Townsend

PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Chapter 1. The Concept of Stress Adaptation

abirb.com/test

MULTIPLE CHOICE

abirb.com/test

1. A client has experienced the death of a close family member and at the same time
becomes unemployed. The client’s 6-month score on the Recent abirb.com/test
Life Changes
Questionnaire is 110. The nurse:
1. Understands the client is at risk for significant stress-related illness.
2. Determines the client is not at risk for significant stress-related illness.
3. Needs further assessment of the client’s coping skills to determine susceptibility to
abirb.com/test
stress-related illness.
4. Recognizes the client may view the losses as challenges and perceive them as
opportunities. abirb.com/test

ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the relationship between stress and diseases ofabirb.com/test
adaptation.
Page: 5
Heading: Stress as an Environmental Event
Integrated Processes: Nursing Process: Evaluation abirb.com/test
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Moderate abirb.com/test

Feedback
1. This is incorrect. Assessment is the first step of the nursingabirb.com/test
process. The nurse
should assess the client’s coping skills and available support before determining
susceptibility to stress-related physical and psychological illnesses. The Recent Life
Changes Questionnaire is an expanded version of the Schedule of Recent
abirb.com/test
Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month
score of 300 or more or a year-score total of 500 or more indicates high stress in a
client’s life and susceptibility to stress-related illnesses.
2. This is incorrect. Assessment is the first step in the nursingabirb.com/test
process. The nurse
should assess the client’s coping skills and available support before determining the
client’s perception of the current stresses. A 6-month score of 300 or more or a year-
score total of 500 or more on the Recent Life Changes Questionnaire indicates high
abirb.com/test
stress in a client’s life and susceptibility to stress-related physical and psychological
illnesses.
3. This is correct. Assessment is the first step in the nursing process. The nurse should
assess the client’s coping skills and available support before determining
abirb.com/test
susceptibility to stress-related physical and psychological illnesses. A 6-month score

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
of 300 or more or a year-score of 500 or more indicates high stress in a client’s life
and risk for significant stress-related physical and psychological illness.
4. This is incorrect. Assessment is the first step in the nursing process. The nurse
should assess the client’s coping skills and available support abirb.com/test
before determining
susceptibility to stress-related illness. A 6-month score of 300 or more or a year-
score of 500 or more on the Recent Life Changes Questionnaire indicates high stress
in a client’s life is susceptible to significant stress-related physical and psychological
abirb.com/test
illness.

CON: Stress
abirb.com/test

2. A physically and emotionally healthy client has just been fired.abirb.com/test

During a routine
office visit, he tells the nurse, “Perhaps this was the best thing to happen. Maybe I’ll
consider pursuing an art degree.” The nurse determines the client perceives the stressor
of his job loss as:
abirb.com/test
1. Irrelevant
2. Harm or loss
3. Threatening
4. A challenge abirb.com/test

ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the managementabirb.com/test
of stress.
Page: 7
Heading: Stress as a transaction between the individual and the environment
>Individual’s Perception of the Event > Primary Appraisal abirb.com/test
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
abirb.com/test
Concept: Stress
Difficulty: Easy

Feedback abirb.com/test
1. This is incorrect. An irrelevant perception is one where the event holds no
significance for the individual.
2. This is incorrect. A harm or loss appraisal refers to damageabirb.com/test
or loss already
experienced by the individual.
3. This is incorrect. A threatening appraisal is perceived as anticipated harms or losses.
4. This is correct. The client’s statement indicates he perceives the loss of his job as a
challenge and an opportunity for growth, demonstrated by abirb.com/test
his statement to consider
an art degree.

CON: Stress abirb.com/test

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test

3. Which client statement alerts the nurse that the client may be maladaptively
responding to stress? abirb.com/test
1. “Avoiding contact with others helps me cope.”
2. “I really enjoy journaling; it’s my private time.”
3. “I signed up for a yoga class this week.” abirb.com/test
4. “I made an appointment to meet with a therapist.”

ANS: 1
Chapter: Chapter 1, The Concept of Stress Adaptation abirb.com/test

Objective: Discuss adaptive coping strategies in the management of stress.

