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Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing 13th 13e edition-Test Bank
Sample Test

Chapter 6

A nurse is meeting with a young woman who has recently lost her job after mov
1. herself as being “anxious and pretty depressed.” What principle of stress and a
plan of care for this patient?
A) Adaptation often fails during stressful events and results in homeosta
B) Stress is a part of all lives, and, eventually, this young woman will ad
C) Acute anxiety and depression can be adaptations that alleviate stres
 D) An accumulation of stressors can disrupt homeostasis and result in d
Ans: D
Feedback:
Four concepts—constancy, homeostasis, stress, and adaptation—are key to th
maintained through emotional, neurologic, and hormonal measures; stressors c
many stressors disrupt homeostasis, and, if adaptation fails, the result is diseas
may never adapt. Acute anxiety and depression are frequently associated with

You are the nurse caring for an adult patient who has just received a diagnosis
2. “never be able to cope with this situation.” How should you best understand the
patient’s needs?
A) Coping is a physiologic measure used to deal with change, and he w
B) Coping is composed of the physiologic and psychological processes
C) Coping is the human need for faith and hope, both of which create c
D) Coping is a social strategy that is used to deal with change and loss.
Ans: B
Feedback:
Indicators of stress and the stress response include both subjective and objecti
or behavioral and reflect social behaviors and thought processes. The physiolog
adapt to stress are the essence of the coping process. Coping is both a physiol
change. Coping is a personal process used to adapt to change.

The nurse is with a patient who has learned that he has glioblastoma multiforme
3. poor prognosis. His heart rate increases, his eyes dilate, and his blood pressure
as being attributable to what response?
A) Part of the limbic system response
B) Sympathetic nervous response
C) Hypothalamic-pituitary response
 D) Local adaptation syndrome
Ans: B
Feedback:
The sympathetic nervous system responds rapidly to stress; norepinephrine is r
respond (i.e., heart rate increases, eyes dilate, and blood pressure increases).
behavior that are critical to survival during times of stress. The hypothalamic-pit
metabolic effect that results in elevated blood sugars during stressful situations
inflammatory reaction.

You are the nurse caring for a 72-year-old woman who is recovering from a hem
4. was very stressful and prolonged, and you note on the chart that her blood suga
her previous medical history. To what do you attribute this elevation in blood su
A) It is a temporary result of increased secretion of antidiuretic hormone
B) She must have had diabetes prior to surgery that was undiagnosed.
C) She has suffered pancreatic trauma during her abdominal surgery.
D) The blood sugars are probably a result of the “fight-or-flight” reaction
Ans: D
Feedback:
During stressful situations, ACTH stimulates the release of cortisol from the adr
releasing amino acids and stimulating the liver to convert amino acids to glucos
hormone is released during stressful situations and stimulates reabsorption of w
kidney. Assuming the patient had diabetes prior to surgery demonstrates a lack
hyperglycemia. No evidence presented in the question other than elevated bloo

A patient tells the nurse that she does not like to “go to the doctor” and is feeling
nurse checks her blood pressure, it is elevated along with her heart rate. The nu
5.
minutes later and it is normal. The patient asks the nurse if she should be conc
statement should guide the nurse’s response?
A) She should not worry; it was stress related and her regular blood pre
 The first blood pressure was part of a simple stress response; our lo
B)
feedback systems.
Blood pressure is only one measure of hypertension; she should rev
C)
regular basis.
The respiratory infection is the probably the cause of the elevated bl
D)
pressure should remain normal.
Ans: B
Feedback:
A simple stress response will temporarily elevate a blood pressure and heart ra
controlled by negative feedback systems.
For a science teacher, this would be an appropriate level of teaching/learning a
would be incorrect in assuming the patient’s blood pressure is good based on o
respiratory infection could account for the elevated blood pressure, but assuring
pressure will return to normal may not be true.

