RNSG 1533 EXAM 1 COGNITION AND COPING
QUESTIONS & VERIFIED ANSWERS
The adult child of a patient diagnosed with major depressive disorder asks, "Do you
think depression and physical illness are connected? Since my father's death, my
mother has had shingles and the flu, but she's usually not one who gets sick." Which
answer by the nurse best reflects current knowledge?
a. "It is probably a coincidence. Emotions and physical responses travel on different
tracts of the nervous system."
b. "You may be paying more attention to your mother since your father died and noticing
more things such as minor illnesses."
c. "So far, research on emotions or stress and becoming ill more easily is unclear. We
do not know for sure if there is a link."
d. "Negative emotions and prolonged stress interfere with the body's ability to protect
itself and can increase the likelihood of illness." - Answers - D.
Research supports a link between negative emotions and/or prolonged stress and
impaired immune system functioning. Activation of the immune system sends
proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines
that signal the central nervous system to initiate myriad responses to stress. Prolonged
stress suppresses the immune system and lowers resistance to illness. Although the
adult child may be more aware of issues involving the mother, the pattern of illnesses
described may be an increase from the mother's baseline
A patient diagnosed with emphysema has severe shortness of breath and needs
portable oxygen when leaving home. Recently the patient has reduced activity because
of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which
image should the patient be encouraged to visualize?
a. Engaging in activity without using any supplemental oxygen
b. Sleeping comfortably and soundly, without respiratory distress
c. Feeling relaxed and taking regular deep breaths when leaving home
d. Having a younger, healthier body that knows no exercise limitations - Answers - C.
The patient has dysfunctional images of dyspnea. Guided imagery can help replace the
dysfunctional image with a positive coping image. Athletes have found that picturing
successful images can enhance performance. Encouraging the patient to imagine a
regular breathing depth and rate will help improve oxygen-carbon dioxide exchange and
help achieve further relaxation. Other options focus on unrealistic goals (being younger,
not needing supplemental oxygen) or restrict her quality of life.
A nurse leads a psychoeducational group for patients experiencing depression. The
nurse plans to implement an exercise regime for each patient. The rationale to use
when presenting this plan to the treatment team is that exercise
a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors.
b. prevents damage from overstimulation of the sympathetic nervous system.
,c. detoxifies the body by removing metabolic wastes and other toxins.
d. improves mood stability for patients with bipolar disorders. - Answers - A.
β-Endorphins produced during exercise result in improvement in mood and lowered
anxiety. The other options are not accurate.
A patient nervously says, "Financial problems are stressing my marriage. I've heard
rumors about cutbacks at work; I am afraid I might get laid off." The patient's pulse is
112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing
intervention will the nurse implement?
a. Advise the patient, "Go to sleep 30 to 60 minutes earlier each night to increase rest."
b. Direct the patient in slow and deep breathing using abdominal muscles.
c. Suggest the patient consider that a new job might be better than the present one.
d. Tell the patient, "Relax by spending more time playing with your pet." - Answers - B
According to the Recent Life Changes Questionnaire, which situation would most
necessitate a complete assessment of a person's stress status and coping abilities?
a. A person who has been assigned more responsibility at work
b. A parent whose job required relocation to a different city
c. A person returning to college after an employer ceased operations
d. A man who recently separated from his wife because of marital problems - Answers -
C.
A person returning to college after losing a job is dealing with two significant stressors
simultaneously. Together, these stressors total more life change units than any of the
single stressors cited in the other options.
A patient newly diagnosed as HIV-positive seeks the nurse's advice on how to reduce
the risk of infections. The patient says, "I went to church years ago and I was in my best
health then. Maybe I should start going to church again." Which response will the nurse
offer?
a. "Religion does not usually affect health, but you were younger and stronger then."
b. "Contact with supportive people at a church might help, but religion itself is not
especially helpful."
c. "Studies show that spiritual practices can enhance immune system function and
coping abilities."
d. "Going to church would expose you to many potential infections. Let's think about
some other options." - Answers - C
When a nurse asks a newly admitted patient to describe social supports, the patient
says, "My parents died last year and I have no family. I am newly divorced, and my
former in-laws blame me. I don't have many friends because most people my age just
want to go out drinking." Which action will the nurse apply?
a. Advise the patient that being so particular about potential friends reduces social
contact.
b. Suggest using the Internet as a way to find supportive others with similar values.
c. Encourage the patient to begin dating again, perhaps with members of the church.
,d. Discuss how divorce support groups could increase coping and social support. -
Answers - D.
