Download sample

Chapter: Chapter 06: Homeostasis, Stress, and Adaptation
Multiple Choice
1. A nurse is meeting with a young woman who has recently lost her mother and her job and
has moved with her husband to a new city. She is complaining of acute anxiety and depression.
What does the nurse knows that would be helpful to this patient?
A) Adaptation often fails during stressful events and results in homeostasis.
B) Stress is a part of our lives, and, eventually, this young woman will adapt.
C) Acute anxiety and depression are seldom associated with stress.
D) Sometimes too many stressors disrupt homeostasis, and, if adaptation fails, the result is
disease.
Ans: D
Chapter: 6
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Page and Header: 79, Fundamental Concepts
Feedback: Four concepts — constancy, homeostasis, stress, and adaptation — are key to the
understanding of steady state. Homeostasis is maintained through emotional, neurologic, and
hormonal measures; stressors create pressure for adaptation. Sometimes too many stressors
disrupt homeostasis, and, if adaptation fails, the result is disease. Option A is incorrect; when
adaptation fails, the result is disease. Option B is incorrect; if a person is overwhelmed by stress,
she may never adapt. Option C is incorrect; acute anxiety and depression are frequently
associated with stress.
2. You are the nurse caring for a patient who has just been diagnosed with cancer. The patient
states that he will “never be able to cope with this situation.” What are you aware that coping is?
A) Coping is a physiologic measure used to deal with change, and he will physically adapt.
B) Coping is the physiologic and psychological processes that people use to adapt to change.
C) Coping is the human need for faith and hope, which create change.
D) Coping is a social measure used to deal with change and loss.
Ans: B
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 2
Page and Header: 79, Fundamental Concepts
Feedback: Indicators of stress and the stress response include both subjective and objective
measures. They are psychological, physiologic, or behavioral and reflect social behaviors and
thought processes. The physiologic and psychological processes that people use to adapt to stress
are the essence of the coping process. Option A is incorrect; coping is both a physiologic and
psychological process. Option C is incorrect; coping is a process used to adapt to change. Option
D is incorrect; coping is a personal process used to adapt to change.
3. The nurse is with a young patient who has just been informed of his terminal illness. His
heart rate increases, his eyes dilate, and his blood pressure increases. The nurse recognizes this
response as what?
A) Part of the limbic system response
B) Sympathetic nervous response
C) Hypothalamic-pituitary response
D) Local adaptation syndrome
Ans: B
Chapter: 6
Client Needs: A-1
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Nursing Process
Objective: 3
Page and Header: 82, Overview of Stress
Feedback: The sympathetic nervous system responds rapidly to stress; norepinephrine is
released at nerve ending causing the organs to respond (i.e., heart rate increases, eyes dilate, and
blood pressure increases). Option A is incorrect; the limbic system is a mediator of emotions and
behavior that are critical to survival during times of stress. Option C is incorrect; the
hypothalamic-pituitary response regulates the cortisol-induced metabolic effect that results in
elevated blood sugars during stressful situations. Option D is incorrect; local adaptation
syndrome is a tissue-specific inflammatory reaction.
4. You are the nurse caring for a 72-year-old female who is recovering from abdominal surgery
on the medical-surgical unit. The surgery was very stressful and prolonged, and you note on the
chart that her blood sugars are elevated, yet she has not been diagnosed with diabetes. To what
do you attribute this elevation in blood sugars?
A) It is a result of antidiuretic hormone.
B) She must have had diabetes prior to surgery.
C) She has become a diabetic from the abdominal surgery.
D) The blood sugars are probably a result of the “fight-or-flight” reaction.
Ans: D
Chapter: 6
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 4
Page and Header: 83, Overview of Stress
Feedback: During stressful situations, ACTH stimulates the release of cortisol from the adrenal
gland, which creates protein catabolism releasing amino acids and stimulating the liver to
convert amino acids to glucose; the result is elevated blood sugars. Option A is incorrect;
antidiuretic hormone is released during stressful situations and stimulates reabsorption of water
in the distal and collecting tubules of the kidney. Option B is incorrect; assuming the patient had
diabetes prior to surgery demonstrates a lack of understanding of stress-induced hyperglycemia.
Option C is incorrect; there is no evidence presented in the question other than elevated blood
sugars that would support a diagnosis of diabetes.
5. A young female science teacher arrives at the health center with a respiratory infection; she
tells the nurse that she does not like to “go to a doctor” and is feeling anxious about “being here.”