A patient presents to the health center and the nurse practitioner’s assessment
6. practitioner believes the thyroid cells may be undergoing hyperplasia. How wou
the patient?
A) Hyperplasia is the abnormal decrease in cell and organ size and is a
B) Hyperplasia is an abnormal increase in new cells and is reversible w
Hyperplasia is the change in appearance of the thyroid due to a chro
C)
removed.
D) Hyperplasia is a cancerous growth and will be removed surgically.
Ans: B
Feedback:
Hyperplasia is an increase in the number of new cells in an organ or tissue. Thi
additional cell division, and this, in turn, enlarges the tissue. Hyperplasia is reve
removed. Hyperplasia is the increase in the number of new cells, not a change
in the number of new cells, which may or may not be cancerous growth.
 A mother has brought her young son to the emergency department (ED). The m
7. by a bee about an hour ago. The mother explains to the nurse, “It hurts him so
can the triage nurse teach the mother?
A) The pain, redness, and swelling are part of the inflammatory process
Bee stings frequently cause infection, pain, and swelling, and, with tr
B)
today.
C) The infection was probably caused by the stinger, which may still be
D) The mother’s assessment is accurate and the ED doctor will probabl
Ans: A
Feedback:
Cells or tissues of the body may be injured or killed by any agent (physical, che
inflammatory response (or inflammation) naturally occurs in the healthy tissues
same as infection. An infectious agent is only one of several agents that may tri
stings may cause infection, the signs and symptoms (very painful, looks swollen
response. If the stinger were still in the wound, it would only be creating inflamm

You are caring for an older female patient who is being treated for acute anxiety
8.
Coping related to a feeling of helplessness. What would be the most appropriat
A) Put the primary onus for planning care on the patient herself.
B) Assess and provide constructive outlets for anger and hostility.
C) Assess the patient’s sources of social support.
D) Encourage an attitude of realistic hope to help her deal with helpless
Ans: D
Feedback:
By encouraging an attitude of realistic hope, the patient will be empowered. Thi
bring about more effective coping patterns. The onus for care planning should n
related to feeling of helplessness, not anger and hostility. Social support is nece
helplessness.
 A 35-year-old woman comes to the local health center with a large mass in her
9. year, but was afraid to come to the clinic because she was sure it was cancer. W
this patient?
A) Self-esteem disturbance related to late diagnosis
B) Ineffective individual coping related to reluctance to seek care
C) Altered family process related to inability to obtain treatment
D) Ineffective denial related to reluctance to seek care
Ans: B
Feedback:
Ineffective individual coping is the inability to assess our own stressors and then
In this case, the patient was unable to access health care even when she was a
esteem Disturbance, Altered Family Process, and Ineffective Denial are all nurs
breast cancer, but the patient’s ineffective individual coping has created a signi
appropriate nursing diagnosis.

The nurse at the student health center is seeing a group of students who are in
10.
identifies guided imagery as an appropriate intervention. What will be included
A) The use of progressive tensing and relaxing of muscles to release te
B) Using a positive self-image to increase and intensify physical exercis
The mindful use of a word, phrase, or visual, which allows oneself to
C)
stressful situations
D) The use of music and humor to create a calm and relaxed demeano
Ans: C
Feedback:
Guided imagery is the mindful use of a word, phrase, or visual image to distract
taking time to relax or reenergize. Guided imagery does not involve muscle rela
 The nurse is assessing a patient and finds two enlarged supraclavicular lymph
11. nodes have noticeably enlarged. The patient states, “I can’t remember. A long t
following is an immediate physiologic response to stress the nurse would expec
A) Vasodilation of peripheral blood vessels
B) Increased blood pressure
C) Decrease in blood glucose levels
D) Pupil constriction
Ans: B
Feedback:
An initial response to stress, as seen by the fight-or-flight response, is an increa
Vasoconstriction leads to the increase in blood pressure. Blood glucose levels i
and pupils dilate.

Your patient tells you that he has just been told that his computed tomography r
12.
sympathetic nervous system has stimulated his adrenal gland to release what?
A) Endorphins
B) Dopamine
C) Epinephrine
D) Testosterone
Ans: C
Feedback:
In the sympathetic-adrenal-medullary response to stress, the sympathetic nervo
epinephrine and norepinephrine.