Page: 8
Heading: Stress Management abirb.com/test
Integrated Processes: Nursing Process: Evaluation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress abirb.com/test

Difficulty: Easy

Feedback abirb.com/test
1. This is correct. Reliance on social isolation as a coping mechanism is a maladaptive
method to relieve stress. It can prevent learning appropriate coping skills and can
prevent access to needed support systems.
abirb.com/test
2. This is incorrect. Journaling is a form of adaptive coping and interpersonal
communication.
3. This is incorrect. Group exercise is a form of adaptive coping, relaxation.
4. This is incorrect. Seeing a therapist is not considered a maladaptive
abirb.com/testcoping method.

CON: Stress
abirb.com/test

4. A nursing student comes down with a sinus infection toward the end of every
semester. Which stage of stress is the student most likely experiencing when this occurs?
abirb.com/test
1. Alarm reaction
2. Resistance
3. Exhaustion abirb.com/test
4. Fight or flight

ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation abirb.com/test
Objective: Explain the relationship between stress and diseases of adaptation.
Page: 2
Heading: Stress as a Biological Response abirb.com/test
Integrated Processes: Nursing Process: Assessment

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy abirb.com/test

Feedback
1. This is incorrect. At the alarm reaction stage, physiologicalabirb.com/test
responses of the fight-or-
flight syndrome are initiated.
2. This is incorrect. At the stage of resistance, the individual uses the physiological
responses of the first stage as a defense in the attempt to adapt to the stressor.
Physiological symptoms may disappear. abirb.com/test

3. This is correct. At the stage of exhaustion, the student’s exposure to stress has been
prolonged, and adaptive energy has been depleted. Diseases of adaptation occur
more frequently in this stage. abirb.com/test
4. This is incorrect. The fight-or-flight syndrome occurs during the alarm reaction
stage.
abirb.com/test
CON: Stress

abirb.com/test
5. A school nurse is assessing a high school student who is overly concerned about her
appearance. The client’s parent states, “That’s not something to be stressed about!”
Which response by the nurse is best?
abirb.com/test
1. “Teenagers don’t truly understand stress.”
2. “Why are you so concerned about your appearance?”
3. “You surely know that isn’t something to be concerned with.”
4. “I understand you feel stressed about this; tell me more about your stress.”
abirb.com/test

ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
abirb.com/test
Objective: Describe the core concept of stress as an environmental event.
Page: 8
Heading: Stress as a Transaction Between the Individual and the Environment
Integrated Processes: Nursing Process: Implementation abirb.com/test
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress abirb.com/test
Difficulty: Moderate

Feedback
1. This is incorrect. This response is judgmental and nontherapeutic. This response
abirb.com/test

minimizes the student’s concerns.

2. This is incorrect. This response puts the student in a defensive position to justify her
feelings. It is nontherapeutic. abirb.com/test
3. This is incorrect. This is a nontherapeutic response that minimizes the student’s

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
feelings. This does not allow the student to verbalize her concerns.
4. This is correct. Determination of an event as stressful depends on the individual’s
cognitive appraisal of the situation, which is an individual’s evaluation of the
personal significance of the event or occurrence. Stress canabirb.com/test
be physical or
psychological in nature. A perceived threat to self-esteem can be as stressful as a
physiological change. This response recognizes the situation and helps to explore the
situation. abirb.com/test

CON: Stress
abirb.com/test

6. A student confides in the school nurse that he is feeling stress about deciding whether
to go to college or work to provide needed income for his family.abirb.com/test
Which is the best
approach by the nurse to assist the student?
1. Teach the student meditation techniques.
2. Assist the student with problem-solving strategies.
abirb.com/test
3. Suggest relaxation methods for the student.
4. Recommend getting a pet for the student.

ANS: 2 abirb.com/test
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 8
abirb.com/test
Heading: Stress Management> Adaptive coping strategies
Integrated Processes: Nursing Process: Implementation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying] abirb.com/test
Concept: Stress
Difficulty: Moderate
abirb.com/test
Feedback
1. This is incorrect. This is not the best approach because it only addresses a means to
reduce stress-related symptoms and does not address the underlying concern for the
student. abirb.com/test
2. This is correct. The student is facing a problem that needs to be viewed objectively,
and the nurse can assist the student, if needed, to apply problem-solving strategies.
3. This is incorrect. While relaxation may assist the student with coping with the
abirb.com/test
stressor, it does not address the student’s underlying concern.
4. This is incorrect. Getting a pet can assist with coping with life stressors; however,
the student has already expressed financial concerns to which the pet will only add.
abirb.com/test

