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:
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 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	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:
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

	3.	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
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	This is incorrect. Journaling is not considered a maladaptive coping method.	
C	This is incorrect. Group exercise is not considered a maladaptive coping method.	
D	This is incorrect. Seeing a therapist is not considered a maladaptive coping method.	

PTS:	1	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?
A.	Alarm reaction	
B.	Resistance	
C.	Exhaustion	
D.	Fight or flight	

ANS:	C
Chapter: Chapter 1, The Concept of Stress Adaptation
Chapter learning objective: Explain the relationship between stress and diseases of adaptation.
Page: 9
Heading: 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	This is incorrect. At the alarm reaction stage, physiological responses of the fight-or-flight syndrome are initiated.	
B	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	CON:	Stress

	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 response by the nurse is best?
A.	“Teenagers! They don’t know a thing about real stress.”	
B.	“Psychological or physical stress occur only when there is a loss.”	
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

	6.	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

	7.	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

	8.	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
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	This is incorrect. An event becomes relevant to an individual when the outcome holds personal significance.	
B	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.	
C	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	CON:	Stress

	9.	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.	An achieved insight into one’s feelings	
C.	A demonstration of appropriate role behaviors	
D.	An enhanced ability to problem-solve	

ANS:	A
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 > 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.	
B	This is incorrect. Meditation does not necessarily produce an achieved insight into one’s feelings.	
C	This is incorrect. Meditation does not help to demonstrate appropriate role behaviors. 	
D	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.	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

	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.	“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

	12.	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.	
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	CON:	Stress

	13.	The nurse identifies which symptom as typical of the fight-or-flight response?
A.	Decreased heart rate	
B.	Increased peristalsis	
C.	Increased salivation	
D.	Pupil constriction	

ANS:	B
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: 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.	The event is irrelevant.	
C.	Resources are available.	
D.	The event is pleasurable.	

ANS:	C
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 > 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

	15.	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

	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?
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

	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.	Awareness of factors creating stress	
C.	Relaxation exercises	
D.	Identification of support systems	

ANS:	B
Chapter: Chapter 1, 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	
A	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.	Maladaptive coping	
C.	Problem-solving	
D.	Self-awareness	

ANS:	B
Chapter: Chapter 1, The Concept of Stress Adaptation
Chapter learning objective: Define adaptation and maladaptation.
Page: 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. 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

	19.	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

	20.	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.	

PTS:	1	CON:	Stress

MULTIPLE RESPONSE

	21.	A nurse is interviewing a distressed client who reports being fired after 15 years of loyal employment. Which of the following questions best assists 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
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 > Individual’s Perception of the Event
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Moderate

	Feedback	
1. 	This is correct. This question specifically addresses the client’s coping resources.	
2. 	This is correct. This question encourages the client to apply learning from past experiences.	
3. 	This is incorrect. Asking who is to blame does not assess coping abilities, but rather, encourages maladaptive behavior.	
4. 	This is incorrect. This question does not assess coping abilities. Requesting an explanation is a nontherapeutic block to communication.	
5.	This is correct. This question focuses on coping strategies and alternative methods for dealing with stress.	

PTS:	1	CON:	Stress

	22.	A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful to assist the client to cope 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.”	

ANS:	A, B, C, D
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	
1. 	This is correct. Pets have been shown to decrease stress.	
2. 	This is correct. Healthy relationships have been shown to decrease stress.	
3. 	This is correct. Music has been shown to decrease stress.	
4. 	This is incorrect. Focusing on the stressors is more likely to increase stress.	
5.	This is correct. Journaling feelings has been shown to decrease stress.	

PTS:	1	CON:	Stress

	23.	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	
1. 	This is incorrect. Dilated pupils, rather than constricted pupils, are related to the fight-or-flight syndrome.	
2. 	This is correct. Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress.	
3. 	This is incorrect. Unusual food cravings have not been identified as a typical biological response to stress.	
4. 	This is correct. Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress.	
5.	This is correct. Increased lacrimal secretions, increased heart rate, and increased respirations are identified as initial biological responses to stress.	

PTS:	1	CON:	Stress

	24.	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	
1. 	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.	
2. 	This is incorrect. Disequilibrium is not included as part of Hobfoll’s theory.	
3. 	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.	
4. 	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.	
5.	This is incorrect. Resilience is not included as part of Hobfoll’s theory.	

PTS:	1	CON:	Stress

ORDERED RESPONSE

	25.	Place the selected steps of the problem-solving process in the correct order.
1. Determine risks and benefits of each option.
2. Formulate goals to resolve the stressful situation.
3. Implement a second alternative.
4. Study the alternatives for dealing with the situation.

ANS:	
The correct order is 2, 4, 1, 3
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
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy

Feedback: Problem-solving is an adaptive coping strategy in which an individual views the situation objectively and applies a decision-making model. The steps of the problem-solving process are: (1) Assessing the facts of the situation; (2) formulating goals for resolution of the stressful situation; (3) studying the alternatives for dealing with the situation; (4) determining the risks and benefits of each alternative; (5) selecting an alternative; (6) implementing the selected alternative; (7) evaluating the outcome of the alternative implemented; and (8) if the first choice is ineffective, selecting and implementing a second option.

PTS:	1	CON:	Stress