You walk into your patient’s room and find her sobbing uncontrollably. When yo
13. “I am so scared. I have never known anyone who goes into a hospital and com
pre-existing nursing diagnosis of Ineffective Coping related to stress. What is th
 A) Patient will adopt coping mechanisms to reduce stress.
B) Patient will be stress free for the duration of treatment.
C) Patient will avoid all stressful situations.
D) Patient will be treated with an antianxiety agent.
Ans: A
Feedback:
Stress management is directed toward reducing and controlling stress and impr
that the patient needs to adopt coping mechanisms that are effective for dealing
other options are incorrect because it is unrealistic to expect a patient to be stre
an antianxiety agent are not the best answers as outcomes for ineffective copin

The nurse is assessing a patient and learns that the patient and his wife were m
14.
statements should underlie the nurse’s care planning for this patient?
A) The patient and spouse should seek counseling to ease their transiti
B) The patient will have better coping skills being in a stable relationshi
C) Happy events do not normally cause stress.
D) Marriage causes transition, which has the potential to cause stress.
Ans: D
Feedback:
Transition can contribute to stress, even if the transition is a positive change. Th
extensively and concerns relatively infrequent situations that directly affect peop
events such as death, birth, marriage, divorce, and retirement. Counseling is no

The nurse is assessing a newly admitted patient who is an 84-year-old woman.

15. simultaneously experienced a hip fracture and the exacerbation of her chronic h
function that restores homeostasis by negative feedback when conditions shift o
A) Body temperature
 B) Pupil dilation
C) Diuresis
D) Blood clotting
Ans: A
Feedback:
Negative feedback mechanisms throughout the body monitor the internal enviro
shift out of normal range. Body temperature, blood pressure, and acid-base bal
these compensatory mechanisms. Blood clotting in the body involves positive fe
are not modulated by negative feedback mechanisms.

A patient who has a 40 pack-year history of smoking may have dysplasia of the
16.
nurse tell the patient about dysplastic cells in the bronchi?
A) This is a benign process that occurs as lung tissue regenerates.
B) Dysplastic cells have a high potential to become malignant.
C) This process involves a rapid increase in number of cells.
D) Dysplasia may cause uncontrolled growth of scar tissue.
Ans: B
Feedback:
Dysplasia is bizarre cell growth resulting in cells that differ in size, shape, or arr
Dysplastic cells have a tendency to become malignant; dysplasia is seen comm
smoke. This may not be a harmless condition and dysplasia does not cause sca
of new cells.

A teenage boy who was the victim of a near drowning has been admitted to the
17. submerged for several minutes and remains unconscious. What pathophysiolog
submersion?
A) Atrophy of brain cells
 B) Cellular lysis
C) Hypoxia to the brain
D) Necrosis to the brain
Ans: C
Feedback:
The length of time different tissues can survive without oxygen varies. The brain
options are incorrect because submersion injuries do not cause atrophy to brain
cause cellular lysis or necrosis to the brain.

Your older adult patient has been diagnosed with urosepsis and has a tempera
18.
oxygen demands of the patient’s body would change in which direction and why
A) Increase due to an increase in metabolism
B) Decrease due to a decrease in metabolism
C) Increase due to a decrease in metabolism
D) Decrease due to an increase in metabolism
Ans: A
Feedback:
When a person’s temperature is elevated, hypermetabolism occurs, and the res
increase. The other options are incorrect because oxygen demands would not d
decrease in metabolism.

You are admitting a patient who presents with inflammation of his right ankle. W
19.
following statements regarding acute inflammation should you recognize?
A) Inflammation is essentially synonymous with infection.
B) Inflammation may impair the healing process.
C) Inflammation is a defensive reaction intended to remove an offendin
 D) Inflammation inhibits the release of histamines in the tissues.
Ans: C
Feedback:
Inflammation is a defensive reaction intended to remove an offending agent and
same as infection, it does not impair the healing process, and it does not inhibit