CON: Stress

abirb.com/test

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
7. An unemployed college graduate confides in the clinic nurse that she is experiencing
severe anxiety over not finding a teaching position and that she is having difficulty with
independent problem-solving. Which nursing intervention is best?
1. Encourage her to seek counseling from a therapist. abirb.com/test
2. Instruct her to listen to her favorite music daily.
3. Assist her with the problem-solving process.
4. Encourage her to keep a daily journal of feelings. abirb.com/test

ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the managementabirb.com/test
of stress.
Page: 8
Heading: Stress Management> Adaptive coping strategies
Integrated Processes: Nursing Process: Implementation abirb.com/test
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Moderate abirb.com/test

Feedback
1. This is incorrect. Counseling is not likely needed in this case due to the situational
abirb.com/test
nature the student is describing.
2. This is incorrect. Listening to music may assist with the stress symptoms; however,
it does not address the underlying problem.
abirb.com/test
3. This is correct. Assist the client with problem-solving. During times of high anxiety
and stress, clients will need more assistance in problem-solving and decision-
making.
4. This is incorrect. A daily journal may assist her with managing her symptoms but
abirb.com/test
does not address the underlying concern the client is expressing.

CON: Stress
abirb.com/test

8. The school nurse is assessing a high school student who is distraught because her
abirb.com/test
parents cannot afford horseback-riding lessons. The nurse recognizes the student’s
perception is that the problem is:
1. Endangering her well-being abirb.com/test
2. Personally relevant
3. Based on immaturity
4. Exceeding her capacity to cope
abirb.com/test
ANS: 2
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the concept of stress as a transaction betweenabirb.com/test
the individual and the
environment.

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Page: 7
Heading: Stress as a Transaction Between the Individual and the Environment
Integrated Processes: Nursing Process: Evaluation
Client Need: Psychosocial Integrity abirb.com/test
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Moderate abirb.com/test

Feedback
1. This is incorrect. The student is not expressing that it endangers her well-being; the
abirb.com/test
distress is related to the fact that she sees it as personally significant.
2. This is correct. Determination of an event as stressful depends on the individual’s
cognitive appraisal of the situation. An event becomes relevant to an individual
when the outcome holds personal significance. abirb.com/test
3. This is incorrect. The distress the client is feeling is not related to immaturity; rather,
she sees it as having personal significance and therefore relevant.
4. This is incorrect. An event becomes relevant to an individual when the outcome
abirb.com/test
holds personal significance.

CON: Stress
abirb.com/test

9. Meditation has been shown to be an effective stress management technique. Which

abirb.com/test
finding indicates meditation has been effective?
1. Achieving a state of relaxation
2. Attaining insight into one’s feelings
3. Demonstrating appropriate role behaviors abirb.com/test
4. Enhanced problem-solving skills

ANS: 1
abirb.com/test
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 8
Heading: Stress Management > Adaptive Coping Strategies abirb.com/test
Integrated Processes: Nursing Process: Evaluation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying] abirb.com/test
Concept: Stress
Difficulty: Easy

Feedback abirb.com/test

1. This is correct. Meditation produces relaxation by creating a special state of

consciousness through focused concentration.
2. This is incorrect. Meditation does not necessarily result in abirb.com/test
attaining insight into
one’s feelings.

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
3. This is incorrect. Meditation does not help to demonstrate appropriate role
behaviors.
4. This is incorrect. Meditation does not necessarily enhance one’s ability to solve
problems. abirb.com/test

