Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation
1. A nurse is meeting with a young woman who has recently lost her job after moving with her
husband to a new city. She describes herself as being anxious and pretty depressed. What
principle of stress and adaptation should be integrated into the nurses plan of care for this patient?
An accumulation of stressors can disrupt homeostasis and result in disease.
2. You are the nurse caring for an adult patient who has just received a diagnosis of prostate cancer.
The patient states that he will never be able to cope with this situation. How should you best
understand the concept of coping when attempting to meet this patient’s needs? Coping is
composed of the physiologic and psychological processes that people use to adapt to change.
3. The nurse is with a patient who has learned that he has glioblastoma multiforme, a brain tumor
associated with an exceptionally poor prognosis. His heart rate increases, his eyes dilate, and his
blood pressure increases. The nurse recognizes these changes as being attributable to what
response? Sympathetic nervous response
4. You are the nurse caring for a 72-year-old woman who is recovering from a hemicolectomy on
the postsurgical unit. The surgery was very stressful and prolonged, and you note on the chart that
her blood sugars are elevated, yet diabetes does not appear in her previous medical history. To
what do you attribute this elevation in blood sugars? The blood sugars are probably a result of the
fight-or-flight reaction.
5. A patient tells the nurse that she does not like to go to the doctor and is feeling anxious about
being in this place. When the nurse checks her blood pressure, it is elevated along with her heart
rate. The nurse rechecks her blood pressure about 10 minutes later and it is normal. The patient
asks the nurse if she should be concerned that she may have hypertension. What statement should
guide the nurse’s response? The first blood pressure was part of a simple stress response; our
long-term blood pressure is controlled by negative feedback systems.
6. A patient presents to the health center and the nurse practitioners assessment reveals an enlarged
thyroid. The nurse practitioner believes the thyroid cells may be undergoing hyperplasia. How
would the nurse practitioner explain this condition to the patient? Hyperplasia is an abnormal
increase in new cells and is reversible with the stimulus for cell growth removed.
7. A mother has brought her young son to the emergency department (ED). The mother tells the
triage nurse that the boy was stung by a bee about an hour ago. The mother explains to the nurse,
It hurts him so bad and it looks swollen, red, and infected. What can the triage nurse teach the
mother? The pain, redness, and swelling are part of the inflammatory process, but it is probably
too early for an infection.
8. You are caring for an older female patient who is being treated for acute anxiety. She has a
nursing diagnosis of Ineffective Coping related to a feeling of helplessness. What would be the
most appropriate nursing intervention? Encourage an attitude of realistic hope to help her deal
with helpless feelings.
9. A 35-year-old woman comes to the local health center with a large mass in her right breast. She
has felt the lump for about a year, but was afraid to come to the clinic because she was sure it was
cancer. What is the most appropriate nursing diagnosis for this patient? Ineffective individual
coping related to reluctance to seek care
10. The nurse at the student health center is seeing a group of students who are interested in reducing
their stress level. The nurse identifies guided imagery as an appropriate intervention. What will be
included in the nurses intervention? The mindful use of a word, phrase, or visual, which allows
oneself to be distracted and temporarily escape from stressful situations
11. The nurse is assessing a patient and finds two enlarged supraclavicular lymph nodes. The nurse
asks the patient how long these nodes have noticeably enlarged. The patient states, I cant
remember. A long time I think. Do I have cancer? Which of the following is an immediate
physiologic response to stress the nurse would expect this patient to experience? Increased blood
pressure
12. Your patient tells you that he has just been told that his computed tomography results were
abnormal. You can expect that his sympathetic nervous system has stimulated his adrenal gland
to release what? Epinephrine
13. You walk into your patient’s room and find her sobbing uncontrollably. When you ask what the
problem is, your patient responds, I am so scared. I have never known anyone who goes into a
hospital and comes out alive. On this patients care plan you note a pre-existing nursing diagnosis
of Ineffective Coping related to stress. What is the best outcome you can expect for this patient?
Patient will adopt coping mechanisms to reduce stress.
14. The nurse is assessing a patient and learns that the patient and his wife were married just 3 weeks
earlier. Which of the following statements should underlie the nurses care planning for this
patient? Marriage causes transition, which has the potential to cause stress.
15. The nurse is assessing a newly admitted patient who is an 84-year-old woman. The nurse learns
that the patient has simultaneously experienced a hip fracture and the exacerbation of her chronic
heart failure. What is an example of a bodily function that restores homeostasis by negative
feedback when conditions shift out of normal range? Body temperature
16. A patient who has a 40 pack-year history of smoking may have dysplasia of the epithelial cells in
her bronchi. What would the nurse tell the patient about dysplastic cells in the bronchi?
Dysplastic cells have a high potential to become malignant.
17. A teenage boy who was the victim of a near drowning has been admitted to the emergency
department. The patient was submerged for several minutes and remains unconscious. What
pathophysiological process has occurred as a result of the submersion? Hypoxia to the brain
18. Your older adult patient has been diagnosed with urosepsis and has a temperature of 103.4F. You
should be aware that the oxygen demands of the patients body would change in which direction
and why? Increase due to an increase in metabolism
19. You are admitting a patient who presents with inflammation of his right ankle. When planning
this patients care, which of the following statements regarding acute inflammation should you
recognize? Inflammation is a defensive reaction intended to remove an offending agent.
20. An elderly man tells you that his wife died 14 months ago and that he cannot stop grieving over
his loss. What should you encourage the patient to consider? Increase his interaction with his
social network.
