Brunner And Suddarth’s Textbook Of Medical Surgical Nursing 11th Edition By Suzanne C. Smeltzer -Test Bank





Brunner And Suddarth’s Textbook Of Medical Surgical Nursing 11th Edition By Suzanne C. Smeltzer -Test Bank

Chapter 6- Homeostasis, Stress, and Adaptation


1. A nurse is meeting with a young woman who has recently lost her mother, her job, and moved with her husband to a new city. She is complaining of acute anxiety and depression. The nurse knows:
A) Adaptation often fails during stressful events and results in homeostasis.
B) Stress is a part of our lives and eventually this young woman will adapt.
C) Acute anxiety and depression are seldom associated with stress.
D) Sometimes too many stressors disrupt homeostasis; if adaptation fails, the result is disease.


2. A patient has just been diagnosed with cancer and states that he will “never be able to cope with this situation.” The nurse is aware that coping is:
A) A physiologic measure used to deal with change and he will physically adapt
B) The physiologic and psychological processes that people use to adapt to change
C) The human need for faith and hope, which create change
D) A social measure used to deal with change and loss


3. The nurse is with a patient who has just been informed of his terminal illness. His heart rate increases, his eyes dilate, and his blood pressure increases. The nurse recognizes this response as a:
A) Part of the limbic system response C) Hypothalamic-pituitary response
B) Sympathetic nervous response D) Local adaptation syndrome


4. A 72-year-old female is recovering from abdominal surgery on the medical-surgical unit. The surgery was very stressful and prolonged; the nurse notes on the chart that her blood sugars are elevated yet she has not been diagnosed with diabetes. The nurse realizes:
A) It is a result of antidiuretic hormone.
B) She must have had diabetes prior to surgery.
C) She has become a diabetic from the abdominal surgery.
D) The blood sugars are probably a result of the “fight or flight” reaction.


5. A young female science teacher arrives at the health center with a respiratory infection; she feels anxiety about seeing the doctor. 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. She is concerned that she may have hypertension. The nurse explains to the patient that:
A) She should not worry; it was stress related and her regular blood pressure is good.
B) The first blood pressure was part of a simple stress response; our long-term blood pressure is controlled by negative feedback systems.
C) Blood pressure is only one measure of hypertension; she should review this with the doctor and plan to recheck it on a regular basis.
D) The respiratory infection is probably the cause of the elevated blood pressure and, with treatment, her blood pressure should remain normal.


6. A patient has come to the health center with an enlarged thyroid; the nurse practitioner believes the thyroid cells may suffer from hyperplasia and is aware that:
A) Hyperplasia is an abnormal decrease in cell and organ size and is a precursor to cancer.
B) Hyperplasia is an abnormal increase in new cells and is reversible with the stimulus for cell growth removed.
C) Hyperplasia is the change in appearance due to a chronic irritation and will reverse with the stimulus removed.
D) Hyperplasia is a cancerous growth and will be removal surgically.


7. A 10-year-old boy and his mother are being seen in the emergency department (ED) by the triage nurse. The boy was stung by a bee about an hour ago, and the mother tells the nurse that it is very painful, looks swollen, red, and infected. The nurse teaches the mother that:
A) The pain, redness, and swelling are part of the inflammatory process but it is probably too early for an infection.
B) Bee stings frequently cause infection, pain, and swelling and, with treatment, the infection should begin to subside late today.
C) The infection was probably caused by the stinger which may still be in the wound.
D) The mother’s assessment is excellent and the ED doctor will probably prescribe antibiotics to fix the problem.


8. An older female patient is being treated for acute anxiety and has a nursing diagnosis of ineffective coping patterns related to feelings of helplessness. The most appropriate nursing intervention would be:
A) Provide the patient with realistic choices for her care.
B) Assess and provide constructive outlets for anger and hostility.
C) Assess the patient’s need for social support.
D) Encourage an attitude of realistic hope to help deal with helpless feelings.


