Copin and Stress

1. The nurse is aware that stress-related physical, behavioral, and cognitive changes are more likely to occur when the stress:

a.
has a sudden onset.
b.
is low level but constant.
c.
is varied and cumulative.
d.
is suppressed or denied.

ANS: C

An accumulation of a variety of stressors is most likely to cause physical, behavioral, or cognitive changes.

DIF: Cognitive Level: Comprehension REF: 224 OBJ: 1

TOP: Stressors KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. The nurse is aware that in the first stage of the general adaptation syndrome (GAS), the body responds by:

a.
decreasing the heart rate.
b.
constricting peripheral vessels.
c.
decreasing blood glucose levels.
d.
decreasing blood pressure.

ANS: B

The body’s response during the alarm phase of the GAS is to increase heart rate and glucose levels, constrict peripheral vessels to increase the blood pressure, and supply more blood to the brain to ready the body to be in the fight-or-flight mode.

DIF: Cognitive Level: Comprehension REF: 226, Table 13-2

OBJ: 2 TOP: General Adaptation Syndrome

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. An extremely stressed woman is in the emergency department after a car wreck. She is breathing rapidly and complains of dizziness and tingling in her extremities. She says, “I think I’m having a heart attack!” The nurse recognizes these complaints as being related to:

a.
a transient ischemic attack.
b.
hyperventilation.
c.
hypotension.
d.
asthma.

ANS: B

An increased respiratory rate associated with stress can lead to hyperventilation, with its attendant distressing symptoms.

DIF: Cognitive Level: Application REF: 226, Table 13-2

OBJ: 2 TOP: Hyperventilation

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The student sitting in class waiting for the final examination develops nausea and excessive gas. The nursing instructor is aware that these symptoms are caused by a stress-related:

a.
increase in the blood glucose level.
b.
release of hormones.
c.
reduction of peristalsis.
d.
decrease in adrenalin.

ANS: C

The stress response of decreased peristalsis will cause abdominal distention, nausea, and gas. The continued response can result in constipation.

DIF: Cognitive Level: Application REF: 226, Table 13-2

OBJ: 2 TOP: Gastrointestinal Stress Response

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse recognizes a stress-related urinary symptom when the patient complains:

a.
“I have to urinate every 10 minutes, and there are only a few drops.”
b.
“I haven’t had to urinate for the past 8 hours.”
c.
“I void large amounts of urine every 2 hours.”
d.
“My urine has absolutely no color. It looks like water.”

ANS: A

Frequent voiding of only a small amount of urine is an indicator of stress.

DIF: Cognitive Level: Application REF: 226, Table 13-2

OBJ: 2 TOP: Urinary Stress Response

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. The nurse explains that mild stress can cause a person to be:

a.
indecisive.
b.
excessively alert.
c.
unable to focus.
d.
ineffective in problem solving.

ANS: B

Mild stress allows the person to be hyperalert, focused, and able to learn and solve problems. As stress increases, these abilities deteriorate.

DIF: Cognitive Level: Application REF: 225 OBJ: 2

TOP: Mild Stress KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

7. The nurse explains that in the general adaptation syndrome (GAS), after the first alarm reaction has been successfully resolved, the following stage, when the body systems return to normal, is the state of:

a.
regeneration.
b.
resistance.
c.
restoration.
d.
reorganization.

ANS: B

Resistance is the stage of the GAS in which body systems return to normal after the fight-or-flight mode.

DIF: Cognitive Level: Comprehension REF: 224 OBJ: 2

TOP: General Adaptation Syndrome KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. An 80-year-old man recently became widowed, moved into a long-term care facility, and had to quit driving. He complains of fatigue and is irritable when questioned about his health. The nurse should:

a.
suggest he take a daytime nap and go to bed early.
b.
report the complaints as expected adjustments to relocation.
c.
approach him to talk about his perceptions related to his relocation.
d.
suggest that he find some quiet time in the facility’s library and read a book.

ANS: C

Stress can cause fatigue and irritability. The approach from the nurse can initiate dialogue relative to his situation and his reaction to it.

DIF: Cognitive Level: Application REF: 225 OBJ: 8

TOP: Emotional Signs of Stress KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

9. The nurse assesses a behavior as a sign of depression in the new admission to a long-term care facility when the resident exhibits disorganization and:

a.
frequently comes to breakfast only partially dressed.
b.
eats excessive amounts of food at mealtime.
c.
socializes with only three or four other residents.
d.
arranges daily activities in order to able to watch Jeopardy at 4:30.

ANS: A

Depressive behaviors are signaled by disorganization, making frequent errors, and leaving tasks incomplete because of preoccupation with depression.