When the nurse checks her blood pressure, it is elevated along with her heart rate. The nurse
rechecks her blood pressure about 10 minutes later and it is normal. The patient asks the nurse if
she should be concerned that she may have hypertension. What is the nurse's best response?
A) She should not worry; it was stress related and her regular blood pressure is good.
B) The first blood pressure was part of a simple stress response; our long-term blood pressure is
controlled by negative feedback systems.
C) Blood pressure is only one measure of hypertension; she should review this with the doctor
and plan to recheck it on a regular basis.
D) The respiratory infection is the probably the cause of the elevated blood pressure, and, with
treatment, her blood pressure should remain normal.
Ans: B
Chapter: 6
Client Needs: B
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Teaching/Learning
Objective: 6
Page and Header: 84, Overview of Stress
Feedback: A simple stress response will temporarily elevate a blood pressure and heart rate.
Long-term blood pressure response is controlled by negative feedback systems.
For a science teacher, this would be an appropriate level of teaching/learning and would serve to
promote health. Option A is incorrect; the nurse is assuming her blood pressure in good based on
only two blood pressure readings. Option C is incorrect; the nurse has given the patient a vague
answer without rationale. Option D is incorrect; the stress of a respiratory infection could
account for the elevated blood pressure, but assuring the patient that with treatment her blood
pressure will return to normal may not be true.
6. A patient presents to the health center with an enlarged thyroid. The nurse practitioner
believes the thyroid cells may suffer from hyperplasia. How would the nurse practitioner explain
this condition to the patient?
A) Hyperplasia is the abnormal decrease in cell and organ size and is a precursor to cancer.
B) Hyperplasia is an abnormal increase in new cells and is reversible with the stimulus for cell
growth removed.
C) Hyperplasia is the change in appearance due to a chronic irritation and will reverse with the
stimulus removed.
D) Hyperplasia is a cancerous growth and will be removal surgically.
Ans: B
Chapter: 6
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Page and Header: 86, Stress at the Cellular Level
Feedback: Hyperplasia is an increase in the number of new cells in an organ or tissue. This is
due to increased mitotic stimulation from the additional cell division, and this, in turn, enlarges
the tissue. Hyperplasia is reversible when the stimulus for cell growth is removed. Options A and
C are incorrect; hyperplasia is the increase in the number of new cells, not a change in size or
appearance. Option D is incorrect; hyperplasia is the increase in the number of new cells, which
may or may not be cancerous growth.
7. A mother has brought her 10-year-old to the emergency department (ED). The mother tells
the triage nurse that the boy was stung by a bee about an hour ago. The mother explains to the
nurse that it is very painful and looks swollen, red, and infected. What can the triage nurse teach
the mother?
A) The pain, redness, and swelling are part of the inflammatory process, but it is probably too
early for an infection.
B) Bee stings frequently cause infection, pain, and swelling, and, with treatment, the infection
should begin to subside late today.
C) The infection was probably caused by the stinger, which may still be in the wound.
D) The mother's assessment is excellent and the ED doctor will probably prescribe antibiotics
to fix the problem.
Ans: A
Chapter: 6
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 8
Page and Header: 89, Stress at the Cellular Level
Feedback: Cells or tissues of the body may be injured or killed by any agent (physical,
chemical, infectious). When this happens, an inflammatory response (or inflammation) naturally
occurs in the healthy tissues adjacent to the site of injury. Inflammation is not the same as
infection. An infectious agent is only one of several agents that may trigger an inflammatory
response. Option B is incorrect; although bee stings may cause infection, the signs and symptoms
(very painful, looks swollen and red) is the acute inflammatory response. Option C is incorrect;
if the stinger were still in the wound, it would only be creating inflammation, not infection.
Option D is incorrect; there is no evidence for the nurse to offer that opinion.
8. You are caring for an older female patient who is being treated for acute anxiety. She has a
nursing diagnosis of ineffective coping patterns related to feeling of helplessness. What would be
the most appropriate nursing intervention?
A) Provide the patient with realistic choices for her care
B) Assess and provide constructive outlets for anger and hostility
C) Assess the patient's need for social support
D) Encourage an attitude of realistic hope to help deal with helpless feelings
Ans: D
Chapter: 6
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 9
Page and Header: 92, Stress Management: Nursing Interventions
Feedback: By encouraging an attitude of realistic hope, the patient will be empowered. This
allows the patient to explore her feelings and bring about more effective coping patterns. Option
A, provide the patient with realistic choices for her care, is a good choice but does not directly
address the feeling of helplessness. Option B is incorrect; the nursing diagnosis is related to
feeling of helplessness, not anger and hostility. Option C is a reasonable intervention but, again,
does not directly address the feeling of helplessness.
