Stress and Stress-Related Disorders

MULTIPLE CHOICE

1. Which scenario best demonstrates an example of eustress? An individual:
a. loses a beloved family pet.
b. prepares to take a 1 week vacation to a tropical island with a group of close friends.
c. receives a bank notice there were insufficient funds in their account for a recent rent payment.
d. receives notification that their current employer is experiencing financial problems and some workers will be terminated.
ANS: B
Eustress is beneficial stress; it motivates people to develop skills they need to solve problems and meet personal goals. Positive life experiences produce eustress. Going on a tropical vacation is an exciting, relaxing experience and an example of eustress. Losing the family pet, worrying about employment security, and having financial problems are examples of distress, a negative experience that drains energy and can lead to significant emotional problems.

DIF: Cognitive Level: Application (Applying) REF: Page: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. A patient diagnosed with liver failure has been on the transplant waiting list 8 months. The patient says, “Why is it taking so long to have the surgery? Maybe I’m meant to die for all the bad things I’ve done.” The nurse should document the patient’s comment in which section of the assessment?
a. Physical
b. Spiritual
c. Financial
d. Psychological
ANS: B
Stress can be evident in a person’s spirituality. This patient’s comment indicates questioning of one’s place in the universe and consequences for wrongdoing, both of which are elements of spirituality. Stress can be related to psychological, physical, or psychosocial well-being, but spirituality is the best answer.

DIF: Cognitive Level: Application (Applying) REF: Page: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system?
a. Thalamus
b. Parietal lobe
c. Hypothalamus
d. Pituitary gland
ANS: C
The individual will find this experience stressful. The hypothalamus functions as the command-and-control center when receiving stressful signals. The hypothalamus responds to signals of stress by engaging the autonomic nervous system. The parietal lobe is responsible for the interpretation of other sensations. The thalamus processes messages associated with pain and wakefulness. The pituitary gland may be involved in other aspects of the person’s response but would not stimulate the autonomic nervous system.

DIF: Cognitive Level: Application (Applying) REF: Page: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

4. A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system is stimulated in response to this experience?
a. Limbic system
b. Peripheral nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system
ANS: C
The autonomic nervous system is made up of the sympathetic (fight-or-flight response) and parasympathetic (relaxation response) nervous systems. In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

5. A patient is brought to the emergency department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient’s vital signs are temperature (T), 98.6° F; pulse (P), 72 beats per minute (bpm); and respirations (R), 16 breaths per minute. After being informed that surgery is required for the broken leg, which vital sign readings would be expected?
a. T, 98.6°; P, 64; R, 14
b. T, 98.6°; P, 68; R, 12
c. T, 98.6°; P, 62; R, 16
d. T, 98.6°; P, 84; R, 22
ANS: D
The patient would experience stress associated with the anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight-or-flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

6. As part of the stress response, the HPA axis is stimulated. Which structures make up this system?
a. Hippocampus, parietal lobe, and amygdala
b. Hypothalamus, pituitary gland, and adrenal glands
c. Hind brain, pyramidal nervous system, and anterior cerebrum
d. Hepatic artery, parasympathetic nervous system, and acoustic nerve
ANS: B
As part of the physiologic response of stress, the hypothalamus stimulates the HPA axis, which is made up of the hypothalamus, pituitary gland, and adrenal glands.

DIF: Cognitive Level: Knowledge (Remembering) REF: Page: 156
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

7. Cortisol is released in response to a patient’s prolonged stress. Which initial effect would the nurse expect to result from the increased cortisol level?
a. Diuresis and electrolyte imbalance
b. Focused and alert mental status
c. Drowsiness and lethargy
d. Restlessness and anxiety
ANS: B
Cortisol is the primary stress hormone and is released in response to prolonged stress. Cortisol helps supply cells with amino acids and fatty acids for energy supply, as well as diverting glucose from muscles for use by the brain. As a result, the brain stays alert and focused. The distractors present effects that would not be expected.

DIF: Cognitive Level: Application (Applying) REF: Pages: 156-157
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

8. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). The nurse’s highest priority is to screen this soldier for which problem?
a. Major depressive disorder
b. Bipolar disorder
c. Schizophrenia
d. Dementia
ANS: A
Major depressive disorder frequently co-occurs with PTSD. The incidence of the disorders identified in the distractors is similar to the general population.

DIF: Cognitive Level: Application (Applying) REF: Pages: 157-158
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

9. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). Which comment by the soldier requires the nurse’s immediate attention?
a. “It’s good to be home. I missed my family and friends.”
b. “I saw my best friend get killed by a roadside bomb. It should have been me instead.”
c. “Sometimes I think I hear bombs exploding, but it’s just the noise of traffic in my hometown.”
d. “I want to continue my education but I’m not sure how I will fit in with other college students.”
ANS: B
The correct response indicates the soldier is thinking about death and feeling survivor’s guilt. These emotions may accompany suicidal ideation, which warrants the nurse’s follow-up assessment. Suicide is a high risk among military personnel diagnosed with PTSD. One distractor indicates flashbacks, which is common with individuals with PTSD but is not solely indicative of further problems. The other distractors are normal emotions associated with returning home and change.

