ST. TONIS COLLEGECollege Of NursingBulanao, Tabuk City, Kalinga

Nursing Care Management 105 : Stress Adaptation

Name : Section : Date :

IINSTRUCTIONS: Choose and encircle the best answer for the following items. No erasures, alterations, and unnecessary markings. Make your answer sheets as clean as possible.

1. 2. A client has been fired from work because of downsizing. Although clearly upset, when explaining the situation to a friend, the client states, Imagine what I can do with this extra time. Which defense mechanism is this client using?A. Denial.B. Intellectualization.C. Rationalization.D. Suppression.3. Which best exemplifies a clients use of the defense mechanism of reaction formation?A. A client feels rage at being raped at a young age, which later is expressed by joining law enforcement.B. A client is unhappy about being a father, although others know him to dote on his son.C. A client is drinking 6 to 8 beers a day while still going to AA as a group leader.D. A client is angry that the call bell is not answered and decides to call the nurse when it is unnecessary.4. Which best exemplifies an individuals use of the defense mechanism of compensation?A. A woman feels unattractive, but decides to pursue fashion design as a career.B. A shy woman who abuses alcohol tells others that alcohol helps her overcome her shyness.C. A poorly paid employee consistently yells at his assistant for minimal mistakes.D. A teenager injures an ankle playing basketball and curls into a fetal position to deal with the pain.5. Which best exemplifies the use of the defense mechanism of sublimation?A. A child who has been told by parents that stealing is wrong reminds a friend not to steal.B. A man who loves sports but is unable to play decides to become an athletic trainer.C. Having chronic asthma with frequent hospitalizations, a young girl admires her nurses. She later chooses nursing as a career.D. A boy who feels angry and hostile decides to become a therapist to help others.6. A nursing instructor is teaching about defense mechanisms. Which of the following student statements indicates that learning has occurred? Select all that apply.A. Defense mechanisms are used when anxiety increases, and the strength of the ego is tested.B. All individuals who use defense mechanisms as a means of stress adaptation exhibit healthy egos.C. When defense mechanisms are overused or maladaptive, unhealthy ego development may result.D. Defense mechanisms are used only by mentally ill individuals to assist with coping.E. At times of mild to moderate anxiety, defense mechanisms are used adaptively to deal with stress.7. A client is admitted to the emergency department after a car accident, but does not remember anything about it. The client is using which defense mechanism?A. Undoing.B. Rationalization.C. Suppression.D. Repression.8. A client in the emergency department was violently attacked and raped. When discussing the incident with the nurse, the client shows no emotion related to the event. Which defense mechanism is the client using?A. Isolation.B. Displacement.C. Compensation.D. Regression.9. After failing an examination, a young physician in his psychiatric residency begins smoking a pipe and growing a beard that makes him look like Sigmund Freud. The nurse manager, realizing the physicians insecurities, recognizes the use of which defense mechanism?A. Identification.B. Repression.C. Regression.D. Reaction formation.10. Which situation reflects the defense mechanism of projection?A. A husband has an affair, then buys his wife a diamond anniversary bracelet.B. A promiscuous wife accuses her husband of having an affair.C. A wife, failing to become pregnant, works hard at becoming teacher of the year.D. A man who was sexually assaulted as a child remembers nothing of the event.11. Which situation reflects the defense mechanism of denial?A. When his twin brother excels in golf, the client begins lessons with a golf pro.B. After a mother spanks her child for misbehaving, the child pulls the cats tail.C. After years of excessive drinking, the client fails to acknowledge a problem.D. The client expresses to his family that 50% of people with his diagnosis survive.12. During visiting hours, a client who is angry at her ex-husbands charges of child neglect expresses this anger by lashing out at her sister-in-law. The nurse understands that the client is demonstrating the use of which defense mechanism?A. Denial.B. Projection.C. Displacement.D. Rationalization.13. On an in-patient unit, a client is isolating self in room and refusing to attend group therapy. Which is an appropriate short-term outcome for this client?A. Client participation will be expected in one group session.B. Provide opportunities for the client to increase self-esteem by discharge.C. The client will communicate with staff by the end of the 3-to-11 shift.D. The client will demonstrate socialization skills when in the milieu.14. A client on an in-patient psychiatric unit is sarcastic to staff and avoids discussions in group therapy. Which long-term outcome is appropriate for this client?A. The client will not injure himself or herself or someone else.B. The client will express feelings of anger in group therapy by end of shift.C. The client will take responsibility for his or her own feelings.D. The client will participate in out-patient therapy within 2 weeks of discharge.15. A girl is jealous of her best friend for winning the scholarship she herself expected. She agrees to meet her friend for lunch and then arrives 1 hour late, apologizing and begging forgiveness. The girl is displaying which behavior?A. Self-assertion.B. Passive-aggressiveness.C. Splitting.D. Omnipotence.16. Which is an example of a cognitive response to a mild level of anxiety?A. Increased respirations.B. Feelings of horror or dread.C. Pacing the hall.D. Increased concentration.17. Which is an example of a behavioral response to a moderate level of anxiety?A. Narrowing perception.B. Heart palpitations.C. Limited attention span.D. Restlessness.18. Which is an example of a physiological response to a panic level of anxiety?A. Inability to focus.B. Loss of consciousness.C. Dilated pupils.D. Possible psychosis.19. A nurse on an in-patient psychiatric unit is assessing a client at risk for acting out behaviors. Which behavioral symptom would the nurse expect to be