Lewis: Medical-Surgical Nursing, 7th Edition

Test Bank

Chapter 9: Stress and Stress Management

MULTIPLE CHOICE

1. A 22-year-old patient is brought to the emergency department (ED) with multiple

abrasions and bruises after being assaulted in a shopping center parking lot. The
patient’s initial blood pressure (BP) is 180/98. The nurse will plan to
a. treat the abrasions and discuss the risks associated with hypertension.
b. discuss the need for hospital admission to control blood pressure.
c. recheck the blood pressure prior to the patient’s discharge from the ED.
d. start an intravenous (IV) line to administer antihypertensive medications.

Correct Answer: C
Rationale: Hypertension is a normal consequence of the activation of the “fight-or-
flight” response. Because hypertension is expected when a patient has experienced an
acute stressor, the nurse should plan to check the BP before discharge, which will provide
a more accurate idea of the patient’s usual blood pressure. Hypertension that occurs in
response to acute stress does not increase risk for health problems such as stroke, indicate
a need for hospitalization, or indicate a need for IV antihypertensive medications.

Cognitive Level: Application Text Reference: p. 114

Nursing Process: Planning NCLEX: Physiological Integrity

2. The husband of a patient who is recovering from a heart attack tells the nurse, “My
wife doesn’t seem like the same person. She is so forgetful and irritable and she has
always been well-organized and calm before this.” Which response by the nurse is
most appropriate?
a. “Mental changes after a severe illness are common and frequently permanent.”
b. “I will ask the doctor about whether a psychiatric consultation should be ordered.”
c. “You may need to talk to a therapist to help you cope with these mental changes.”
d. “Stress frequently causes transient changes in concentration and mood.”

Correct Answer: D
Rationale: Behavioral responses to stress include changes in memory and irritability;
these are temporary and will resolve as the stress resolves. The changes are not
permanent and do not usually require psychiatric care. Because the changes are
temporary, an explanation and appropriate support by the nurse are needed, but a referral
to a therapist is not typically necessary.

Cognitive Level: Application Text Reference: p. 115

Nursing Process: Implementation NCLEX: Psychosocial Integrity

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 9-2

3. A hospitalized patient is very anxious about missing work and is afraid of being fired
because of this illness. An appropriate nursing diagnosis for the patient is
a. insomnia related to anxiety about work.
b. ineffective denial related to lack of effective coping resources.
c. risk for strain of the caregiver role related to lack of family support.
d. complicated grieving related to prolonged stressful situation.

Correct Answer: A
Rationale: The information about the patient indicates that insomnia may occur as a
result of the patient’s stress. There is no evidence to support the diagnoses of ineffective
denial, risk for caregiver role strain, or complicated grieving.

Cognitive Level: Application Text Reference: p. 115

Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

4. A 28-year-old male patient who is diabetic is hospitalized for a gangrenous foot

infection. The patient’s wife visits the patient for a few minutes every other day. The
patient tells the nurse that his wife is angry about being married to an invalid. The
nurse identifies the nursing diagnosis of
a. ineffective denial related to inadequate knowledge about diabetes.
b. compromised family coping related to insufficient support from wife.
c. ineffective health maintenance related to expectations of family members.
d. anxiety related to lack of ability to adapt to changes in lifestyle.

Correct Answer: B
Rationale: The wife’s visiting pattern and patient statement support the diagnosis of
compromised family coping. There is no evidence indicating that the patient is in denial
about his diabetes or that the ineffective health maintenance is caused by the wife’s
expectations. The patient’s statement does not provide evidence to support anxiety for
either the patient or wife.

Cognitive Level: Application Text Reference: p. 116

Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

5. A patient who has fibromyalgia tells the nurse, “My life feels very chaotic and out of
my control. I will not be able to manage if anything else happens.” Which response
by the nurse will be helpful?
a. “Regular massages may help reduce your pain.”
b. “Remember that stress can make your illness worse.”
c. “Tell me more about how your life has been recently.”
d. “You will find a way to cope if another crisis occurs.”

