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ST.

TONIS COLLEGE
College Of Nursing
Bulanao, Tabuk City, Kalinga

Nursing Care Management 105 : Stress Adaptation

Name : Section : Date :

IINSTRUCTIONS: Choose and encircle the best answer for the following items. No erasures, alterations, and unnecessary markings. Make your
answer sheets as clean as possible.

1. A client has been fired from work because of downsizing.
Although clearly upset, when explaining the situation to a
friend, the client states, Imagine what I can do with this extra
time. Which defense mechanism is this client using?
A. Denial.
B. Intellectualization.
C. Rationalization.
D. Suppression.
2. Which best exemplifies a clients use of the defense
mechanism of reaction formation?
A. A client feels rage at being raped at a young age, which
later is expressed by joining law enforcement.
B. A client is unhappy about being a father, although others
know him to dote on his son.
C. A client is drinking 6 to 8 beers a day while still going to
AA as a group leader.
D. A client is angry that the call bell is not answered and
decides to call the nurse when it is unnecessary.
3. Which best exemplifies an individuals use of the defense
mechanism of compensation?
A. A woman feels unattractive, but decides to pursue fashion
design as a career.
B. A shy woman who abuses alcohol tells others that alcohol
helps her overcome her shyness.
C. A poorly paid employee consistently yells at his assistant
for minimal mistakes.
D. A teenager injures an ankle playing basketball and curls
into a fetal position to deal with the pain.
4. Which best exemplifies the use of the defense mechanism of
sublimation?
A. A child who has been told by parents that stealing is
wrong reminds a friend not to steal.
B. A man who loves sports but is unable to play decides to
become an athletic trainer.
C. Having chronic asthma with frequent hospitalizations, a
young girl admires her nurses. She later chooses nursing
as a career.
D. A boy who feels angry and hostile decides to become a
therapist to help others.
5. A nursing instructor is teaching about defense mechanisms.
Which of the following student statements indicates that
learning has occurred? Select all that apply.
A. Defense mechanisms are used when anxiety increases,
and the strength of the ego is tested.
B. All individuals who use defense mechanisms as a means
of stress adaptation exhibit healthy egos.
C. When defense mechanisms are overused or maladaptive,
unhealthy ego development may result.
D. Defense mechanisms are used only by mentally ill
individuals to assist with coping.
E. At times of mild to moderate anxiety, defense
mechanisms are used adaptively to deal with stress.
6. A client is admitted to the emergency department after a car
accident, but does not remember anything about it. The client
is using which defense mechanism?
A. Undoing.
B. Rationalization.
C. Suppression.
D. Repression.
7. A client in the emergency department was violently attacked
and raped. When discussing the incident with the nurse, the
client shows no emotion related to the event. Which defense
mechanism is the client using?
A. Isolation.
B. Displacement.
C. Compensation.
D. Regression.
8. After failing an examination, a young physician in his
psychiatric residency begins smoking a pipe and growing a
beard that makes him look like Sigmund Freud. The nurse
manager, realizing the physicians insecurities, recognizes the
use of which defense mechanism?
A. Identification.
B. Repression.
C. Regression.
D. Reaction formation.
9. Which situation reflects the defense mechanism of projection?
A. A husband has an affair, then buys his wife a diamond
anniversary bracelet.
B. A promiscuous wife accuses her husband of having an
affair.
C. A wife, failing to become pregnant, works hard at
becoming teacher of the year.
D. A man who was sexually assaulted as a child remembers
nothing of the event.
10. Which situation reflects the defense mechanism of denial?
A. When his twin brother excels in golf, the client begins
lessons with a golf pro.
B. After a mother spanks her child for misbehaving, the
child pulls the cats tail.
C. After years of excessive drinking, the client fails to
acknowledge a problem.
D. The client expresses to his family that 50% of people with
his diagnosis survive.
