Question 1

A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: "Perhaps this was the best thing to happen. Maybe I'll look into pursuing an art degree." How should the nurse characterize the client's appraisal of the job loss stressor?

Accepted Answer

The client's statement suggests that he is viewing the job loss as a potential opportunity for growth and positive change, rather than as a threat or loss. This indicates that he is appraising the stressor as challenging.

Question 2

A bright student confides in the school nurse about conflicts related to attending college, or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time?

Accepted Answer

Problem-solving training would be the most appropriate coping strategy to recommend to the student. This would allow the student the opportunity to develop effective ways of managing conflicts related to attending college and also adding needed financial support to the family. This skill would also be helpful for the student in future situations where problem-solving is necessary. While meditation, relaxation, and journaling may be useful coping strategies, they may not directly address the student's specific conflicts.

Question 3

A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is the most appropriate nursing response?

Accepted Answer

Option B is the best choice because it acknowledges the impact of past experiences on present stress levels. It suggests that a person's reaction to stressful situations is influenced by past experiences and how they have learned to cope with them. This response can help the client to better understand their feelings of stress and encourage them to reflect on their past experiences.

Question 4

Which symptom should a nurse identify as typical of the "fight-or-flight" response?

Accepted Answer

The "fight-or-flight" response is characterized by increased heart rate, as the body prepares to either fight the perceived threat or flee from it. Pupil constriction, increased salivation, and increased peristalsis are not typical of the fight-or-flight response.

Question 5

A school nurse is assessing a distraught female high school student who is overly concerned because her parents can't afford horseback riding lessons. How should the nurse interpret the student's reaction to her perceived problem?

Accepted Answer

The student's concern about not being able to afford horseback riding lessons is a personal and significant issue to her, even if it may not seem like a major problem to others. It is important for the nurse to validate the student's feelings and provide support and resources for coping with the situation.

Question 6

A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs which stage of stress is the student most likely experiencing?

Accepted Answer

The student is likely experiencing the stage of exhaustion, which is the final stage of the stress response. This stage occurs when the body is no longer able to cope with the stressor and starts to break down. The student may be experiencing physical symptoms such as the sinus infection due to the prolonged stress of the semester.

Question 7

A nurse is interviewing a distressed client who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the client's appraisal of the situation? (Select all that apply.)

Accepted Answer

Questions A and B focus on the client's past experiences and coping mechanisms, which can provide insight into their current situation. Question E assesses the client's perception of their own skills and abilities, which can help identify potential job opportunities. Questions C and D, on the other hand, may be interpreted as judgmental or accusatory, which could exacerbate the client's distress.

Question 8

A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful when assisting the client in coping with stress? (Select all that apply.)

Accepted Answer

It is helpful to suggest enjoyable and relaxing activities, such as spending time with loved ones, listening to music, journaling feelings, and enjoying a pet. It is not recommended to focus on the stressors as this may increase anxiety and exacerbate the stress.

Question 9

Research undertaken by Miller and Rahe in 1997 demonstrated a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool?

Accepted Answer

The Recent Life Changes Questionnaire (RLCQ) does not take into account the personal perception of the event, which can significantly influence how stressful an event is perceived to be by an individual. This limits the tool's effectiveness in assessing the true impact of life changes on an individual's health.

Question 10

Which client statement should alert a nurse that a client may be responding maladaptively to stress?

Accepted Answer

Avoiding contact with others is a maladaptive coping mechanism, as social support can be an important factor in managing stress. This statement suggests that the client may be isolating themselves, which could lead to increased feelings of loneliness and exacerbate their stress levels.

Question 11

When an individual's stress response is sustained over a long period of time, which physiological effect of the endocrine system should a nurse anticipate?

Accepted Answer

Prolonged stress can lead to chronic activation of the stress response, resulting in a suppression of the immune system and decreased resistance to disease.

Question 12

A nurse is evaluating a client's response to stress. What would indicate to the nurse that the client is experiencing a secondary appraisal of the stressful event?

Accepted Answer

A secondary appraisal involves evaluating the resources and skills needed to deal with the stressful event. Option A (judging the event to be benign) is an example of a primary appraisal, while option B (judging the event to be irrelevant) is an example of a potential coping strategy for dealing with stress. Option D (judging the event to be pleasurable) does not apply to a stressful event.

Question 13

A distraught, single, first-time mother cries and says to a nurse, "How can I go to work if I can't afford childcare!" What is the nurse's initial action in assisting the client with the problem-solving process?

Accepted Answer

The nurse's initial action would be to assess the facts of the situation, including the mother's financial situation and available resources, in order to gather information and identify potential solutions.

Question 14

Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess?

Accepted Answer

When meditation is effective, a nurse can expect to assess an achieved state of relaxation. Meditation induces a relaxation response, which helps to reduce stress and promote a sense of calm and relaxation. While meditation may also lead to other benefits such as improved insight, appropriate role behaviors, and enhanced problem-solving abilities, the primary goal of meditation as a stress management technique is to induce relaxation.

Question 15

A nursing instructor is teaching about diseases of adaptation and when they are likely to occur. When questioned about situations that precipitate these diseases, which student statement indicates that learning has occurred?

Accepted Answer

Diseases of adaptation occur when an individual's physiological and psychological resources have become depleted, meaning that they are unable to cope with the stressors they are experiencing. Limited experience dealing with stress (A) can contribute to stress-related diseases, but it is not the only factor. Inheriting maladaptive genes (B) can also make it more likely for an individual to develop diseases of adaptation, but this is not always the case. Finally, existing conditions that exacerbate stress (C) can also contribute to stress-related diseases, but again, this is not the only factor.

Question 16

A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Miller and Rahe Recent Life Changes Questionnaire. How should the nurse evaluate this client data?

Accepted Answer

The Miller and Rahe Recent Life Changes Questionnaire score alone does not determine susceptibility to stress-related illness; coping resources and support systems are also crucial factors.

Question 17

An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention?

Accepted Answer

Working through the problem-solving process with the client can help them develop the skills to independently solve similar problems in the future. Completing the process for the client does not empower them to develop these skills, and encouraging relaxation exercises or journaling may be appropriate interventions but do not directly address the client's anxiety about finding a job.

Question 18

A school nurse is assessing a female high school student who is overly concerned about her appearance. The client's mother states, "That's not something to be stressed about!" Which is the most appropriate nursing response?

Accepted Answer

The best response would be D, as it acknowledges that stress can be caused by psychological factors and threats to self-esteem, which are common issues among teenagers concerned about their appearance. The other options either belittle the client's concerns or provide unrelated information.

Quiz 1: The Concept of Stress Adaptation