Anxiety, Stress, and Coping
A patient tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking." Which response would be in keeping with the dr's recommendation? a. Teaching the patient to recognize, reframe, and reconsider irrational thoughts. b. Encouraging the patient to imagine being in a calming circumstance. c. Teaching the patient to use instruments that give feedback about bodily function d. Provide the patient with a blank journal and guidance about journaling
a
A trauma survivor is requesting sleep medication because of "bad dreams." The nurse is concerned that the patient may be experiencing post-traumatic stress disorder (PTSD). Which question is a priority for the nurse to ask the patient? a. "Are you reliving your trauma?" b. "Are you having chest pain?" c. "Can you describe your phobias?" d. "Can you tell me when you wake up?"
a
An adult patient who is hospitalized after a motorcycle crash tells the nurse, "I didn't sleep last night because I worried about missing work at my new job and losing my insurance coverage." Which nursing diagnosis is appropriate to include in the plan of care? a. Anxiety b. Ineffective denial c. Defensive coping d. Risk prone health behavior
a
Generally, which statement regarding ego defense mechanisms is true? a. They often involve some degree of self-deception b. They are rarely used by mentally healthy people c. They seldom make the person more comfortable d. They are usually effective in resolving conflicts
a
Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of A. panic attacks with agoraphobia. B. obsessive-compulsive disorder. C. posttraumatic stress response. D. generalized anxiety disorder.
a
Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form? a. Social support b. Cultural support c. Life satisfaction d. Cognitive reframing
a
The nurse is planning to teach a patient how to use relaxation techniques to prevent elevation of blood pressure and heart rate. The nurse is teaching the patient to control which physiological function? a. Switch from the sympathetic mode of the ANS to the parasympathetic mode b. Alter the internal state by modifying electronic signals related to physiologic processes c. Replace stress-producing thoughts and activities with daily stress-reducing thoughts and activities d. Reduce catecholamine production and promote the production of additional beta-endorphins
a
The nurse is reviewing the care plan for a patient experiencing difficulty coping with stress. The nurse recognizes that an example of initiating a cognitive restructuring intervention to enhance coping abilities is known as which of the following? a. Identifying the cause of fear b. Accessing a community support group c. Identifying relaxation methods d. Reviewing an educational pamphlet
a
The nurse teaches a patient who is experiencing stress at work how to use imagery as a relaxation technique. Which statement by the nurse would be appropriate? a. "Think of a place where you feel peaceful and comfortable." b. "Place the stress in your life into an image that you can destroy." c. "Repeatedly visualize yourself experiencing the distress in your workplace." d. "Bring what you hear and sense in your work environment into your image."
a
What information should the nurse give to the family of a client who has had a dissociative episode? a. Dissociation is a method for coping with severe stress b. Dissociation suggests the possibility of early dementia c. Brief periods of psychotic behavior may occur d. Ways to intervene to prevent self-mutilation and suicide attempts
a
When discussing the symptoms of PTSD, the nurse should make which statement? a. "The symptoms can occur almost immediately or take years to manifest" b. "PTSD causes agitation and hypervigilance but rarely chronic depression" c. "When experiencing a flashback, the client generally experiences a slowing of responses" d. "PTSD is an emotional response that does not cause significant changes in brain chemistry"
a
Which statement about structural dissociation of the personality is true? a. An organic basis exists for this type of disorder b. Nurses perceive clients with this disorder as easy to care for c. No known link exists between this disorder and early childhood loss or trauma d. This disorder results in a split in the personality causing a lack of integration
a
A nurse is assessing a patient with prolonged stress. Which conditions will the nurse monitor for in this patient? (Select all that apply.) a. Cancer b. Diabetes c. Infections d. Allostasis e. Low blood pressure
a, b, c
The symptoms of an adjustment disorder can include which characteristics? (Select all that apply) a. Guilt b. Social withdrawal c. Overachieving d. Anger e. Depression
a, b, d, e,
4. A patient is extremely anxious about having a biopsy on a femoral lymph node. Which relaxation technique would be the best choice for the nurse to facilitate during the procedure? a. Yoga stretching b. Relaxation breathing c. Guided imagery d. Mindfulness meditation
b
