(Test Bank) Davis Advantage for Psychiatric Mental Health Nursing

Morgan, 10

Nursing

Test Bank

10th Edition

• $15.00 $50.00

---

Description

Test Bank for Davis Advantage for Psychiatric Mental Health Nursing, The downloadable file consists of 937 pages, and the total size of the file is 8.52 MB. Purchase now only for highly discounted price.

Author(s): Morgan

---

---

Study Note Preview

Townsend PMHN, 10e Chapter 1 - ETB Chapter 1. The Concept of Stress Adaptation MULTIPLE CHOICE 1. A client has experienced the death of a close family member and at the same time becomes unemployed. The client’s 6-month score on the Recent Life Changes Questionnaire is 110. The nurse: 1. Understands the client is at risk for significant stress-related illness. 2. Determines the client is not at risk for significant stress-related illness. 3. Needs further assessment of the client’s coping skills to determine susceptibility to stress-related illness. 4. Recognizes the client may view the losses as challenges and perceive them as opportunities. ANS: 3 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Explain the relationship between stress and diseases of adaptation. Page: 5 Heading: Stress as an Environmental Event Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1. This is incorrect. Assessment is the first step of the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related physical and psychological illnesses. The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more or a year-score total of 500 or more indicates high stress in a client’s life and susceptibility to stress-related illnesses. 2. This is incorrect. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining the client’s perception of the current stresses. A 6-month score of 300 or more or a year-score total of 500 or more on the Recent Life Changes Questionnaire indicates high stress in a client’s life and susceptibility to stress-related physical and psychological illnesses. 3. This is correct. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related physical and psychological illnesses. A 6-month score Townsend PMHN, 10e Chapter 1 - ETB of 300 or more or a year-score of 500 or more indicates high stress in a client’s life and risk for significant stress-related physical and psychological illness. 4. This is incorrect. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related illness. A 6-month score of 300 or more or a year-score of 500 or more on the Recent Life Changes Questionnaire indicates high stress in a client’s life is susceptible to significant stress-related physical and psychological illness. CON: Stress 2. A physically and emotionally healthy client has just been fired. During a routine office visit, he tells the nurse, “Perhaps this was the best thing to happen. Maybe I’ll consider pursuing an art degree.” The nurse determines the client perceives the stressor of his job loss as: 1. Irrelevant 2. Harm or loss 3. Threatening 4. A challenge ANS: 4 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 7 Heading: Stress as a transaction between the individual and the environment >Individual’s Perception of the Event > Primary Appraisal Integrated Processes: Nursing Process: Assessment Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. An irrelevant perception is one where the event holds no significance for the individual. 2. This is incorrect. A harm or loss appraisal refers to damage or loss already experienced by the individual. 3. This is incorrect. A threatening appraisal is perceived as anticipated harms or losses. 4. This is correct. The client’s statement indicates he perceives the loss of his job as a challenge and an opportunity for growth, demonstrated by his statement to consider an art degree. CON: Stress Townsend PMHN, 10e Chapter 1 - ETB 3. Which client statement alerts the nurse that the client may be maladaptively responding to stress? 1. “Avoiding contact with others helps me cope.” 2. “I really enjoy journaling; it’s my private time.” 3. “I signed up for a yoga class this week.” 4. “I made an appointment to meet with a therapist.” ANS: 1 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback 1. This is correct. Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learning appropriate coping skills and can prevent access to needed support systems. 2. This is incorrect. Journaling is a form of adaptive coping and interpersonal communication. 3. This is incorrect. Group exercise is a form of adaptive coping, relaxation. 4. This is incorrect. Seeing a therapist is not considered a maladaptive coping method. CON: Stress 4. A nursing student comes down with a sinus infection toward the end of every semester. Which stage of stress is the student most likely experiencing when this occurs? 1. Alarm reaction 2. Resistance 3. Exhaustion 4. Fight or flight ANS: 3 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Explain the relationship between stress and diseases of adaptation. Page: 2 Heading: Stress as a Biological Response Integrated Processes: Nursing Process: Assessment Townsend PMHN, 10e Chapter 1 - ETB Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. At the alarm reaction stage, physiological responses of the fight-or-flight syndrome are initiated. 2. This is incorrect. At the stage of resistance, the individual uses the physiological responses of the first stage as a defense in the attempt to adapt to the stressor. Physiological symptoms may disappear. 3. This is correct. At the stage of exhaustion, the student’s exposure to stress has been prolonged, and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage. 4. This is incorrect. The fight-or-flight syndrome occurs during the alarm reaction stage. CON: Stress 5. A school nurse is assessing a high school student who is overly concerned about her appearance. The client’s parent states, “That’s not something to be stressed about!” Which response by the nurse is best? 1. “Teenagers don’t truly understand stress.” 2. “Why are you so concerned about your appearance?” 3. “You surely know that isn’t something to be concerned with.” 4. “I understand you feel stressed about this; tell me more about your stress.” ANS: 4 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Describe the core concept of stress as an environmental event. Page: 8 Heading: Stress as a Transaction Between the Individual and the Environment Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1. This is incorrect. This response is judgmental and nontherapeutic. This response minimizes the student’s concerns. 2. This is incorrect. This response puts the student in a defensive position to justify her feelings. It is nontherapeutic. 3. This is incorrect. This is a nontherapeutic response that minimizes the student’s Townsend PMHN, 10e Chapter 1 - ETB feelings. This does not allow the student to verbalize her concerns. 4. This is correct. Determination of an event as stressful depends on the individual’s cognitive appraisal of the situation, which is an individual’s evaluation of the personal significance of the event or occurrence. Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change. This response recognizes the situation and helps to explore the situation. CON: Stress 6. A student confides in the school nurse that he is feeling stress about deciding whether to go to college or work to provide needed income for his family. Which is the best approach by the nurse to assist the student? 1. Teach the student meditation techniques. 2. Assist the student with problem-solving strategies. 3. Suggest relaxation methods for the student. 4. Recommend getting a pet for the student. ANS: 2 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management> Adaptive coping strategies Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1. This is incorrect. This is not the best approach because it only addresses a means to reduce stress-related symptoms and does not address the underlying concern for the student. 2. This is correct. The student is facing a problem that needs to be viewed objectively, and the nurse can assist the student, if needed, to apply problem-solving strategies. 3. This is incorrect. While relaxation may assist the student with coping with the stressor, it does not address the student’s underlying concern. 4. This is incorrect. Getting a pet can assist with coping with life stressors; however, the student has already expressed financial concerns to which the pet will only add. CON: Stress Townsend PMHN, 10e Chapter 1 - ETB 7. An unemployed college graduate confides in the clinic nurse that she is experiencing severe anxiety over not finding a teaching position and that she is having difficulty with independent problem-solving. Which nursing intervention is best? 1. Encourage her to seek counseling from a therapist. 2. Instruct her to listen to her favorite music daily. 3. Assist her with the problem-solving process. 4. Encourage her to keep a daily journal of feelings. ANS: 3 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management> Adaptive coping strategies Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1. This is incorrect. Counseling is not likely needed in this case due to the situational nature the student is describing. 2. This is incorrect. Listening to music may assist with the stress symptoms; however, it does not address the underlying problem. 3. This is correct. Assist the client with problem-solving. During times of high anxiety and stress, clients will need more assistance in problem-solving and decision-making. 4. This is incorrect. A daily journal may assist her with managing her symptoms but does not address the underlying concern the client is expressing. CON: Stress 8. The school nurse is assessing a high school student who is distraught because her parents cannot afford horseback-riding lessons. The nurse recognizes the student’s perception is that the problem is: 1. Endangering her well-being 2. Personally relevant 3. Based on immaturity 4. Exceeding her capacity to cope ANS: 2 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Explain the concept of stress as a transaction between the individual and the environment. Townsend PMHN, 10e Chapter 1 - ETB Page: 7 Heading: Stress as a Transaction Between the Individual and the Environment Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1. This is incorrect. The student is not expressing that it endangers her well-being; the distress is related to the fact that she sees it as personally significant. 2. This is correct. Determination of an event as stressful depends on the individual’s cognitive appraisal of the situation. An event becomes relevant to an individual when the outcome holds personal significance. 3. This is incorrect. The distress the client is feeling is not related to immaturity; rather, she sees it as having personal significance and therefore relevant. 4. This is incorrect. An event becomes relevant to an individual when the outcome holds personal significance. CON: Stress 9. Meditation has been shown to be an effective stress management technique. Which finding indicates meditation has been effective? 1. Achieving a state of relaxation 2. Attaining insight into one’s feelings 3. Demonstrating appropriate role behaviors 4. Enhanced problem-solving skills ANS: 1 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management > Adaptive Coping Strategies Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback 1. This is correct. Meditation produces relaxation by creating a special state of consciousness through focused concentration. 2. This is incorrect. Meditation does not necessarily result in attaining insight into one’s feelings. Townsend PMHN, 10e Chapter 1 - ETB 3. This is incorrect. Meditation does not help to demonstrate appropriate role behaviors. 