Moments after hearing a frightening diagnosis, a patient has a racing heart, rising blood pressure, and sweaty palms. Which stage of the general adaptation syndrome is the patient in?
Alarm reaction
✓
Resistance stage
Exhaustion stage
Recovery stage
Correct Answer
Alarm reaction
The alarm reaction is the first stage of Selye's general adaptation syndrome, when the body recognizes a stressor and mounts the classic sympathetic response. The resistance stage follows if the body adapts to a continuing stressor, and symptoms lessen. The exhaustion stage occurs only when the stressor persists and the body can no longer adapt. A recovery stage is not one of the named stages of the model.
Category: Adaptation Models
Question 2
A patient's surgical incision is red and swollen, but the patient has no fever, a normal blood glucose, and a normal white blood cell count. Which response to stress does this pattern show?
General adaptation syndrome
Local adaptation syndrome
✓
Systemic inflammatory response syndrome
Fight-flight-freeze response
Correct Answer
Local adaptation syndrome
The local adaptation syndrome, described by Selye, is a response confined to the injured area: inflammation brings blood and white cells to the wound to begin repair without body-wide signs such as fever, high blood glucose, or a raised white cell count. The general adaptation syndrome is a whole-body response to stress. Systemic inflammatory response syndrome is a body-wide response marked by abnormal temperature, rapid heart and breathing rates, and an abnormal white blood cell count. The fight-flight-freeze response is a whole-body sympathetic reaction, not a reaction limited to one wound.
Category: Adaptation Models
Question 3
A patient with type 2 diabetes is admitted after a car crash and is eating very little, yet the blood glucose is higher than usual. What best explains this finding?
Low food intake directly raises blood glucose
Pain blocks the kidneys from removing glucose
Stress hormones such as cortisol raise blood glucose
✓
Bed rest causes the pancreas to release glucose
Correct Answer
Stress hormones such as cortisol raise blood glucose
During physical or emotional stress the adrenal glands release cortisol and other hormones that raise blood glucose to fuel the stress response, so glucose can rise even when intake is low; the nurse monitors glucose closely in stressed patients with diabetes. Low food intake does not directly raise blood glucose. Pain does not block the kidneys from removing glucose. Bed rest does not cause the pancreas to release glucose; the pancreas releases insulin and glucagon, not glucose itself.
Category: Physiologic Stress Response
Question 4
A family caregiver who has looked after a parent with dementia for a long time now catches one infection after another. Which effect of chronic stress best explains this?
Chronic stress raises the white blood cell count too high
Stress hormones kill bacteria before they can multiply
Prolonged stress makes the skin thicker and drier
Prolonged cortisol elevation suppresses immune function
✓
Correct Answer
Prolonged cortisol elevation suppresses immune function
Long-term stress keeps cortisol elevated, and cortisol reduces lymphocyte function, so the body's defenses weaken and infections become more frequent. Chronic stress raising the white blood cell count too high does not explain repeated infections. Stress hormones do not kill bacteria. Prolonged stress making the skin thicker and drier is not a recognized cause of frequent infection.
Category: Physiologic Stress Response
Question 5
Which behavior is an example of adaptive coping with stress?
Joining a support group for people with the same diagnosis
✓
Drinking alcohol every evening to unwind
Sleeping most of the day to avoid problems
Smoking more cigarettes during tense moments
Correct Answer
Joining a support group for people with the same diagnosis
Adaptive coping manages stress in socially acceptable ways that lead to positive outcomes, such as seeking support, counseling, or medical care. Drinking alcohol every evening to unwind brings short-term relief but adds health risks and hides the problem. Sleeping most of the day to avoid problems is withdrawal that leaves the stressor unresolved. Smoking more cigarettes during tense moments is a maladaptive behavior that harms health.
Category: Coping and Appraisal
Question 6
A patient admitted with burns from a house fire seems far more upset than the injuries would suggest. What should the nurse do first to understand the patient's stress?
Explain that the burns are minor and will heal
Ask the patient what worries them most right now
✓
Assume the stress is about losing the house
Request a sedative to calm the patient
Correct Answer
Ask the patient what worries them most right now
Stress depends on how the person appraises the event, so the nurse first asks what the patient finds most stressful; the main worry may be something unexpected, such as a missing pet, that the care team can help with. Explaining that the burns are minor dismisses the patient's concern. Assuming the stress is about losing the house may miss the real worry. Requesting a sedative to calm the patient treats the reaction without finding its cause.
Category: Coping and Appraisal
Question 7
A patient who has just been told they have cancer cannot recall anything the provider said about treatment. What best explains this?
The patient was not paying attention on purpose
Cancer directly damages the memory centers of the brain
High stress impairs information processing and memory
✓
The provider used too few medical terms
Correct Answer
High stress impairs information processing and memory
Excessive stress makes thinking less clear and interferes with taking in information, reasoning, and decision-making, so a patient facing a new diagnosis often needs information repeated, written materials, and a support person present. Saying the patient was not paying attention on purpose blames the patient for an expected stress response. Cancer directly damaging the memory centers of the brain does not explain a sudden inability to recall a conversation. Using too few medical terms would not impair recall; plain language usually helps.
Category: Recognizing Stress
Question 8
Why do hospitals often ask a family to choose one key family member as the main contact for staff?
It keeps other relatives from visiting the patient
It moves medical decisions from the patient to that relative
It removes the need to update the patient directly
It keeps updates consistent and reduces distortion of information among relatives
✓
Correct Answer
It keeps updates consistent and reduces distortion of information among relatives
A single designated contact simplifies communication for staff and lowers the chance that messages are changed as they pass from relative to relative. It does not keep other relatives from visiting the patient. It does not move medical decisions from the patient to that relative. It does not remove the need to update the patient directly, who remains the center of care.
Category: Family Health
Question 9
Which nursing action reflects family-centered care for a patient admitted with a stroke?
Asking the spouse how the family is managing at home
✓
Limiting the spouse's visits so the patient can rest
Giving updates only to the patient and not the spouse
Directing all of the spouse's questions to the provider
Correct Answer
Asking the spouse how the family is managing at home
Family-centered care extends patient-centered care to the whole family by recognizing that one member's illness affects everyone, so the nurse asks about family members and their needs. Limiting the spouse's visits removes a source of support. Giving updates only to the patient and not the spouse leaves the family out of care. Directing all of the spouse's questions to the provider misses the nurse's own role in supporting the family.
Category: Family Health
Question 10
The spouse of a hospitalized patient tells the nurse the family cannot pay rent since the patient stopped working. What should the nurse do?
Tell the spouse that money matters are outside health care
Contact the case manager or social worker about available resources
✓
Advise the spouse to take out a personal loan
Wait until discharge to bring up the concern
Correct Answer
Contact the case manager or social worker about available resources
Financial strain is a common family stressor, and nurses connect families to resources by working with case managers and social workers who can arrange financial aid and other services. Telling the spouse that money matters are outside health care ignores a stressor that affects the patient's recovery. Advising the spouse to take out a personal loan is financial advice outside the nurse's role and may add to the burden. Waiting until discharge delays help the family needs now.
Category: Family Health
Question 11
During a head-to-toe assessment, which finding may suggest a behavior linked to chronic stress?
Clubbing of the fingertips
Yellowing of the eyes
Picked skin around the nails
✓
Pitting edema of both ankles
Correct Answer
Picked skin around the nails
Picking at the skin, nails, or hair is a recognized physical sign of chronic stress that the nurse can find during a routine assessment. Clubbing of the fingertips points to long-term low oxygen levels from heart or lung disease. Yellowing of the eyes suggests liver or gallbladder problems. Pitting edema of both ankles suggests fluid overload, as in heart or kidney failure.
Category: Recognizing Stress
Question 12
A patient waiting for a biopsy is trembling and breathing quickly and says, "I can't calm down." Which nursing action helps reduce the sympathetic response?
Leave the patient alone so they can settle
Describe every possible complication of the biopsy
Encourage the patient to hold their breath
Coach the patient through slow, deep breathing
✓
Correct Answer
Coach the patient through slow, deep breathing
Slow, controlled breathing modeled by the nurse can lower heart rate and blood pressure and calm the fight-flight-freeze response. Leaving the patient alone removes support at a frightening moment. Describing every possible complication of the biopsy is likely to increase fear. Encouraging the patient to hold their breath does not calm the stress response.
Category: Stress Management Care
Question 13
A patient awaiting test results keeps saying, "This is going to ruin my whole life." Which nurse question uses a cognitive behavioral approach?
"What is the worst that could realistically happen?"
✓
"Why are you letting this upset you?"
"Have you tried simply not thinking about it?"
"Would you like something to help you sleep?"
Correct Answer
"What is the worst that could realistically happen?"
Cognitive behavioral therapy rests on the link between thoughts, emotions, and behavior, so the nurse helps the patient examine a negative thought and separate realistic outcomes from worst-case fears. Asking why the patient is letting this upset them sounds blaming and closes the conversation. Asking whether they have tried simply not thinking about it dismisses the worry. Offering something to help them sleep addresses a symptom without addressing the thought.
Category: Stress Management Care
Question 14
A patient receiving chemotherapy also uses meditation and aromatherapy along with the prescribed treatment plan. Which term describes using these practices alongside conventional treatment?
Alternative medicine
Integrative medicine
✓
Allopathic medicine
Homeopathic medicine
Correct Answer
Integrative medicine
Integrative medicine combines complementary practices with prescribed conventional treatment rather than replacing it. Alternative medicine refers to practices used in place of conventional care. Allopathic medicine is conventional Western medicine by itself. Homeopathic medicine is a specific system based on highly diluted extracts.
Category: Stress Management Care
Question 15
A hurried nurse rushes through care and sighs while answering a call light. How is this behavior likely to affect the patient?
The patient will feel reassured that care is efficient
The patient's stress response will be unaffected
The patient may feel responsible for the nurse's stress and become more anxious
✓
The patient's trust in the nurse will increase
Correct Answer
The patient may feel responsible for the nurse's stress and become more anxious
A nurse's visible stress can affect patients, and visible impatience can make patients feel they are a burden, adding to their own stress; planning and organization help prevent this. The patient is not likely to feel reassured that care is efficient when the nurse seems rushed. The patient's stress response is unlikely to be unaffected, because patients read the nurse's cues. The patient's trust in the nurse is not likely to increase when the nurse appears impatient.
Category: Stress Management Care
Question 16
A patient's hypertension has been well controlled for years but becomes hard to manage during months of caring for a dying parent. What explains this change?
Stress lowers blood pressure, so the medication becomes too strong
Hypertension improves once a stressor begins
The medication stops working because of grief
Chronic stress reduces the body's ability to adapt and worsens existing conditions
✓
Correct Answer
Chronic stress reduces the body's ability to adapt and worsens existing conditions
Prolonged stress keeps the sympathetic response active and wears down the body's adaptive capacity, so conditions that were manageable can worsen; nurses often meet patients in this state. Saying stress lowers blood pressure is incorrect, because the stress response raises it. Saying hypertension improves once a stressor begins is incorrect, because stress pushes blood pressure up. Saying the medication stops working because of grief misplaces the cause; the drug has not changed, the body's stress load has.
Category: Physiologic Stress Response
Question 17
An older adult who lives alone is newly diagnosed with heart failure and becomes very anxious. Which factor commonly makes a new health problem especially stressful for an older adult?
It can threaten the person's independence
✓
Older adults have no prior experience with stress
Older adults cannot use any coping strategies
Older adults no longer have a stress response
Correct Answer
It can threaten the person's independence
Older adults are at higher risk from stress because health problems can threaten their independence and cognitive changes may slow processing; their life experience, however, can help them cope. Saying older adults have no prior experience with stress is false. Saying they cannot use any coping strategies ignores their many strengths. Saying they no longer have a stress response is false.
Category: Recognizing Stress
Question 18
Why are young children at higher risk than adults from the effects of stress?
They do not have a sympathetic nervous system yet
Their coping skills and emotional vocabulary are still developing
✓
They cannot experience fear until adolescence
They produce no stress hormones
Correct Answer
Their coping skills and emotional vocabulary are still developing
Children have less developed coping skills, emotional vocabulary, and emotional regulation, so they may not be able to name or manage stress; with caregiver support they are often resilient. Children do have a sympathetic nervous system. They can experience fear from infancy. They do produce stress hormones.
Category: Recognizing Stress
Question 19
A veteran reports being easily startled by loud noises, trouble sleeping, irritability, and feelings of guilt about past combat events. Which condition do these findings suggest?
Generalized anxiety disorder
Obsessive-compulsive disorder
Post-traumatic stress disorder
✓
Seasonal affective disorder
Correct Answer
Post-traumatic stress disorder
Post-traumatic stress disorder follows a traumatic event and can cause constant vigilance, being easily startled, irritability or anger, guilt or shame, poor concentration, and sleep disturbance; reminders of the trauma can trigger symptoms. Generalized anxiety disorder involves ongoing worry about many everyday matters rather than reactions tied to a trauma. Obsessive-compulsive disorder involves intrusive thoughts and repetitive behaviors. Seasonal affective disorder is depression that follows a seasonal pattern.
Category: Recognizing Stress
Question 20
Before a bone marrow biopsy, the nurse explains what the patient will see, hear, and feel during the procedure to lower anxiety. What is this intervention called?
Informed consent
Therapeutic touch
Crisis intervention
Anticipatory guidance
✓
Correct Answer
Anticipatory guidance
Anticipatory guidance prepares a patient for what to expect, which reduces fear of the unknown and can strengthen the calming effect of any prescribed anxiolytic. Informed consent is the provider's process of explaining risks and benefits so the patient can agree to the procedure. Therapeutic touch is an energy-based practice. Crisis intervention is short-term help for a person overwhelmed by a crisis, not routine preparation for a procedure.
Category: Stress Management Care