A 72-year-old patient diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When his provider orders lorazepam, 1 mg PO BID, the nurse questions the prescription based primarily on what fact? a. The client may become addicted faster than younger patients b. The client is at a risk for falls c. The client has a history of nonadherence with medications d. The client should be treated with cognitive therapies because of his advanced age
b
A child who is able to regain mental stability after a traumatic event is said to be demonstrating what trait? a. Autonomy b. Resilience c. Maturity d. Independence
b
A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? a. Panic disorder b. Adult separation anxiety disorder c. Agoraphobia d. Social anxiety disorder
b
Empathic listening is therapeutic because it focuses on what action? a. Enhancing self-esteem b. Lessening feelings of isolation c. Reducing anxiety d. Encouraging resilience
b
What symptom can the nurse expect a client diagnosed with depersonalization disorder to manifest? a. Aimless wandering with confusion and disorientation b. A feeling of detachment form one's body of mental processes c. Existence of two or more personalities that take control of your behavior d. Worry about having a serious disease based on symptom misinterpretation
b
Which behavior best supports the diagnosis of PTSD in a 4-year-old child? a. Overeating b. Hypervigilance c. A drive to be perfect d. Passivity
b
Which of the following statements about dissociative disorder is true? a. Dissociative symptoms are under the person's conscious control b. Dissociative symptoms are not under the person's conscious control c. Dissociative symptoms are usually a cry for attention d. Dissociative symptoms are always negative
b
Which statement, made by a client diagnosed with dissociative identity disorder, demonstrates effective understanding in response to the question "What exactly are your 'alters'?" illustrates that the education provided has been effective. a. "Alters are based in mysticism and religiosity, such as demons" b. "Alters are separate personalities with their own characteristics that take over during stress" c. "Alters are never aware of each other" d. "Alters are just like me, but they have no memory of the trauma I went through"
b
A patient who is hospitalized with a pelvic fracture after a motor vehicle accident just received news that the driver of the car died from multiple injuries. What actions should the nurse take based on knowledge of the physiologic stress reactions that may occur in this patient (select all that apply)? a. Assess for bradycardia. b. Observe for decreased appetite. c. Ask about epigastric discomfort. d. Monitor for decreased respiratory rate. e. Check for elevated blood glucose levels.
b, c, e
The nurse is working with a patient who recently lost her spouse after a lengthy illness. The patient shares that she would like to sell her home and move to another state now that her spouse has passed away. Which of the following interventions would be considered a priority for this patient? (Select all that apply.) a. Notify the provider to evaluate for antidepressant therapy. b. Suggest that the patient consider a support group for widows. c. Suggest that the patient learn stress reduction breathing exercises. d. Suggest that the patient take prescribed antianxiety medications. e. Assist the patient in identifying support systems. f. Notify the provider to evaluate the need for antianxiety medications.
b, c, e
A 4-year-old is referred to the outpatient mental health clinic after being a severe car accident, during which their mother died. The father states the child is withdrawn, not sleeping, having nightmares, and acts out the car accident over and over again while playing. The child states "It's my fault because I'm bad". What trauma-induced disorder does this data support? a. Adjustment disorder b. Dissociative identity disorder c. PTSD d. Acute stress disorder
c
A Gulf War veteran is entering treatment for PTSD. What assessment is of importance to this particular client? a. Ascertain how long ago the trauma occurred b. Find out if the client uses acting-out behavior c. Determine the use of chemical substances for anxiety relief d. Establish whether the client has chronic hypertension related to high anxiety
c
A child who was physically and sexually abused is at great risk for demonstrating which characteristic? a. Depression b. Suicide attempts c. Bullying and abusing others d. Becoming active in a gang
c
A client diagnosed with PTSD shows little symptom improvement after being prescribed an SSRI. The nurse expects that which medication will be prescribed next? a. Beta blocker b. Barbiturate c. Tricyclic antidepressant d. Sedative
c
A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as A. mild. B. moderate. C. severe. D. panic
c
A nurse is planning care for a patient that uses displacement. Which information should the nurse consider when planning interventions? a. This copes with stress directly. b. This evaluates an event for its personal meaning. c. This protects against feelings of worthlessness and anxiety. d. This triggers the stress control functions of the medulla oblongata.