11. During visiting hours, a client who is angry at her ex-
husbands charges of child neglect expresses this anger by
lashing out at her sister-in-law. The nurse understands that
the client is demonstrating the use of which defense
mechanism?
A. Denial.
B. Projection.
C. Displacement.
D. Rationalization.
12. On an in-patient unit, a client is isolating self in room and
refusing to attend group therapy. Which is an appropriate
short-term outcome for this client?
A. Client participation will be expected in one group session.
B. Provide opportunities for the client to increase self-
esteem by discharge.
C. The client will communicate with staff by the end of the
3-to-11 shift.
D. The client will demonstrate socialization skills when in
the milieu.
13. A client on an in-patient psychiatric unit is sarcastic to staff
and avoids discussions in group therapy. Which long-term
outcome is appropriate for this client?
A. The client will not injure himself or herself or someone
else.
B. The client will express feelings of anger in group therapy
by end of shift.
C. The client will take responsibility for his or her own
feelings.
D. The client will participate in out-patient therapy within 2
weeks of discharge.
14. A girl is jealous of her best friend for winning the scholarship
she herself expected. She agrees to meet her friend for lunch
and then arrives 1 hour late, apologizing and begging
forgiveness. The girl is displaying which behavior?
A. Self-assertion.
B. Passive-aggressiveness.
C. Splitting.
D. Omnipotence.
15. Which is an example of a cognitive response to a mild level of
anxiety?
A. Increased respirations.
B. Feelings of horror or dread.
C. Pacing the hall.
D. Increased concentration.
16. Which is an example of a behavioral response to a moderate
level of anxiety?
A. Narrowing perception.
B. Heart palpitations.
C. Limited attention span.
D. Restlessness.
17. Which is an example of a physiological response to a panic
level of anxiety?
A. Inability to focus.
B. Loss of consciousness.
C. Dilated pupils.
D. Possible psychosis.
18. A nurse on an in-patient psychiatric unit is assessing a client
at risk for acting out behaviors. Which behavioral symptom
would the nurse expect to be exhibited?
A. Invasion of personal space.
B. Flushed face.
C. Increased anxiety.
D. Misinterpretation of stimuli.
19. Which immediate biological responses are associated with
fight-or-flight syndrome?
A. Bronchioles in the lungs dilate, and respiration rate
increases.
B. Vasopressin increases fluid retention and increases blood
pressure.
C. Thyrotropic hormone stimulates the thyroid gland to
increase metabolic rate.
D. Gonadotropins cause a decrease in secretion of sex
hormone and produce impotence.
20. A severely anxious client experiencing headaches, palpitations,
and inability to concentrate is admitted to a medical floor.
Which nursing intervention would take priority?
A. Encourage the client to express feelings.
B. Discuss alternative coping strategies with the client.
C. Use a distraction, such as having the client attend group.
D. Sit with the client, and use a calm but directive approach.
21. A client is exhibiting tension and needs direction to solve
problems. Which intervention would the nurse implement
using a behavioral approach?
A. Assess the clients family history for anxiety disorders.
B. Encourage the client to use deep breathing techniques.
C. Ask the client to think of a time in the past when anxiety
was manageable.
D. Encourage journal writing to express feelings.
22. The nursing student is developing a plan of care for a client
experiencing a crisis situation. Number the following in
priority order for implementation of this plan.
___ Assess for suicidal and homicidal ideation.
___ Discuss coping skills used in the past, and note if they were
effective.
___ Establish a working relationship by active listening.
___ Develop a plan of action for dealing with future stressors.
___ Evaluate the developed plans effectiveness.
23. The nurse is assessing clients on an in-patient psychiatric unit.
Which client would require immediate intervention?
A. A client experiencing rapid, pressured speech and poor
personal boundaries.
B. A client expressing homicidal ideations toward the
neighborhood butcher.
C. A client sleeping only 1 to 2 hours per night for the last 2
nights.
D. A client secluding self from others and refusing to attend
