses as challenges and perceive them as opportunities.
ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the relationship between stress and diseases of adaptation.
Page: 5
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. 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 sus-
ceptibility to stress-related physical and psychological illnesses. The Recent Life
Changes Questionnaire is an expanded version of the Schedule of Recent Experi-
ences 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.
2. 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 more or a year-
score total 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
illnesses.
3. 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 suscepti-
bility to stress-related physical and psychological illnesses. A 6-month score of 300
or more 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.
4. 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 sus-
ceptibility to stress-related illness. A 6-month score of 300 or more 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 ill-
ness.
CON: Stress
2. 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:
1. Irrelevant
2. Harm or loss
3. Threatening
4. A challenge
ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 7
Heading: Stress as a transaction between the individual and the environment >Individual’s Per-
ception of the Event > Primary Appraisal
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
Feedback
1. This is incorrect. An irrelevant perception is one where the event holds no signifi-
cance for the individual.
2. This is incorrect. A harm or loss appraisal refers to damage or loss already experi-
enced by the individual.
3. This is incorrect. A threatening appraisal is perceived as anticipated harms or losses.
4. This is correct. The client’s statement indicates he perceives the loss of his job as a
challenge and an opportunity for growth, demonstrated by his statement to consider
an art degree.
CON: Stress
,3. Which client statement alerts the nurse that the client may be maladaptively responding to
stress?
1. “Avoiding contact with others helps me cope.”
2. “I really enjoy journaling; it’s my private time.”
3. “I signed up for a yoga class this week.”
4. “I made an appointment to meet with a therapist.”
ANS: 1
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 8
Heading: Stress Management
Integrated Processes: Nursing Process: Evaluation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
Feedback
1. 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.
2. This is incorrect. Journaling is a form of adaptive coping and interpersonal commu-
nication.
3. This is incorrect. Group exercise is a form of adaptive coping, relaxation.
4. This is incorrect. Seeing a therapist is not considered a maladaptive coping method.
CON: Stress
4. 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?
1. Alarm reaction
2. Resistance
3. Exhaustion
4. Fight or flight
ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the relationship between stress and diseases of adaptation.
Page: 2
Heading: Stress as a Biological Response
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
, Concept: Stress
Difficulty: Easy
Feedback
1. This is incorrect. At the alarm reaction stage, physiological responses of the fight-or-
flight syndrome are initiated.
2. This is incorrect. At the stage of resistance, the individual uses the physiological re-
sponses of the first stage as a defense in the attempt to adapt to the stressor. Physi-
ological symptoms may disappear.
3. 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.
4. This is incorrect. The fight-or-flight syndrome occurs during the alarm reaction
stage.
CON: Stress
5. A school nurse is assessing a high school student who is overly concerned about her appear-
ance. The client’s parent states, “That’s not something to be stressed about!” Which response by
the nurse is best?
1. “Teenagers don’t truly understand stress.”
2. “Why are you so concerned about your appearance?”
3. “You surely know that isn’t something to be concerned with.”
4. “I understand you feel stressed about this; tell me more about your stress.”
ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Describe the core concept of stress as an environmental event.
Page: 8
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
1. This is incorrect. This response is judgmental and nontherapeutic. This response
minimizes the student’s concerns.
2. This is incorrect. This response puts the student in a defensive position to justify her
feelings. It is nontherapeutic.
3. This is incorrect. This is a nontherapeutic response that minimizes the student’s feel-
ings. This does not allow the student to verbalize her concerns.
4. This is correct. Determination of an event as stressful depends on the individual’s
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:
1. Understands the client is at risk for significant stress-related illness.
2. Determines the client is not at risk for significant stress-related illness.
3. Needs further assessment of the client’s coping skills to determine susceptibility to stress-re-
lated illness.
4. Recognizes the client may view the losses as challenges and perceive them as opportunities.
ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the relationship between stress and diseases of adaptation.
Page: 5
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. 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 sus-
ceptibility to stress-related physical and psychological illnesses. The Recent Life
Changes Questionnaire is an expanded version of the Schedule of Recent Experi-
ences 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.
2. 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 more or a year-
score total 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
illnesses.
3. 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 suscepti-
bility to stress-related physical and psychological illnesses. A 6-month score of 300
or more 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.
4. 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 sus-
ceptibility to stress-related illness. A 6-month score of 300 or more 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 ill-
ness.
CON: Stress
2. 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:
1. Irrelevant
2. Harm or loss
3. Threatening
4. A challenge
ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 7
Heading: Stress as a transaction between the individual and the environment >Individual’s Per-
ception of the Event > Primary Appraisal
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
Feedback
1. This is incorrect. An irrelevant perception is one where the event holds no signifi-
cance for the individual.
2. This is incorrect. A harm or loss appraisal refers to damage or loss already experi-
enced by the individual.
3. This is incorrect. A threatening appraisal is perceived as anticipated harms or losses.
4. This is correct. The client’s statement indicates he perceives the loss of his job as a
challenge and an opportunity for growth, demonstrated by his statement to consider
an art degree.
CON: Stress
,3. Which client statement alerts the nurse that the client may be maladaptively responding to
stress?
1. “Avoiding contact with others helps me cope.”
2. “I really enjoy journaling; it’s my private time.”
3. “I signed up for a yoga class this week.”
4. “I made an appointment to meet with a therapist.”
ANS: 1
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 8
Heading: Stress Management
Integrated Processes: Nursing Process: Evaluation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
Feedback
1. 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.
2. This is incorrect. Journaling is a form of adaptive coping and interpersonal commu-
nication.
3. This is incorrect. Group exercise is a form of adaptive coping, relaxation.
4. This is incorrect. Seeing a therapist is not considered a maladaptive coping method.
CON: Stress
4. 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?
1. Alarm reaction
2. Resistance
3. Exhaustion
4. Fight or flight
ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the relationship between stress and diseases of adaptation.
Page: 2
Heading: Stress as a Biological Response
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
, Concept: Stress
Difficulty: Easy
Feedback
1. This is incorrect. At the alarm reaction stage, physiological responses of the fight-or-
flight syndrome are initiated.
2. This is incorrect. At the stage of resistance, the individual uses the physiological re-
sponses of the first stage as a defense in the attempt to adapt to the stressor. Physi-
ological symptoms may disappear.
3. 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.
4. This is incorrect. The fight-or-flight syndrome occurs during the alarm reaction
stage.
CON: Stress
5. A school nurse is assessing a high school student who is overly concerned about her appear-
ance. The client’s parent states, “That’s not something to be stressed about!” Which response by
the nurse is best?
1. “Teenagers don’t truly understand stress.”
2. “Why are you so concerned about your appearance?”
3. “You surely know that isn’t something to be concerned with.”
4. “I understand you feel stressed about this; tell me more about your stress.”
ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Describe the core concept of stress as an environmental event.
Page: 8
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
1. This is incorrect. This response is judgmental and nontherapeutic. This response
minimizes the student’s concerns.
2. This is incorrect. This response puts the student in a defensive position to justify her
feelings. It is nontherapeutic.
3. This is incorrect. This is a nontherapeutic response that minimizes the student’s feel-
ings. This does not allow the student to verbalize her concerns.
4. This is correct. Determination of an event as stressful depends on the individual’s