DIF: Cognitive Level: Application REF: 226 OBJ: 2

TOP: Depression KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

10. The nurse is aware that physical illness increases stress in many older adults because physical illness:

a.
is an acceptable reason to request relief.
b.
takes away energy to cope with new stressors.
c.
stimulates the family to be more attentive.
d.
most often has a clear pharmaceutical remedy.

ANS: B

Physical illness drains energy that might otherwise be mobilized to cope with stress. Many older adults think that it is acceptable to request assistance with a physical illness, the family is more attentive with the presence of a physical illness, and physical illnesses can have pharmaceutical relief, but none of those facts explain the reduced ability to cope with stress.

DIF: Cognitive Level: Analysis REF: 227 OBJ: 2

TOP: Illness and Stress KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

11. The long-term care facility nurse is assessing a newly admitted older adult who has become active in the facility, goes to every activity, carefully makes her bed every day, does jigsaw puzzles, and chats with tablemates at mealtime. The new resident is using the defense mechanism of:

a.
projection.
b.
rationalization.
c.
intellectualization.
d.
substitution.

ANS: D

Substitution prompts the person to substitute activity to reduce stress, a healthy and helpful mechanism.

DIF: Cognitive Level: Analysis REF: 227 OBJ: 3

TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

12. The nurse is aware that the use of a defense mechanism is a normal response to stress and only becomes problematic if the patient uses:

a.
more than one defense mechanism at a time.
b.
the defense mechanism longer than 1 week.
c.
the defense mechanism excessively.
d.
the defense mechanism until a more durable coping mechanism is formed.

ANS: C

Excessive or prolonged use of a defense mechanism to avoid dealing with stress is not a healthy use of defense mechanisms.

DIF: Cognitive Level: Comprehension REF: 227 OBJ: 3

TOP: Defense Mechanisms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

13. The nurse explains that problem-focused coping strategies are based on the ability to:

a.
eliminate the cause of stress.
b.
deny the cause of stress.
c.
repress the response to stressors.
d.
use prescription drugs to alter perception of the problem.

ANS: A

Elimination or changing the perception of the problem is the objective of problem-focused stress resolution strategies.

DIF: Cognitive Level: Comprehension REF: 228 OBJ: 3

TOP: Coping Strategies KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

14. The 80-year-old man who is experiencing stress because visual loss has caused him to quit driving says, “I have friends and family who will be my transportation. I can still get around and I’ll have entertaining company.” He is using the problem-solving method of:

a.
confrontation.
b.
escape.
c.
emotional distancing.
d.
avoidance.

ANS: C

Emotional distancing requires that the patient change his or her attitude toward the stressor.

DIF: Cognitive Level: Analysis REF: 228 OBJ: 3

TOP: Emotional Distancing KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

15. The nurse clarifies that older adults who have used effective coping skills during their younger years will:

a.
continue to use the same skills without modification.
b.
modify old skills and develop new ones.
c.
be at a loss when different types of stresses present themselves.
d.
be resistant to learning new skills.

ANS: B

Persons who have developed coping skills at a younger age will modify them and develop new skills.

DIF: Cognitive Level: Application REF: 228 OBJ: 8

TOP: Coping Skills KEY: Nursing Process Step: Implementation

MSC: NCLEX: Comprehension

16. The timid, newly admitted 84-year-old widow has stayed in her room at the long-term care facility listening to her radio, which is playing loud jazz, and has been lying in bed fully clothed. To help her reduce her stress related to relocation, the nurse should:

a.
insist that she come out and interact with other residents.
b.
turn her radio to a more soothing station.
c.
bring two other residents into the room to socialize with her.
d.
encourage her to verbalize feelings related to relocation.

ANS: D

Verbalization of concerns allows residents to identify them and deal with them more effectively.

DIF: Cognitive Level: Application REF: 228 OBJ: 8

TOP: Interventions to Reduce Stress KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

MULTIPLE RESPONSE

1. The nurse explains that as stress increases, the person will experience __________. (Select all that apply.)

a.
widened focus
b.
decreased problem-solving ability
c.
indecisiveness
d.
irrational behavior
e.
attention to detail

ANS: B, C, D

As stress increases, the focus narrows, with no attention to detail, and problem-solving skills decrease, which leads to irrational behavior and indecisiveness.

DIF: Cognitive Level: Application REF: 225 OBJ: 2

TOP: Cognitive Signs of Stress KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. The long-term care facility nurse carefully assesses the newly admitted older adult for signs of depression, which include __________. (Select all that apply.)

a.
appetite changes
b.
weight loss
c.
complaints of minor physical ailments
d.
sleep disturbances
e.
taking part in only one social activity a day

ANS: A, B, C, D

Older adults do not always present with the classic signs of depression because they may feel that they should deal with it independently, but they will have minor physical complaints. Disturbances in intake and sleep are also classic signs of depression. Voluntary socialization is not a sign of depression.