High-quality social support enhances mental and physical health and acts as a
significant buffer against distress. Low-quality support relationships affect a person's
coping negatively. Resuming dating soon after a divorce could place additional stress
on the patient rather than helping her cope with existing stressors. Developing
relationships on the Internet probably would not substitute fully for direct contact with
other humans and could expose her to predators misrepresenting themselves to take
advantage of vulnerable persons
A patient experiencing significant stress associated with a disturbing new medical
diagnosis asks the nurse, "Do you think saying a prayer would help?" Select the nurse's
best answer.
a. "It could be that prayer is your only hope."
b. "You may find prayer gives comfort and lowers your stress."
c. "I can help you feel calmer by teaching you meditation exercises."
d. "We do not have evidence that prayer helps, but it wouldn't hurt." - Answers - B
A patient is brought to the Emergency Department after a motorcycle accident. The
patient is alert, responsive, and diagnosed with a broken leg. The patient's vital signs
are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the
broken leg, which vital sign readings would be expected?
a. P 64, R 14
b. P 68, R 12
c. P 72, R 16
d. P 80, R 20 - Answers - D.
In times of stress, the sympathetic nervous system takes over (fight or flight response)
and sends signals to the adrenal glands, thereby releasing norepinephrine. The
circulating norepinephrine increases the heart rate. Respirations increase, bringing
more oxygen to the lungs
A patient tells the nurse, "I know that I should reduce the stress in my life, but I have no
idea where to start." What would be the best initial nursing response?
a. "Physical exercise works to elevate mood and reduce anxiety."
b. "Reading about stress and how to manage it might be a good place to start."
c. "Why not start by learning to meditate? That technique will cover everything."
d. "Let's talk about what is going on in your life and then look at possible options." -
Answers - D
In this case, the nurse lacks information about what stressors the patient is coping with
or about what coping skills are already possessed. Further assessment is indicated
before potential solutions can be explored. Suggesting exploration of the stress facing
the patient is the only option that involves further assessment rather than suggesting a
particular intervention.
, A patient tells the nurse, "My doctor thinks my problems with stress relate to the
negative way I think about things and suggested I learn new ways of thinking." Which
response by the nurse would support the recommendation?
a. Encourage the patient to imagine being in calm circumstances.
b. Provide the patient with a blank journal and guidance about journaling.
c. Teach the patient to recognize, reconsider, and reframe irrational thoughts.
d. Teach the patient to use instruments that give feedback about bodily functions. -
Answers - C
A patient who had been experiencing significant stress learned to use progressive
muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2
weeks later, which finding most clearly shows the patient is coping more effectively with
stress?
a. The patient's systolic blood pressure has changed from the 140s to the 120s mm Hg.
b. The patient reports, "I feel better, and that things are not bothering me as much."
c. The patient reports, "I spend more time napping or sitting quietly at home."
d. The patient's weight decreased by 3 pounds - Answers - A
Objective measures tend to be the most reliable means of gauging progress. In this
case, the patient's elevated blood pressure, an indication of the body's physiological
response to stress, has diminished. The patient's report regarding activity level is
subjective; sitting quietly could reflect depression rather than improvement. Appetite,
mood, and energy levels are also subjective reports that do not necessarily reflect
physiological changes from stress and may not reflect improved coping with stress. The
patient's weight change could be a positive or negative indicator; the blood pressure
change is the best answer
A patient tells the nurse, "I will never be happy until I'm as successful as my older
sister." The nurse asks the patient to reassess this statement and reframe it. Which
reframed statement by the patient is most likely to promote coping?
a. "People should treat me as well as they treat my sister."
b. "I can find contentment in succeeding at my own job level."
c. "I won't be happy until I make as much money as my sister."
d. "Being as smart or clever as my sister isn't really important." - Answers - B
Finding contentment within one's own work, even when it does not involve success as
others might define it, is likely to lead to a reduced sense of distress about achievement
level. It speaks to finding satisfaction and happiness without measuring the self against
another person. Focusing on salary is simply a more specific way of being as successful
as the sister, which would not promote coping. Expecting others to treat her as they do
her sister is beyond her control. Dismissing the sister's cleverness as unimportant
indicates that the patient continues to feel inferior to the sibling.
A patient says, "One result of my chronic stress is that I feel so tired. I usually sleep
from 11:00 PM to 6:30 AM. I started setting my alarm to give me an extra 30 minutes of
sleep each morning, but I don't feel any better and I'm rushed for work." Which nursing
response would best address the patient's concerns?
a. "You may need to speak to your doctor about taking a sedative to help you sleep."