9. A 35-year-old women comes to the local health center with a large mass is her right breast.
She has felt the lump for about a year but was afraid to come to the clinic because she was sure it
was cancer. What is the most appropriate nursing diagnosis for this patient?
A) Self-esteem disturbance
B) Ineffective individual coping
C) Altered family process
D) Ineffective denial
Ans: B
Chapter: 6
Client Needs: A-1
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 10
Page and Header: 84, Overview of Stress
Feedback: Ineffective individual coping is the inability to assess our own stressors and then
make choices to access appropriate resources. In this case, the patient was unable to access
health care even when she was aware the disorder could be life threatening. Option A,
self-esteem disturbance, option C, altered family process, and option D, ineffective denial are all
nursing diagnoses that are often associated with breast cancer, but her ineffective individual
coping has created a significant safety risk and is, therefore, the most appropriate nursing
diagnosis.
10. The nurse at the student health center is seeing a group of nursing students who are
interested in reducing their stress level. The nurse identifies guided imagery as an appropriate
intervention. What does guided imagery involve?
A) The use of progressive tensing and relaxing of muscles to release tension in each muscle
group
B) Using a positive self-image to increase and intensify physical workouts in the gym, which
decreases stress
C) The mindful use of a word, phrase, or visual image, which allows oneself to be distracted
and temporarily escape from stressful situations
D) The use of music and humor to create a calm and relaxed demeanor, which allows escape
from stressful situations
Ans: C
Chapter: 6
Client Needs: D-3
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 11
Page and Header: 93, Stress Management: Nursing Interventions
Feedback: Guided imagery is the mindful use of a word, phrase, or visual image for the purpose
of distracting oneself from distressing situations or consciously taking time to relax or
reenergize. Option A is incorrect; it describes progressive muscle relaxation. Option B is
incorrect; it is not an identified technique and is an answer that “sounds good” and creates a
distraction for the test taker. Option D is incorrect; relaxing with music is not guided imagery.
11. The nurse is assessing a patient and finds two enlarged supraclavicular lymph nodes. The
nurse asks the patient how long these enlarged nodes have been there. The patient states, “I can't
remember. A long time I think. Do I have cancer?” The nurse is aware that that body responds to
stress. Which of the following is an immediate physiologic response to stress the nurse would
expect to see in this patient?
A) Vasodilation of peripheral blood vessels
B) Increased blood pressure
C) Decrease in blood glucose levels
D) Pupil constriction
Ans: B
Chapter: 6
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 5
Page and Header: 82, Overview of Stress
Feedback: An initial response to stress, as seen by the fight-or-flight response, is an increase in
the patient's heart rate and blood pressure. Vasoconstriction leads to the increase in blood
pressure. Blood glucose levels increase, supplying more readily available energy, and pupils
dilate.
12. Your patient tells you that he has just had an argument with his spouse over the phone.
What can you expect that his sympathetic nervous system has stimulated his adrenal gland to
release?
A) Endorphins
B) Dopamine
C) Epinephrine
D) Testosterone
Ans: C
Chapter: 6
Client Needs: D-4
Cognitive Level: Comprehension
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 4
Page and Header: 83, Overview of Stress
Feedback: In the sympathetic-adrenal-medullary response to stress, the sympathetic nervous
system stimulates the adrenal gland to release epinephrine and norepinephrine.
Corticotropin-releasing factor, ACTH, and glucocorticoids are released in the
hypothalamic-pituitary response to stress.
13. You walk into your patient's room and find her sobbing uncontrollably. When you ask what
the problem is, your patient responds, “I am so scared. I have never known anyone who goes into
a hospital and comes out alive.” On this patient's care plan you note a nursing diagnosis of
ineffective coping related to stress. What is the best outcome you can expect for this patient?
A) Patient will adapt relaxation techniques to reduce stress.
B) Patient will be stress free.
C) Patient will avoid stressful situations.
D) Patient will start anti-anxiety agent.
