College of Nursing
4 MAXE SDNUF
★ ★
N Department of Health Sciences
SCIENTIA · CURA · COMPASSIO
EST. 1908
Fundamentals of Nursing — Examination 4
ST R E SS / CO P I N G · LO SS / G R I E F · D O CU M E N TAT I O N · E L I M I N AT I O N · PA I N M A N A G E M E N T
INSTITUTION College of Nursing COURSE CODE NURS 1101
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Fundamentals of Nursing Exam 4 TOTAL QUESTIONS 75+ Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice & Select All That Apply
EXAMINATION INSTRUCTIONS
▸ This comprehensive exam covers stress/coping, loss/grief, documentation, urinary/bowel elimination, and pain management.
▸ Select the single best answer unless "Select all that apply" is indicated.
▸ Correct answers and clinical rationales appear below each question for NCLEX preparation.
SECTION I — STRESS, COPING & ADAPTATION Questions 1 – 16
1. When released in response to alarm, what substance promotes a sense of well-being?
a. Aldosterone
b. Thyroid-stimulating hormone
c. Endorphins
d. Adrenocorticotropic hormone
CORRECT ANSWER c — Endorphins
RATIONALE Endorphins are the body's natural opioids — released during stress, pain, and exercise. They produce
analgesia and a sense of well-being. Aldosterone regulates sodium/water. TSH stimulates thyroid. ACTH
stimulates cortisol release.
2. After a motor vehicle accident, a patient's BP decreased despite surgery and fluid resuscitation, with increased HR
and RR. What GAS stage is this?
a. Alarm
b. Resistance
c. Exhaustion
d. Recovery
CORRECT ANSWER c — Exhaustion
RATIONALE The exhaustion stage occurs when the body can no longer maintain compensation — BP drops, HR/RR
increase as final compensatory mechanisms fail. The alarm stage has initial sympathetic activation.
Resistance is the adaptation phase. Recovery follows successful adaptation.
,3. When responding to an emergency, which substance will your body secrete in large amounts to prepare you to
react?
a. Epinephrine
b. Corticotrophin-releasing hormone
c. Aldosterone
d. Antidiuretic hormone
CORRECT ANSWER a — Epinephrine
RATIONALE Epinephrine (adrenaline) is the primary "fight or flight" hormone released from the adrenal medulla during
acute stress. It increases HR, BP, and blood glucose — preparing the body for immediate action. CRH triggers
the HPA axis. Aldosterone and ADH regulate fluid balance.
4. What is the function of ADH when released in the alarm stage of GAS?
a. Promotes fluid retention by increasing water reabsorption by kidney tubules
b. Increases efficiency of cellular metabolism and fat conversion to energy
c. Increases use of fats/proteins for energy; conserves glucose for the brain
d. Promotes fluid retention by causing kidneys to reabsorb more sodium
CORRECT ANSWER a — Promotes fluid retention by increasing water reabsorption
RATIONALE ADH (vasopressin) increases water reabsorption in the collecting ducts, conserving blood volume during
stress. Option b describes thyroid hormone. Option c describes cortisol. Option d describes aldosterone
(sodium reabsorption, not water directly).
5. What step in the inflammatory process will the patient experience first?
a. Cellular inflammation
b. Exudate formation
c. Tissue regeneration
d. Vascular response
CORRECT ANSWER d — Vascular response
RATIONALE The vascular response occurs first: vasoconstriction followed by vasodilation, increased capillary
permeability, and arrival of WBCs. Cellular inflammation and exudate formation follow. Tissue regeneration
is the final stage of healing.
6. A patient has a vague, uneasy feeling of dread with elevated heart rate. What nursing diagnosis is most
appropriate?
a. Anger
b. Fear
c. Anxiety
d. Hopelessness
CORRECT ANSWER c — Anxiety
RATIONALE Anxiety is a vague, uneasy feeling of dread or apprehension with physiological symptoms (elevated HR).
Fear has a specific identifiable threat. Anger is a feeling of displeasure. Hopelessness is a subjective state of
despair.