QUESTIONS & VERIFIED ANSWERS
The adult child of a patient diagnosed with major depressive disorder asks, "Do you
think depression and physical illness are connected? Since my father's death, my
mother has had shingles and the flu, but she's usually not one who gets sick." Which
answer by the nurse best reflects current knowledge?
a. "It is probably a coincidence. Emotions and physical responses travel on different
tracts of the nervous system."
b. "You may be paying more attention to your mother since your father died and noticing
more things such as minor illnesses."
c. "So far, research on emotions or stress and becoming ill more easily is unclear. We
do not know for sure if there is a link."
d. "Negative emotions and prolonged stress interfere with the body's ability to protect
itself and can increase the likelihood of illness." - Answers - D.
Research supports a link between negative emotions and/or prolonged stress and
impaired immune system functioning. Activation of the immune system sends
proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines
that signal the central nervous system to initiate myriad responses to stress. Prolonged
stress suppresses the immune system and lowers resistance to illness. Although the
adult child may be more aware of issues involving the mother, the pattern of illnesses
described may be an increase from the mother's baseline
A patient diagnosed with emphysema has severe shortness of breath and needs
portable oxygen when leaving home. Recently the patient has reduced activity because
of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which
image should the patient be encouraged to visualize?
a. Engaging in activity without using any supplemental oxygen
b. Sleeping comfortably and soundly, without respiratory distress
c. Feeling relaxed and taking regular deep breaths when leaving home
d. Having a younger, healthier body that knows no exercise limitations - Answers - C.
The patient has dysfunctional images of dyspnea. Guided imagery can help replace the
dysfunctional image with a positive coping image. Athletes have found that picturing
successful images can enhance performance. Encouraging the patient to imagine a
regular breathing depth and rate will help improve oxygen-carbon dioxide exchange and
help achieve further relaxation. Other options focus on unrealistic goals (being younger,
not needing supplemental oxygen) or restrict her quality of life.
A nurse leads a psychoeducational group for patients experiencing depression. The
nurse plans to implement an exercise regime for each patient. The rationale to use
when presenting this plan to the treatment team is that exercise
a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors.
b. prevents damage from overstimulation of the sympathetic nervous system.
,c. detoxifies the body by removing metabolic wastes and other toxins.
d. improves mood stability for patients with bipolar disorders. - Answers - A.
β-Endorphins produced during exercise result in improvement in mood and lowered
anxiety. The other options are not accurate.
A patient nervously says, "Financial problems are stressing my marriage. I've heard
rumors about cutbacks at work; I am afraid I might get laid off." The patient's pulse is
112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing
intervention will the nurse implement?
a. Advise the patient, "Go to sleep 30 to 60 minutes earlier each night to increase rest."
b. Direct the patient in slow and deep breathing using abdominal muscles.
c. Suggest the patient consider that a new job might be better than the present one.
d. Tell the patient, "Relax by spending more time playing with your pet." - Answers - B
According to the Recent Life Changes Questionnaire, which situation would most
necessitate a complete assessment of a person's stress status and coping abilities?
a. A person who has been assigned more responsibility at work
b. A parent whose job required relocation to a different city
c. A person returning to college after an employer ceased operations
d. A man who recently separated from his wife because of marital problems - Answers -
C.
A person returning to college after losing a job is dealing with two significant stressors
simultaneously. Together, these stressors total more life change units than any of the
single stressors cited in the other options.
A patient newly diagnosed as HIV-positive seeks the nurse's advice on how to reduce
the risk of infections. The patient says, "I went to church years ago and I was in my best
health then. Maybe I should start going to church again." Which response will the nurse
offer?
a. "Religion does not usually affect health, but you were younger and stronger then."
b. "Contact with supportive people at a church might help, but religion itself is not
especially helpful."
c. "Studies show that spiritual practices can enhance immune system function and
coping abilities."
d. "Going to church would expose you to many potential infections. Let's think about
some other options." - Answers - C
When a nurse asks a newly admitted patient to describe social supports, the patient
says, "My parents died last year and I have no family. I am newly divorced, and my
former in-laws blame me. I don't have many friends because most people my age just
want to go out drinking." Which action will the nurse apply?
a. Advise the patient that being so particular about potential friends reduces social
contact.
b. Suggest using the Internet as a way to find supportive others with similar values.
c. Encourage the patient to begin dating again, perhaps with members of the church.
,d. Discuss how divorce support groups could increase coping and social support. -
Answers - D.
High-quality social support enhances mental and physical health and acts as a
significant buffer against distress. Low-quality support relationships affect a person's
coping negatively. Resuming dating soon after a divorce could place additional stress
on the patient rather than helping her cope with existing stressors. Developing
relationships on the Internet probably would not substitute fully for direct contact with
other humans and could expose her to predators misrepresenting themselves to take
advantage of vulnerable persons
A patient experiencing significant stress associated with a disturbing new medical
diagnosis asks the nurse, "Do you think saying a prayer would help?" Select the nurse's
best answer.
a. "It could be that prayer is your only hope."
b. "You may find prayer gives comfort and lowers your stress."
c. "I can help you feel calmer by teaching you meditation exercises."
d. "We do not have evidence that prayer helps, but it wouldn't hurt." - Answers - B
A patient is brought to the Emergency Department after a motorcycle accident. The
patient is alert, responsive, and diagnosed with a broken leg. The patient's vital signs
are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the
broken leg, which vital sign readings would be expected?
a. P 64, R 14
b. P 68, R 12
c. P 72, R 16
d. P 80, R 20 - Answers - D.
In times of stress, the sympathetic nervous system takes over (fight or flight response)
and sends signals to the adrenal glands, thereby releasing norepinephrine. The
circulating norepinephrine increases the heart rate. Respirations increase, bringing
more oxygen to the lungs
A patient tells the nurse, "I know that I should reduce the stress in my life, but I have no
idea where to start." What would be the best initial nursing response?
a. "Physical exercise works to elevate mood and reduce anxiety."
b. "Reading about stress and how to manage it might be a good place to start."
c. "Why not start by learning to meditate? That technique will cover everything."
d. "Let's talk about what is going on in your life and then look at possible options." -
Answers - D
In this case, the nurse lacks information about what stressors the patient is coping with
or about what coping skills are already possessed. Further assessment is indicated
before potential solutions can be explored. Suggesting exploration of the stress facing
the patient is the only option that involves further assessment rather than suggesting a
particular intervention.
, A patient tells the nurse, "My doctor thinks my problems with stress relate to the
negative way I think about things and suggested I learn new ways of thinking." Which
response by the nurse would support the recommendation?
a. Encourage the patient to imagine being in calm circumstances.
b. Provide the patient with a blank journal and guidance about journaling.
c. Teach the patient to recognize, reconsider, and reframe irrational thoughts.
d. Teach the patient to use instruments that give feedback about bodily functions. -
Answers - C
A patient who had been experiencing significant stress learned to use progressive
muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2
weeks later, which finding most clearly shows the patient is coping more effectively with
stress?
a. The patient's systolic blood pressure has changed from the 140s to the 120s mm Hg.
b. The patient reports, "I feel better, and that things are not bothering me as much."
c. The patient reports, "I spend more time napping or sitting quietly at home."
d. The patient's weight decreased by 3 pounds - Answers - A
Objective measures tend to be the most reliable means of gauging progress. In this
case, the patient's elevated blood pressure, an indication of the body's physiological
response to stress, has diminished. The patient's report regarding activity level is
subjective; sitting quietly could reflect depression rather than improvement. Appetite,
mood, and energy levels are also subjective reports that do not necessarily reflect
physiological changes from stress and may not reflect improved coping with stress. The
patient's weight change could be a positive or negative indicator; the blood pressure
change is the best answer
A patient tells the nurse, "I will never be happy until I'm as successful as my older
sister." The nurse asks the patient to reassess this statement and reframe it. Which
reframed statement by the patient is most likely to promote coping?
a. "People should treat me as well as they treat my sister."
b. "I can find contentment in succeeding at my own job level."
c. "I won't be happy until I make as much money as my sister."
d. "Being as smart or clever as my sister isn't really important." - Answers - B
Finding contentment within one's own work, even when it does not involve success as
others might define it, is likely to lead to a reduced sense of distress about achievement
level. It speaks to finding satisfaction and happiness without measuring the self against
another person. Focusing on salary is simply a more specific way of being as successful
as the sister, which would not promote coping. Expecting others to treat her as they do
her sister is beyond her control. Dismissing the sister's cleverness as unimportant
indicates that the patient continues to feel inferior to the sibling.
A patient says, "One result of my chronic stress is that I feel so tired. I usually sleep
from 11:00 PM to 6:30 AM. I started setting my alarm to give me an extra 30 minutes of
sleep each morning, but I don't feel any better and I'm rushed for work." Which nursing
response would best address the patient's concerns?
a. "You may need to speak to your doctor about taking a sedative to help you sleep."