groups in the milieu.
24. The nursing student is reviewing information about crisis.
Which of the following student statements indicate(s) that
learning has occurred? Select all that apply.
A. A crisis is associated with psychopathology.
B. A crisis is precipitated by a specific identifiable event.
C. A crisis is chronic in nature and needs multiple
interventions over time.
D. A crisis is specific to an individual, and the cause may
vary.
E. A crisis contains the potential for psychological growth or
deterioration.
25. At an out-patient obstetrical clinic, a pregnant client on
welfare exhibits extreme anxiety when discussing a failure in
school. This is an example of which type of crisis?
A. Dispositional crisis.
B. Crisis of anticipated life transition.
C. Maturational/developmental crisis.
D. Crisis reflecting psychopathology.
26. A 17-year-old client whose boyfriend has recently broken their
engagement is brought into the emergency department after
taking a handful of lorazepam (Ativan). Which nursing
intervention would take priority during this psychiatric crisis?
A. Discuss the clients feelings about the breakup with her
boyfriend.
B. Monitor vital signs and note any signs of central nervous
system depression.
C. Allow the client time to rest because lorazepam (Ativan)
is sedating.
D. Decrease fluids, and place the client on close observation.
27. The nurse should assess which of the following client
behaviors when completing a risk assessment? Select all that
apply.
A. Past history of violence.
B. Disturbed thought process.
C. Invasion of personal space.
D. Flushed face.
E. Self-mutilation.
28. 35. A client with rigid posture and raised voice uses profanity
while demanding to use the phone. Which nursing diagnosis is
a priority?
A. Risk for injury toward others R / T anxiety AEB rigid
posture and profanity.
B. Ineffective coping R / T inability to express feelings AEB
aggressive demeanor.
C. Disturbed thought process R / T altered perception AEB
demanding behaviors.
D. Social isolation R / T anger AEB inability to get along
with staff.
29. A student is learning about prodromal syndrome. Which
student statement indicates that learning has occurred?
A. Behaviors associated with prodromal syndrome
necessitate immediate action by the nurse.
B. Prodromal syndrome occurs after a clients outburst.
C. Staff cannot assist clients who are experiencing a
prodromal syndrome to gain control.
D. Very few symptoms are associated with a prodromal
syndrome.
30. On an in-patient psychiatric unit, a nurse is completing a risk
assessment on a newly admitted client experiencing agitation.
Which cognitive symptom expressed by the client would the
nurse document?
A. Past history of violence.
B. Disturbed thought process.
C. History of throwing objects on the unit.
D. Flushed face.
31. In group therapy, an angry client becomes increasingly restless
and irritable and shouts at the facilitator. Which nursing
diagnosis takes priority?
A. Risk for injury toward others R / T inability to deal with
frustration.
B. Ineffective coping R / T inability to express feelings AEB
raised voice.
C. Anxiety R / T topic at hand AEB restlessness in group
therapy.
D. Social isolation R / T intimidation of others AEB solitary
activities.
32. A client is transported to the emergency department by
emergency medical services for head and abdominal trauma
sustained in a physical altercation with a family member. In
this situation, which nursing diagnosis would take priority?
A. Risk for other-directed violence R / T anger toward a
family member.
B. Poor self-esteem R / T altered family processes.
C. Risk for injury R / T possible complications secondary to
trauma.
D. Anxiety R / T injuries AEB tremors and crying.
33. An agency nurse is coming to an in-patient psychiatric unit
for the first time. The charge nurse of the unit would assign
which client to this nurse?
A. A client newly admitted for suicidal ideations with a plan
to jump off a bridge.
B. A client admitted 2 days ago for alcohol detoxification
with a history of seizures.
C. A client grimacing and pacing the halls with a grim
defiant affect.
D. A client starting clozapine (Clozaril) therapy to treat
auditory hallucinations.



-===== Good luck & God bless =====-



Prepared by:

Lucky P. Roaquin, RN, MAN
STCI-CON Faculty