Ans: A
Chapter: 6
Client Needs: C
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 11
Page and Header: 92, Stress Management: Nursing Interventions
Feedback: Stress management is directed toward reducing and controlling stress and improving
coping. The outcome for this diagnosis is that the patient needs to adopt coping mechanisms that
are effective for dealing with stress, such as relaxation techniques. The other options are
incorrect because it is unrealistic to expect a patient to be stress free; avoiding stressful situations
and starting an anti-anxiety agent are not the best answers as outcomes for ineffective coping.
14. The nurse is assessing a patient and learns that the patient has recently been married. What
is the nurse aware of with this patient?
A) The patient and spouse should seek counseling due to their divorce history.
B) The patient will have better coping skills.
C) Happy events do not cause stress.
D) Marriage causes transition, which, in turn, causes stress.
Ans: D
Chapter: 6
Client Needs: C
Cognitive Level: Comprehension
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 3
Page and Header: 80, Overview of Stress
Feedback: Transition can contribute to stress, even if the transition is a positive change. The
third group of stressors has been studied most extensively and concerns relatively infrequent
situations that directly affect people. This category includes the influence of life events such as
death, birth, marriage, divorce, and retirement. Options A and B are incorrect because there is no
divorce history mentioned in this question, and there is no mention of ineffective coping skills.
Option C is incorrect because happy events do cause stress.
15. The nurse is assessing her newly admitted patient and finds data that indicates conditions in
the body have shifted out of normal range. The nurse is aware that an example of a bodily
function that restores homeostasis when conditions shift out of normal range would be what?
A) Body temperature
B) Pupil dilation
C) Urination
D) Blood clotting
Ans: A
Chapter: 6
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 6
Page and Header: 86, Stress at the Cellular Level
Feedback: Negative feedback mechanisms throughout the body monitor the internal
environment and restore homeostasis when conditions shift out of normal range. Body
temperature, blood pressure, and acid-base balances are examples of functions regulated by these
compensatory mechanisms. Blood clotting in the body involves positive feedback mechanisms.
16. A patient who is a heavy smoker may have dysplasia of epithelial cells in the bronchi.
What would the nurse tell the patient about dysplastic cells in the bronchi?
A) This is harmless as lung tissue regenerates.
B) Dysplastic cells may become malignant.
C) Surgery is often required for this condition.
D) Dysplasia may cause scar tissue.
Ans: B
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Page and Header: 86, Stress at the Cellular Level
Feedback: Dysplasia is bizarre cell growth resulting in cells that differ in size, shape, or
arrangement from other cells of the same tissue type. Dysplastic cells have a tendency to become
malignant; dysplasia is seen commonly in epithelial cells in the bronchi of people who smoke.
The other options are incorrect because this may not be a harmless condition, surgery is
sometimes required if a tumor develops, and dysplasia does not cause scar tissue.
17. A victim of a near drowning has been admitted to the emergency department. The patient
was submerged for 10 minutes and remains unconscious. What possible damage to the body has
occurred as a result of the submersion?
A) Atrophy to brain cells
B) Cellular repair
C) Hypoxia to the brain
D) Necrosis to the brain
Ans: C
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 7
Page and Header: 87, Stress at the Cellular Level
Feedback: The length of time different tissues can survive without oxygen varies. The brain
will become hypoxic in 3 to 6 minutes. The other options are incorrect because submersion
injuries do not cause atrophy to brain cells right away; submersion injuries also do not cause
cellular repair or necrosis to the brain.
18. Your patient has an increased temperature of 106°F. You should be aware that the oxygen
demands of the body would change in which direction and why?
A) Increase due to an increase in metabolism
B) Decrease due to a decrease in metabolism
C) Increase due to a decrease in metabolism
D) Decrease due to an increase in metabolism
Ans: A
Chapter: 6
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 2
Page and Header: 88, Stress at the Cellular Level
Feedback: When a person's temperature is elevated, hypermetabolism occurs, and the
respiratory rate, heart rate, and basal metabolic rate increase. The other options are incorrect
because oxygen demands would not decrease and they would not increase due to a decrease in
metabolism.
19. You are admitting a patient with a diagnosis of inflammation of the right ankle. Which of
the following statements is true regarding acute inflammation?
A) Inflammation is the same as infection.
B) Inflammation may impair the healing process.
C) Inflammation is a defensive reaction intended to remove an offending agent.
D) Inflammation inhibits the release of histamines in the tissues.
Ans: C
Chapter: 6
Client Needs: D-4
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 8
Page and Header: 89, Stress at the Cellular Level
Feedback: Inflammation is a defensive reaction intended to remove an offending agent and
prepare the site for repair. Inflammation is not the same as infection, it does not impair the
healing process, and it does not inhibit the release of histamines in the tissues.