DIF: Cognitive Level: Analysis (Analyzing) REF: Pages: 157-159
TOP: Nursing Process: Analysis| Nursing Process: Diagnosis
MSC: NCLEX: Psychosocial Integrity

10. A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with post-traumatic stress disorder (PTSD). The soldier says, “If there’s a loud noise at night, I get under my bed because I think we’re getting bombed.” What type of experience has the soldier described?
a. Illusion
b. Flashback
c. Nightmare
d. Auditory hallucination
ANS: B
Flashbacks are dissociative reactions in which an individual feels or acts as if the traumatic event were recurring. Illusions are misinterpretations of stimuli; although the experience is similar, the more accurate term is flashback because of the diagnosis of PTSD. Auditory hallucinations have no external stimuli. Nightmares commonly accompany PTSD, but this experience is stimulated by an actual environmental sound.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 160
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

11. A soldier returned 3 months ago from Afghanistan and was diagnosed with post-traumatic stress disorder (PTSD). Which social event would most likely be disturbing for this soldier?
a. Halloween festival with neighborhood children
b. Singing carols around a Christmas tree
c. Family outing to the seashore
d. Fireworks display on July 4th
ANS: D
exploding noises associated with fireworks are most likely to provoke exaggerated responses for this soldier. The distractors are not associated with offensive sounds.

DIF: Cognitive Level: Analysis (Analyzing) REF: Page: 160
TOP: Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity

12. A soldier served in combat zones in Iraq in 2010 and was deployed to Afghanistan in 2013. When is it most important for the nurse to screen for signs and symptoms of post-traumatic stress disorder (PTSD)?
a. Immediately upon return to the United States from Afghanistan
b. Before departing Afghanistan to return to the United States
c. One year after returning from Afghanistan
d. Screening should be ongoing
ANS: D
PTSD can have a long lag time—months to years. Screening should be ongoing.

DIF: Cognitive Level: Application (Applying) REF: Page: 159
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13. A nurse assesses soldiers in a combat zone in Afghanistan. When is it most important for the nurse to screen for signs and symptoms of traumatic brain injury (TBI)?
a. After a fall, vehicle crash, or exposure to a blast
b. Before departing Afghanistan to return to the United States
c. One year after returning to the United States from Afghanistan
d. Immediately upon return to the United States from Afghanistan
ANS: A
The military estimates that up to 20% of the combat veterans in both Afghanistan and Iraq suffer some degree of TBI. TBI exhibits signs shortly after the injury, and these signs usually resolve in days or weeks. Screening after an exposure to an explosion and before returning to the United States is important.

DIF: Cognitive Level: Application (Applying) REF: Page: 159
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

14. A soldier in a combat zone tells the nurse, “I saw a child get blown up over a year ago, and now I keep seeing bits of flesh everywhere. I see something red and the visions race back to my mind.” Which phenomenon associated with post-traumatic stress disorder (PTSD) is this soldier describing?
a. Re-experiencing
b. Hyperarousal
c. Avoidance
d. Psychosis
ANS: A
Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events are often associated with PTSD. The soldier has described intrusive thoughts and visions associated with re-experiencing the traumatic event. This description does not indicate psychosis, hypervigilance, or avoidance.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 160
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

15. A soldier who served in a combat zone returned to the United States. The soldier’s spouse complains to the nurse, “We had planned to start a family, but now he won’t talk about it. He won’t even look at children.” The spouse is describing which symptom associated with post-traumatic stress disorder (PTSD)?
a. Reexperiencing
b. Hyperarousal
c. Avoidance
d. Psychosis
ANS: C
Physiologic reactions to reminders of the event include a persistent avoidance of the stimuli associated with the trauma; the individual avoids talking about the event or avoids activities, people, or places that arouse memories of the trauma. Avoidance is exemplified by a sense of foreshortened future and estrangement. No evidence suggests that this soldier is having a hyperarousal reaction or is re-experiencing war-related traumas. Psychosis is not evident.

DIF: Cognitive Level: Comprehension (Understanding) REF: Page: 160
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

16. A soldier returned home last year after deployment to a war zone. The soldier’s spouse complains, “We were going to start a family but now he won’t talk about it. He will not look at children. I wonder if we’re going to make it as a couple.” Select the nurse’s best response.
a. “Post-traumatic stress disorder often changes a person’s sexual functioning.”
b. “I encourage you to continue to participate in social activities where children are present.”
c. “Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior.”
d. “Post-traumatic stress disorder often strains relationships. I will suggest some community resources for help and support.”
ANS: D
PSTD precipitates changes that often lead to divorce. Providing support to both the veteran and spouse is important. Confrontation will not be effective. Although providing information is important, ongoing support is more effective.