c
A nurse is teaching the staff about a nursing theory that views a person, family, or community developing a normal line of defense. Which theory is the nurse describing? a. Ego defense model b. Immunity model c. Neuman Systems Model d. Pender's Health Promotion Model
c
A nurse prepares an adult patient with a severe burn injury for a dressing change. The nurse knows that this is a painful procedure and wants to try providing music to help the patient relax. Which action is best for the nurse to take? a. Use music composed by Mozart. b. Play music that does not have words. c. Ask the patient about music preferences. d. Select music that has 60 to 80 beats/minute.
c
Dissociative identity disorder is characterized by what event? a. The inability to recall important information b. Sudden, unexpected travel away from home and inability to remember the past c. The existence of two of more subpersonalities, each with its own patterns of thinking d. Recurring feelings of detachment from one's body or mental processes.
c
Panic attacks in Latin American individuals often involve a. repetitive involuntary actions. b. blushing. c. fear of dying. d. offensive verbalizations
c
The nurse is caring for a patient on day 1 post surgical procedure. The patient becomes visibly anxious and short of breath, and states "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the patient's actions? a. Reassure the patient that what they are feeling is normal anxiety and do deep breathing exercises with her b. Use the call light to inquire whether the patient has been prescribed PRN anxiety medication c. Call for staff help and assess the client's vital signs d. Reassure the patient that you will stay until the anxiety subsides
c
Which statement concerning syndromes seen in other cultures but not in our own, such as piblokto, Navajo frenzy witchcraft and amok should be considered true? a. They are dissociative disorders, such as dissociative identity disorders b. They are physical disorders, not mental disorders c. They are culture-bound syndromes that are not dissociative disorders d. They are myths, or rumors, because they have not been sufficiently studied to be classified as real
c
Which of the following symptoms would lead a provider to suspect that a client is experiencing PTSD? (Select all that apply) a. Visiting the scene of the accident over and over b. Talking with strangers about the events of the accident c. Flashbacks of the accident d. Hypervigilance e. Irritability f. Difficulty concentrating g. Mania
c, d, e, g
A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? a. Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over b. Antianxiety medication to help her relax c. Starting a hobby to keep her mind off the troubling event d. Talking with friends and attending a loss support group
d
A female patient is anxious after receiving the news that she needs a breast biopsy to rule out breast cancer. The nurse is assisting with a breast biopsy. Which relaxation technique will be best to use at this time? a. Massage b. Meditation c. Guided imagery d. Relaxation breathing
d
A nurse is caring for a patient with stress and is in the evaluation stage of the critical thinking model. Which actions will the nurse take? a. Select nursing interventions and promote patient's adaptation to stress. b. Establish short- and long-term goals with the patient experiencing stress. c. Identify stress management interventions and achieve expected outcomes. d. Reassess patient's stress-related symptoms and compare with expected outcomes.
d
A patient who was recently diagnosed with diabetes is having trouble concentrating. This patient is usually very organized and laid back. What action should the nurse take? a. Ask the HCP for a psych referral b. Administer PRN sedative every 4 hours. c. Suggest the use of a home caregiver to the patient's family d. Plan to reinforce and repeat teaching about diabetes managment
d
A symptom commonly associated with panic attacks is a. Obsessions b. Apathy c. Fever d. Fear of impending doom
d
An adult who was in a motor vehicle accident is brought into the emergency department by paramedics, who report the following in-transit vital signs: -Oral temperature: 99.0° F -Pulse: 102 beats/min -Respiratory rate: 26 breaths/min -Blood pressure: 140/106 Which hormones should the nurse consider as the most likely causes of the abnormal vital signs? a. ADH and ACTH b. ACTH and epinephrine c. ADH and norepinephrine d. Epinephrine and norepinephrine
d
Delusionary thinking is a characteristic of A. chronic anxiety. B. acute anxiety. C. severe anxiety. D. panic level anxiety.