An elderly man tells you that his wife died 14 months ago and that he cannot st
20.
encourage the patient to consider?
A) Improve his nutritional intake.
B) Make an appointment at a wellness clinic.
C) Walk on a daily basis.
D) Increase his interaction with his social network.
Ans: D
Feedback:
Social networks can reduce stress by providing the individual with a positive so
information, and new social contacts. Changes to diet and activity may be bene
particular benefit. Attendance at a wellness clinic may or may not be beneficial,

You are caring for a 65-year-old widower whose wife died 4 months ago. He tel
21.
friends and family seem hesitant to talk with him about his wife. What could the
A) Refer him to a consciousness-raising group.
B) Refer him to a psychiatrist.
C) Refer him to a support group.
D) Refer him to a church or temple.
Ans: C
Feedback:
 Being a member of a group with similar problems or goals has a releasing effec
expression and exchange of ideas. Psychiatry may or may not be necessary. S
any referral to a specific religious setting. Consciousness-raising groups are no

A 44-year-old woman will undergo a bilateral mastectomy later today and the n
22.
patient education. What positive outcome of providing the patient with informati
A) Increased concentration
B) Decreased depression levels
C) Sharing of personal details
D) Building interdependent relationships
Ans: A
Feedback:
Giving patients information also reduces the emotional response so that they ca
effectively. Educating the patient does not decrease depression levels or build i
does not mean sharing of personal details.

You are the nurse caring for a 51-year-old man who has just been told in a fam
23. expect that the patient now has an increase in blood pressure, heart rate and re
patient and his vital signs become closer to normal range. To what would you a
A) Cortisol levels are decreasing.
B) Endocrine activity has increased.
C) The patient is adapting to noxious stressors.
D) The sympathetic response has been activated.
Ans: C
Feedback:
Selye developed a theory of adaptation to biologic stress that he named the gen
phases: alarm, resistance, and exhaustion. During the alarm phase, the sympa
 release of catecholamines and the onset of the adrenocorticotropic hormone (A
reaction is defensive and anti-inflammatory but self-limited. Because living in a
people move into the second stage, resistance. During the resistance stage, ad
cortisol activity is still increased. If exposure to the stressor is prolonged, the thi
exhaustion stage, endocrine activity increases, and this has negative effects on
digestive, and immune systems) that can lead to death.

While talking with the parents of conjoined twins who are medically unstable, yo
24. aggressive stance, is speaking in a loud voice, and makes several hostile state
that doctor who told us our babies would be okay.” You know that this father’s c
A) Harm/loss feelings
B) Feelings of challenge
C) A positive adjustment to the possible loss of his children
D) The development of negative emotions
Ans: D
Feedback:
The appraisal process contributes to the development of an emotion. Negative
harm/loss appraisals, and positive emotions accompany challenge. Harm and c
options are incorrect. There is nothing in the scenario that indicates that the fath
loss of his children.

The nurse is caring for a patient who was widowed 2 years prior to this current
25. husband. The woman says to the nurse, “The doctor says my blood pressure is
pressure so high?” What does the nurse know about the probable cause of this
A) Prolonged or unrelenting suffering can cause physical illness.
B) Physical illness is always caused by prolonged stress.
C) The elderly are at increased risk for hypertension due to stress.
D) Stress always exacerbates the physiologic processes of the elderly.
Ans: A
 Feedback:
When a person endures prolonged or unrelenting suffering, the outcome is freq
Physical illness is not always caused by prolonged stress. The elderly populatio
hypertension due to stress. Stress does not always exacerbate the physiologic
statement, and true absolutes are rare.

You are the psychiatric-mental health nurse caring for a young, recently married
26. killed in a motor vehicle accident. This young woman is making arrangements f
insight into her current stressors. What do you know is occurring with this young
A) The mediating process is occurring.
B) The patient is experiencing an expected level of denial.
C) The patient’s awareness of her stress makes it more acute.
D) The patient is emotionally overwhelmed.
Ans: A
Feedback:
After recognizing a stressor, a person consciously or unconsciously reacts to m
process. Nothing in the scenario indicates the patient is either in denial or feelin
necessarily exacerbate it.