DIF: Cognitive Level: Application REF: 226, Box 13-1

OBJ: 2 TOP: Depression Related to Stress

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

3. The nurse is aware that depression is a common symptom in older adults admitted to a long-term care facility because many residents believe that they have lost control of their lives and __________. (Select all that apply.)

a.
their usual coping skills have been overwhelmed
b.
they think that they have no family support
c.
they have self-knowledge that will enable them to cope with new situations
d.
they find support of self-worth through activities and making new friends
e.
they actively seek assistance to reduce depression

ANS: A, B

Relocation is often overwhelming and can cause persons to feel abandoned. Seeking activities and social contacts, developing new coping skills, and asking for assistance with depression are not signs of depression, but of recovery.

DIF: Cognitive Level: Application REF: 226 OBJ: 2

TOP: Depression KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

4. The nurse encourages a patient to use the problem-focused approach to reduce stress to __________. (Select all that apply.)

a.
confront a stressor
b.
use emotional distancing to alter perception of the stressor
c.
develop alternative coping skills
d.
identify all stressors
e.
practice a strategy with small stressors

ANS: A, B, C, E

With the problem-focused approach, a single stressor needs to be identified, and a specific strategy for solution designed.

DIF: Cognitive Level: Analysis REF: 228 OBJ: 3

TOP: Problem-Focused Coping Strategies

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

5. The nurse cautions that the use of avoidance is an effective stress reducer if __________. (Select all that apply.)

a.
the stressor has great personal significance
b.
avoidance does not affect the outcome of the event
c.
the stressor is not a frequently recurring event
d.
continued avoidance does not add stress
e.
avoidance does not diminish the self-image

ANS: B, C, D, E

Avoidance is helpful if it does not affect the outcome, the stressor is not a frequently occurring event, and if avoidance does not add stress or diminish the self-image.

DIF: Cognitive Level: Analysis REF: 227 OBJ: 3

TOP: Avoidance KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

6. The newly admitted male resident is brought into the care-planning session so that he can have the benefit of __________. (Select all that apply.)

a.
maintaining some degree of control of his care
b.
rejecting the care plan
c.
voicing his preferences
d.
improving his problem-solving capabilities
e.
gaining insight to overall goals of care

ANS: A, C, E

Participation in care planning does not allow outright rejection of the plan, nor will it necessarily improve problem-solving skills.

DIF: Cognitive Level: Application REF: 231 OBJ: 8

TOP: Care Planning KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

7. The nurse is enthusiastic about the effects of geriatric massage, which include __________. (Select all that apply.)

a.
improved circulation
b.
increased range of motion
c.
reduction of anxiety
d.
increased sexual potency
e.
improved mobility

ANS: A, B, C, E

Sexual potency is not enhanced by geriatric massage.

DIF: Cognitive Level: Application REF: 228 OBJ: 8

TOP: Geriatric Massage KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

8. The nurse introduces several methods for coping with stress to a group of older adults at a senior citizens center. These methods include __________. (Select all that apply.)

a.
meditation
b.
talking with family and friends
c.
swimming
d.
alcohol use in moderation
e.
massage therapy

ANS: A, B, C, E

The use of alcohol does not relieve stress but may be used in response to a stressful situation. Alcohol use can lead to abuse in some older adults. The safe level of alcohol decreases in the elderly. Physical activity in moderation, relaxation techniques, and viable support systems provide positive interventions to cope with stress.

DIF: Cognitive Level: Application REF: 228 OBJ: 6

TOP: Methods of Relieving Stress KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The nurse informs a group of nursing students working in the geriatric psychiatric unit that older adults are at greater risk for stress-related problems if they have __________. (Select all that apply.)

a.
a chronic illness
b.
suffered the loss of a spouse
c.
relocated
d.
reduced income
e.
general adaptation syndrome

ANS: A, B, C, D

A chronic illness, the loss of a spouse, relocation, and reduced income are stress-producing events. General adaptation syndrome is a theory.

DIF: Cognitive Level: Application REF: 227 OBJ: 5

TOP: Risk For Stress-Related Problems KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

1. The nurse explains that a Japanese stress reduction strategy that increases the energy of life force by laying-on of hands is called __________.

ANS: Reiki

DIF: Cognitive Level: Comprehension REF: 228 OBJ: 3

TOP: Alternative Therapies KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

2. The nurse explains that according to the general adaptation syndrome theory, if coping skills do not resolve the initial alarm response, the body becomes depleted of its reserve and the person enters the __________ stage.

ANS: exhaustion

DIF: Cognitive Level: Comprehension REF: 224 OBJ: 2

TOP: General Adaptation Syndrome KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation