Chapter 6: Individual and Family Homeostasis, Stress, and Adaptation Prepu

A nurse is teaching a group of families who have members experiencing addiction about this problem. Which of the following, if stated by the families, indicates that the teaching was successful? a) A single factor is usually responsible for development of addiction. b) Addiction results from a defect in the person's character. c) Addiction rarely results in the person experiencing relapse. D) Addiction is not a result of a person having moral faults.

D) Addiction is not a result of a person having moral faults. Addiction is not a defect in character or a moral fault. It results from a combination of factors, such as values, beliefs, family and personal norms, spiritual convictions, and conditions of the current social environment. Even with treatment, relapse, which is considered part of the illness process, can occur.

Which condition is a sympathetic-adrenal medullary response to stress? a) Constricted pupils b) Increased heart rate c) Mental confusion d) Decreased blood glucose level

b) Increased heart rate Increased heart rate is a sympathetic-adrenal-medullary response to stress. Mental confusion, decreased blood glucose levels, and constricted pupils do not occur as part of this response.

The physician tells a client, "You are lucky. This episode of chest pain is a warning sign." How can the nurse explain to the client what the physician means? a) A decrease in blood supply to the heart causes stress to cells through the perception of pain. b) Chest pain alerts a client that the ability of the cell to transform energy is compromised. c) The pressure on the heart is warning of a muscular disease. d) As the cardiac cells display pain, the cells are not able to make proteins for energy.

a) A decrease in blood supply to the heart causes stress to cells through the perception of pain. Ischemia means that blood supply to an organ is deficient. In the case of the heart, the decreased blood supply results in chest pain. The chest pain warns the client that ischemia is occurring in the heart and that the client needs to seek medical attention.

A nurse has developed a plan of care for a patient with a nursing diagnosis of "risk for spiritual distress." Which interventions would the plan most likely include? Select all that apply. a) Actively listen to the patient. b) Encourage the patient to talk about his or her faith. c) Encourage the patient to avoid usual rituals. d) Limit the amount of time spent with the patient. e) Demonstrate acceptance of the patient.

a) Actively listen to the patient. b) Encourage the patient to talk about his or her faith. e) Demonstrate acceptance of the patient. Interventions that foster spiritual growth and reconciliation include being fully present; listening actively; conveying a sense of caring, respect, and acceptance; using therapeutic communication to encourage expression; suggesting the use of prayer, meditation, or imagery; and facilitating contact with spiritual leaders or performance of spiritual rituals. Being present indicates that the nurse is available to the patient and does not limit the amount of time spent.

A client has an abnormal result on a Papanicolaou test. The client asks the nurse what dysplasia means. Which definition should the nurse provide? a) Alteration in the size, shape, and organization of differentiated cells b) Increase in the number of normal cells in a normal arrangement in a tissue or an organ c) Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found e) Presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin

a) Alteration in the size, shape, and organization of differentiated cells The nurse should explain that dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin is called anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found is called metaplasia.

A client has an abnormal result on a Papanicolaou test. The client asks the nurse what dysplasia means. Which definition should the nurse provide? a) Alteration in the size, shape, and organization of differentiated cells b) Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found c) Presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin d) Increase in the number of normal cells in a normal arrangement in a tissue or an organ

a) Alteration in the size, shape, and organization of differentiated cells The nurse should explain that dysplasia refers to an alteration in the size, shape, and organization of differentiated cells. The presence of completely undifferentiated tumor cells that don't resemble cells of the tissues of their origin is called anaplasia. An increase in the number of normal cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement of one type of fully differentiated cell by another in tissues where the second type normally isn't found is called metaplasia.

A nurse identifies a nursing diagnosis of spiritual distress for a patient based on assessment of which of the following? Select all that apply. a) Ambivalence b) Peacefulness c) Despair d) Acceptance e) Anger

a) Ambivalence c) Despair e) Anger Spiritually distressed patients may show despair, discouragement, ambivalence, detachment, anger, resentment, or fear. They may question the meaning of suffering or life and express a sense of emptiness.

The nurse is caring for a client with diabetes who has an infection. The nurse creates a plan of care for the client based on a knowledge of the hypothalamic-pituitary response to stress by including which nursing intervention in the plan of care? a) Assessment for hyperglycemia b) Increase in insulin dosage c) Measurement of intake/output d) Restriction of dietary protein

a) Assessment for hyperglycemia The hypothalamic-pituitary response to stress includes stimulation of the adrenal cortex to produce glucocorticoids that inhibit glucose uptake. This increases need for insulin in a client with diabetes and the need for the nurse to assess for hyperglycemia. Restriction of dietary protein is contraindicated because the hypothalamic-pituitary response includes catabolism of body protein. Measurement of intake/output is not indicated in this case. Although the client's insulin dosage will most likely need to be increased, this is not a nursing action and requires a physician's order.

Cells in which organ are unable to regenerate? a) Brain b) Kidney c) Liver d) Pancreas

a) Brain Brain cells are not able to regenerate. Stable cells in some organ systems have a latent ability to regenerate under normal physiologic processes. Examples of regenerative cells include functional cells of the kidney, liver, and pancreas.

A client admitted for a voluntary breast reduction is displaying many signs and symptoms of stress. Which of the following findings would be consistent with this analysis by the nurse? a) Bruxism and excessive sweating b) Neck pain and easy bruising c) Drooling and urinary frequency d) Dizziness and increased sense of smell

a) Bruxism and excessive sweating Indicators of stress and the stress response include both subjective and objective measures. Signs and symptoms may be observed directly or reported. Over time, a client tends to develop a characteristic pattern of behavior during stress to warn that the system is out of balance. Teeth grinding and excessive sweating are signs and symptoms of stress.

A nurse is working with a family that is under stress. Which trait would the nurse emphasize in the plan of care as being most useful to the family's coping? a) Communication skills b) Individual talents c) Emotional strengths d) Cognitive abilities

a) Communication skills Communication skills and spirituality have been identified as the most useful traits that enhance family members' coping. Other helpful traits include cognitive abilities, emotional strengths, individual strengths and talents, relationship capabilities, and willingness to use community resources.

Which of the following interventions should a nurse recommend for fostering effective coping skills and a sense of hardiness? a) Daily exercise b) Nonprescribed sedative drug c) Balanced diet d) Periodic checkup

a) Daily exercise A nurse should recommend a daily exercise program to reduce stimulating neurotransmitters and release endorphins and enkephalins. Diet and periodic checkups are not essential to foster effective coping skills and a sense of hardiness. It is essential for the client to avoid a nonprescribed sedative drug for self-treatment, because it does not foster effective coping skills and a sense of hardiness.

he nurse is evaluating a client's social support network. The nurse knows that the network will assist the client in coping with stress when which action is noted? a) Daughter helps mother with laundry. b) Son does not acknowledge his mother's diagnosis. c) Client finds new recipes online that were posted by other users. d) Client avoids situations that expose her to new people.

a) Daughter helps mother with laundry. Social networks assist in the management of stress when they provide material aid and tangible services, such as a daughter helping her mother with the laundry. In addition, networks should provide a positive social identity and emotional support as well as access to information and new social contacts/social roles.

A client is diagnosed with posttraumatic stress disorder (PTSD). Which finding would the nurse most likely assess? a) Diaphoresis b) Muscle flaccidity c) Constricted pupils d) Bradycardia

a) Diaphoresis With posttraumatic stress disorder (PTSD), the client may exhibit diaphoresis with cold, clammy skin, dilated pupils, tachycardia or palpitations, and muscle tension. These physiologic findings are related to increased sympathetic nervous system activity, increased plasma catecholamine levels, and increased urinary epinephrine and norepinephrine levels.

Which of the following conditions triggers the general adaptation syndrome? a) Distress b) Eustress c) Helplessness d) Placebo effect

a) Distress Excessive, ill-timed, or unrelieved stress is called distress. It triggers the general adaptation syndrome, a nonspecific physiologic response. Eustress means the right amount of stress and maintains a healthy balance in life. It cannot trigger a general adaptation syndrome. The placebo effect refers to healing or improvement that takes place because the person believes a treatment method will be more effective. Helplessness is a psychological factor that makes a client with stress disease prone. It is not a condition that triggers the general adaptation syndrome.

A nurse is developing a set of programs that focuses on reducing the risk factors for mental health problems for a community health care center. Which program would be least appropriate? a) Genetic counseling b)Substance abuse education classes c) Nutritional counseling for teens d) Yoga and relaxation classes

a) Genetic counseling Genetic counseling programs would be least appropriate because although genetic background is a risk factor for mental health problems, it cannot be modified. However, risk factors such as nutritional status, physical health, stress level, and alcohol and drug misuse can be modified, making nutritional counseling, yoga and relaxation classes, and substance abuse education classes appropriate strategies for risk reduction.

A client who has had a traumatic experience states that he has no lasting effects from this experience. His wife disagrees. Which of the following will the nurse assess if the wife is correct about the lasting stress? a) High blood pressure, palpitations b) Dilated pupils, hypoglycemic episodes c) Pinpoint pupils, increased glucose level d) Low blood pressure, bradycardia

a) High blood pressure, palpitations Stressors exist in many forms and categories. Stressors are classified as (1 day-to-day frustrations, (2) major complex occurrences involving large groups, and (3) less frequent stressors involving fewer people. The second group influences larger groups, even nations. These include events of history such as terrorism. High blood pressure and palpitations are physiologic responses of stress.

What is the term for an adaptation to environmental stress that occurs when tissue mass enlarges due to cell multiplication and increased stimulation? a) Hyperplasia b) Metaplasia c) Dysplasia d) Atrophy

a) Hyperplasia Hyperplasia is an increase in the number of new cells in an organ or a tissue. Atrophy is shrinkage in the size of a cell, leading to a decrease in organ size. Dysplasia is a change in the appearance of cells after they have been subjected to chronic irritation. Metaplasia is a cell transformation in which highly specialized cells change to less specialized cells.

When approaching health care holistically, which of the following would the nurse do? a) Include physical, emotional, and social elements b) Foster the use of technological advances in care c) Emphasize the client's strengths with passive participation d) Focus on complementary and alternative practices

a) Include physical, emotional, and social elements Holistic care involves the promotion of the total health of mind, body, and spirit. This approach integrates the client's physical, emotional, and social elements of health. Complementary and alternative practices are included with holistic health but are not the primary focus. Active participation and capitalizing on the client's personal strengths are part of holistic health. Holistic health includes a balance and integration of traditional medicine and advanced technology in conjunction with the influence of the mind and spirit on healing.

Students are reviewing information about substance abuse and its effects on individuals and families. The students demonstrate understanding of this topic when they identify which of the following? a) Individuals with substance abuse often have difficulty using adaptive behaviors. b) Substance abuse is most frequently seen in outpatient settings. c) Substance abuse applies primarily to the use of illegal drugs. d) Individuals use substances to enhance their decision-making ability.

a) Individuals with substance abuse often have difficulty using adaptive behaviors. Substance abuse refers to the use of alcohol and illegally obtained, prescribed, or over-the-counter drugs alone or combined in ineffective attempts to cope with the pressures, strains, and burdens of life. Thus, individuals with substance abuse often have difficulty identifying and implementing adaptive behaviors. Substance abuse occurs in all settings. Individuals who abuse substances are unable to make healthy decisions and to solve problems effectively.

Which statements about the placebo effect are correct? Select all that apply. a) The placebo effect often is used as an example of how the mind and body are connected. b) The placebo effect has been discredited by most medical authorities. c) The placebo effect only works if the medication in the capsule, tablet, etc. is appropriate for the disease being treated. d) The placebo effect refers to the healing or improvement that takes place simply because the individual believes a treatment method will be effective.

a) The placebo effect often is used as an example of how the mind and body are connected. d) The placebo effect refers to the healing or improvement that takes place simply because the individual believes a treatment method will be effective. The placebo effect often is used as an example of how the mind and body are connected. The placebo effect refers to the healing or improvement that takes place simply because the individual believes a treatment method will be effective.

During assessment, a client states, "I don't know why God is punishing me like this." What coping strategy will the nurse offer the client? a) a telephone call to a spiritual leader b) offering to watch television with the client c) assistance with a warm shower d) a discussion of current events

a) a telephone call to a spiritual leader Spiritual distress is typically manifested by despair, discouragement, ambivalence, detachment, anger, resentment, or fear. Therefore, the statement about God punishing the client suggests spiritual distress. A telephone call to a spiritual leader is the best response to this sort of statement. A warm shower and offering television are relaxation strategies. A discussion of current events does not meet the needs for spiritual help.

A client with a foodborne illness is concerned his gastrointestinal tract will never be the same again. Which of the following would be an appropriate response from the nurse? a) "Give it time. Don't worry." b) "New gastrointestinal cells replace damaged ones constantly." c) "Gastrointestinal cells can adapt to the new environment created d) by the infection." "It's true. You may have to readjust your eating habits."

b) "New gastrointestinal cells replace damaged ones constantly." Labile cells multiply constantly to replace worn-out cells. Epithelial cells of the gastrointestinal tract are labile and will constantly regenerate.

Brain cell death may occur in as little as: a) 5 minutes b) 3 minutes c) 7 minutes d) 1 minute

b) 3 minutes The length of time that different tissues can survive without oxygen varies. Brain cells may succumb in 3 to 6 minutes, depending on the situation.

A nurse is preparing to make a home visit to a family. Which of the following would the nurse need to keep in mind as most reflective of a family? a) Several generations involved in providing physical and emotional support to one another b) A group related by reciprocal caring, mutual responsibilities, and loyalties c) A husband, wife, and children living under the same roof d) A group of individuals related by blood or marriage

b) A group related by reciprocal caring, mutual responsibilities, and loyalties Family refers to a group of individuals who are related by reciprocal caring, mutual responsibilities, and loyalties. It is more than the relationship by blood or marriage and may or may not involve a spousal, parent-child, or multigenerational relationship.

After teaching a group of cancer survivors about loss and grief, the nurse determines that the teaching was successful when the group identifies loss as which of the following? a) The response experienced by anyone who has suffered distress b) A part of the life cycle in the form of change, growth, and transition c) Feelings of apprehension or worry in response to a situation d)A feeling of connectedness with one's self and others

b) A part of the life cycle in the form of change, growth, and transition Loss is part of the life cycle and occurs in the form of change, growth, and transition. Grief refers to the universal response to any loss. It is experienced by anyone suffering any type of loss. Spirituality refers to the feeling of connectedness with self, others, a life force, or God that allows people to find meaning in life. Anxiety refers to feelings of apprehension or worry in response to or about a situation.

Studying for the NCLEX-RN examination is an example of which type of stressor? a) Chronic enduring b) Acute, time limited c) Chronic intermittent d) Stressor sequence

b) Acute, time limited An example of an acute, time-limited stressor would be studying for final examinations, such as the NCLEX-RN examination. A stressor sequence is a series of stressful events that results from an initial event such as a job loss or divorce. Chronic intermittent stressors consist of daily stressors. A chronic enduring stressor is a stressor that persists over time, such as chronic illness, disability, or poverty.

The nurse is caring for a client with an anxiety disorder. The client reports feelings of anxiousness when in social situations. Which classification of medications does the nurse anticipate? a) Adrenergic blockers b) Benzodiazepines c) Corticosteroids d) Antipsychotics

b) Benzodiazepines The nurse is correct to anticipate that client with an anxiety disorder would be prescribed a medication from the benzodiazepine classification. Adrenergic blockers and corticosteroids offer antianxiety properties. Antipsychotic medications offer a wide range of changes in brain chemistry in addition to antianxiety effects, which may occur in some medication types.

The nurse is working with a client who is in a stressful situation. The nurse evaluates the client's resiliency by assessing the client's ability to do what? a) Admit past mistakes b) Continue to function well c) Verbalize feelings of anger d) Respond with strong emotions

b) Continue to function well Resilience has been defined by researchers as the ability of a person to function well in stressful situations. It is demonstrated by controlling strong emotional reactions, using appropriate communication and problem-solving skills, and knowing when to take action, when to rely on others, and when to nurture the self.

As a nurse practitioner is completing a Papanicolaou screening test, she notices an irregular, black mole with dried blood on the client's inner thigh. Upon questioning, the client says it is nothing and downplays the need for further medical care. The nurse realizes the client is displaying which maladaptive response? a) Projection b) Denial c) Distancing d) Impatience

b) Denial Ineffective responses to actual or potential stressors are referred to as maladaptive. Maladaptive responses do not promote the goals of adaption and led to inappropriate coping. Denial allows for control over the threat but may also endanger life.

The nurse is performing an assessment to determine the patient's social support systems. What question is important for the nurse to ask? a) What is the client's current employment status? b) Does the patient belong to a group that is mutually dependent and communicative? c) Does the client have an exercise plan to stay motivated? d) Does the client regularly attend a support group?

b) Does the patient belong to a group that is mutually dependent and communicative? The nature of social support and its influence on coping have been studied extensively. Social support has been demonstrated to be an effective moderator of life stress. Such support has been found to provide people with several different types of emotional information. The first type of information leads people to believe that they are cared for and loved. This emotional support appears most often in a relationship between two people in which mutual trust and attachment are expressed by helping one another meet their emotional needs. The second type of information leads people to believe that they are esteemed and valued. This is most effective when there is recognition demonstrating a person's favorable position in the group. Known as esteem support, this elevates the person's sense of self-worth. The third type of information leads people to feel that they belong to a network of communication and mutual obligation. Members of this network share information and make goods and services available to the members as needed.

The nurse is caring for a client diagnosed with Parkinson's disease. The nurse is most correct to correlate the client's uncontrolled tremors as a physical characteristic of a lack of which neurotransmitter? a) Acetylcholine b) Dopamine c) Serotonin d) Norepinephrine

b) Dopamine Parkinson's disease is a neurodegenerative disorder and the most common movement disorder. It is characterized by progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and imbalance. Low levels of the neurotransmitter dopamine have been linked to the uncontrollable tremors.

Impaired balance and uncontrolled tremors of Parkinson's disease is correlated with which neurotransmitter? a) Serotonin b) Dopamine c) Glutamate d) Acetylcholine

b) Dopamine The impaired balance and uncontrolled tremors of Parkinson's disease have been linked with low levels of dopamine. The other neurotransmitters have not been implicated in Parkinson's disease in this manner.

A deep vein thrombosis (DVT) results in vascular vasodilation, local tissue congestion, and increased capillary permeability. The nurse would expect to see which of the following body responses in a client with a DVT? a) Tenting skin turgor and warmth b) Erythema and pain c) Impaired functioning and drainage d) Edema and subnormal skin temperature

b) Erythema and pain Inflammation occurs with a DVT and prepares the site for repair. The inflammatory response is a sequence of events that involves changes in the microcirculation, as identified in the question. As these changes take place, five cardinal signs of inflammation are produced: erythema, warmth, edema, pain, and impaired functioning.

Which of the following factors are implicated in the development of heart disease? a) Excess and low levels of dopamine b) Frequent activation of the sympathetic nervous system c) Result of imbalances in serotonin d) Brain pathology

b) Frequent activation of the sympathetic nervous system Frequent activation of the sympathetic nervous system in persons prone to anger and hostility is a factor implicated in the development of heart disease. Brain pathology is seen as the major factor contributing to mental illnesses called psychobiologic disorders. Results of excess levels of dopamine imply disorganized thought patterns and bizarre behaviors of schizophrenia. Results of imbalances in serotonin imply depression, eating disorders, sleep disturbances, and obsessive-compulsive disorders.

A client has gastroenteritis. He not only has diarrhea and dehydration but also complains of feeling very warm. What systemic response may the client experience with this inflammatory infection? a) Redness of the anus b) Increased body temperature c) Intestinal inflammation d) Stomatitis

b) Increased body temperature A systemic reaction occurs throughout the body. Fever is the most common sign of a systemic response to injury. It is caused by the release of pyrogens from neutrophils. This substance influences the hypothalamus and produces a fever.

After educating a class about depression, the instructor determines that additional class time is needed for teaching when the class identifies which of the following as an indicator of depression? a) Sleep disturbances b) Increased concentration c) Increased thoughts about death d) Feelings of worthlessness

b) Increased concentration With depression, the patient often has difficulty concentrating. Feelings of worthlessness, thinking about death or suicide, and sleeping difficulties are associated with depression.

According to Wright & Leahey (2005), which family function incorporates the use of power and decision making about resources? a) Communication b) Management c) Boundary setting d) Socialization

b) Management Management involves the use of power, decision-making about resources, establishment of rules, provision of finances, and future planning, all responsibilities that are assumed by the adults of the family. Boundary setting makes clear distinctions between the generations and the roles of adults and children within the family structure. It is important that families have a full range of clear, direct, and meaningful communication among their members. Socialization involves the families' transmission of culture and the acceptable behaviors to perform adequately in the home and in the world.

A patient with diabetes is admitted to the hospital with a blood sugar level of 320 mg/dL. Why should the nurse monitor fluid intake and output for this patient? a) The blood's hypotonicity will result in tissue fluid retention and weight gain. b) Polyuria results from osmotic diuresis, which is compensatory to hyperglycemia. c) Decreased blood osmolarity causes fluid to shift into the interstitial spaces, resulting in polydipsia. d) Polydipsia occurs when glucose catabolism is accelerated, thereby increasing the body's need for fluids.

b) Polyuria results from osmotic diuresis, which is compensatory to hyperglycemia. Large amounts of glucose can cause osmotic shifts, affecting the fluid and electrolyte balance and leading to polyuria, or increased urination.

1 diabetes. Which of the following would be most appropriate for the nurse to do? a) Assist the patient to focus on the future. b) Provide written back-up instructions for care. c) Spontaneously give the patient a gentle hug. d) Tell the patient to avoid using distraction.

b) Provide written back-up instructions for care. To assist in managing anxiety related to a new medical diagnosis, it would be most appropriate for the nurse to provide the patient with written back-up instructions related to care. Doing so prevents the patient from becoming overwhelmed with all the necessary information. In addition, the written instructions provide an as-needed future reference for the patient. Touch should be used only as appropriate and with the patient's permission. The focus should be on positive aspects in the present, the "here and now." Distraction can be helpful to relax and prevent the patient from becoming overwhelmed.

Which theorist proposed behavior is the result of intrapersonal conflicts that arise during certain stages of development? a) B. F. Skinner b) Sigmund Freud c) Harry Stack Sullivan d) Erik Erikson

b) Sigmund Freud Sigmund Freud proposed that disordered behavior is the result of intrapersonal (within oneself) conflicts that arise during particular stages of development that occur between infancy and adolescence. This was not a proposition of the other theorists.

During a family assessment, the mother states, "When I was a child, we always had a special dinner on Christmas Eve, that my mother had when she was a child. Now our family follows the same tradition." The nurse interprets this statement as indicating which family function? a) Management b) Socialization c) Education d) Boundary setting

b) Socialization The socialization function involves the family's transmission of culture and acceptable behaviors to perform adequately in the home and the world. The management function of a family involves the use of power, decision-making about resources, establishment of rules, provision of finances, and future planning. Boundary setting makes clear distinctions between the generations and roles of the adults and children. Communication is reflected by the interaction among members. Education and support involves modeling skills for living a physically, emotionally, and socially healthy life; support is indicated by family members feeling cared about and loved.

The nurse is caring for a client with hypoxia. What is the nurse's consideration with regard to the client experiencing brain cell death? a) The client may have brain cell death in 1 to 3 minutes. b) The client may have brain cell death in 3 to 6 minutes. c)The client may have brain cell death in 9 to 12 minutes. d) The client may have brain cell death in 6 to 9 minutes.

b) The client may have brain cell death in 3 to 6 minutes. The length of time that different tissues can survive without oxygen varies. Brain cells may succumb in 3 to 6 minutes, depending on the situation.

A client comes to the emergency department with swelling in the left knee. The nurse is aware of the cardinal signs of inflammation occurring in the knee. Identify the correct cardinal signs of inflammation. Select all that apply. a) Paralysis b) Warmth c) Erythema d) Subluxation e) Rash

b) Warmth c) Erythema Inflammation is a defensive reaction intended to neutralize, control, or eliminate an offending agent and to prepare the site for repair. A general sequence of events occurs in the local inflammatory response. Five cardinal signs of inflammation are produced: erythema, warmth, edema, pain, and loss of function.

When implementing nursing interventions for a client with anxiety disorder, it is important for the nurse to stay with the client during periods of severe anxiety in order to a) help deal with multiple simultaneous stimuli. b) restore control to a more comfortable level. c) help the client manage time and cope with personal demands. d) model a controlled state.

b) restore control to a more comfortable level. The nurse should stay with a client with anxiety disorder during periods of severe anxiety, as the nurse's presence may help the client stay in control or restore control to a more comfortable level. Reducing external stimuli, such as noise, bright lights, and activity, helps the client to deal with multiple simultaneous stimuli. To help the client manage time and cope with personal demands, the nurse should follow a consistent schedule for routine activities because unpredictability heightens anxiety. The nurse should be composed when interacting with the client, as anxiety is communicated. By modeling a controlled state, the nurse can promote a similar response in the patient.

The general adaptation syndrome (GAS) is a nonspecific physiologic response to a stressor. Which stage is not a part of the process? a) alarm stage b) stress awareness stage c) resistance stage d) exhaustion stage

b) stress awareness stage The general adaptation syndrome can cycle many times through the alarm and resistance stages before reaching the exhaustion stage. The process occurs through the neuroendocrine and autonomic nervous systems.

The nurse is instructing a community education class on stress. The nurse asks the participants, "Is all stress bad for you?" Which answer by the participants is most accurate? a) "No, not all stress is bad, but all stress can make a person sick." b) "Yes, all stress is bad but in varying degrees depending on the nature." c) "No, the right amount of stress can be motivating to accomplish goals." d) "Yes, all stress has negative effects on the body systems."

c) "No, the right amount of stress can be motivating to accomplish goals." The most accurate answer is the participant that states that not all stress is bad because the right amount of stress can be motivating. Just the right amount of stress, called eustress, is what maintains a healthy balance in life.

A pregnant patient is experiencing changes in her breast and asks the nurse if this should be cause for concern. What is the nurse's best response about the cellular adaptation to stress in the pregnant woman? a) "This is called hypertrophy, which refers to an increased production of cells because of pregnancy." b) "This is called neoplasia, which refers to the production of abnormal cells caused by the hormones from the pregnancy." c) "This is hyperplasia, which refers to an increase in cells because of the hormones from pregnancy." d) "This is called dysplasia, which refers to the production of abnormal cells."

c) "This is hyperplasia, which refers to an increase in cells because of the hormones from pregnancy." Hyperplasia is an increase in the number of new cells in an organ or tissue. As cells multiply and are subjected to increased stimulation, the tissue mass enlarges. This mitotic response (a change occurring with mitosis) is reversible when the stimulus is removed. This mechanism distinguishes hyperplasia from neoplasia or malignant growth, which continues after the stimulus is removed. Hyperplasia may be hormonally induced. An example is the increased size of the thyroid gland caused by thyroid-stimulating hormone (secreted from the pituitary gland) when a deficit in thyroid hormone occurs.

The nurse is working with a client who is in a stressful situation. The nurse evaluates the client's resiliency by assessing the client's ability to do what? a) Respond with strong emotions b) Verbalize feelings of anger c) Continue to function well d) Admit past mistakes

c) Continue to function well Resilience has been defined by researchers as the ability of a person to function well in stressful situations. It is demonstrated by controlling strong emotional reactions, using appropriate communication and problem-solving skills, and knowing when to take action, when to rely on others, and when to nurture the self.

Which of the following interventions should a nurse recommend for fostering effective coping skills and a sense of hardiness? a) Periodic checkup b) Nonprescribed sedative drug c) Daily exercise d) Balanced diet

c) Daily exercise A nurse should recommend a daily exercise program to reduce stimulating neurotransmitters and release endorphins and enkephalins. Diet and periodic checkups are not essential to foster effective coping skills and a sense of hardiness. It is essential for the client to avoid a nonprescribed sedative drug for self-treatment, because it does not foster effective coping skills and a sense of hardiness.

Nursing students are reviewing information about post-traumatic stress disorder (PTSD). They demonstrate understanding of this information when they identify which of the following as the common underlying issue? a) Attempt to commit suicide b) Prolonged bouts of depression c) Exposure to an overwhelming traumatic event d) Uncontrolled anxiety

c) Exposure to an overwhelming traumatic event The underlying issue of PTSD is experiencing an overwhelming event that is outside the range of normal human experience. Examples of such events include rape, family violence, torture, terrorist attacks, fire, earthquake, and military combat. As a result of PTSD, the patient may exhibit anxiety, depression, and suicidal thoughts.

A patient has a hemoglobin level of 7 g/dL. What should the nurse be alert to assess for? a) Hypoglycemia b) Hypertension c) Hypoxia d) Hyperemia

c) Hypoxia Inadequate cellular oxygenation (hypoxia) interferes with the cell's ability to transform energy. Hypoxia may be caused by a decrease in blood supply to an area, a decrease in the oxygen- carrying capacity of the blood (decreased hemoglobin), a ventilation-perfusion or respiratory problem that reduces the amount of arterial oxygen available, or a problem in the cell's enzyme system that makes it unable to use oxygen.

Which of the following patients would the nurse identify as LEAST likely to be experiencing loss? a) Patient with diabetes who had his foot amputated b) Patient whose spouse just recently died from a chronic illness c) Patient who is abusing substances d) Patient who was just told that he has lung cancer

c) Patient who is abusing substances Patients experience loss as part of the life cycle as well as losses of health, a body part, self-image, self-esteem, and even one's own life. Thus, a patient who has learned that he has lung cancer, one who has undergone a foot amputation, and one whose spouse has just died are experiencing loss. Although a patient who is abusing substances is at risk for loss of health, family, and other consequences, this person would be the least likely individual of those mentioned.

Which of the following would least suggest emotional health? a) Management of every day challenges b) Pursuit of personal goals c) Realistic sense of hopelessness d) Acceptance of reality

c) Realistic sense of hopelessness Emotional health is manifested by maintaining a realistic sense of hope as well as by the achievement of personal goals, ability to manage every day challenges and problems, and an acceptance of reality.

Which type of healing occurs when the edges are not approximated and the wound fills with granulation tissue? a) Third intention b) First intention c) Second intention d) Cellular necrosis

c) Second intention In second-intention healing, the edges are not approximated, and the wound fills with granulation tissue. Scar tissue may form, with loss of specialized function. In first-intention healing, the wound edges are approximated as in a surgical wound. In third-intention healing, the wound edges are not approximated, and healing is delayed. Cellular necrosis is part of the inflammatory process.

The nurse has just completed the latest version of the Mini-Mental Status Examination with a newly admitted client, and the client received a score of 21. The nurse understands that this score has what implications for client care? a) The client is severely cognitively impaired, requiring total nursing care and possibly needing an individual to be present in the room at all times. b) The client exhibits very high cognitive abilities and should be able to easily understand all information that is presented. c) The client is likely cognitively impaired. Further assessment is required to determine what areas of nursing care are most impacted. d) The client exhibits no issues related to cognition. Nursing care is not impacted by the score.

c) The client is likely cognitively impaired. Further assessment is required to determine what areas of nursing care are most impacted. The MMSE-2 is a newer version of the Mini-Mental Status Examination. This tool for assessing cognitive function is often used with older adult clients. The scores range from 0 to 30. A score of less than 23 indicates likely cognitive impairment, so a score of 21 would signify likely impairment, indicating a need for further assessment.

The immune system and the brain communicate with each other through the chemical messenger system using neurotransmitters and immunopeptides. Stress impacts the immune system in what way? a) prevents autoimmune responses from occurring b) increases the number of white blood cells c) can lower the number of white blood cells, the immune system's disease fighters e) neurotransmitter action blocks the immune responses

c) can lower the number of white blood cells, the immune system's disease fighters Stress can lower the number of white blood cells, the immune system's disease fighters.

The plan of care for a client with anxiety includes a nursing diagnosis of ineffective coping. The nurse determines that the plan of care was successful when the client states which of the following? a) "I guess I'll just have to learn to live with my fears." b) "I need to avoid any kind of stress in my life." c) "I won't have to take my medication for very long." d) "I know that the breathing techniques I've learned help me relax."

d) "I know that the breathing techniques I've learned help me relax." Effectiveness of interventions related to a nursing diagnosis of ineffective coping would be indicated by the client's ability to use effective coping strategies and identify sources of anxiety. Thus, the statement about using breathing techniques indicates that the client has learned an effective method for coping. Medications may or may not be prescribed; if they are prescribed, the duration is highly variable. Avoiding stress is unrealistic. The statement about learning to live with the fears is also unrealistic and does not address the need for coping.

A client with diabetes whose husband recently died reports elevated blood glucose levels. She admits she is barely eating anything; she does not feel hungry. How will the nurse best respond to this client? a) "Have you checked the batteries in your glucose monitor recently?" b) "The body reacts in strange ways when we go through stressful times." c) "You probably do not realize all that you are eating during this stressful time." d) "Often with stress, glucose level increases because the body needs more energy."

d) "Often with stress, glucose level increases because the body needs more energy." During stress, the sympathetic nervous system is stimulated to release hormones that produce metabolic effects, including an increased blood glucose level. The rise in glucose is caused by increased liver and muscle glycogen breakdown. This mechanism allows more energy to be available for the body to handle the stressor.

A 12-year-old boy taken to the emergency department after a soccer injury cries out, "Look, my leg is bigger now!" How will the nurse respond to the boy? a) "Yes. it is supposed to. This is a good thing." b) "Let me look at that. We may need to have the doctor examine you." c) "No need to worry. Soccer is a dangerous sport." d) "Swelling is a normal response from your body to prepare for healing."

d) "Swelling is a normal response from your body to prepare for healing." Inflammation is a defensive reaction after injury that helps to prepare the site for repair. At the age of 12 years, children should be given age-appropriate responses for better understanding of what is happening to them. The correct choice is the best therapeutic communication response.

The nurse is developing a plan of care to assist a patient in coping with a below-the-knee amputation (BKA) on the right leg. Which intervention should the nurse include? a) Establish nurse-determined goals b) Discourage complementary medicine c) Obtain subjective appraisal of event by client d) Allow client to verbalize feelings of loss

d) Allow client to verbalize feelings of loss Nursing interventions to enhance client's ability to cope with stressful events include allowing the client to verbalize feelings of loss, such as those associated with the loss of a lower extremity. The nurse should also encourage objective, not subjective, appraisal of the event by the client, and assist the client in establishing mutual client nursing goals, not nurse-determined goals. If the client desires, the nurse should assist the client to use other forms of alternative therapy such as meditation, music therapy, etc.

A nurse assesses that a patient is at increased risk for depression based on which of the following? a) Sporadic alcohol ingestion b) Supportive family c) Male gender d) Co-existing medical problems

d) Co-existing medical problems Risk factors for depression include a medical comorbidity, family history, stressful situations, female gender, prior episodes of depression, an onset before age 40 years, past suicide attempts, lack of support systems, history of physical or sexual abuse, and current substance abuse. Sporadic alcohol ingestion does not indicate substance abuse.

Nursing students are reviewing information about depression. The students demonstrate understanding of the information when they state which of the following? a) Depression is more common in men than in women. b) Elderly clients often demonstrate specific symptoms of depression. c) Individuals with depression often seek treatment for it. d) Depression is commonly under diagnosed and undertreated.

d) Depression is commonly under diagnosed and undertreated. Depression is often underdiagnosed and undertreated. Statistics reveal that only one in three people with depression is properly diagnosed and treated. Depression can occur at any age and is most frequently diagnosed in women than in men. Many people experience depression but seek treatment for somatic complaints, not for depression. Elderly clients may exhibit a wide range of symptoms. Nurses need to be aware that decreased mental alertness or withdrawal-type responses may indicate depression in the elderly.

Which therapy aims at correcting the underlying biochemical abnormality and is useful for depression? a) Light therapy b) Electroconvulsive therapy c) Cognitive therapy d) Drug therapy

d) Drug therapy Drug therapy aims at correcting the underlying biochemical abnormality and is helpful for depression, anxiety disorders, and schizophrenia. Light therapy is used to correct seasonal affective disorder (SAD). Electroconvulsive therapy (ECT) is a treatment for severe mental illness in which application of electric stimulus is used to produce a generalized seizure. ECT does not help to correct the biochemical abnormality. Cognitive therapy is implemented on a physical level and may not be helpful to correct the underlying biochemical abnormality.

A nurse is developing a plan of care for a patient diagnosed with post-traumatic stress disorder (PTSD). Which of the following would be the priority? a) Assisting the patient to work through the traumatic experience b) Administering prescribed drug therapy c) Teaching coping skills for self-care d) Establishing a trusting nurse-patient relationship

d) Establishing a trusting nurse-patient relationship The priority when caring for a patient with PTSD is establishing a trusting nurse-patient relationship, because the patient is physically compromised and struggling emotionally with situations that are not considered part of the normal human experience. Once trust is established, then the nurse can assist the patient in working through the traumatic experience, teach coping skills for recovery and self-care, and administer prescribed medications.

Which of the following is associated with psychobiologic disorders? a) Inflammatory or altered immune responses b) Overuse of coping mechanisms c) Skin disorders such as eczema and psoriasis d) Malfunctions within the cerebral cortex and its structures

d) Malfunctions within the cerebral cortex and its structures Malfunctions within the cerebrum and its structures are typically associated with psychobiologic disorders. When a client overuses coping mechanisms, the client becomes dysfunctional. Inflammatory or altered immune responses are typically associated with psychosomatic diseases. Skin disorder, such as eczema and psoriasis, are typically associated with stress-related disorders.

A patient with diabetes is admitted to the hospital with a blood sugar level of 320 mg/dL. Why should the nurse monitor fluid intake and output for this patient? a)Polydipsia occurs when glucose catabolism is accelerated, thereby increasing the body's need for fluids. b) Decreased blood osmolarity causes fluid to shift into the interstitial spaces, resulting in polydipsia. c) The blood's hypotonicity will result in tissue fluid retention and weight gain. d) Polyuria results from osmotic diuresis, which is compensatory to hyperglycemia.

d) Polyuria results from osmotic diuresis, which is compensatory to hyperglycemia. Large amounts of glucose can cause osmotic shifts, affecting the fluid and electrolyte balance and leading to polyuria, or increased urination.