21. You are caring for a 65-year-old widower whose wife died 4 months ago. He tells you that he is not
doing well and that his friends and family seem hesitant to talk with him about his wife. What could the
nurse do to help the patient? Refer him to a support group.
22. A 44-year-old woman will undergo a bilateral mastectomy later today and the nurse in surgical
admitting has begun the process of patient education. What positive outcome of providing the
patient with information should the nurse expect? Increased concentration
23. You are the nurse caring for a 51-year-old man who has just been told in a family meeting that he
has stage IV colon cancer. You expect that the patient now has an increase in blood pressure,
heart rate and respiratory rate. You spend time talking with this patient and his vital signs become
closer to normal range. To what would you attribute this phenomenon? The patient is adapting to
noxious stressors.
24. While talking with the parents of conjoined twins who are medically unstable, you note that the
father of the babies has an aggressive stance, is speaking in a loud voice, and makes several
hostile statements such as, Id sure like to have words with that doctor who told us our babies
would be okay. You know that this fathers cognitive appraisal has led to what? The development
of negative emotions
25. The nurse is caring for a patient who was widowed 2 years prior to this current hospitalization,
her fifth since the death of her husband. The woman says to the nurse, The doctor says my blood
pressure is dangerously high. What is making my blood pressure so high? What does the nurse
know about the probable cause of this patients hypertension? Prolonged or unrelenting suffering
can cause physical illness.
26. You are the psychiatric-mental health nurse caring for a young, recently married woman, whose
sister and niece were recently killed in a motor vehicle accident. This young woman is making
arrangements for the funerals, and you know that your patient has insight into her current
stressors. What do you know is occurring with this young woman? The mediating process is
occurring.
27. As an occupational health nurse at a large industrial plant, you are planning the return to work of
an employee who was exposed to a chemical spill. To what type of stressor has this patient been
exposed? Physical
28. You are caring for a patient in the urgent care center who presented with complaints of lethargy,
malaise, aching, weakness, and loss of appetite. During the assessment, you note an area on the
patients right posterior calf that is warm to touch, edematous, and tender to touch. You know the
most probable cause of this patients symptoms is what? Systemic inflammatory response
29. You are discharging a 4-year-old boy from the emergency department. The boy was seen for an
insect bite that became swollen and reddened and warm and painful to touch. The patients vital
signs are all within normal range for age. While giving discharge instructions to the patients
father, he asks why the child is not going to get antibiotics for the infected insect bite. What
would be your best response? This is a local inflammatory response to the insect bite; it is not an
infection so antibiotics will not help.
30. A group of nursing students are applying the concept of steady state to the nursing care plan of a
patient who is undergoing chemotherapy and radiotherapy for the treatment of lung cancer. What
would be the most complete statement by the students about the concept of steady state? The
mechanisms of steady state work to maintain balance in the body.
31. A nursing student has presented a concept map of a medical patients health that demonstrates the
maintenance of a steady state. The student has elaborated on the relationship of individual cells to
compensatory mechanisms. When do compensatory mechanisms occur in the human body?
Continuously
32. A nurse is planning the care of a woman who has been admitted to the medical unit following an
ischemic cerebrovascular accident. What would the nurse recognize as the longest-acting phase of
the woman’s physiologic response to stress and its cause? Hypothalamic-pituitary response
caused by persistent stress
33. Selyes general adaptation syndrome (GAS) is a theory of adaption to biologic stress. Selye
compared the GAS with the life process: childhood, adulthood, and later years. What would occur
during adulthood in the GAS? Stressful events occur and resistance or adaption occurs.
34. You are auditing the electronic health record of a 33-year-old patient who was treated for a
postpartum hemorrhage. When reviewing the patients records, you can see various
demonstrations of negative feedback loops. Which of the following constitute negative feedback
loops? Select all that apply.
Serum glucose levels , Acid-base balance , Temperature
35. A group of nurses are planning the care of an older adult who is being rehabilitated following a
stroke. A nurse notes that hypertension and cardiovascular disease could have occurred over time
if the patient previously experienced a state of chronic arousal. In a state of chronic arousal, what
can happen within the body? Arteriosclerosis may develop.
36. A group of nurses are attending an educational Inservice on adaptive and maladaptive responses
to stress. When talking about the assessment of coping strategies in patients, the nurses discuss
the use of drugs and alcohol to reduce stress. What is most important for the nurses to know about
these coping behaviors? They increase the risk of illness.
37. You are assessing an older adult patient post-myocardial infarction. You attempt to identify your
patients health patterns and to assess if these health patterns are achieving the patients goals. How
should you best respond if it is found that the patients health patterns are not achieving their
goals? Seek ways to promote balance in the patient.
38. A patient is experiencing intense stress during his current hospital admission for the exacerbation
of chronic obstructive pulmonary disease (COPD). Which of the patients actions best
demonstrates adaptively coping? Reprioritizing needs and roles
39. The nurse is performing discharge planning for a patient who has numerous chronic health
problems. The nurse recognizes that lifestyle changes would likely benefit the patients health
status. Which factor would the nurse identify as most important in determining health status?
Social class
40. The nurse is admitting a 51-year-old patient to the medical-surgical unit after a diagnosis of
cellulitis of the calf. What factors does the nurse know impact the processes of inflammation,
repair, and replacement? Select all that apply.
Severity of the injury , Condition of the host , Nature of the injury