CON: Stress
abirb.com/test

10. A first-time parent is crying and asks the nurse, “How can I go to work if I can’t
abirb.com/test
afford child care?” Which is the appropriate initial response by the nurse to assist with
problem-solving?
1. Determine the risks and benefits for each alternative.
2. Formulate goals for resolution of the problem. abirb.com/test
3. Evaluate the outcome of the implemented alternative.
4. Assess the facts of the situation.
abirb.com/test
ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 8 abirb.com/test
Heading: Stress Management >Adaptive Coping Strategies
Integrated Processes: Nursing Process: Implementation
Client Need: Psychosocial Integrity
abirb.com/test
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
abirb.com/test
Feedback
1. This is incorrect. Determining the risks and benefits of each alternative is done
approximately halfway through the problem-solving process.
abirb.com/test
2. This is incorrect. Assessment is the first step of the nursing process. Formulating
goals for resolving the stressful situation occurs after assessing the facts of the
situation.
3. This is incorrect. Evaluating the outcome is nearly the last abirb.com/test
step in the problem-
solving process.
4. This is correct. Assessment is the first step of the problem-solving process. Accurate
information about the situation must be gathered before any other steps can be taken,
abirb.com/test

CON: Stress

abirb.com/test

11. The client is hospitalized with coronary artery disease and demonstrates other
conditions often associated with diseases of adaptation, includingabirb.com/test
headaches and
depression. Currently, the client is demonstrating anxiety and states he is

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
“really worried” about his spouse. Which is the most appropriate nursing response to the
situation?

1. Inform the client that he has to learn to cope with stressors. abirb.com/test
2. Teach the client how to meditate when he is feeling anxious.
3. Encourage the client to talk through his concerns about his spouse.
4. Ask the client if he has a pet he would like to see while in the abirb.com/test
hospital.

ANS: 3
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the managementabirb.com/test
of stress.
Page: 8
Heading: Stress Management
Integrated Processes: Nursing Process: Evaluation abirb.com/test
Client Need: Psychological Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy abirb.com/test

Feedback
1. This is incorrect. Informing the client that he needs to learnabirb.com/test
something new at this
time will likely increase his stress and is not helpful to the immediate situation.
2. This is incorrect. Teaching the client mediation is not appropriate at this time, when
he is expressing the anxiety and concerns about his spouse.
3. This is correct. Interpersonal communication can assist theabirb.com/test
nurse to understand the
client’s concerns and allows the client to reduce the escalation of stress at this time.
4. This is incorrect. While this may be helpful in some situations, it is not something
that can address the client’s immediate needs. abirb.com/test

CON: Stress
abirb.com/test

12. When an individual’s stress response is sustained over a long period, the nurse
anticipates which physiological effect? abirb.com/test
1. Decreased resistance to disease
2. Increased libido
3. Decreased blood pressure abirb.com/test
4. Increased feelings of well-being

ANS: 1
Chapter: Chapter 1, The Concept of Stress Adaptation abirb.com/test
Objective: Identify physiological responses to stress.
Page: 3
Heading: Stress as a Biological Response abirb.com/test
Integrated Processes: Nursing Process: Assessment

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Client Need: Physiological Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Moderate abirb.com/test

Feedback
1. This is correct. Selye’s general adaptation syndrome identified that prolonged
abirb.com/test
exposure to stress leads to a decreased immune response and resistance to disease.
During the stage of exhaustion, the body’s compensatory mechanisms no longer
function effectively and diseases of adaptation occur.
2. abirb.com/test
This is incorrect. Selye’s general adaptation syndrome identified that prolonged
exposure to stress leads to a decreased immune response and resistance to disease.
The client is likely to experience decreases in libido rather than increases.
3. This is incorrect. Selye’s general adaptation syndrome identified that prolonged
abirb.com/test
exposure to stress leads to a decreased immune response and resistance to disease.
The client is likely to experience increases in blood pressure rather than decreases.
4. This is incorrect. Selye’s general adaptation syndrome identified that prolonged
abirb.com/test
exposure to stress leads to a decreased immune response and resistance to disease.
The client is not likely to have feelings of increased well-being due to the prolonged
stress response.
abirb.com/test
CON: Stress

abirb.com/test

13. Which is a typical part of the fight-or-flight syndrome?

1. Decreased heart rate
2. Decreased peristalsis abirb.com/test
3. Increased salivation
4. Pupil constriction
abirb.com/test
ANS: 2
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Identify physiological responses to stress.
Page: 3 abirb.com/test
Heading: Stress as a Biological Response
Integrated Processes: Nursing Process: Assessment
Client Need: Physiological Integrity abirb.com/test
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy
abirb.com/test
Feedback
1. This is incorrect. During the fight-or-flight syndrome, the heart rate increases in
response to the release of epinephrine. abirb.com/test
2. This is correct. During the fight-or-flight syndrome, peristalsis decreases as the body

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
slows nonessential functions.
3. This is incorrect. Salivation decreases as the body slows nonessential functions.
4. This is incorrect. During the fight-or-flight syndrome, pupils dilate to enhance
vision. abirb.com/test

CON: Stress
abirb.com/test

14. A nurse is assessing a client’s response to stress. The nurse concludes that the client
is performing a secondary appraisal of a stressful event when theabirb.com/test
client determines:
1. The event is benign.
2. The event is irrelevant.
3. Resources are available. abirb.com/test
4. The event is pleasurable.

ANS: 3
abirb.com/test
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the concept of stress as a transaction between the individual and the
environment.
Page: 7 abirb.com/test
Heading: Stress as a Transaction Between the Individual and the Environment >
Individual’s Perception of the Event
Integrated Processes: Nursing Process: Evaluation
abirb.com/test
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy abirb.com/test

Feedback
1. This is incorrect. The benign-positive outcome is a primary appraisal that is
abirb.com/test
perceived as producing pleasure for the individual.
2. This is incorrect. When an event is judged as irrelevant, this is the primary appraisal
process.
3. This is correct. When the individual considers the resources and skills needed to deal
abirb.com/test
with the event, the individual is conducting a secondary appraisal.
4. This is incorrect. Judging an event as pleasurable is a part of the primary appraisal
process. abirb.com/test

CON: Stress

abirb.com/test

15. Miller and Rahe (1997) identified a correlation between the effects of life change
and illness. This research led to the development of the Recent Life Changes
abirb.com/test
Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool?

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
1. Specific physical and psychological illnesses are not identified.
2. Numerical values associated with specific life events are randomly assigned.
3. Stress is viewed as a solely physiological response.
4. An individual’s personal perception of the event is excluded. abirb.com/test

ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation abirb.com/test
Objective: Explain the relationship between stress and diseases of adaptation.
Page: 5
Heading: Stress as an Environmental Event
Integrated Processes: Nursing Process: Evaluation abirb.com/test

Client Need: Psychosocial Integrity

Cognitive Level: Comprehension [Understanding]
Concept: Stress abirb.com/test
Difficulty: Easy

Feedback
abirb.com/test
1. This is incorrect. Several physical and psychological illnesses are part of the
questionnaire
2. This is incorrect. The numerical values associated with specific life events are not
randomly assigned. abirb.com/test
3. This is incorrect. Stress is seen as both a physiological and a psychological response.
4. This is correct. Individuals differ in response to life events, and this is not considered
in many life changes questionnaires.
abirb.com/test

CON: Stress

abirb.com/test

16. A client tells the nurse, “I experience stress on a regular basis. Why do I feel so
terrible this time?” Which is the nurse’s most appropriate response?
abirb.com/test
1. “Genetics has nothing to do with your temperament or feelings.”
2. “Your reactions to past experiences influence your current feelings.”
3. “Your stress level is lower when you are in good physical health.”
4. “You’ll experience less stress if you use appropriate coping skills.”
abirb.com/test

ANS: 2
Chapter: Chapter 1, The Concept of Stress Adaptation abirb.com/test
Objective: Explain the concept of stress as a transaction between the individual and the
environment.
Page: 7
Heading: Stress as a Transaction Between the Individual and theabirb.com/test
Environment >
Predisposing Factors
Integrated Processes: Nursing Process: Implementation
Client Need: Psychosocial Integrity abirb.com/test
Cognitive Level: Application [Applying]

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Concept: Stress
Difficulty: Moderate

Feedback abirb.com/test

1. This is incorrect. Genetic influences do impact the way a person responds to stress
and influences temperament and feelings.
2. This is correct. Past experiences are occurrences that resultabirb.com/test
in learned patterns that
can influence an individual’s current adaptation response. They include previous
exposure to the stressor or other stressors in general, learned coping responses, and
degree of adaptation to previous stressors.
3. This is incorrect. Stress levels are not lower when one is inabirb.com/test
good physical health;
however, one who is in good physical health has more reserves to deal with the
stressful event.
4. This is incorrect. Adaptive coping responses help to deal with stressful events;
abirb.com/test
however, this does not mean one will experience less stress.

CON: Stress
abirb.com/test

17. A nurse is providing education on anxiety and stress management. Which of the
abirb.com/test
following should be identified as the most important initial step in learning how to
manage anxiety?
1. Diagnostic blood tests
abirb.com/test
2. Awareness of factors creating stress
3. Relaxation exercises
4. Identification of support systems
abirb.com/test
ANS: 2
Chapter: Chapter 1, The Core concept of Stress Adaptation
Objective: Discuss adaptive coping strategies in the management of stress.
abirb.com/test
Page: 8
Heading: Stress Management > Adaptive Coping Strategies
Integrated Processes: Teaching and Learning and Learning
Client Need: Health Promotion and Maintenance abirb.com/test
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy abirb.com/test

Feedback
1. This is incorrect. Diagnostic blood tests are not part of the initial steps in anxiety and
stress management. abirb.com/test

2. This is correct. The initial step is awareness that stress is being experienced and
awareness of factors that create stress.
3. This is incorrect. Relaxation exercises can be implementedabirb.com/test
after the client becomes
aware of factors that create stress.

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
4. This is incorrect. Identifying support systems can be implemented after the client
becomes aware of factors that create stress.

CON: Stress abirb.com/test

abirb.com/test
18. A 32-year-old person is speaking to the office nurse at an initial visit. The nurse
asked, “What brings you in today?” The client replied, “I have been having headaches
three to four times a week for the past month or so. I’m not sleeping well and feel tired
most of the time. I work 60 hours per week and am going through abirb.com/test
a divorce.” The nurse
determines the client’s symptoms represent which of the following?
1. Adaptive coping
2. Maladaptive coping abirb.com/test
3. Problem-solving
4. Self-awareness
abirb.com/test
ANS: 2
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Define adaptation and maladaptation.
Page: 8 abirb.com/test
Heading: Core Concepts
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity
abirb.com/test
Cognitive Level: Application [Applying]
Concept: Stress
Difficulty: Easy
abirb.com/test
Feedback
1. This is incorrect. An adaptive response to stress is a behavior that maintains the
integrity of the individual.
abirb.com/test
2. This is correct. When behavior disrupts the integrity of the individual, it is perceived
as maladaptive. Maladaptive responses are considered negative or unhealthy.
3. This is incorrect. Problem-solving is an adaptive approach to dealing with stress.
4. This is incorrect. Self-awareness is an adaptive approach toabirb.com/test
dealing with stress and
likely won’t result in the symptoms the client is describing.

CON: Stress abirb.com/test

19. The emergency department nurse is providing discharge instructions to a 23-year-old

abirb.com/test

man who was injured in a motor vehicle crash. The client stated, “My heart was racing
when I saw the car coming through the red light was going to hit me. I didn’t know my
heart could go that fast!” Which is the nurse’s best response? abirb.com/test
1. “Don’t worry, your heart is strong because you are young and in good health.”

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
2. “Everyone gets scared when they realize another car is going to hit them.”
3. “You had a panic attack when you saw the car that hit you was not going to stop.”
4. “Your body responded to the stress of knowing the car was going to hit you.”
abirb.com/test
ANS: 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Identify physiological responses to stress. abirb.com/test
Page: 3
Heading: Stress as a Biological Response
Integrated Processes: Teaching and Learning
Client Need: Psychosocial Integrity abirb.com/test

Cognitive Level: Application [Applying]

Concept: Stress
Difficulty: Moderate abirb.com/test

Feedback
1. This is incorrect. The nurse’s response in this example is nontherapeutic.
2. This is incorrect. The nurse’s response does not explain theabirb.com/test
reason for the client’s
rapid heart rate.
3. This is incorrect. The client did not experience a panic attack. This was a normal
response to the situation. abirb.com/test
4. This is correct. The client experienced a physical reaction to the stressor of the
impending car crash. A stressor is a biological, psychological, social, or chemical
factor that causes physical or emotional tension. The client’s increased heart rate was
abirb.com/test
a physical response during the alarm reaction stage of the fight-or-flight syndrome.

CON: Stress
abirb.com/test

20. The nurse in the intensive care unit (ICU) is giving report to the nurse on the cardiac
abirb.com/test
step-down unit. The nurse states, “The client is a 48-year-old admitted 3 days ago for
chest pain and a stent placement. Vital signs are stable, but I am worried about her stress
level. She said she just moved here due to a job transfer, and her spouse stayed behind to
sell the house. She told me they have a high insurance deductible,abirb.com/test
and she is worried
about the hospital bill.” Which factor has the most significant influence on the client’s
health?
1. Coping skills abirb.com/test
2. Existing conditions
3. Individual vulnerability
4. Perceived threat
abirb.com/test
ANS: 2
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Identify physiological responses to stress. abirb.com/test
Page: 7

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Heading: Stress as a Transaction between the Individual and the Environment >
Predisposing Factors
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity abirb.com/test
Cognitive Level: Analysis [Analyzing]
Concept: Stress
Difficulty: Moderate abirb.com/test

Feedback
1. This is incorrect. Coping skills do not have the most influence on the client’s health
at this time. abirb.com/test

2. This is correct. Existing conditions incorporate vulnerabilities that influence the

adequacy of an individual’s resources to deal with adaptive demands. Existing
stressors are the recent move, loss of the support system, and financial concerns.
abirb.com/test
3. This is incorrect. Individual vulnerabilities are part of the existing conditions that are
influencing the adequacy of the resources.
4. This is incorrect. The perceived threat is part of the primary appraisal of an event.
abirb.com/test

CON: Stress

abirb.com/test

MULTIPLE RESPONSE
abirb.com/test

21. A nurse is interviewing a distressed client who reports being fired after 15 years of
loyal employment. Which of the following questions best assist the nurse to determine
abirb.com/test
the client’s appraisal of the situation? Select all that apply.
1. “What resources have you previously used in stressful situations?”
2. “Have you ever experienced a similar stressful situation?”
abirb.com/test
3. “Who do you think is to blame for this situation?”
4. “Why do you think you were fired from your job?”
5. “What skills do you possess that might lead to gainful employment?”
abirb.com/test
ANS: 1, 2, 5
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the concept of stress as a transaction betweenabirb.com/test
the individual and the
environment.
Page: 7
Heading: Stress as a Transaction Between the Individual and the Environment >
Individual’s Perception of the Event abirb.com/test
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying] abirb.com/test
Concept: Stress

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Difficulty: Moderate

Feedback
1. abirb.com/test
This is correct. This question specifically addresses the client’s coping resources.
2. This is correct. This question encourages the client to apply learning from past
experiences.
3. This is incorrect. Asking who is to blame does not assess coping abilities but rather
abirb.com/test
encourages maladaptive behavior.
4. This is incorrect. This question does not assess coping abilities. Requesting an
explanation is a nontherapeutic block to communication.
5. This is correct. This question focuses on coping strategies abirb.com/test
and alternative methods
for dealing with stress.

CON: Stress abirb.com/test

abirb.com/test
22. A nurse is working with a client who has recently been under a great deal of stress.
Which nursing recommendations would be most helpful to assist the client to cope with
stress? Select all that apply.
1. “Enjoy a pet.” abirb.com/test
2. “Spend time with a loved one.”
3. “Listen to music.”
4. “Focus on the stressors.”
abirb.com/test
5. “Journal your feelings.”

ANS: 1, 2, 3, 5
Chapter: Chapter 1, The Concept of Stress Adaptation abirb.com/test
Objective: Discuss adaptive coping strategies in the management of stress.
Page: 8
Heading: Stress Management > Adaptive Coping Strategies
abirb.com/test
Integrated Processes: Nursing Process: Implementation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
Concept: Stress abirb.com/test
Difficulty: Moderate

Feedback abirb.com/test
1. This is correct. Pets have been shown to decrease stress.
2. This is correct. Healthy relationships have been shown to decrease stress.
3. This is correct. Music has been shown to decrease stress.
abirb.com/test
4. This is incorrect. Focusing on the stressors is more likely to increase stress.
5. This is correct. Journaling feelings has been shown to decrease stress.

CON: Stress abirb.com/test

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test

23. A client presents in the emergency department immediately following a shooting

incident in a school where she has been teaching. Which are common initial biological
abirb.com/test
responses to stress the teacher might demonstrate? Select all that apply.
1. Constricted pupils
2. Watery eyes abirb.com/test
3. Unusual food cravings
4. Increased heart rate
5. Increased respirations
abirb.com/test

ANS: 2, 4, 5
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Identify physiological responses to stress. abirb.com/test
Page: 3
Heading: Stress as a Biological Response
Integrated Processes: Nursing Process: Assessment
Client Need: Physiological Integrity abirb.com/test

Cognitive Level: Analysis [Analyzing]

Concept: Stress
Difficulty: Moderate abirb.com/test

Feedback
1. This is incorrect. Dilated pupils, rather than constricted pupils, are related to the
abirb.com/test
fight-or-flight syndrome.
2. This is correct. Increased lacrimal secretions, increased heart rate, and increased
respirations are identified as initial biological responses to stress.
3. This is incorrect. Unusual food cravings have not been identified as a typical
abirb.com/test
biological response to stress.
4. This is correct. Increased heart rate is identified as an initial biological response to
stress.
abirb.com/test
5. This is correct. Increased respirations are identified as an initial biological response
to stress.

CON: Stress abirb.com/test

abirb.com/test
24. Which concepts are included in Hobfoll’s Conservation of Resources theory? Select
all that apply.
1. Availability of resources
2. Disequilibrium abirb.com/test
3. Genetics
4. Past experiences
5. Resilience abirb.com/test

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
ANS: 1, 3, 4
Chapter: Chapter 1, The Concept of Stress Adaptation
Objective: Explain the concept of stress as a transaction between the individual and the
environment. abirb.com/test
Page: 7
Heading: Stress as a Transaction Between the Individual and the Environment
Integrated Processes: Nursing Process: Assessment abirb.com/test
Client Need: Psychosocial Integrity
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy abirb.com/test

Feedback
1. This is correct. Hobfoll’s Conservation of Resources theory asserts a variety of
abirb.com/test
elements influence an individual’s perception and response to a stressful event.
Available resources affect an individual’s perception of adaptive capabilities.
2. This is incorrect. Disequilibrium is not included as part of Hobfoll’s theory.
abirb.com/test
3. This is correct. Hobfoll’s Conservation of Resources theory asserts that a variety of
elements influence an individual’s perception and response to a stressful event.
Predisposing factors strongly influence whether the response is adaptive or
maladaptive. These include genetic influences, past experiences, and existing
abirb.com/test
conditions.
4. This is correct. Hobfoll’s Conservation of Resources theory asserts that a variety of
elements influence an individual’s perception and response to a stressful event.
abirb.com/test
These include genetic influences, past experiences, and existing conditions. An
individual who experiences stress in the present becomes more vulnerable to future
stress when there is a loss or lack of resources.
5. This is incorrect. Resilience is not included as part of Hobfoll’s theory.
abirb.com/test

CON: Stress
abirb.com/test

ORDERED RESPONSE
abirb.com/test

25. Place the selected steps of the problem-solving process in theabirb.com/test

correct order.
1. Determine risks and benefits of each option.
2. Formulate goals to resolve the stressful situation.
3. Implement a second alternative.
4. Study the alternatives for dealing with the situation. abirb.com/test

ANS: The correct order is 2, 4, 1, 3

Chapter: Chapter 1, The Concept of Stress Adaptation abirb.com/test
Objective: Discuss adaptive coping strategies in the management of stress.

abirb.com/test
Townsend
PMHN, 10e
Chapter 1 - ETB
abirb.com/test
Page: 8
Heading: Stress Management > Adaptive Coping Strategies
Integrated Processes: Nursing Process
Client Need: Psychosocial Integrity abirb.com/test
Cognitive Level: Comprehension [Understanding]
Concept: Stress
Difficulty: Easy abirb.com/test

Feedback: Problem-solving is an adaptive coping strategy in which an individual views

the situation objectively and applies a decision-making model. The steps of the problem-
solving process are: (1) Assessing the facts of the situation; (2) formulating
abirb.com/test goals for

resolution of the stressful situation; (3) studying the alternatives for dealing with the
situation; (4) determining the risks and benefits of each alternative; (5) selecting an
alternative; (6) implementing the selected alternative; (7) evaluating the outcome of the
abirb.com/test
alternative implemented; and (8) if the first choice is ineffective, selecting and
implementing a second option.

abirb.com/test

CON: Stress

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test