9. A 35-year-old woman comes to the local health center with a large mass is 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. The most appropriate nursing diagnosis would be:
A) Self-esteem disturbance C) Altered family process
B) Ineffective individual coping D) Ineffective denial


10. The nurse at the student health center is seeing a nursing student who is interested in reducing his stress level. The nurse identifies guided imagery as an appropriate intervention. Guided imagery involves:
A) The use of progressive tensing and relaxing of muscles to release tension in each muscle group
B) Using positive self-image to increase and intensify physical workouts in the gym, which decreases stress
C) The mindful use of a word, phrase, or visual image that allows one’s self to be distracted and temporarily escape from stressful situations
D) The use of music and humor to create a calm and relaxed demeanor, which allows escape from stressful situations


11. Chronic stress is a problem in today’s society and it requires the attention and teaching of nurses. Which of the following stressors causes the greatest impact on health?
A)  Day-to-day hassles    B)  Technologic change    C)  Divorce    D)  Retirement


12. A vital 75-year-old woman has been hospitalized with a myocardial infarction. Her condition is critical. She is experiencing extreme stress from her hospitalization in the intensive care unit. This may be due primarily from:
A) Overstimulation C) Immobilization
B) Loss of privacy D) Interruption in personal rituals


13. While assessing a patient, the nurse is aware that the body responds to stress. Which of the following is an immediate physiologic response to stress?
A) Vasodilation of peripheral blood vessels
B) Increased blood pressure
C) Decrease in blood glucose levels
D) Pupil constriction


14. Your patient has just had an argument with his spouse. You can expect that his sympathetic nervous system has stimulated his adrenal gland to release which of the following?
A)  Endorphins    B)  Dopamine    C)  Epinephrine    D)  Testosterone


15. Your patient is a 45-year-old man with a type A personality who has been admitted with hypertension. You know that potentially this patient is at an increased risk for:
A)  Myocardial infarction    B)  Liver failure    C)  Lung disease    D)  Depression


16. An expected outcome for a patient who has a nursing diagnosis of ineffective coping related to stress is that the patient will:
A) Adapt relaxation techniques to reduce stress
B) Be stress free
C) Avoid stressful situations
D) Start an anti-anxiety agent


17. When assessing a patient, the nurse learns that the patient has recently been married. The nurse is aware that:
A) The patient and spouse should seek counseling due to their divorce history.
B) The patient will have better coping skills.
C) Happy events do not cause stress.
D) Marriage causes transition, which in turn causes stress.


18. The nurse is assessing her newly admitted patient and is aware that an example of a bodily function that restores homeostasis when conditions shift out of normal range would be:
A)  Body temperature    B)  Pupil dilation    C)  Urination    D)  Blood clotting


19. The nurse informs the patient who is a heavy smoker and may have dysplasia of epithelial cells in the bronchi that:
A) This is harmless, as lung tissue regenerates.
B) Dysplastic cells may become malignant.
C) Surgery is often required for this condition.
D) Dysplasia may cause scar tissue.


20. A patient who has been admitted after near drowning was submerged for 10 minutes and remains unconscious. What possible damage to the body has occurred as a result of the submersion?
A) Atrophy to brain cells C) Hypoxia to the brain
B) Cellular injury D) Necrosis to the brain


21. A patient who is a construction worker has a chemical injury on his arm caused by lye. What assessment should the nurse make to the arm?
A) Damage to the epithelial tissues C) Joint immobility
B) Pigment changes D) Muscle tonicity


22. The patient has a temperature of 106° F. The nurse should be aware that the oxygen demands of the body would:
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


23. The nurse is caring for a patient who has an ankle with acute inflammation. Which of the following statements is true regarding acute inflammation?
A) It is the same as infection.
B) It may impair the healing process.
C) It is a defensive reaction intended to remove an offending agent.
D) It inhibits the release of histamines in the tissues.


24. The patient has been complaining of tightness in the shoulder muscle and frequent headaches. Which of the following might the nurse implement in patient teaching?
A) Teach the patient to tense and relax the muscle groups.
B) Encourage the patient to express his or her feelings.
C) Encourage the patient to seek peer support.
D) Explain the use of analgesics for discomfort.


25. An elderly man is grieving over the loss of his wife who died a year ago. The nurse should encourage the patient to consider which of the following?
A) Improving his nutritional intake
B) Making an appointment at a wellness clinic
C) Walking daily
D) Joining a lawn bowling league


26. The nurse in a clinic is seeing a child with leukemia. The parents are having trouble coping and ask the nurse for advice. What is the nurse’s best response?
A) Suggest a support group for parents of children with leukemia.
B) Have the parents see a social worker.
C) Encourage the parents to have hope.
D) Offer a website to gain information.


