PSYCHIATRIC MENTAL HEALTH NURSING 9TH EDITION TOWNSEND TEST BANK
Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 2
Chapter 01. The Concept of Stress Adaptation
Multiple Choice
1. 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 Recent Life Changes Questionnaire. How should
the nurse evaluate this client data?
A. The client is experiencing severe distress and is at risk for physical and psychological illness.
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of
stress-related illness.
C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of
coping resources and available supports.
D. The client may view these losses as challenges and perceive them as opportunities.
ANS: C
The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the
Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500
or more, indicates high stress in a clients life. However, positive coping mechanisms and strong social support
can limit susceptibility to stress-related illnesses.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
2. 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 Ill look into pursuing an art degree. How should the
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nurse characterize the clients appraisal of the job loss stressor?
A. Irrelevant
B. Harm/loss
C. Threatening
D. Challenging
ANS: D
The client perceives the situation of job loss as a challenge and an opportunity for growth.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
3. Which client statement should alert a nurse that a client may be responding maladaptively to stress?
A. Ive found that avoiding contact with others helps me cope.
B. I really enjoy journaling; its my private time.
C. I signed up for a yoga class this week.
D. I made an appointment to meet with a therapist.
ANS: A
Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent
learning appropriate coping skills and can prevent access to needed support systems.
NURSINGTB.COM
, PSYCHIATRIC MENTAL HEALTH NURSING 9TH EDITION TOWNSEND TEST BANK
Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 3
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
4. 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?
A. Alarm reaction stage
B. Stage of resistance
C. Stage of exhaustion
D. Fight-or-flight stage
ANS: C
At the stage of exhaustion, the students exposure to stress has been prolonged and adaptive energy has been
depleted. Diseases of adaptation occur more frequently in this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
5. A school nurse is assessing a female high school student who is overly concerned about her appearance. The
clients mother states, Thats not something to be stressed about! Which is the most appropriate nursing
response?
A. Teenagers! They dont know a thing about real stress.
B. Stress occurs only when there is a loss.
C. When you are in poor physical condition, you cant experience psychological well-being.
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D. Stress can be psychological. A threat to self-esteem may result in high stress levels.
ANS: D
Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a
physiological change.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
6. 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?
A. Meditation
B. Problem-solving training
C. Relaxation
D. Journaling
ANS: B
The student must assess his or her situation and determine the best course of action. Problem-solving training,
by providing structure and objectivity, can assist in decision making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
NURSINGTB.COM
, PSYCHIATRIC MENTAL HEALTH NURSING 9TH EDITION TOWNSEND TEST BANK
Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 4
7. 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?
A. Encourage the student to use the alternative coping mechanism of relaxation exercises.
B. Complete the problem-solving process for the client.
C. Work through the problem-solving process with the client.
D. Encourage the client to keep a journal.
ANS: C
During times of high anxiety and stress, clients will need more assistance in problem-solving and decision
making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
8. A school nurse is assessing a distraught female high school student who is overly concerned because her
parents cant afford horseback riding lessons. How should the nurse interpret the students reaction to her
perceived problem?
A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.
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ANS: B
Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation
or event. Self-image is of particular importance to adolescents, who feel entitled to have all the advantages that
other adolescents experience.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
9. Meditation has been shown to be an effective stress management technique. When meditation is effective,
what should a nurse expect to assess?
A. An achieved state of relaxation
B. An achieved insight into ones feelings
C. A demonstration of appropriate role behaviors
D. An enhanced ability to problem-solve
ANS: A
Meditation produces relaxation by creating a special state of consciousness through focused concentration.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
10. A distraught, single, first-time mother cries and asks a nurse, How can I go to work if I cant afford
childcare? What is the nurses initial action in assisting the client with the problem-solving process?
NURSINGTB.COM
, PSYCHIATRIC MENTAL HEALTH NURSING 9TH EDITION TOWNSEND TEST BANK
Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 5
A. Determine the risks and benefits for each alternative.
B. Formulate goals for resolution of the problem.
C. Evaluate the outcome of the implemented alternative.
D. Assess the facts of the situation.
ANS: D
Before any other steps can be taken, accurate information about the situation must be gathered and assessed.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
11. A nursing instructor is asking students about diseases of adaptation and when they are likely to occur.
Which student response indicates that learning has occurred?
A. When an individual has limited experience dealing with stress
B. When an individual inherits maladaptive genes
C. When an individual experiences existing conditions that exacerbate stress
D. When an individuals physiological and psychological resources have become depleted
ANS: D
During the stage of exhaustion of the general adaptation syndrome, the individual loses the capacity to adapt
effectively because physiological and psychological resources have become depleted. This is the time when
diseases of adaptation may occur. NURSINGTB.COM
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Health Promotion and Maintenance
12. When an individuals stress response is sustained over a long period of time, which physiological effect of
the endocrine system should a nurse anticipate?
A. Decreased resistance to disease
B. Increased libido
C. Decreased blood pressure
D. Increased inflammatory response
ANS: A
In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at which time
the bodys compensatory mechanisms no longer function effectively and diseases of adaptation occur. A
decreased immune response is seen at this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Physiological Integrity
13. Which symptom should a nurse identify as typical of the fight-or-flight response?
A. Pupil constriction
B. Increased heart rate
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Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 2
Chapter 01. The Concept of Stress Adaptation
Multiple Choice
1. 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 Recent Life Changes Questionnaire. How should
the nurse evaluate this client data?
A. The client is experiencing severe distress and is at risk for physical and psychological illness.
B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of
stress-related illness.
C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of
coping resources and available supports.
D. The client may view these losses as challenges and perceive them as opportunities.
ANS: C
The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the
Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500
or more, indicates high stress in a clients life. However, positive coping mechanisms and strong social support
can limit susceptibility to stress-related illnesses.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
2. 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 Ill look into pursuing an art degree. How should the
NURSINGTB.COM
nurse characterize the clients appraisal of the job loss stressor?
A. Irrelevant
B. Harm/loss
C. Threatening
D. Challenging
ANS: D
The client perceives the situation of job loss as a challenge and an opportunity for growth.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
3. Which client statement should alert a nurse that a client may be responding maladaptively to stress?
A. Ive found that avoiding contact with others helps me cope.
B. I really enjoy journaling; its my private time.
C. I signed up for a yoga class this week.
D. I made an appointment to meet with a therapist.
ANS: A
Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent
learning appropriate coping skills and can prevent access to needed support systems.
NURSINGTB.COM
, PSYCHIATRIC MENTAL HEALTH NURSING 9TH EDITION TOWNSEND TEST BANK
Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 3
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
4. 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?
A. Alarm reaction stage
B. Stage of resistance
C. Stage of exhaustion
D. Fight-or-flight stage
ANS: C
At the stage of exhaustion, the students exposure to stress has been prolonged and adaptive energy has been
depleted. Diseases of adaptation occur more frequently in this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Psychosocial Integrity
5. A school nurse is assessing a female high school student who is overly concerned about her appearance. The
clients mother states, Thats not something to be stressed about! Which is the most appropriate nursing
response?
A. Teenagers! They dont know a thing about real stress.
B. Stress occurs only when there is a loss.
C. When you are in poor physical condition, you cant experience psychological well-being.
NURSINGTB.COM
D. Stress can be psychological. A threat to self-esteem may result in high stress levels.
ANS: D
Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a
physiological change.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
6. 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?
A. Meditation
B. Problem-solving training
C. Relaxation
D. Journaling
ANS: B
The student must assess his or her situation and determine the best course of action. Problem-solving training,
by providing structure and objectivity, can assist in decision making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
NURSINGTB.COM
, PSYCHIATRIC MENTAL HEALTH NURSING 9TH EDITION TOWNSEND TEST BANK
Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 4
7. 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?
A. Encourage the student to use the alternative coping mechanism of relaxation exercises.
B. Complete the problem-solving process for the client.
C. Work through the problem-solving process with the client.
D. Encourage the client to keep a journal.
ANS: C
During times of high anxiety and stress, clients will need more assistance in problem-solving and decision
making.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
8. A school nurse is assessing a distraught female high school student who is overly concerned because her
parents cant afford horseback riding lessons. How should the nurse interpret the students reaction to her
perceived problem?
A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.
NURSINGTB.COM
ANS: B
Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation
or event. Self-image is of particular importance to adolescents, who feel entitled to have all the advantages that
other adolescents experience.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
9. Meditation has been shown to be an effective stress management technique. When meditation is effective,
what should a nurse expect to assess?
A. An achieved state of relaxation
B. An achieved insight into ones feelings
C. A demonstration of appropriate role behaviors
D. An enhanced ability to problem-solve
ANS: A
Meditation produces relaxation by creating a special state of consciousness through focused concentration.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Psychosocial Integrity
10. A distraught, single, first-time mother cries and asks a nurse, How can I go to work if I cant afford
childcare? What is the nurses initial action in assisting the client with the problem-solving process?
NURSINGTB.COM
, PSYCHIATRIC MENTAL HEALTH NURSING 9TH EDITION TOWNSEND TEST BANK
Test Bank - Psychiatric Mental Health Nursing by Mary Townsend (9th Edition, 2017) 5
A. Determine the risks and benefits for each alternative.
B. Formulate goals for resolution of the problem.
C. Evaluate the outcome of the implemented alternative.
D. Assess the facts of the situation.
ANS: D
Before any other steps can be taken, accurate information about the situation must be gathered and assessed.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need:
Psychosocial Integrity
11. A nursing instructor is asking students about diseases of adaptation and when they are likely to occur.
Which student response indicates that learning has occurred?
A. When an individual has limited experience dealing with stress
B. When an individual inherits maladaptive genes
C. When an individual experiences existing conditions that exacerbate stress
D. When an individuals physiological and psychological resources have become depleted
ANS: D
During the stage of exhaustion of the general adaptation syndrome, the individual loses the capacity to adapt
effectively because physiological and psychological resources have become depleted. This is the time when
diseases of adaptation may occur. NURSINGTB.COM
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need:
Health Promotion and Maintenance
12. When an individuals stress response is sustained over a long period of time, which physiological effect of
the endocrine system should a nurse anticipate?
A. Decreased resistance to disease
B. Increased libido
C. Decreased blood pressure
D. Increased inflammatory response
ANS: A
In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion at which time
the bodys compensatory mechanisms no longer function effectively and diseases of adaptation occur. A
decreased immune response is seen at this stage.
KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need:
Physiological Integrity
13. Which symptom should a nurse identify as typical of the fight-or-flight response?
A. Pupil constriction
B. Increased heart rate
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