, 7. A family member says the patient is pretending to have ulcer symptoms to avoid work. Which somatoform
disorder is this?
a. Hypochondriasis
b. Somatization
c. Somatoform pain disorder
d. Malingering
CORRECT ANSWER d — Malingering
RATIONALE Malingering is the deliberate feigning of symptoms for external gain (avoiding work). It is not a psychiatric
disorder. Hypochondriasis involves genuine belief of illness. Somatization involves real physical symptoms
from psychological distress. Somatoform pain disorder has pain as the predominant symptom.
8. Nursing diagnosis: "Diarrhea related to stress." What intervention helps relieve the cause?
a. Monitor and record stool frequency
b. Administer prescribed antidiarrheal medications
c. Encourage the patient to verbalize about stressors and anxiety
d. Provide oral fluids on a regular schedule
CORRECT ANSWER c — Encourage verbalization about stressors and anxiety
RATIONALE The etiology is stress — addressing the cause (stress) through verbalization is the priority intervention.
Monitoring and medication treat symptoms, not the cause. Fluids prevent dehydration but don't address
the stress etiology.
9. After guided imagery, what physical finding suggests the relaxation technique was successful?
a. Decreased blood pressure
b. Decreased peripheral skin temperature
c. Increased heart rate
d. Increased respiratory rate
CORRECT ANSWER a — Decreased blood pressure
RATIONALE Successful relaxation decreases sympathetic nervous system activity: BP decreases, HR decreases, RR
decreases, and peripheral skin temperature INCREASES (vasodilation). Options b, c, and d indicate
continued sympathetic activation.
10. Why would the nurse remove her stethoscope before entering the room of an angry, yelling patient?
a. Could be used by the patient to hurt her
b. Might cause the patient not to trust her
c. Would distract her from focusing on the patient
d. Will function as another stressor for the patient
CORRECT ANSWER a — Could be used by the patient to hurt her
RATIONALE Safety first — the stethoscope cord can be used as a ligature/weapon by an agitated patient. Removing it
eliminates this risk. This is a universal precaution when approaching potentially violent patients.
4 MAXE SDNUF
★ ★
N Department of Health Sciences
SCIENTIA · CURA · COMPASSIO
EST. 1908
Fundamentals of Nursing — Examination 4
ST R E SS / CO P I N G · LO SS / G R I E F · D O CU M E N TAT I O N · E L I M I N AT I O N · PA I N M A N A G E M E N T
INSTITUTION College of Nursing COURSE CODE NURS 1101
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Fundamentals of Nursing Exam 4 TOTAL QUESTIONS 75+ Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice & Select All That Apply
EXAMINATION INSTRUCTIONS
▸ This comprehensive exam covers stress/coping, loss/grief, documentation, urinary/bowel elimination, and pain management.
▸ Select the single best answer unless "Select all that apply" is indicated.
▸ Correct answers and clinical rationales appear below each question for NCLEX preparation.
SECTION I — STRESS, COPING & ADAPTATION Questions 1 – 16
1. When released in response to alarm, what substance promotes a sense of well-being?
a. Aldosterone
b. Thyroid-stimulating hormone
c. Endorphins
d. Adrenocorticotropic hormone
CORRECT ANSWER c — Endorphins
RATIONALE Endorphins are the body's natural opioids — released during stress, pain, and exercise. They produce
analgesia and a sense of well-being. Aldosterone regulates sodium/water. TSH stimulates thyroid. ACTH
stimulates cortisol release.
2. After a motor vehicle accident, a patient's BP decreased despite surgery and fluid resuscitation, with increased HR
and RR. What GAS stage is this?
a. Alarm
b. Resistance
c. Exhaustion
d. Recovery
CORRECT ANSWER c — Exhaustion
RATIONALE The exhaustion stage occurs when the body can no longer maintain compensation — BP drops, HR/RR
increase as final compensatory mechanisms fail. The alarm stage has initial sympathetic activation.
Resistance is the adaptation phase. Recovery follows successful adaptation.