20. An elderly man tells you that his wife died a year ago and that he cannot stop grieving over
her loss. What should you encourage the patient to consider?
A) Improve his nutritional intake
B) Make an appointment at a wellness clinic
C) Walk daily
D) Join a lawn bowling league
Ans: D
Chapter: 6
Client Needs: B
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Nursing Process
Objective: 11
Page and Header: 93, Stress Management: Nursing Interventions
Feedback: Social networks can reduce stress by providing the individual with a positive social
identity, emotional support, material aide, information, and new social contacts.
21. You are caring for a 65-year-old widower whose wife died 4 months ago. He tells you that
he is not doing well and that no one will talk with him about his wife. What could the nurse do to
help the patient?
A) Refer him to a consciousness-raising group
B) Refer him to an encounter group
C) Refer him to a support group
D) Refer him to a religious support group
Ans: C
Chapter: 6
Client Needs: C
Cognitive Level: Analysis
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 11
Page and Header: 93, Stress Management: Nursing Interventions
Feedback: Being a member of a group with similar problems or goals has a releasing effect on a
person that promotes freedom of expression and exchange of ideas. Options A, B, and D are
incorrect because these are not the kind of groups to which the nurse would refer this patient.
22. Patient education is an integral part of the nursing process. What are the positive aspects of
providing the patient with information?
A) Increased concentration
B) Decreased depression levels
C) Sharing of personal details
D) Building interdependent relationships
Ans: A
Chapter: 6
Client Needs: C
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 11
Page and Header: 93, Stress Management: Nursing Interventions
Feedback: Giving patients information also reduces the emotional response so that they can
concentrate and solve problems more effectively. Educating the patient does not decrease
depression levels or build interpersonal relationships. Educating the patient does not mean
sharing of personal details.
23. You are the nurse caring for a 51-year-old male who has just been diagnosed with stage IV
colon cancer. You note the patient now has an increased blood pressure and heart rate. His
respiratory rate has increased. You spend time talking with this patient and you note that his vital
signs are now back in the normal range. What would you note has happened?
A) Cortisol levels are decreasing.
B) Endocrine activity has increased.
C) The patient is adapting to noxious stressors.
D) The sympathetic response has been activated.
Ans: C
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 5
Page and Header: 81, Overview of Stress
Feedback: Selye developed a theory of adaptation to biologic stress that he named the general
adaptation syndrome (GAS), which has three phases: alarm, resistance, and exhaustion. During
the alarm phase, the sympathetic “fight-or-flight” response is activated with release of
catecholamines and the onset of the adrenocorticotropic hormone (ACTH) – adrenal cortical
response. The alarm reaction is defensive and anti-inflammatory but self-limited. Because living
in a continuous state of alarm would result in death, people move into the second stage,
resistance. During the resistance stage, adaptation to the noxious stressor occurs, and cortisol
activity is still increased. If exposure to the stressor is prolonged, the third stage, exhaustion,
occurs. During the exhaustion stage, endocrine activity increases, and this has negative effects on
the body systems (especially the circulatory, digestive, and immune systems) that can lead to
death. Stages one and two of this syndrome are repeated, in different degrees, throughout life as
the person encounters stressors. Based on these facts, option C is the only correct response.
24. You are caring for a 4-day-old set of conjoined twins and their parents. The infants are
doing well at this point, but the parents are each in a heightened anxiety state after being told that
when the babies are separated one of them may become permanently disabled. By the statements
the parents are making, the nurse knows they are cognitively appraising the situation their family
is in. While talking with the parents, you note that the father of the babies has an aggressive
stance, is speaking in a loud voice, and makes several hostile statements such as, “I'd like to
strangle that doctor who told us our babies would be okay.” You know that this father's cognitive
appraisal has lead to what?
A) Harm/loss feelings
B) Feelings of challenge
C) A positive adjustment to the possible loss of his children
D) The development of negative emotions
Ans: D
Chapter: 6
Client Needs: D-4
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Caring
Objective: 2
Page and Header: 81, Overview of Stress
Feedback: The appraisal process contributes to the development of an emotion. Negative
emotions such as fear and anger accompany harm/loss appraisals, and positive emotions
accompany challenge. Harm and challenge are not feelings, so options A and B are incorrect.
There is nothing in the scenario that indicates that the father is making a positive adjustment to
the possible loss of his children.
25. The nurse caring for an elderly widow notes her patient making statements such as, “Ever
since my husband died I can't seem to do anything right.” The patient was widowed 2 years prior
to this current hospitalization, which is her fifth since losing her husband to cancer after a long
struggle. The woman says to the nurse, “The doctor says my blood pressure is dangerously high.
What is making my blood pressure so high?” What does the nurse know about the probable
cause of this patient's hypertension?
A) Prolonged or unrelenting suffering can cause physical illness.
B) Physical illness is always caused by prolonged stress.
C) The elderly are at increased risk for hypertension due to stress.
D) Stress always exacerbates the physiologic processes of the elderly.
Ans: A
Chapter: 6
Client Needs: D-4
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing Care
Objective: 10
Page and Header: 80, Overview of Stress
Feedback: When a person endures prolonged or unrelenting suffering, the outcome is
frequently the development of a stress-related illness. Physical illness is not always caused by
prolonged stress. The elderly population is not the only population at increased risk for
hypertension due to stress. Option D is incorrect because stress does not always exacerbate (or
make worse) the physiologic processes of the elderly. This is an absolute statement, and in the
physical world there are no absolutes.
26. You are the mental health nurse caring for a young, recently married woman, whose sister
and niece were just killed in a traffic accident. This young woman is making arrangements for
the funerals, and you know that your patient has good insight into her stress. What do you know
is occurring with this young woman?
A) The mediating process is occurring.
B) The patient is in denial.
C) The patient is not getting on with her life.
D) The patient is overwhelmed.
Ans: A
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 1
Page and Header: 80, Overview of Stress
Feedback: After recognizing a stressor, a person consciously or unconsciously reacts to manage
the situation. This is termed the mediating process. Options B and D are incorrect because
nothing in the scenario indicates the patient is either in denial or feeling overwhelmed. Option C
is incorrect because by making funeral arrangements the patient is getting on with her life.
27. As an occupational health nurse at an oil refinery on the Gulf Coast of Texas, you are doing
patient education with a man in his mid-40s. The patient is being seen after having been exposed
to a chemical spill at the refinery. What type of stressor has this patient been exposed to?
A) Physiologic
B) Psychosocial
C) Physical
D) Psychiatric
Ans: C
Chapter: 6
Client Needs: D-3
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Page and Header: 80, Overview of Stress
Feedback: Physical stressors include cold, heat, and chemical agents; physiologic stressors
include pain and fatigue. These facts make options A, B, and D incorrect.
28. You are caring for a patient in the urgent care center who presented with complaints of
lethargy, malaise, aching, weakness, and loss of appetite. During the assessment, the nurse notes
an area on the patient's right posterior calf that is warm to touch, edematous, and sore. This area
is measured at 5 cm x 10 cm and has what appears to be a small puncture wound at its center.
The patient tells you that he was out in the woods 3 days ago when he fell and poked his leg on
something sticking up out of the ground. The patient cannot tell you what it was that poked into
his leg. The patient asks you why he is feeling so bad. You know the most probable cause of this
patient's symptoms is what?
A) Local inflammatory response
B) Systemic shock response
C) Local infectious response
D) Systemic inflammatory response
Ans: D
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 11
Page and Header: 90, Stress at the Cellular Level
Feedback: The inflammatory response is often confined to the site, causing only local signs and
symptoms. However, systemic responses can also occur. During this process, general,
nonspecific symptoms develop, including malaise, loss of appetite, aching, and weakness.
29. You are discharging a 4-year-old patient from the emergency department. The patient was
seen for an insect bite that became swollen and reddened and warm and painful to touch. The
patient's vital signs are all within normal range for age. While giving discharge instructions to
the patient's father, you are asked why the child is not going to get antibiotics for the infected
insect bite. What would be your best response?
A) “This is a local inflammatory response to the insect bite; it is not an infection so antibiotics
will not help.”
B) “I am sure the doctor knows what he is doing.”
C) “You don't need to worry; your son will be fine.”
D) “Infection is not the same as inflammation. What your son has is inflammation.”
Ans: A
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Teaching/Learning
Objective: 8
Page and Header: 89, Stress at the Cellular Level
Feedback: Regardless of the cause, a general sequence of events occurs in the local
inflammatory response. This sequence involves changes in the microcirculation, including
vasodilation, increased vascular permeability, and leukocytic cellular infiltration. As these
changes take place, five cardinal signs of inflammation are produced: redness, heat, swelling,
pain, and loss of function. Options B and C are incorrect responses because they negate the
father's concern for his son. Option D is a correct response but does not respond to the question
the father asks the nurse.