d
Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. Which response should the nurse provide to best address the parent's concerns? a. Children of this age usually have imaginary friends b. It is nothing to worry about unless the child starts to socially isolate c. The child needs more of their one-on-one attention d. The imaginary friend is a coping mechanism the child is using
d
The nurse caring for a patient experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medication? a. Standard antipsychotic medication b. Tricyclic antidepressant medication c. Anticholinergic medication d. A short-acting benzodiazepine medication
d
The nurse has been asked to administer a coping measurement instrument to a patient. What education would the nurse present to the patient related to this tool? a. "This tool will let us compare your stress to other patients in the hospital." b. "This tool is short because it only measures the negative stressors you are experiencing." c. "You will need to ask your parents about stressors you had as a child to complete this tool." d. "This tool will help assess recent positive and negative events you are experiencing."
d
The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious and begins to report dizziness and heart pounding. The patient also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? a. Reinforce the preoperative teaching by restating it slowly b. Have the patient read the teaching materials instead of providing verbal instruction c. Have a family member read the preoperative materials to the patient d. Do not attempt any further teaching at this time
d
What is the major distinction between fear and anxiety? a. Fear is a universal experience; anxiety is neurotic. b. Fear enables constructive action; anxiety is dysfunctional c. Fear is a psychological experience; anxiety is a physiological experience d. Fear is a response to a specific danger; anxiety is a response to an unknown danger
d
What tool should the nurse use in assessing the amount of stress a client has experienced in the past year? a. NANDA handbook b. DSM-IV-TR c. Quick Mental Status Assessment d. Life-Changing Event Questionnaire
d
Which child is at greatest risk for developing attachment problems as a result of neurobiological development? a. !3-year-old male b. 10-year-old female c. 7-year-old male d. 4-year old female
d
Which medication is FDA approved for treatment of anxiety in children? a. Sertraline b. Fluoxetine c. Clomipramine d. Duloxetine
d
A patient who is taking antiretroviral medication to control human immunodeficiency virus (HIV) infection tells the nurse about feeling mildly depressed and anxious. Which additional information about the patient is most important to communicate to the health care provider? a. The patient takes vitamin supplements and St. John's wort. b. The patient recently experienced the death of a close friend. c. The patient's blood pressure has increased to 152/88 mm Hg. d. The patient expresses anxiety about whether the drugs are effective.
a
What factor exerts the greatest influence on the degree to which various life events upset a specific individual? A. The individual's perception of the event B. The individual's degree of spirituality C. The effect of the individual's health-sustaining behaviors D. The amount of social support available to the individual
a
What is a possible outcome criterion for a client diagnosed with anxiety disorder? a. Client demonstrates effective coping strategies b. Client reports reduced hallucinations c. Client reports feelings of tension and fatigue d. Client demonstrates persistent avoidance behaviors
a
What is the physiological basis for the success of guided imagery? a. Beta endorphin release raises the pain threshold b. Imagery raises the body level of cortisol and epinephrine c. The SNS is stimulated to produce a quiet state d. Brain catecholamines are less available to transmit pain impulses
a
What would a client experience during a progressive relaxation session? A. Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed B. Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter C. Having a nurse enter the client's energy field to rebalance it and bring harmony D. Being led into a positive imaginary sensory experience
a
The nurse is assessing the coping patterns of a newly admitted patient. What will the nurse include in this assessment? (Select all that apply.) a. Currents stressors as perceived by the patient b. Use of drugs or alcohol c. Recent weight changes d. Age and height e. Temperature
a, b, c
The nurse anticipates that the nursing history of a client diagnosed with OCD will reveal what common assessment data? (Select all that apply) a. A history of childhood trauma b. A sibling with the disorder c. A history of sexual abuse d. A previous suicide attempt e. An eating disorder
a, b, c, e,
The nurse knows that which of the following medical conditions are most commonly associated with anxiety? (Select all that apply) a. Cancer b. COPD c. Hypothyroidism d. Dysrhythmias e. Encephalitis f. Hyperthyroidism
a, b, d, e, f
Stress can be attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? (Select all that apply.) a. Insulin resistance b. A high resting heart rate c. Digestive problems d. Chronic muscle tension e. Obesity
a, e
A patient tells the nurse, "I'm told I should reduce the stress in my life, but I have no idea where to start." What would be the best initial nursing response? a. "Why not start by learning to meditate? That will cover everything." b. "In cases like yours, physical exercise works to elevate mood and reduce anxiety." c. "Reading about stress and how to manage it might be a good place to start." d. "Let's talk about what is going on in your life and then look at possible options."
d
An obese female patient who had enjoyed active outdoor activities is stressed because osteoarthritis in her hips now limits her activity. Which action by the nurse will best assist the patient to cope with this situation? a. Have the patient practice frequent relaxation breathing. b. Ask the patient what outdoor activities she misses the most. c. Teach the patient to use imagery for reducing pain and stress. d. Encourage the patient to consider weight loss to improve symptoms
d
An older patient presents to the outpatient clinic with a chief complaint of headache and insomnia. In gathering the history, the nurse notes which factors as contributing to this patient's chief complaint? a. The patient is responsible for caring for two school-age grandchildren. b. The patient's daughter works to support the family. c. The patient is being treated for hypertension and is overweight. d. The patient has recently lost her spouse and needed to move in with her daughter.
d
Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? a. Meditation b. Breathing exercises c. Journal keeping d. Biofeedback
d
Working to help the client view an occurrence in a more positive light is called A. flooding. B. desensitization. C. response prevention. D. cognitive restructuring.
d
A patient reports that he is overwhelmed with anxiety. Which question would be most important to use in assessing the patient during your first meeting? a. "What kinds of things do you do to reduce or copy with your stress?" b. "Tell me about your family history - do any relatives have problems with stress?" c. "Tell me about exercise - how far do you typically run when you go jogging?" d. "Stress can interfere with sleep. How much did you sleep last night?"
a
A client experiencing a panic attack keeps repeating "I'm dying, I can't breathe." Which action by the nurse would be the most therapeutic initially? a. Encouraging the client to take slow, deep breaths b. Verbalizing mild disapproval of the anxious behavior c. Asking the client what he means when he says "I am dying" d. Offering an explanation about why the symptoms are occurring
a
A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? a. "What things have you done in the past that helped you feel more comfortable?" b. "Let's try to focus on that adorable little granddaughter of yours" c. "Why don't you sit down over there and work on that jigsaw puzzle?" d. "Try not to think about the feelings and sensations you're experiencing"
a
A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes a. Biofeedback b. Guided imagery c. Therapeutic touch d. Assertiveness training
a
A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to A. suddenly tremble severely. B. exhibit stoic behavior. C. report both nausea and vomiting. D. laugh inappropriately.
a
A nurse is helping parents who have a child with attention-deficit/hyperactivity disorder. Which strategy will the nurse share with the parents to reduce stress regarding homework assignments? a. Time-management skills b. Speech articulation skills c. Routine preventative health visits d. Assertiveness training for the family
a
A nurse is teaching the staff about the general adaptation syndrome. In which order will the nurse list the stages, beginning with the first stage? 1. Resistance 2. Exhaustion 3. Alarm a. 3, 1, 2 b. 3, 2, 1 c. 1, 3, 2 d. 1, 2, 3
a
A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? a. "Stressors are events that happen that threaten your current functioning and require you to adapt." b. "Stressors are complicated neuro stimuli that cause mental illness." c. "It's best if you ask questions like that of your provider for a complete answer." d. "Instead of focusing on what stressors are, let's explore your coping skills."
a
A patient complains of insomnia during his stay in the hospital. Which nursing diagnosis would be a top priority for this patient? a. Anxiety related to hospitalization b. Ineffective coping related to hospitalization c. Denial related to hospitalization d. High Risk for Insomnia related to hospitalization
a
A patient in a motor vehicle accident states, "I did not run the red light," despite very clear evidence on the street surveillance tape. Which defense mechanism is the patient using? a. Denial b. Conversion c. Dissociation d. Compensation
a
A patient is the primary caregiver for a disabled family member at home, and has now been unexpectedly hospitalized for surgery. What action can the nurse take to enhance the coping ability of the patient? a. Ask if there is another family member who can help at home while the patient is in the hospital. b. Plan to transfer the patient to a rehabilitation unit after surgery to allow uninterrupted time to recover. c. Coordinate an ambulance transfer of the family member to an alternate family member's home. d. Ask social services to assess what the patient's needs will be after discharge to home.
a
A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? a. Projection b. Repression c. Displacement d. Reaction formation
b
A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? a. Symptoms started right after being robbed at gunpoint b. Being unable to work for the last 12 months c. Eating in public makes the client extremely uncomfortable d. Repeated verbalizing prayers results in a relaxed feeling
b
A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests that use of which ego defense mechanism? a. Altruism b. Denial c. Undoing d. Suppression
b
A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. What term is used to identify this technique? a. Guided imagery b. Cognitive reframing c. Wishful thinking d. Confrontational assertion
b
A patient is newly diagnosed with anxiety and placed on SSRIs. The nurse is developing the plan of care for this patient. How long will it take for this medication to become effective? a. Immediately b. Up to 12 weeks c. Up to 6 weeks d. Up to 4 weeks
b
A preadolescent patient is experiencing maturational stress. Which area will the nurse focus on when planning care? a. Identity issues b. Self-esteem issues c. Physical appearance d. Major changing life events
b
A senior college student visits the college health clinic about a freshman student living on the same dormitory floor. The senior student reports that the freshman is crying and is not adjusting to college life. The clinic nurse recognizes this as a combination of situational and maturational stress factors. Which is the best response by the nurse? a. "Let's call 911 because this freshman student is suicidal." b. "Give the freshman student this list of university and community resources." c. "I recommend that you help the freshman student start packing bags to go home." d. "You must make an appointment for the freshman student to obtain medications."
b
A woman who was sexually assaulted a month ago presents to the emergency department with reports of recurrent nightmares, fear of going to sleep, repeated vivid memories of the sexual assault, and inability to feel much emotion. Which medical problem will the nurse expect to see documented in the chart? a. General adaptation syndrome b. Post-traumatic stress disorder c. Acute stress disorder d. Alarm reaction
b
After a natural disaster occurred, an emergency worker referred a family for crisis intervention services. One family member refused to attend the services, stating, "No way, I'm not crazy." What is the nurse's best response? a. "Many times disasters can create mental health problems, so you really should participate with your family." b. "Seeking this kind of help does not mean that you have a mental illness; it is a short-term problem-solving technique." c. "Don't worry now. The psychiatrists are well trained to help." d. "This will help your family communicate better."
b
An obsession is defined as a. Thinking of an action and immediately taking action b. A recurrent, persistent thought or impulse c. An intense irrational fear of an object or situation d. A recurrent behavior performed in the same manner
b
Despite working in a highly stressful nursing unit and accepting additional shifts, a new nurse has a strategy to prevent burnout. Which strategy will be best for the nurse to use? a. Delegate complex nursing tasks to nursing assistive personnel. b. Strengthen friendships outside the workplace. c. Write for 10 minutes in a journal every day. d. Use progressive muscle relaxation.
b
Selective inattention is first noted when experiencing which level of anxiety? a. Mild b. Moderate c. Severe d. Panic
b
The first stage of the general adaptation syndrome (GAS) can be characterized by which response? a. Eustress b. Fight or flight c. Resistance d. Exhaustion
b
The nurse is assessing the social support of a patient who is recently divorced and has moved from their hometown to the city due to a change in jobs. Which response related to social support would be the most therapeutic? a. Encourage the patient to begin dating again, perhaps with members of her church b. Discuss how divorce support groups could increase coping and social support c. Note that being so particular about potential friends reduces social contact d. Discuss using the Internet as a way to find supportive others with similar values.
b
The nurse is teaching a hospitalized patient to use mindfulness to reduce anxiety. Which statement by the nurse is appropriate? a. "How do you feel about what happened to you as a child?" b. "How do you feel about what is going on right now?" c. "Remember a time when you were calm." d. "Tap your hands until the feeling goes away."
b
The relaxation response calls upon the initiation of what process? a. Sympathetic activation b. Parasympathetic activation c. Brainstem deactivation d. Increased cortisol production by the adrenals
b
What can be said about the comorbidity of anxiety disorders? a. Anxiety disorders generally exist alone b. Depression may occur prior to onset of anxiety c. Anxiety disorders virtually never coexist with mood disorders d. Substance abuse disorders rarely coexist with anxiety disorders
b
What defense mechanisms can only be used in healthy ways? a. Suppression and humor b. Altruism and sublimation c. Idealization and splitting d. Reaction formation and denial
b
Which client behavior illustrates eustress? a. A college student fails an exam b. A bride planning for her wedding c. A man is laid off from his job d. An adolescent gets into a fight at school
b
Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? a. "I do not have the ability to handle that job." b. "I can be successful if I do all the things required to learn the job." c. "I may be fired from the job but eventually I will find something else to do with my life." d. "I can never learn all there is to know for the job."
b
What action should the nurse take to monitor the effects of an acute stressor on a hospital patient? a. Assess for bradycardia b. Ask about epigastric pain c. Observe for increased appetite d. Check for elevated blood glucose levels e. Monitor for a decrease in respiratory rate
b, c, d
The nurse wishes to use guided imagery to help an anxious patient relax. Which comment would be appropriate to include in the guided imagery script? (Select all that apply.) a. "Imagine others treating you the way they should, the way you want to be treated..." b. "With each breath, you are feeling calmer, more relaxed, almost as if you are floating..." c. "You are alone on a beach; the sun is warm; and you hear only the sound of the surf..." d. "You have taken control; nothing can hurt you now; everything is going your way..." e. "You have grown calm; your mind is still; there is nothing to disturb your well-being..." f. "You will feel better as work calms down, as your boss becomes more understanding..."
b, c, e
An adult patient who arrived at the triage desk in the emergency department (ED) with minor facial lacerations after a motor vehicle accident has a blood pressure (BP) of 182/94. Which action by the nurse is appropriate? a. Start an IV line to administer antihypertensive medications b. Recheck the blood pressure after the patient has been assessed c. Discuss the need for hospital admission to control blood pressure d. Teach the patient about the stroke risk associated with uncontrolled hypertension
b.
A female patient who initially came to the clinic with incontinence was recently diagnosed with endometrial cancer. She is usually well organized and calm, but the nurse who is giving her preoperative instructions observes that the patient is irritable, has difficulty concentrating, and yells at her husband. Which action should the nurse take? a. Ask the health care provider for a psychiatric referral. b. Focus teaching on preventing postoperative complications. c. Try to calm the patient before repeating any information about the surgery. d. Encourage the patient to combine the hysterectomy with surgery for bladder repair.
c
A hospitalized patient with diabetes tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up. This is so frustrating." Which response by the nurse is accurate? a. "The liver is not able to metabolize glucose as well during stressful times." b. "Your diet at the hospital is the most likely cause of the increased glucose." c. "The stress of illness causes release of hormones that increase blood glucose." d. "It is probably coincidental that your blood glucose is higher when you are ill."
c
A patient has not been sleeping well because he is worried about losing his job and not being able to support his family. The nurse takes the patient's vital signs and notes a pulse rate of 112 beats/min, respirations are 26 breaths per minute, and his BP is 166/88 instead of his usual 110-120/76-84 range. Which nursing interventions or recommendations should be used first? a. Go to sleep 30 to 60 minutes earlier each night to increase rest. b. Relax by spending more time playing with his pet dog c. Slow and deepen breathing via use of a positive, repeated word d. Consider that a new job might be better than his present one
c
A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for a follow-up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress? a. The patient's wife reports that he spends more time sitting quietly at home b. He reports that his appetite, mood, and energy levels are all good c. His systolic blood pressure has gone from the 140s to the 120s mmHg d. He reports that he feels better and that things are not bothering him as much
c
A patient who has frequent migraines tells the nurse, "My life feels chaotic and out of my control. I could not manage if anything else happens." Which response should the nurse make initially? a. "Regular exercise may get your mind off the pain." b. "Guided imagery can be helpful in regaining control." c. "Tell me more about how your life has been recently." d. "Your previous coping resources can be helpful to you now."
c
A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? a. Projection b. Rationalization c. Reaction formation d. Undoing
c
A young male patient is diagnosed with testicular cancer. Which action will the nurse take first? a. Provide information to the patient. b. Allow time for the patient's friends. c. Ask about the patient's priority needs. d. Find support for the family and patient.