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 9-3

Correct Answer: C
Rationale: The nurse’s initial strategy should be further assessment of the stressors in the
patient’s life. Massage therapy may be of assistance to the patient, but more assessment is
needed before the nurse can determine this. A reminder that stress may increase
symptoms will increase the patient’s stress. The response, “You will find a way to cope if
another crisis occurs” offers false reassurance, since the nurse has not yet assessed the
patient’s coping abilities.

Cognitive Level: Application Text Reference: p. 111

Nursing Process: Implementation NCLEX: Psychosocial Integrity

6. When assessing patients for the possible health impact of stressors, the most
important information to obtain is
a. the importance of religious influences for the patient.
b. how long the patient has been exposed to the stressor.
c. medications that the patient is taking to control anxiety.
d. any family history of stress-related physical illnesses.

Correct Answer: B
Rationale: The length of time the patient has been exposed to the stressor is a variable
that impacts on the health consequences of a stressor. Information about the type of
stressor, medications the patient is taking, and family history is usually collected but will
not have as much impact on the health of the patient as the length of time the patient has
been stressed.

Cognitive Level: Application Text Reference: p. 111

Nursing Process: Assessment NCLEX: Physiological Integrity

7. The nurse is teaching a hospitalized patient to use imagery as a technique for stress
management. Which statement by the nurse is appropriate?
a. “Bring what you hear and sense in your present environment into your image of
the scene.”
b. “If your scene is stressful to you, continue visualizing until you can overcome the
distress.”
c. “Pay attention to what you hear, smell, and feel at this place.”
d. “Place your stress in the image of a form you can destroy.”

Correct Answer: C
Rationale: Focusing on the sensory information in the imagined place assists the patient
in relaxing. The patient is unlikely to relax if the sensory information from the hospital is
used during imagery. The purpose of imagery is to generate calm feelings, and focusing
on overcoming or destroying stresses is likely to increase stress level and the release of
stress-related hormones.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 9-4

Cognitive Level: Application Text Reference: p. 118

Nursing Process: Implementation NCLEX: Psychosocial Integrity

8. An overweight patient who enjoys active outdoor activities develops arthritis in the
knees. To help the patient cope with the diagnosis, the most helpful intervention by
the nurse is to
a. ask the patient to discuss feelings about the diagnosis.
b. encourage the patient to think about how weight loss might improve symptoms.
c. teach the patient how to use imagery to decrease pain and decrease stress.
d. have the patient practice frequent relaxation breathing.

Correct Answer: B
Rationale: For problems that can be changed or controlled, problem-focused coping
strategies, such as encouraging the patient to lose weight, are most helpful. The other
strategies may also assist the patient in coping with the diagnosis, but they will not be as
helpful as a problem-oriented strategy.

Cognitive Level: Application Text Reference: p. 116

Nursing Process: Implementation NCLEX: Psychosocial Integrity

9. A diabetic patient who is hospitalized tells the nurse, “I don’t understand why I can
keep my blood sugar under control at home with diet alone, but when I get sick, my
blood sugar goes up.” Which response by the nurse is appropriate?
a. “Stressors such as illness cause the release of hormones that increase blood sugar.”
b. “It is probably just coincidental that your blood sugars are high when you are ill.”
c. “Increased blood sugar occurs because the kidneys are not able to metabolize
glucose as well during stressful times.”
d. “Your diet is different here in the hospital than at home and that is the most likely
cause of the increased glucose level.”

Correct Answer: A
Rationale: The release of cortisol, epinephrine, and norepinephrine increases blood
glucose levels. The increase in blood sugar is not coincidental. The kidneys do not
control blood glucose. A diabetic patient who is hospitalized will be on an appropriate
diet to help control blood glucose.

Cognitive Level: Application Text Reference: pp. 113-114

Nursing Process: Implementation NCLEX: Physiological Integrity

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.