,3. When responding to an emergency, which substance will your body secrete in large amounts to prepare you to
react?
a. Epinephrine
b. Corticotrophin-releasing hormone
c. Aldosterone
d. Antidiuretic hormone
CORRECT ANSWER a — Epinephrine
RATIONALE Epinephrine (adrenaline) is the primary "fight or flight" hormone released from the adrenal medulla during
acute stress. It increases HR, BP, and blood glucose — preparing the body for immediate action. CRH triggers
the HPA axis. Aldosterone and ADH regulate fluid balance.
4. What is the function of ADH when released in the alarm stage of GAS?
a. Promotes fluid retention by increasing water reabsorption by kidney tubules
b. Increases efficiency of cellular metabolism and fat conversion to energy
c. Increases use of fats/proteins for energy; conserves glucose for the brain
d. Promotes fluid retention by causing kidneys to reabsorb more sodium
CORRECT ANSWER a — Promotes fluid retention by increasing water reabsorption
RATIONALE ADH (vasopressin) increases water reabsorption in the collecting ducts, conserving blood volume during
stress. Option b describes thyroid hormone. Option c describes cortisol. Option d describes aldosterone
(sodium reabsorption, not water directly).
5. What step in the inflammatory process will the patient experience first?
a. Cellular inflammation
b. Exudate formation
c. Tissue regeneration
d. Vascular response
CORRECT ANSWER d — Vascular response
RATIONALE The vascular response occurs first: vasoconstriction followed by vasodilation, increased capillary
permeability, and arrival of WBCs. Cellular inflammation and exudate formation follow. Tissue regeneration
is the final stage of healing.
6. A patient has a vague, uneasy feeling of dread with elevated heart rate. What nursing diagnosis is most
appropriate?
a. Anger
b. Fear
c. Anxiety
d. Hopelessness
CORRECT ANSWER c — Anxiety
RATIONALE Anxiety is a vague, uneasy feeling of dread or apprehension with physiological symptoms (elevated HR).
Fear has a specific identifiable threat. Anger is a feeling of displeasure. Hopelessness is a subjective state of
despair.
, 7. A family member says the patient is pretending to have ulcer symptoms to avoid work. Which somatoform
disorder is this?
a. Hypochondriasis
b. Somatization
c. Somatoform pain disorder
d. Malingering
CORRECT ANSWER d — Malingering
RATIONALE Malingering is the deliberate feigning of symptoms for external gain (avoiding work). It is not a psychiatric
disorder. Hypochondriasis involves genuine belief of illness. Somatization involves real physical symptoms
from psychological distress. Somatoform pain disorder has pain as the predominant symptom.
8. Nursing diagnosis: "Diarrhea related to stress." What intervention helps relieve the cause?
a. Monitor and record stool frequency
b. Administer prescribed antidiarrheal medications
c. Encourage the patient to verbalize about stressors and anxiety
d. Provide oral fluids on a regular schedule
CORRECT ANSWER c — Encourage verbalization about stressors and anxiety
RATIONALE The etiology is stress — addressing the cause (stress) through verbalization is the priority intervention.
Monitoring and medication treat symptoms, not the cause. Fluids prevent dehydration but don't address
the stress etiology.
9. After guided imagery, what physical finding suggests the relaxation technique was successful?
a. Decreased blood pressure
b. Decreased peripheral skin temperature
c. Increased heart rate
d. Increased respiratory rate
CORRECT ANSWER a — Decreased blood pressure
RATIONALE Successful relaxation decreases sympathetic nervous system activity: BP decreases, HR decreases, RR
decreases, and peripheral skin temperature INCREASES (vasodilation). Options b, c, and d indicate
continued sympathetic activation.
10. Why would the nurse remove her stethoscope before entering the room of an angry, yelling patient?
a. Could be used by the patient to hurt her
b. Might cause the patient not to trust her
c. Would distract her from focusing on the patient
d. Will function as another stressor for the patient
CORRECT ANSWER a — Could be used by the patient to hurt her
RATIONALE Safety first — the stethoscope cord can be used as a ligature/weapon by an agitated patient. Removing it
eliminates this risk. This is a universal precaution when approaching potentially violent patients.