DIF: Cognitive Level: Application (Applying) REF: Pages: 160-162
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

17. A nurse talks with the caregiver of a combat veteran diagnosed with severe traumatic brain injuries. The caregiver says, “I don’t know how much longer I can do it. My whole life is consumed with taking care of my partner.” Select the nurse’s best response.
a. “How are you taking care of yourself?”
b. “Let’s review your partner’s diagnostic results.”
c. “I have some web-based programs for you to visit.”
d. “Your partner is lucky to have someone so devoted.”
ANS: A
The caregiver is the focus of the nurse’s attention. The caregiver is suffering. The nurse must be empathetic and assess how the caregiver is caring for self. Reassurance and isolated computer activities do not help. The partner is already aware of the diagnostic results.

DIF: Cognitive Level: Application (Applying) REF: Pages: 159-161
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

18. A professor’s 4-year-old child has a fever of 101.6° F, diarrhea, and complains of stomach pain. The professor is scheduled to teach three classes today. Which nursing diagnosis best applies to this scenario?
a. Decisional conflict
b. Unilateral neglect
c. Disabled family coping
d. Ineffective management of the therapeutic regimen
ANS: A
The caregiver is the focus of the nurse’s attention. The professor is under stress, related to the conflict between his parenting and professional roles. This scenario presents a decisional conflict. No evidence suggests that family coping is disabled or that a therapeutic regimen is not managed. Unilateral neglect refers to the awareness of the body.

DIF: Cognitive Level: Application (Applying) REF: Pages: 156-157
TOP: Nursing Process: Diagnosis| Nursing Process: Analysis
MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. An individual says to the nurse, “I feel so stressed out lately. I think the stress is affecting my body also.” Which somatic complaints are most likely to accompany this feeling? Select all that apply.
a. Headache
b. Neck pain
c. Insomnia
d. Anorexia
e. Myopia
ANS: A, B, C, D
When individuals feel “stressed-out,” they often have accompanying somatic complaints, especially associated with sleep, eating, and headache or back pain. Changes in vision, such as myopia, would not be expected.

DIF: Cognitive Level: Application (Applying) REF: Pages: 156-158
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. Which experiences are most likely to precipitate post-traumatic stress disorder (PTSD)? Select all that apply.
a. An 8-year-old child watches an R-rated movie with both parents.
b. A young adult jumps from a bridge with a bungee cord with a best friend.
c. An adolescent is kidnapped and held for 2 years in the home of a sexual predator.
d. A passenger is in a bus that overturns on a sharp curve in the road, tumbling down an embankment.
e. An adult is trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.
ANS: C, D, E
PTSD usually follows a traumatic event that is outside the range of usual experience. Examples are childhood physical abuse, torture or kidnapping, military combat, sexual assault, and natural disasters such as floods, tornados, earthquakes, and tsunamis; human disasters such as a bus or elevator accident or crime-related events such being taken hostage are additional examples. The common element in these experiences is the individual’s extraordinary helplessness or powerlessness in the face of such stressors. Bungee jumping by adolescents is part of the developmental task and might be frightening but in an exhilarating way rather than a harmful way. A child may be disturbed by an R-rated movie, but the presence of the parents would modify the experience in a positive way.

DIF: Cognitive Level: Application (Applying) REF: Pages: 157-159
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

3. A nurse assesses the health status of soldiers returning from Afghanistan. Screening will be a priority for signs and symptoms of which health problems? Select all that apply.
a. Schizophrenia
b. Eating disorder
c. Traumatic brain injury
d. Seasonal affective disorder
e. Post-traumatic stress disorder
ANS: C, E
TBI and PTSD each occur in approximately 20% of soldiers returning from Afghanistan. Some soldiers have both problems. The incidence of disorders identified in the distractors would be expected to parallel the general population.

DIF: Cognitive Level: Application (Applying) REF: Pages: 158-159
TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. A professor’s 4-year-old child has a temperature of 101.6° F, diarrhea, and complains of stomach pain. The professor is scheduled to teach three classes today. Which actions by the professor demonstrate effective parenting? Select all that apply.
a. Telephoning a grandparent to stay with the child at home for the day.
b. Telephoning a colleague to teach his classes and staying home with the sick child.
c. Taking the child to the university and keeping the child in a private office for the day.
d. Taking the child to a daycare center and hoping daycare workers will not notice the child is sick.
e. Giving the child one dose of ibuprofen (Motrin) and taking the child to the daycare center.
ANS: A, B
The correct responses demonstrate fulfillment of the role as a parent. The distractors indicate the professor has not cared for the sick child in an effective way. Taking the child to a daycare center exposes other children to a potential infection. Taking the child to one’s office does not keep the child comfortable or provide for the child while the professor is teaching.

DIF: Cognitive Level: Application (Applying) REF: Pages: 159-160
TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance