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Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. While being assessed, a patient tells the nurse that she has many stresses in her life. Of these
stresses, which of the following would be considered an external stressor?
1. Rigid rules on the job
2. The need to please everyone
3. Workaholic
4. Use of caffeine
Correct Answer: Rigid rules on the job
Rationale: External stressors originate outside the body and are precipitated by changes in the external
environment. They can be triggered by the actual physical environment, the social environment, the
organizational environment, major life events, and by trauma. Daily hassles, such as commuting long
distances, misplacing keys, and experiencing mechanical breakdowns, also act as external stressors.
The need to please everyone, being a workaholic, and the use of caffeine are considered internal
stressors.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Psychosocial Integrity
LO: 1
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
2. A patient tells the nurse that he is recently unemployed and has fears that he will never find another
job. The nurse recognizes this patients internal stressor as being:
1.
2.
3.
4.
All-or-nothing thinking.
Denial.
A catastrophic event.
A realistic expectation.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
3. A patient tells the nurse that he should not have answered his cell phone because he just learned he
has a major meeting to attend in an hour and he is not prepared. The nurse realizes this patient has had
a sudden onset of ___________ stress.
1.
2.
3.
4.
External
Internal
External and internal
Situational
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
4. A patient tells the nurse that when something happens out of the ordinary, she considers if the
situation is good, bad, or means nothing. The nurse realizes this patient is describing which type of
appraisal within the transactional theory of stress?
1.
2.
3.
4.
Primary
Secondary
Cognitive reappraisal
Hassles and uplifts
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
5. While discharge planning, the nurse asks the patient if there is anything in particular the patient will
need once she returns home. The patient states that she has everything she needs, considering she is
returning home in better shape than when she arrived at the hospital. The nurse, using the transactional
theory of stress, realizes this patient is describing which type of appraisal?
1.
2.
3.
4.
Cognitive
Primary
Secondary
Emotional
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
6. A patient scored 350 on the Holmes and Rahe Social Readjustment Rating Scale and is not
demonstrating any physical or emotional signs of illness. The nurse realizes it is also important to
assess:
1.
2.
3.
4.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
7. A patient with a history of dog bites is admitted with a new severe dog bite and tells the nurse that
he feels fine except for the bite. The nurse realizes this patient is functioning within which phase of the
general adaptation syndrome?
1.
2.
3.
4.
Resistance
Alarm
Transaction
Exhaustion
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
8. The nurse is preparing a burn patient for surgery. Because of this patients amount of stress, the
nurse realizes that the patient would benefit from:
1.
2.
3.
4.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
9. The nurse is reviewing the serum laboratory values of a patient admitted with traumatic injuries.
Which of the following laboratory values might be abnormally elevated because of the trauma?
1.
2.
3.
4.
Glucose
Sodium
Potassium
Hemoglobin
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
10. A patient tells the nurse that she takes 400 IU of vitamin E every day. The nurse realizes this
patient is:
1. Neutralizing oxygen free radicals.
2. Overdosing on vitamin E.
3. Increasing the chances of blood clotting.
4. Taking a vitamin that is not necessary for health.
Correct Answer: Neutralizing oxygen free radicals.
Rationale: Free radicals are involved in many cellular functions and are a normal part of living.
Although free radicals have useful functions in the body under controlled conditions, they are
extremely unstable molecules that can damage cells if left uncontrolled. Normally, oxygen free
radicals are neutralized by antioxidants such as vitamin E or enzymes such as superoxide dismutase.
The nurse does not have enough information to know if the patient is overdosing on vitamin E. It is
believed that too much vitamin E can cause bleeding, not blood clotting. Vitamin E is necessary for
health.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 4
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
11. A patient asks the nurse about free radicals and how they contribute to illnesses. Which of the
following would be the nurses best response to this patient?
1. Molecules that are paired are called reduced and cause the molecule to be unstable and cause
damage to other cells.
2. Molecules that are unpaired are called reduced and cause the molecule to be unstable and cause
damage to other cells.
3. Free radicals are bad and clog the liver so the liver cannot get rid of body toxins.
4. Increasing oxygen consumption eliminates free radicals, so taking deep breaths helps remove
them from the body.
Correct Answer: Molecules that are paired are called reduced and cause the molecule to be unstable
and cause damage to other cells.
Rationale: Molecules that donate electrons and thereby become unpaired are called oxidized. When a
molecule gains an electron and is paired, it is called reduced. The reduced molecules are the free
radicals. Free radicals are able to react with other molecules to cause damage to other cells. Not all
free radicals are bad, so the nurse should not encourage the patient to eliminate free radicals by saying
they clog the liver. Increasing oxygen consumption does not impact the number of free radicals.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 4
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
12. A patient in the intensive care unit is demonstrating signs of acute respiratory distress syndrome.
The nurse realizes that which of the following contributed to the development of this syndrome?
1.
2.
3.
4.
Oxidative stress
Poor fluid balance
Immobility
Renal failure
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
13. A patient tells the nurse that she has been trying to get pregnant but has not been successful. The
nurse should assess _______________ in this patient.
1.
2.
3.
4.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
16. A patient tells the nurse that she never had bowel problems until she started a new job that is
highly demanding. How should the nurse respond to this patient?
1. The new job might be a trigger for a stress reaction to occur in your body, causing the new
bowel problems.
2. Stress causes gastrointestinal problems.
3. You might have had the bowel problems all along but didnt realize it until recently.
4. There really isnt any connection between the new bowel problems and the new job.
Correct Answer: The new job might be a trigger for a stress reaction to occur in your body, causing
the new bowel problems.
Rationale: Stress can be a trigger to cause gastrointestinal problems, but stress does not cause
gastrointestinal problems directly. The stress circuit influences the stomach and intestines and can lead
to problems such as diarrhea, constipation, cramping, and bloating. Excessive stomach acid can lead to
gastric burning. It would be misleading to tell the patient that stress causes gastrointestinal problems.
The nurse does not have enough information to say that the patient has had bowel problems all along
but did not realize it until the new job started. The nurse should not tell the patient that there is not any
connection between the bowel problems and the new job, because she does not know for sure.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 6
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
17. A patient tells the nurse that she is under a great deal of stress, and now the doctor tells her she has
high cholesterol levels. The nurse realizes that the elevated cholesterol levels are indicative of:
1.
2.
3.
4.
Correct Answer: The bodys response to stress by releasing fat into the bloodstream.
Rationale: One way the body responds to stress is by releasing fat into the bloodstream. This release of
fat will cause an increase in the cholesterol level. This increase might be temporary. The nurse should
explain the cholesterol elevation to the patient. Without further assessment, the nurse has no way of
knowing if the patient is consuming food high in fat, too much protein, or if the patient is not having
enough physical activity.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
LO: 6
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
18. A patient tells the nurse that she recently lost her job but is doing well because she has the time
now to catch up with things at home and can search for a better job. The nurse realizes this patient is
demonstrating:
1.
2.
3.
4.
Coping.
Denial.
Avoidance.
Delusional thinking.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
19. At the completion of an assessment, the nurse reviews the list of a patients stated and observed
behaviors. Which of the following would indicate to the nurse that the patient is experiencing stress?
Select all that apply.
1.
2.
3.
4.
5.
Correct Answers:
1. Patient stated inability to sleep more than 2 hours per night.
2. Observed patients hands trembling.
3. Patient asked for water for a dry throat.
Rationale:
Patient stated inability to sleep more than 2 hours per night. Insomnia and other sleep disturbances
are signs of stress. Observed patients hands trembling. Trembling and nervous tics are signs of
stress. Patient asked for water for a dry throat. Dryness of the throat and mouth are signs of stress.
Patient sat quietly in chair, hands resting in lap. A sign of stress is the inability to sit still. Patient
commented on recent pleasant weather. Irritability and excitation are signs of stress.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Psychosocial Integrity
LO: 7
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
20 . A patient, informed that he can return to work 1 week after being discharged from the hospital,
tells the nurse that he is not sure that he can return so soon because of the physical expectations of the
job. The nurse realizes the patient experiences:
1.
2.
3.
4.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
21. A patient becomes angry and verbally abusive when he learns that he needs shoulder surgery.
Which of the following is the nurses best response to this patient?
1.
2.
3.
4.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
22. A patient with chronic pain tells the nurse that as soon as she returns home, she is going to be
expected to pick up where she left off, which is causing her a great deal of stress. Which of the
following would be the best instruction for this patient?
1.
2.
3.
4.
Correct Answer: Learn how to prioritize tasks and modify role demands.
Rationale: The patient in pain will need to learn how to prioritize tasks and modify role demands; the
tasks the patient is expected to resume need to be modified along with role demands. Suggesting that
the patient take a vacation does not address the expectations once the patient returns home. Unless it is
prescribed as an activity level, suggesting the patient spend time in bed does not help the patient
address the cause of stress. The nurse should not instruct the nurse to take pain medication around the
clock to control the pain while resuming her normal activities of daily living.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Physiological Integrity
LO: 7
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
23. A patient tells the nurse that taking deep breaths usually works to reduce acute stress, but lately it
has not been working very well. The nurse should do which of the following to help the patient?
1. Review a variety of other techniques, such as progressive relaxation, humor, or music therapy.
2. Encourage the patient to continue to take deep breaths because that is one of the best ways to
reduce stress.
3. Tell the patient that most stress reduction techniques do not work anyway.
4. Ask the patient what physical activities she prefers since this is the only way to reduce stress.
Correct Answer: Review a variety of other techniques, such as progressive relaxation, humor, or music
therapy.
Rationale: The nurse should help the patient understand that no single stress reduction method is
always successful to reduce stress. The nurse should offer other techniques, such as progressive
relaxation, humor, or music therapy. The nurse should not encourage the patient to continue a
technique that is not working such as deep breathing. The nurse should also not falsely tell the patient
that stress reduction techniques do not work. Even though physical activity is known to reduce stress,
the nurse should not tell the patient that this is the only way to reduce stress.
Cognitive Level: Applying
Nursing Process: Implementation
Client Need: Psychosocial Integrity
LO: 7
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.