As an occupational health nurse at a large industrial plant, you are planning the
27.
to a chemical spill. To what type of stressor has this patient been exposed?
A) Physiologic
B) Psychosocial
C) Physical
D) Psychiatric
Ans: C
Feedback:
 Physical stressors include cold, heat, and chemical agents; physiologic stresso
neither a psychiatric nor a psychosocial phenomenon.

You are caring for a patient in the urgent care center who presented with compl
28. loss of appetite. During the assessment, you note an area on the patient’s right
and tender to touch. You know the most probable cause of this patient’s sympto
A) Local inflammatory response
B) Systemic shock response
C) Local infectious response
D) Systemic inflammatory response
Ans: D
Feedback:
The inflammatory response is often confined to the site, causing only local sign
can also occur. During this process, general, nonspecific symptoms develop, in
weakness. The fact that the patient is experiencing systemic effects such as let
appetite suggests that inflammation is not limited to one specific site.

You are discharging a 4-year-old boy from the emergency department. The boy
and reddened and warm and painful to touch. The patient’s vital signs are all wi
29.
instructions to the patient’s father, he asks why the child is not going to get antib
your best response?
A) “This is a local inflammatory response to the insect bite; it is not an in
B) “In children who are previously healthy, inflammation and infections
C) “I’ll make sure the doctor is made aware that you’d like your son to h
D) “Infection is not the same as inflammation. What your son has is infla
Ans: A
Feedback:
 Regardless of the cause, a general sequence of events occurs in the local infla
changes in the microcirculation, including vasodilation, increased vascular perm
these changes take place, five cardinal signs of inflammation are produced: red
Infections do not always resolve spontaneously. The nurse should teach the pa
unnecessary rather than simply deferring to the physician.

A group of nursing students are applying the concept of steady state to the nurs
30. chemotherapy and radiotherapy for the treatment of lung cancer. What would b
about the concept of steady state?
A) “The concept of steady state preserves life.”
B) “The mechanisms of steady state work to maintain balance in the bo
C) “This concept compensates for biologic and environmental attacks o
D) “Steady state is the same as adaptation.”
Ans: B
Feedback:
Mechanisms for adjusting internal conditions promote the normal steady state o
mechanisms are compensatory in nature and work to restore balance in the bod
state; it is not the concept itself.

A nursing student has presented a concept map of a medical patient’s health th

31. state. The student has elaborated on the relationship of individual cells to comp
mechanisms occur in the human body?
A) According to a diurnal cycle
B) When needed
C) Continuously
D) Sporadically
Ans: C
Feedback:
 The concept of the cell as existing on a continuum of function and structure incl
mechanisms, which occur continuously in the body to maintain the steady state

A nurse is planning the care of a woman who has been admitted to the medical
32. accident. What would the nurse recognize as the longest-acting phase of the w
cause?
A) Sympathetic-adrenal-medullary response caused by persistent stres
B) Hypothalamic-pituitary response caused by acute stress
C) Sympathetic-adrenal-medullary response caused by acute stress
D) Hypothalamic-pituitary response caused by persistent stress
Ans: D
Feedback:
The longest-acting phase of the physiologic response, which is more likely to oc
hypothalamic-pituitary pathway, not the sympathetic-adrenal-medullary pathwa

Selyes’ general adaptation syndrome (GAS) is a theory of adaption to biologic s

33.
process: childhood, adulthood, and later years. What would occur during “adult
A) Stressful events occur and resistance or adaption occurs.
B) Successful avoidance of stressful life events leaves the body vulnera
C) The accumulation of life’s stressors causes resistance to fall.
D) Vulnerability leads to eventual death.
Ans: A
Feedback:
Selye compared the general adaptation syndrome with the life process. During
promote the development of adaptive functioning, and children are vulnerable. D
occur, and people develop resistance or adaptation. During the later years, the
on the organism again decrease people’s ability to adapt, so resistance falls, an
 comparison, options B, C, and D are incorrect.