27. The nurse is developing a care plan for a patient who’s at risk for ineffective coping due to the effects of chronic illness. Which factor provides the best evidence that the patient is at risk for difficulty in coping?
A) Poor sleeping habits C) Adverse drug effects
B) Lack of social support D) Presence of panic disorder



Answer Key


1. D
2. B
3. B
4. D
5. B
6. B
7. A
8. D
9. B
10. C
11. A
12. C
13. B
14. C
15. A
16. A
17. D
18. A
19. B
20. C
21. A
22. A
23. C
24. A
25. D
26. A
27. B


Chapter 7- Individual and Family Considerations Related to Illness

1. A nurse in a wellness center is presenting a class on integrating holistic therapies with traditional health care. Which of the following would be considered a holistic approach to health?
A) Physical, emotional, and spiritual well-being
B) Emotional and sexual contact
C) Healthy work environment
D) Financial success and post-secondary education


2. During an initial health assessment, which of the following behaviors would be indicative of a patient with an emotionally healthy attitude?
A) Limiting goal setting C) Avoiding conflict
B) Having a sense of humor D) Desire to question reality


3. A patient admitted to telemetry with chest pain is a business executive in a large corporation who has indicated he consumes 7 to 8 oz of scotch every evening. Which of the following is the best indicator of the patient’s ability to cope?
A) Maladaptive stress management C) Behaving in a realistic manner
B) Inability to satisfy basic needs D) Engaging in rewarding behavior


4. A 25-year-old patient has been diagnosed with testicular cancer. Which developmental tasks may be affected?
A) Achieving self-actualization C) Reviewing life’s accomplishments
B) Marrying and starting a family D) Establishing financial security


5. A nurse is caring for a patient who has just been diagnosed with multiple sclerosis. After delivering this news, the nurse anticipates that the patient will most likely experience which emotional symptom?
A)  Lethargy    B)  Bargaining    C)  Lack of interest    D)  Anxiety


6. A patient has been involved in an automobile accident in which the passenger died. The patient arrives in the clinic with complaints of nightmares, inability to concentrate, and impaired memory. The patient is most likely experiencing which of the following?
A) Posttraumatic stress disorder C) Drug addiction
B) Developmental difficulties D) Mild stress


7. A nurse working in a behavioral health facility cares for patients with various symptoms. Which of the following patients would the nurse identify as being at an increased risk for suicide?
A) A 35-year-old man with anxiety
B) A person with a family history of suicide
C) A person with an inability to form trusting relationships
D) A person with loss of interest in career


8. The nurse working in a drug rehabilitation facility is discussing codependent behaviors with the husband of a person who is addicted alcohol. Which of the following would be considered a codependent behavior?
A) Calling in sick at work on behalf of a hung-over spouse
B) Showing anger because the wife has relapsed
C) Verbalizing a desire to end the marriage
D) Discussing the addiction with his wife


9. A nurse is caring for a terminally ill patient who says to the nurse, “If only I could live until my granddaughter has her first birthday.” The nurse assesses this patient to be in the stage of grief termed:
A)  Disbelief    B)  Anger    C)  Acceptance    D)  Bargaining


10. A hospice nurse discusses the grieving process with three children who recently experienced the death of 75-year-old mother from breast cancer. The nurse defines a basic goal of the grieving process as:
A) Healing the self
B) Constant reflection on the loss
C) Encouraging sadness and depression
D) Effectively role-modeling loss for offspring


11. How might the nurse assist the terminally ill patient to stimulate, regain, or strengthen a connection within his or her inner self?
A) Inquire about the patient and his or her family’s need for spiritual care.
B) Have the patient transferred home.
C) Have the patient keep a journal.
D) Have a hospital volunteer read to the patient on a daily basis.


12. A patient is terminally ill and has become unconscious. The spouse of the patient is very upset even though the patient has not yet died. What might the spouse be experiencing?
A)  Anticipatory grief    B)  False hope    C)  Regret    D)  Denial


13. A nurse working in a senior center encounters a patient who recently lost his spouse as well as several friends and family members. What is the best way for the nurse to assist the patient?
A) Recommend that the patient get over the loss and move on with his life.
B) Encourage the patient to participate in grief counseling.
C) Suggest that the patient move into a senior residence to avoid reminders of his wife.
D) Ask another elder member of the senior center to discuss his experiences with grief with the patient.


14. A nurse developing a holistic plan of care for a patient with diabetes knows that for the plan to be successful it must:
A) Take into account the cost of care
B) Connect families, friends, and the environment
C) Provide a connection between medicine and nursing
D) Address the disease but also incorporate the mind, body, and spirit


15. The nurse is working with a patient who is in an acute depression following the death of her youngest daughter. The patient is on high-dose antidepressants and wonders “why the drugs are not fixing this.” The nurse explains:
A) The antidepressants will only work if you are willing to help yourself, so you need to try harder.
B) Your sense of well-being will return in about a year when you forget about the death of your daughter.
C) The medications help balance chemicals in our bodies during periods of depression, but they do not fix the losses and stress that created the imbalance.
D) The key to the medication working is taking the medication correctly; you must take it everyday at the same time and dose.


16. An elderly patient is concerned that his stress level is affecting his ability to cope with many of his activities of daily living. He states that he was “raised in a family that didn’t get along well” and has “struggled with his emotions in the past.” The nurse’s best response is:
A) Family experience and early childhood experiences often have little influence on our coping ability, and stress is often related to needless worry.
B) Coping is determined by our own attitude and how we decide to view our family life today; behavior needs to be controlled to decrease stress level.
C) Family experience and early childhood experiences often influence a person’s ability to cope, and exploring these issues may help relieve stress.
D) Children raised in dysfunctional homes may become mentally ill later in life and need to be medicated; do you feel like medication may help?


17. A 22-year-old man has come to a Veterans Administration clinic following a tour of duty in Iraq. He complains of uncontrollable anger and states that he “hates himself and is depressed because of a recent arrest for a fight in a tavern.” The nurse suspects the man will be diagnosed with:
A) Situational depression C) Schizophrenia
B) Posttraumatic stress disorder D) Acute depression


18. The home health nurse is visiting a 78-year-old woman who seems confused, withdrawn, and says that her neighbor who has been a friend for years has been “watching her.” The nurse suspects that the woman suffers from:
A)  Panic disorder    B)  Loss and grief    C)  Depression    D)  Anxiety


19. A home health nurse meets with the family of a 90-year-old woman who is living independently but needs help to remain at home. The family is arguing about who is going to provide that care or who will pay for it. The nurse’s plan of care should focus on:
A) Accessing who is going to be involved in the care of the patient so that assignments can be given
B) Allowing the patient to negotiate the situation with her family to create trust and understanding
C) Providing family access to a professional problem-solver, such as an attorney to provide legal advice to the woman
D) Accessing and facilitating family member communication and design interventions that focus on coping behaviors


20. A 45-year-old woman is being seen at a free clinic and states she needs help because “her husband drinks heavily and it is ruining her family.” The best nursing intervention would be:
A) Call the husband’s family and friends to obtain support for an intervention.
B) Allow the woman to express her feelings and assess for codependent behaviors.
C) Call the police and have the man arrested for alcohol abuse and have him hospitalized.
D) Remind the woman that her husband’s alcohol problem is not her fault and that it is simply a defect in her husband’s character.


21. A 49-year-old woman who is terminally ill with metastatic breast cancer has been coping with her impending death by speaking at cancer conventions, putting her affairs in order, and looking inward for answers. The nurse is aware that these activities:
A) Could be spiritual in nature and that the family would benefit if they were included when ever possible
B) May result in dysfunctional behaviors and denial that alienates the family
C) Represent the need to control her final days, by showing the world and her family that she is fine
D) Need to be addressed and limited, so she spends time with her family or it will result in dysfunctional grieving when she dies


22. The nurse is meeting with a family that is facing the death of their father. They are looking for ways to help him and themselves during this period. The nurse would need to:
A) Assess the faith needs of the group.
B) Diagnose any faith-related problems and evaluate their ability to provide spiritual care for themselves.
C) Inform the family it is out of the nurse’s scope of care to provide spiritual guidance.
D) Contact clergy to provide professional guidance.


23. A 20-year-old college student arrives at the student health center during finals week complaining of “stomach problems.” She broke up with her boyfriend in the first week of the semester and has not been feeling well or doing well in school since. The nurse is aware that:
A) The “stomach problems” may be cardiac related and she could be in danger.
B) The boyfriend is the core issue and a plan of care that addresses his influence is important.
C) The girl is probably not telling the truth and could be in an abusive relationship.
D) The “stomach problems” are likely related to stress and depression.



Answer Key


1. A
2. B
3. A
4. B
5. D
6. A
7. B
8. A
9. D
10. A
11. A
12. A
13. B
14. D
15. C
16. C
17. B
18. C
19. D
20. B
21. A
22. A
23. D