chapter 005

Fortinash: Psychiatric Mental Health Nursing, 5th Edition

Chapter 05: Adaptation to Stress

Test Bank

MULTIPLE CHOICE

1. Although stress may result from either a positive or a negative event, the physical effects are similar. Which statement best describes the long term effects of stress?

a.

Eustress is likely to result in short term stress.

b.

Chronic distress can take a toll on the individual.

c.

Stress usually manifests in physical symptoms first.

d.

Distress generally results in more effective coping skills.

ANS: BDistress is damaging to an individual whether it is a result of either positive or negative stress. This stressor can become chronic if the conflict is not resolved. Distress can take a toll on an individual’s body as well as on his or her emotional state. Eustress occurs as a result of a positive stress such as from anticipation of a child’s birth but such stress is not necessarily short term and can result in the same symptoms as distress. Distress is less likely to occur if previous stress has brought about good coping skills.

DIF: Cognitive Level: Application REF: Pages 89-90TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity, Physiological Integrity

2. When explaining the fight-or-flight response to stress, the nurse identifies that the role of the pituitary gland is to:

a.

Minimize the secretion of cortisol.

b.

Facilitate the conservation of energy.

c.

Secrete adrenocorticotropic hormone.

d.

Encourage fleeing from the stressor.

ANS: CThe pituitary gland secretes adrenocorticotropic hormone, which stimulates the adrenal cortex to release cortisol. Cortisol is involved in helping the entire body to react to the stress by mobilizing the energy reserves so that the body can rapidly respond to the stressors by either fighting or fleeing.

Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Test Bank

DIF: Cognitive Level: Comprehension REF: Page 90TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity, Physiological Integrity

3. It is believed that an individual’s locus of control has a major role to play in how stress will be handled. Which statement characterizes an internal locus of control?

a.

“I’ll need to manage my money better in order to get out of debt.”

b.

“The economy has really caused my finances to be in a real mess.”

c.

“I don’t think I’ll ever be able to save enough to pay off my bills.”

d.

“Having a family makes being able to stay out of debt really difficult.”

ANS: AIndividuals who demonstrate an internal locus of control view their capability to have personal success or failure as having to do with their own efforts and their ability to complete a task. An individual with an external locus of control views task completion as having to do with circumstances beyond his or her control. The options involving the economy, never being able to pay off the bills, and having a family exhibit external control locus.

DIF: Cognitive Level: Application REF: Page 91TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. A nurse manager is attempting to address issues of work-related stress and dissatisfaction on the unit. Which administrative intervention has been identified through research as providing the most positive impact on staff morale even when job demands are high?

a.

Scheduling so that all staff gets two weekends off a month

b.

Arranging for extra staff when patient activity is above the unit average

c.

Offering a paid vacation day to anyone who has no absents for six months

d.

Assuring that no staff will be mandated overtime more than twice monthly

ANS: CWorkplaces with positive social interactions involve less stress, even when the job demands are high. When there is competition among workers, negative interactions among staff members, and no assistance when the workload becomes overwhelming, job dissatisfaction and stress is evident. The nurse manager will best impact the stress and resulting dissatisfaction by arranging for help with patient care when the need exists. Although the other options are not inappropriate, they do not address the issue research has identified as the primary cause of stress in the workplace.


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Test Bank

DIF: Cognitive Level: Application REF: Page 92TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

5. The nurse suggests that a patient help manage the stressors that are triggering generalized anxiety by implementing compartmentalization. Which activity provides proof that the patient is employing this healthy defense mechanism?

a.

Attends a meditation class 3 times a week right after work

b.

Uses chocolate as a reward when keeping stress under control

c.

Counts to 10 before responding to a coworker who is a source of stress

d.

Shares with the office manager the situations that regularly cause increased stress

ANS: AThe person who uses compartmentalization learns to leave the stressor in a designated space. An example of this mechanism would be regularly attending a class that serves to separate the stressful work environment from one’s private life. Using food as a reward may not be healthy and as with the remaining options, it is not examples of compartmentalization.

DIF: Cognitive Level: Application REF: Page 93 TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

6. The spouse of a patient exhibiting symptoms of chronic stress asks how they can help their spouse. Which suggestion by the nurse shows an understanding of a family member’s role in the management of stress?

a.

Offer to discuss the problem with the person who is most responsible for causing their spouse’s stress.

b.

Listen attentively when their spouse talks about the stressors and provide hugs to show your support.

c.

Help the spouse limit the amount of time each day they devote to discussing and otherwise dwelling on the stress.

d.

Provide the spouse with a variety of options and techniques for dealing with the stressors and the resulting physical symptoms.

ANS: B


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Test Bank

People need people to prevent isolation to promote their ability to deal with stress. In a study, it was found that individuals who had significant relationships that involved an expression of affection had a reduction in the fight-or-flight response when stressed. Those who regularly received hugs from their romantic partners had a decrease in resting heart rate and a healthy functioning limbic-hypothalamic-pituitary-adrenal axis. Conversely, individuals who lacked such support showed a higher level of stress and an increased possibility of developing an illness. Offering to confront the source of the stress is not supporting the spouse in learning to manage stress. Limiting time to dwell on obsessive thoughts may be therapeutic, but when a spouse implements this technique too often, it suggests a lack of patience and understanding of the problem. The spouse may not be qualified to provide such therapeutic options; that is the role of a mental health professional.


7. The patient is being introduced to mindfulness-based stress reduction to help manage chronic stress. The patient is first taught to focus on:

a.

What is causing the stress

b.

Both inhaling and exhaling

c.

Relaxing each major muscle group

d.

Visualizing their life without the stress

ANS: BIt is helpful to teach individuals a generic method of relaxation by first concentrating on the rhythm of breathing. Paying attention to each breath as one takes in a respiration and releases an expiration provides a focus for the meditation. The remaining options are not steps included in mindful mediation.


MULTIPLE RESPONSE

1. What is the role of the brain in producing the fight-or-flight stress response? Select all that apply.

a.

The medulla oblongata increases heart rate.

b.

Blood flow is increased by the medulla oblongata.

c.

The hypothalamus is stimulated via the limbic area.

d The reticular formation coordinates the brain’s sensory and motor tracks.


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Test Bank

.e.

Adrenocorticotropic hormone production is increased in the hypothalamus.

ANS: A, B, C, DThe brain (specifically the medulla oblongata) is responsible for the heart rate, the blood pressure rate, and the respiration rate. When a stressor is detected, the autonomic nervous system tells the medulla oblongata to increase the blood flow to certain organs (e.g., the muscles) to allow the individual to prepare for fight-or-flight. The brain receives an increase in oxygenated blood to increase awareness and the ability to think and respond to the stressor. The blood in the brain has an increase in glucose, epinephrine, and norepinephrine to assist the individual with reacting to the stressor. The reticular formation supports the coordination of the sensory and motor tract of the individual’s brain. This provides the individual with the ability to fight or flee. The limbic area of the brain communicates with the hypothalamus that the stress is occurring. The pituitary gland secretes adrenocorticotropic hormone which stimulates the adrenal cortex to release cortisol.


2. Nursing interventions appropriate to the generalized adaptation syndrome (GAS) exhaustion state include which of the following? Select all that apply.

a.

Planning care to best conserve the patient’s energy

b.

Assessment for respiratory disorders such as asthma

c.

Monitoring of exacerbation of compulsive ritual behaviors

d.

Frequent assessment of pain management related to headaches

e.

Planned periods to reinforce effective relaxation techniques

ANS: A, B, D, EIf the individual’s body does not adapt and the stressor continues to be prominent, then the third stage, called the exhaustion stage, occurs. The exhaustion stage can manifest itself in the form of illnesses such as infections, headaches, hypertension, asthma attacks, chronic fatigue syndrome, depression, anxiety disorders, and many other chronic conditions.


3. Which are expected outcomes for a patient who is effectively implementing a decision tree to enhance their problem-solving abilities? Select all that apply.

a.

A large, complex problem will be turned into a series of smaller, manageable problems.


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Test Bank

b.

The patient will not be overwhelmed and made to feel powerless by the problem.

c.

The problem and the resulting stress will be clearly and concisely defined.

d.

All resulting stress will be eliminated and the patient will feel empowered.

e.

Several different options for resolving the problem will be formulated.

ANS: A, B, C, EA decision tree enhances the person’s ability to think through a problem without getting stuck in a pattern of feeling overwhelmed and therefore unable to determine ways to reduce the effect of the stressful situation. The decision tree provides individuals with opportunities to problem solve by breaking down a problem or a stressor into smaller increments. Defining a problem clearly and determining options for solving it can help a person to think about more than one way to work on the problem or stressor. The use of a decision tree will not remove all stress but rather empower the individual to strive to solve the problem causing the stress.


4. The patient has been taught to use the stop, divert, and reframe method to deal with stress. Which responses indicate that the patient can affective utilize the technique when preparing to take a written examination? Select all that apply.

a.

Is heard declaring that, “It’s only a test; if I fail this one I will just study harder for the next one..

b.

Is observed opening a notebook and focusing on a family picture taken during a recent vacation

c.

Is heard stating, “Stop thinking that you can’t correctly answer the question. You can and you will.”

d.

Is observed asking the test monitor to be allow to sit somewhere “quiet and away from other people

e.

Is heard saying, “I will read the question thoroughly, find the key word, and then look at the options I’m given.”

ANS: B, C, EStop interrupts the negative train of thought. Divert allows focus on something that will rapidly reduce the stress. Reframe reinforces what you can do to reduce the stressor. The remaining options do not address any of the identified steps in this stress management method.

DIF: Cognitive Level: Application REF: Page 94 TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity


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chapter 005

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