Which type of healing occurs when the edges are not approximated and the wound fills with granulation tissue? a) Third intention b) First intention c) Cellular necrosis d) Second intention

d) Second intention In second-intention healing, the edges are not approximated, and the wound fills with granulation tissue. Scar tissue may form, with loss of specialized function. In first-intention healing, the wound edges are approximated as in a surgical wound. In third-intention healing, the wound edges are not approximated, and healing is delayed. Cellular necrosis is part of the inflammatory process

The patient wants to be prescribed an anti-infective drug for the flu. The nurse understands that anti-infective medications would not be useful against which biologic agents? a) Fungi b) Mycoplasmas c) Bacteria d) Viruses

d) Viruses Viruses are among the smallest living organisms known and survive as parasites of the living cells they invade. Viruses infect specific cells. Through a complex mechanism, viruses replicate within cells and then invade other cells, where they continue to replicate. As the body mounts an immune response to eliminate the viruses, cells harboring the viruses can be injured in the process. Typically, an inflammatory response and immune reaction are the body's physiologic responses to viral infection. Anti-infective medications are not typically effective against viruses.

The nurse is assessing a postoperative client's surgical incision site. The nurse anticipates which finding? a) Abnormal cell functionality b) Moderate amount of scar formation c) Granulation tissue formation d) Wound edge approximated

d) Wound edge approximated Surgical sites heal by first intention. In first-intentional healing, the wound edges are approximated, little scar formation occurs, and the wound heals without granulation tissue. In addition, in first-intentional healing, cell functionality is preserved.

Which newest diagnostic tool might be efficient in diagnosing psychobiologic disorders in the future? a) EEG b) positron emission tomography c) All options are correct. d) brain mapping

d) brain mapping Brain mapping is a technique that compares a client's brain activity patterns (from an EEG or other electronic image) with a computerized database of electrophysiologic abnormalities. A growing database of distinctive patterns for seizure disorders, schizophrenia, depression, dementia, anxiety disorders, attention deficit/hyperactivity disorder, and others now exists for comparison.

An increase in the number of new cells in an organ or tissue that is reversible when the stimulus for production of new cells is removed is termed a) atrophy. b) hypertrophy. c) neoplasia. d) hyperplasia.

d) hyperplasia. Hyperplasia occurs as cells multiply and are subjected to increased stimulation resulting in tissue mass enlargement. Hypertrophy is an increase in size and bulk of tissue that does not result from an increased number of cells. Atrophy refers to reduction in size of a structure after having come to full maturity. With neoplasia, the increase in the number of new cells in an organ or tissue continues after the stimulus is removed.

he nurse is using progressive muscle relaxation with a client to reduce stress. What will the nurse teach the client to do? a) repeat a word or phrase while bending at the waist b) imagine a pleasant scene c) use a weight and lift in sessions of 10 movements d) tense and relax specific muscles

d) tense and relax specific muscles During progressive muscle relaxation, the client lies in a quiet room and tenses the muscles of the body one at a time. The client holds the tension and then relaxes. Using weights or bending at the waist does not relax muscles. Imaging a pleasant scene is part of guided imagery.

A nurse is giving discharge instructions to a client who came to the emergency department following an ankle sprain. The client asks a)"Why does this hurt so much?" Which response would be most appropriate from the nurse? b) "The local heat at the sprain causes pain." c) "The hypothalamus gets reset by the injury and produces the pain response." d) "The blood vessels are damaged, and this releases histamine, which causes pain." e) "The nerves are being stimulated by the pressure from the swelling at the sprain."

e) "The nerves are being stimulated by the pressure from the swelling at the sprain." A sprain injury causes a cellular response. The inflammatory response causes pain. The pain that occurs is attributed to the pressure of swelling on nerve endings and to the irritation of nerve endings by chemical release.

When assessing a client for manifestations of posttraumatic stress disorder (PTSD), which of the following would the nurse expect to assess? Select all that apply. a) Lack of impulse control b) Focused concentration c) Nightmares d) Muscle flaccidity e) Strong startle response

e) Strong startle response a) Lack of impulse control c) Nightmares Assessment findings associated with PTSD include strong startle response, lack of impulse control, inability to concentrate, heightened vigilance, generalized anxiety, societal withdrawal, nightmares or flashbacks, phobic avoidance reaction (avoidance of activities that arouse recollection of the traumatic event), muscle tension or soreness, and dry mouth.

A client has a diagnosis of hypertrophy of the heart muscle, which correlates with cellular adaptation to injury. What findings will the nurse expect to occur with the hypertrophy of the cells? Select all that apply. a) muscle mass enlargement b) decreased cell size c) cellular alteration compensatory to some stimulus d) decreased blood supply e) cell changes with stress

e) cell changes with stress a) muscle mass enlargement c) cellular alteration compensatory to some stimulus Hypertrophy and atrophy lead to changes in the size of cells and hence the size of the organs they form. Compensatory hypertrophy is the result of an enlarged muscle mass and commonly occurs in skeletal and cardiac muscle that experiences a prolonged, increased workload, such as occurs in cardiac disease. Decreased blood supply and decreased cell size occur with atrophy.

A client comes to the clinic and reports frequent headaches and daily fatigue that is interfering with normal functioning. During collection of psychosocial history, the nurse notes a stressor sequence that may be causing the physical deviations. Which series of events represents a stressor sequence?

job loss, bankruptcy, and loss of house A stressor sequence is a series of stressful events that result from an initial event. In this case, the job loss led to bankruptcy and subsequently the loss of the house. People experiencing long-term stress have a high incidence of psychosomatic disease. Birth of twins and vacationing may not be stressful and negative but joyous. Studying for a law exam and starting a family may not be negative. Traveling and buying a new house may not be negative.