30. The nursing instructor is discussing the concept of steady state with her first-semester
nursing students. What would be the most complete statement to the students about this concept?
A) “The concept of steady state preserves life.”
B) “The mechanisms of steady state work to restore balance in the body.”
C) “This concept compensates for biologic and environmental attacks on the body.”
D) “Steady state is the same as adaptation.”
Ans: B
Chapter: 6
Client Needs: B
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 1
Page and Header: 79, Fundamental Concepts
Feedback: Mechanisms for adjusting internal conditions promote the normal steady state of the
organism and its survival. These mechanisms are compensatory in nature and work to restore
balance in the body. Options A and C are correct but incomplete statements. Option D is
incorrect because adaptation is a part of the concept of steady state; it is not the concept itself.
31. First-semester nursing students are presenting a group project to their classmates about the
concept of steady state. These students describe the relationship of individual cells to
compensatory mechanisms. When do compensatory mechanisms occur in the human body?
A) Daily
B) When needed
C) Continuously
D) Sporadically
Ans: C
Chapter: 6
Client Needs: B
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 2
Page and Header: 86, Stress at the Cellular Level
Feedback: The concept of the cell as existing on a continuum of function and structure includes
the relationship of the cell to compensatory mechanisms, which occur continuously in the body
to maintain the steady state.
32. A nursing instructor is lecturing on stress and the stress response to her pathophysiology
class. The instructor talks about the body's physiologic response to stress. What would this
instructor cite as the longest-acting phase of the physiologic response and its cause?
A) Sympathetic-adrenal-medullary response caused by persistent stress
B) Hypothalamic-pituitary response caused by acute stress
C) Sympathetic-adrenal-medullary response caused by acute stress
D) Hypothalamic-pituitary response caused by persistent stress
Ans: D
Chapter: 6
Client Needs: B
Cognitive Level: Application
Difficulty: Difficult
Integrated Process: Teaching/Learning
Objective: 4
Page and Header: 83, Overview of Stress
Feedback: The longest-acting phase of the physiologic response, which is more likely to occur
in persistent stress, involves the hypothalamic-pituitary pathway, not the
sympathetic-adrenal-medullary pathway.
33. Selyes' general adaptation syndrome (GAS) is a theory of adaption to biologic stress. Selye
compared the GAS with the life process: childhood, adulthood, and later years. What would
occur during “adulthood” in the GAS?
A) Stressful events occur and resistance or adaption occurs.
B) Too few stressful life events have occurred leaving the body vulnerable.
C) The accumulation of life's stressors has caused resistance to fall.
D) Vulnerability leads to eventual death.
Ans: A
Chapter: 6
Client Needs: B
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 5
Page and Header: 81, Overview of Stress
Feedback: Selye compared the general adaptation syndrome with the life process. During
childhood, too few encounters with stress occur to promote the development of adaptive
functioning, and children are vulnerable. During adulthood, a number of stressful events occur,
and people develop resistance or adaptation. During the later years, the accumulation of life's
stressors and wear and tear on the organism again decrease people's ability to adapt, so resistance
falls, and, eventually, death occurs. Based on this comparison, options B, C, and D are incorrect.
Multiple Selection
34. You are a nursing instructor and you are talking with a group of prenursing students in an
anatomy and physiology class about negative feedback loops. You explain that negative
feedback loops sense changes in the set points of the body and act to offset these deviations.
What examples could you give the students of negative feedback loops? (Mark all that apply.)
A) Serum glucose levels
B) Acid-base balance
C) Temperature
D) Blood clotting
E) Labor onset
Ans: A, B, C
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 6
Page and Header: 86, Stress at the Cellular Level
Feedback: These mechanisms work by sensing deviations from a predetermined set point or
range of adaptability and triggering a response aimed at offsetting the deviation. Blood pressure,
acid–base balance, blood glucose level, body temperature, and fluid and electrolyte balance are
examples of functions regulated through such compensatory mechanisms. Options D and E are
incorrect because they are representative of positive feedback loops.
Multiple Choice
35. During a recent lecture to a class of anatomy and physiology students, a nursing instructor
lectures on stress and adaptive processes. The instructor explains how hypertension and
cardiovascular disease can occur over time if a state of chronic arousal develops. In a state of
chronic arousal, what can happen within the body?
