Townsend Chapter 1-1
Psychiatric Mental Health Nursing, 8e
Instructor ETB
Chapter 1. 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 client’s 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 I’ll look into pursuing an art
degree.” How should the nurse characterize the client’s 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
,Townsend Chapter 1-2
Psychiatric Mental Health Nursing, 8e
Instructor ETB
3. Which client statement should alert a nurse that a client may be responding maladaptively to
stress?
A. “I’ve found that avoiding contact with others helps me cope.”
B. “I really enjoy journaling; it’s 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.
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 student’s 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 client’s mother states, “That’s not something to be stressed about!” Which is the
most appropriate nursing response?
A. “Teenagers! They don’t know a thing about real stress.”
B. “Stress occurs only when there is a loss.”
C. “When you are in poor physical condition, you can’t experience psychological well-being.”
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.
,Townsend Chapter 1-3
Psychiatric Mental Health Nursing, 8e
Instructor ETB
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
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 can’t afford horseback riding lessons. How should the nurse interpret the
student’s reaction to her perceived problem?
A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
, Townsend Chapter 1-4
Psychiatric Mental Health Nursing, 8e
Instructor ETB
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.
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 one’s 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 can’t
afford childcare?” What is the nurse’s initial action in assisting the client with the problem-
solving process?
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
Psychiatric Mental Health Nursing, 8e
Instructor ETB
Chapter 1. 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 client’s 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 I’ll look into pursuing an art
degree.” How should the nurse characterize the client’s 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
,Townsend Chapter 1-2
Psychiatric Mental Health Nursing, 8e
Instructor ETB
3. Which client statement should alert a nurse that a client may be responding maladaptively to
stress?
A. “I’ve found that avoiding contact with others helps me cope.”
B. “I really enjoy journaling; it’s 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.
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 student’s 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 client’s mother states, “That’s not something to be stressed about!” Which is the
most appropriate nursing response?
A. “Teenagers! They don’t know a thing about real stress.”
B. “Stress occurs only when there is a loss.”
C. “When you are in poor physical condition, you can’t experience psychological well-being.”
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.
,Townsend Chapter 1-3
Psychiatric Mental Health Nursing, 8e
Instructor ETB
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
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 can’t afford horseback riding lessons. How should the nurse interpret the
student’s reaction to her perceived problem?
A. The problem is endangering her well-being.
B. The problem is personally relevant to her.
, Townsend Chapter 1-4
Psychiatric Mental Health Nursing, 8e
Instructor ETB
C. The problem is based on immaturity.
D. The problem is exceeding her capacity to cope.
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 one’s 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 can’t
afford childcare?” What is the nurse’s initial action in assisting the client with the problem-
solving process?
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