c
After a management decision to admit terminal care patients to a medical unit, the nursing manager notes that nursing staff on the unit appear tired and anxious. Staff absences from work are increasing. The nurse manager is concerned that staff may be experiencing stress and burnout at work. What action would be best for the manager to take that will help the staff? a. Ask administration to require staff to meditate daily for at least 30 minutes. b. Have a staff psychologist available on the unit once a week for required counseling. c. Have training sessions to help the staff understand their new responsibilities. d. Ask support staff from other disciplines to complete some nursing tasks to provide help.
c
An adult male reports new-onset, seizure-like activity. An EEG and a neurology consultant's report rule out a seizure disorder. It is determined the patient is using conversion. Which action should the nurse take next? a. Suggest acupuncture. b. Confront the patient on malingering. c. Obtain history of any recent life stressors. d. Recommend a regular exercise program.
c
An effective stress-reduction technique a nurse might teach an individual with performance anxiety is a. Assertiveness b. Journal keeping c. Deep breathing d. Restructuring and setting priorities
c
In a natural disaster relief facility, the nurse observes that an older-adult male has a recovery plan, while a 25-year-old male is still overwhelmed by the disaster situation. A nurse is planning care for both patients. Which factors will the nurse consider about the different coping reactions? a. Restorative care factors b. Strong financial resource factors c. Maturational and situational factors d. Immaturity and intelligence factors
c
Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friends with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by: a. projection. b. denial. c. perception. d. repression.
c
Meditation is successful in promoting stress reduction because it a. prevents endorphin release. b. changes the client's energy field. c. quiets the sympathetic nervous system. d. activates the parasympathetic nervous system.
c
The nurse is developing a care plan for a patient with ineffective coping skills. Which intervention would be an example of a problem-focused coping strategy? a. Scheduling a regular exercise program b. Attending a seminar on treatment options c. Identifying a confidant to share feelings d. Attending a support group of families
c
The nurse teaches stress-reduction and relaxation training to a health education group of patients after cardiac bypass surgery. Which level of intervention is the nurse using? a. Primary b. Secondary c. Tertiary d. Quad
c
The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? A. Having the client repeatedly touch "dirty" objects B. Not allowing the client to seek reassurance from staff C. Not allowing the client to wash hands after touching a "dirty" object D. Telling the client that he or she must relax whenever tension mounts
c
The record mentions that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? a. Makes jokes to relieve tension. b. Misses appointments. c. Justifies illogical ideas and feelings. d. Behaves in ways that are the opposite of his or her feelings.
c
The school nurse is assessing the coping skills of high school students who attend an alternative school for high risk students. What is the priority concern that the nurse has for this student population? a. Altered VS recordings b. Inaccurate perception of stressors c. Increased risk for suicide d. Decreased access to alcoholic beverages
c
When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should a. question the physician's order because the dose is excessive. b. explain the long-term nature of benzodiazepine therapy. c. teach the client to limit caffeine intake. d. tell the client to expect mild insomnia.
c
Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex? a. Heart rate b. Triglycerides c. Blood glucose levels d. Brain norepinephrine
c
Which sociocultural finding in the history of a patient will alert the nurse to a possible developmental problem? a. Family relocation b. Childhood obesity c. Prolonged poverty d. Loss of stamina
c
A female teen with celiac disease continues to eat food she knows will make her ill several hours after ingestion. While planning care, the nurse considers maturational and tertiary-level interventions. Which intervention will the nurse add to the care plan? a. Teach the teen about the food pyramid. b. Administer antidiarrheal medications with meals. c. Gently admonish the teen and her parents regarding the consistently poor diet choices. d. Assist the teen in meeting dietary restrictions while eating foods similar to those eaten by her friends.
d
A middle-aged male patient with usually well-controlled hypertension and diabetes visits the clinic. Today he has a blood pressure of 174/94 mm Hg and a blood glucose level of 190 mg/dL. What patient information may indicate that additional intervention by the nurse is needed? a. The patient states that he takes his prescribed antihypertensive medications daily. b. The patient states that both of his parents have high blood pressure and diabetes. c. The patient indicates that he does blood glucose monitoring several times each day. d. The patient reports that he and his wife are disputing custody of their 8-yr-old son.
d
A nurse is teaching guided imagery to a prenatal class. Which technique did the nurse describe? a. Singing b. Massaging back c. Listening to music d. Using sensory peaceful words
d