A) Blood pressure decreases.
B) Serum glucose levels drop.
C) Tumors may develop.
D) Infections are diminished.
Ans: C
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 10
Page and Header: 84, Overview of Stress
Feedback: If the sympathetic adrenal-medullary response is prolonged or excessive, a state of
chronic arousal develops that may lead to high (not low) blood pressure, arteriosclerotic changes,
and cardiovascular disease. If the production of ACTH is prolonged or excessive, behavior
patterns of withdrawal and depression are seen. In addition, the immune response is decreased,
and infections and tumors may develop.
36. A group of nursing students is giving a presentation to classmates on adaptive and
maladaptive responses to stress. When talking about assessing coping strategies in patients, the
nursing students discuss the use of drugs and alcohol to reduce stress. What is most important for
the students to point out about these coping behaviors?
A) They are effective coping behaviors.
B) They do not really reduce stress in the body.
C) They are adaptive behaviors.
D) They increase the risk of illness.
Ans: D
Chapter: 6
Client Needs: D-4
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Teaching/Learning
Objective: 10
Page and Header: 84, Overview of Stress
Feedback: Coping processes that include the use of alcohol or drugs to reduce stress increase
the risk of illness. The use of drugs and alcohol as a means to reduce stress are not effective
coping behaviors, they give the perception of reduced stress, and they are maladaptive behaviors.
37. While assessing your patient, you know to identify health patterns and if these health
patterns are achieving their goals. If you find that the patient's health patterns are not achieving
their goals, then what are you, as the nurse, obligated to do?
A) Seek ways to promote balance.
B) Create an opportunity for social balance.
C) Identify alternative forms of care.
D) Provide insight into the physiologic failings of the system.
Ans: A
Chapter: 6
Client Needs: D-4
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 9
Page and Header: 93, Stress Management: Nursing Interventions
Feedback: The nurse has a significant role and responsibility in identifying the health patterns
of the patient receiving care. If those patterns are not achieving physiologic, psychological, and
social balance, the nurse is obligated, with the assistance and agreement of the patient, to seek
ways to promote balance. The nurse is not obligated to create an opportunity for social balance,
identify alternative forms of care, or provide insight into the physiologic failings of the system if
the patient's health patterns are not achieving their goals.
38. Five predominant ways of coping with illness were identified by nursing research studies.
These are not the only means of coping. What would be another way of adaptively coping?
A) Becoming controlling
B) Reprioritizing needs and roles
C) Becoming aggressive
D) Withdrawing
Ans: B
Chapter: 6
Client Needs: B
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 3
Page and Header: 92, Stress Management: Nursing Interventions
Feedback: The five predominant ways of coping with illness identified in a review of 57
nursing research studies were as follows: trying to be optimistic about the outcome, using social
support, using spiritual resources, trying to maintain control either over the situation or over
feelings, and trying to accept the situation. Other ways of coping included seeking information,
reprioritizing needs and roles, lowering expectations, making compromises, comparing oneself
to others, planning activities to conserve energy, taking things one step at a time, listening to
one's body, and using self-talk for encouragement. Becoming controlling or aggressive are not
ways to cope adaptively. Option D is incorrect because withdrawing is not a positive coping
behavior.
39. The nursing instructor is going over patient assessment with her first-semester nursing
class. Which factor would the instructor identify as most important in determining health status?
A) Level of education
B) Support system
C) Social class
D) Interfamilial relationships
Ans: C
Chapter: 6
Client Needs: B
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Teaching/Learning
Objective: 9
Page and Header: 92, Stress Management: Nursing Interventions
Feedback: The single most important factor for determining health status is social class, and
within a social class the research suggests that the major factor influencing health is level of
education. Therefore options A, B, and D are incorrect.
40. The nurse is admitting a 59-year-old patient to the medical-surgical unit after a diagnosis of
cellulitis of the calf. What factors does the nurse know impact the processes of inflammation,
repair, and replacement? (Mark all that apply.)
A) Severity of the injury
B) Social relationships
C) Condition of the host
D) Familial support
E) Nature of the injury
Ans: D
Chapter: 6
Client Needs: B
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing Process
Objective: 8
Page and Header: 90, Stress at the Cellular Level
Feedback: The condition of the host, the environment, and the nature and severity of the injury
affect the processes of inflammation, repair, and replacement. The patients' social relationships
and familial support do not affect the processes of inflammation, repair, and replacement.