You are auditing the electronic health record of a 33-year-old patient who was t
34. reviewing the patient’s records, you can see various demonstrations of negative
negative feedback loops? Select all that apply.
A) Serum glucose levels
B) Acid-base balance
C) Temperature
D) Blood clotting
E) Labor onset
Ans: A, B, C
Feedback:
These mechanisms work by sensing deviations from a predetermined set point
aimed at offsetting the deviation. Blood pressure, acid–base balance, blood glu
electrolyte balance are examples of functions regulated through such compens
are results of positive feedback loops.

A group of nurses are planning the care of an older adult who is being rehabilita
35. hypertension and cardiovascular disease could have occurred over time if the p
arousal. In a state of chronic arousal, what can happen within the body?
A) Blood pressure decreases.
B) Serum glucose levels drop.
C) Arteriosclerosis may develop.
D) Tissue necrosis may occur.
Ans: C
Feedback:
If the sympathetic-adrenal-medullary response is prolonged or excessive, a sta
 high (not low) blood pressure, arteriosclerotic changes, and cardiovascular dise
excessive, behavior patterns of withdrawal and depression are seen. In addition
infections and tumors may develop.

A group of nurses are attending an educational inservice on adaptive and mala

36. the assessment of coping strategies in patients, the nurses discuss the use of d
important for the nurses to know about these coping behaviors?
A) They are effective, but alternative, coping behaviors.
B) They do not directly influence stress in the body.
C) They are adaptive behaviors.
D) They increase the risk of illness.
Ans: D
Feedback:
Coping processes that include the use of alcohol or drugs to reduce stress incre
alcohol as a means to reduce stress are not effective coping behaviors. They a
a short-term effect on stress.

You are assessing an older adult patient post-myocardial infarction. You attemp
37. assess if these health patterns are achieving the patient’s goals. How should yo
health patterns are not achieving their goals?
A) Seek ways to promote balance in the patient.
B) Refer the patient to social work.
C) Identify alternative models of health care.
D) Provide insight into the patient’s physiological failings.
Ans: A
Feedback:
The nurse has a significant role and responsibility in identifying the health patte
 are not achieving physiologic, psychological, and social balance, the nurse is o
patient, to seek ways to promote balance. The nurse is not obligated to refer to
provide insight into the physiologic failings of the system if the patient’s health p

A patient is experiencing intense stress during his current hospital admission fo

38.
pulmonary disease (COPD). Which of the patient’s actions best demonstrates a
A) Becoming controlling
B) Reprioritizing needs and roles
C) Using benzodiazepines as ordered
D) Withdrawing
Ans: B
Feedback:
Adaptive ways of coping included seeking information, reprioritizing needs and
compromises, comparing oneself to others, planning activities to conserve ener
one’s body, and using self-talk for encouragement. Becoming controlling or with
Benzodiazepines are sometimes indicated, but these are not considered to be a

The nurse is performing discharge planning for a patient who has numerous ch
39. lifestyle changes would likely benefit the patient’s health status. Which factor wo
determining health status?
A) Gender
B) Ethnicity
C) Social class
D) Interfamilial relationships
Ans: C
Feedback:
The single most important factor for determining health status is social class an
 the major factor influencing health is level of education. This factor supersedes
relationships.

The nurse is admitting a 51-year-old patient to the medical-surgical unit after a

40.
the nurse know impact the processes of inflammation, repair, and replacement?
A) Severity of the injury
B) Social relationships
C) Condition of the host
D) Familial support
E) Nature of the injury
Ans: A, C, E
Feedback:
The condition of the host, the environment, and the nature and severity of the in
and replacement. The patients’ social relationships and familial support do not d
repair, and replacement.

Computed tomography of a 72-year-old woman reveals lung cancer with metas

40. adamant that any “bad news” be withheld from his in order to protect her from s
How should the nurse and the other members of the care team best respond?
A) Explain to the son the team’s ethical obligation to inform the patient.
B) Refer the family to social work.
C) Have a nurse or physician from the patient’s culture make contact w
D) Speak with the son to explore his rationale and attempt to reach a co
Ans: D
Feedback:
Nurses must promote open dialogue and work with patients, families, physician
culturally appropriate solution for the individual patient. A referral to social work
caregiver from the same culture may not be ethical or effective.