exhibited?A. Invasion of personal space.B. Flushed face.C. Increased anxiety.D. Misinterpretation of stimuli.20. Which immediate biological responses are associated with fight-or-flight syndrome?A. Bronchioles in the lungs dilate, and respiration rate increases.B. Vasopressin increases fluid retention and increases blood pressure.C. Thyrotropic hormone stimulates the thyroid gland to increase metabolic rate.D. Gonadotropins cause a decrease in secretion of sex hormone and produce impotence.21. A severely anxious client experiencing headaches, palpitations, and inability to concentrate is admitted to a medical floor. Which nursing intervention would take priority?A. Encourage the client to express feelings.B. Discuss alternative coping strategies with the client.C. Use a distraction, such as having the client attend group.D. Sit with the client, and use a calm but directive approach.22. A client is exhibiting tension and needs direction to solve problems. Which intervention would the nurse implement using a behavioral approach?A. Assess the clients family history for anxiety disorders.B. Encourage the client to use deep breathing techniques.C. Ask the client to think of a time in the past when anxiety was manageable.D. Encourage journal writing to express feelings.23. The nursing student is developing a plan of care for a client experiencing a crisis situation. Number the following in priority order for implementation of this plan.___ Assess for suicidal and homicidal ideation.___ Discuss coping skills used in the past, and note if they were effective.___ Establish a working relationship by active listening.___ Develop a plan of action for dealing with future stressors.___ Evaluate the developed plans effectiveness.24. The nurse is assessing clients on an in-patient psychiatric unit. Which client would require immediate intervention?A. A client experiencing rapid, pressured speech and poor personal boundaries.B. A client expressing homicidal ideations toward the neighborhood butcher.C. A client sleeping only 1 to 2 hours per night for the last 2 nights.D. A client secluding self from others and refusing to attend groups in the milieu.25. The nursing student is reviewing information about crisis. Which of the following student statements indicate(s) that learning has occurred? Select all that apply.A. A crisis is associated with psychopathology.B. A crisis is precipitated by a specific identifiable event.C. A crisis is chronic in nature and needs multiple interventions over time.D. A crisis is specific to an individual, and the cause may vary.E. A crisis contains the potential for psychological growth or deterioration.26. At an out-patient obstetrical clinic, a pregnant client on welfare exhibits extreme anxiety when discussing a failure in school. This is an example of which type of crisis?A. Dispositional crisis.B. Crisis of anticipated life transition.C. Maturational/developmental crisis.D. Crisis reflecting psychopathology.27. A 17-year-old client whose boyfriend has recently broken their engagement is brought into the emergency department after taking a handful of lorazepam (Ativan). Which nursing intervention would take priority during this psychiatric crisis?A. Discuss the clients feelings about the breakup with her boyfriend.B. Monitor vital signs and note any signs of central nervous system depression.C. Allow the client time to rest because lorazepam (Ativan) is sedating.D. Decrease fluids, and place the client on close observation.28. The nurse should assess which of the following client behaviors when completing a risk assessment? Select all that apply.A. Past history of violence.B. Disturbed thought process.C. Invasion of personal space.D. Flushed face.E. Self-mutilation.29. 35. A client with rigid posture and raised voice uses profanity while demanding to use the phone. Which nursing diagnosis is a priority?A. Risk for injury toward others R / T anxiety AEB rigid posture and profanity.B. Ineffective coping R / T inability to express feelings AEB aggressive demeanor.C. Disturbed thought process R / T altered perception AEB demanding behaviors.D. Social isolation R / T anger AEB inability to get along with staff.30. A student is learning about prodromal syndrome. Which student statement indicates that learning has occurred?A. Behaviors associated with prodromal syndrome necessitate immediate action by the nurse.B. Prodromal syndrome occurs after a clients outburst.C. Staff cannot assist clients who are experiencing a prodromal syndrome to gain control.D. Very few symptoms are associated with a prodromal syndrome.31. On an in-patient psychiatric unit, a nurse is completing a risk assessment on a newly admitted client experiencing agitation. Which cognitive symptom expressed by the client would the nurse document?A. Past history of violence.B. Disturbed thought process.C. History of throwing objects on the unit.D. Flushed face.32. In group therapy, an angry client becomes increasingly restless and irritable and shouts at the facilitator. Which nursing diagnosis takes priority?A. Risk for injury toward others R / T inability to deal with frustration.B. Ineffective coping R / T inability to express feelings AEB raised voice.C. Anxiety R / T topic at hand AEB restlessness in group therapy.D. Social isolation R / T intimidation of others AEB solitary activities.33. A client is transported to the emergency department by emergency medical services for head and abdominal trauma sustained in a physical altercation with a family member. In this situation, which nursing diagnosis would take priority?A. Risk for other-directed violence R / T anger toward a family member.B. Poor self-esteem R / T altered family processes.C. Risk for injury R / T possible complications secondary to trauma.D. Anxiety R / T injuries AEB tremors and crying.34. An agency nurse is coming to an in-patient psychiatric unit for the first time. The charge nurse of the unit would assign which client to this nurse?A. A client newly admitted for suicidal ideations with a plan to jump off a bridge.B. A client admitted 2 days ago for alcohol detoxification with a history of seizures.C. A client grimacing and pacing the halls with a grim defiant affect.D. A client starting clozapine (Clozaril) therapy to treat auditory hallucinations.

-===== Good luck & God bless =====-

Prepared by:

Lucky P. Roaquin, RN, MANSTCI-CON Faculty