Chapter 12: Understanding Stress and Holistic Approaches to Stress Man-agement

Chapter 12: Understanding Stress and Holistic Approaches to Stress Management

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1)   The daughter of a severely depressed client asks the nurse “What do you think about the relationship between depression and physical illness? Since my mother has been grieving over my father’s death, she has been physically unwell. She has had a series of colds, an outbreak of shingles, and an episode of the flu.” The answer that best reflects the current thinking about psychoimmunology is

A.	“It is probably a coincidence. Not much evidence is available that the stress of grieving makes one prone to physical illnesses.”
B.	“Your observation might be explained by the fact you are paying more attention to your mother since your father died and you are noticing things such as minor illnesses.”
C.	“The literature has not dwelt on the relation between mental state and the body other than to say that one influences the other.”
D.	“The immune system is thought to respond to changes in brain chemistry by suppressing white blood cell production when the person experiences prolonged stress.”

 

ANS:   D

Option D best explains evidence-based thinking. Research indicates that stress can induce modulation of the immune system. Activation of the immune system sends proinflammatory cytokines to the brain. The brain, in turn, releases it own cytokines that signal the central nervous system to initiate myriad responses to stress. Alteration in neural activity in the brain can alter everything that flows from neural activity, including behavior, thought, and mood. Prolonged stress suppresses the immune system and lowers resistance to infections. The other options underplay the fact that evidence exists that partially explains the effect of stress on the immune system.

 

DIF:    Cognitive Level: Application

REF:    Text Pages: 198, Text Pages: 199, Text Pages: 200

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Physiologic Integrity

 

 

 

2)   A client with emphysema who has severe shortness of breath and frequent hospitalizations often depends on her portable oxygen tank when she leaves her home. Recently she was tearful at a Better Breathers Group meeting because in the last 2 weeks she has not been able to go upstairs to her bedroom at night because of slight shortness of breath by the third step and fear of having severe breathing difficulty as she continues up the stairs. The group leader provides several suggestions and arranges to teach the client guided imagery. What image would the client be encouraged to imagine?

A.	A younger, healthier body that knows no exercise limitations.
B.	Learning to sleep downstairs as an acceptable alternative to her bedroom.
C.	Separating herself from and being free and independent from her oxygen tank.
D.	Walking up the stairs in a relaxed manner with regular depth and rate of breathing.

 

ANS:   D

The client has dysfunctional images of dyspnea and her ability to climb stairs. Guided imagery can help her replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the client to imagine a regular breathing depth and rate will help improve oxygen–carbon dioxide exchange and help her achieve further relaxation. Options A and C are not as closely related to the stated problem as option D. Option B introduces an entirely different resolution.

 

DIF:    Cognitive Level: Application             REF:    Text Pages: 205

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Psychosocial Integrity

 

 

3)   A nurse who leads group therapy for a group of depressed clients also plans to implement a plan of exercise for each client. The rationale to use when presenting this plan to the treatment team is that exercise

A.	releases hormones called ß-endorphins that have antidepressant and anxiolytic effects.
B.	prevents damage from sympathetic nervous system overstimulation.
C.	improves circulation and oxygenation to brain and body cells.
D.	detoxifies the body by ridding it of metabolic wastes.

 

ANS:   A

ß-Endorphins produced during exercise result in improvement in mood and lowered anxiety. The other options are not accurate.

 

DIF:    Cognitive Level: Application             REF:    Text Pages: 205

TOP:    Nursing Process: Implementation      MSC:   NCLEX: Physiologic Integrity

 

 

4)   A recent immigrant from Central America is brought to the clinic by her daughter, who has been a U.S. resident for 10 years. The daughter says the stress of immigration has made her mother unwell. For which expression of stress should the nurse be alert during the assessment interview?

A.	Moderate anxiety
B.	Somatic complaints
C.	Memory deficiencies
D.	Sensory perceptual alterations

 

ANS:   B

Many people from Central American cultures express distress in somatic terms. The other options are less likely to be observed.

 

DIF:    Cognitive Level: Application             REF:    Text Pages: 200, Text Pages: 201

TOP:    Nursing Process: Assessment            MSC:   NCLEX: Psychosocial Integrity