4. This is incorrect. Meditation does not necessarily enhance one’s ability to solve problems. CON: Stress 10. A first-time parent is crying and asks the nurse, “How can I go to work if I can’t afford child care?” Which is the appropriate initial response by the nurse to assist with problem-solving? 1. Determine the risks and benefits for each alternative. 2. Formulate goals for resolution of the problem. 3. Evaluate the outcome of the implemented alternative. 4. Assess the facts of the situation. ANS: 4 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management >Adaptive Coping Strategies Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. Determining the risks and benefits of each alternative is done approximately halfway through the problem-solving process. 2. This is incorrect. Assessment is the first step of the nursing process. Formulating goals for resolving the stressful situation occurs after assessing the facts of the situation. 3. This is incorrect. Evaluating the outcome is nearly the last step in the problem-solving process. 4. This is correct. Assessment is the first step of the problem-solving process. Accurate information about the situation must be gathered before any other steps can be taken, CON: Stress 11. The client is hospitalized with coronary artery disease and demonstrates other conditions often associated with diseases of adaptation, including headaches and depression. Currently, the client is demonstrating anxiety and states he is Townsend PMHN, 10e Chapter 1 - ETB “really worried” about his spouse. Which is the most appropriate nursing response to the situation? 1. Inform the client that he has to learn to cope with stressors. 2. Teach the client how to meditate when he is feeling anxious. 3. Encourage the client to talk through his concerns about his spouse. 4. Ask the client if he has a pet he would like to see while in the hospital. ANS: 3 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management Integrated Processes: Nursing Process: Evaluation Client Need: Psychological Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. Informing the client that he needs to learn something new at this time will likely increase his stress and is not helpful to the immediate situation. 2. This is incorrect. Teaching the client mediation is not appropriate at this time, when he is expressing the anxiety and concerns about his spouse. 3. This is correct. Interpersonal communication can assist the nurse to understand the client’s concerns and allows the client to reduce the escalation of stress at this time. 4. This is incorrect. While this may be helpful in some situations, it is not something that can address the client’s immediate needs. CON: Stress 12. When an individual’s stress response is sustained over a long period, the nurse anticipates which physiological effect? 1. Decreased resistance to disease 2. Increased libido 3. Decreased blood pressure 4. Increased feelings of well-being ANS: 1 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Identify physiological responses to stress. Page: 3 Heading: Stress as a Biological Response Integrated Processes: Nursing Process: Assessment Townsend PMHN, 10e Chapter 1 - ETB Client Need: Physiological Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Moderate Feedback 1. This is correct. Selye’s general adaptation syndrome identified that prolonged exposure to stress leads to a decreased immune response and resistance to disease. During the stage of exhaustion, the body’s compensatory mechanisms no longer function effectively and diseases of adaptation occur. 2. This is incorrect. Selye’s general adaptation syndrome identified that prolonged exposure to stress leads to a decreased immune response and resistance to disease. The client is likely to experience decreases in libido rather than increases. 3. This is incorrect. Selye’s general adaptation syndrome identified that prolonged exposure to stress leads to a decreased immune response and resistance to disease. The client is likely to experience increases in blood pressure rather than decreases. 4. This is incorrect. Selye’s general adaptation syndrome identified that prolonged exposure to stress leads to a decreased immune response and resistance to disease. The client is not likely to have feelings of increased well-being due to the prolonged stress response. CON: Stress 13. Which is a typical part of the fight-or-flight syndrome? 1. Decreased heart rate 2. Decreased peristalsis 3. Increased salivation 4. Pupil constriction ANS: 2 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Identify physiological responses to stress. Page: 3 Heading: Stress as a Biological Response Integrated Processes: Nursing Process: Assessment Client Need: Physiological Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. During the fight-or-flight syndrome, the heart rate increases in response to the release of epinephrine. 2. This is correct. During the fight-or-flight syndrome, peristalsis decreases as the body Townsend PMHN, 10e Chapter 1 - ETB slows nonessential functions. 3. This is incorrect. Salivation decreases as the body slows nonessential functions. 4. This is incorrect. During the fight-or-flight syndrome, pupils dilate to enhance vision. CON: Stress 14. A nurse is assessing a client’s response to stress. The nurse concludes that the client is performing a secondary appraisal of a stressful event when the client determines: 1. The event is benign. 2. The event is irrelevant. 3. Resources are available. 4. The event is pleasurable. ANS: 3 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Explain the concept of stress as a transaction between the individual and the environment. Page: 7 Heading: Stress as a Transaction Between the Individual and the Environment > Individual’s Perception of the Event Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. The benign-positive outcome is a primary appraisal that is perceived as producing pleasure for the individual. 2. This is incorrect. When an event is judged as irrelevant, this is the primary appraisal process. 3. This is correct. When the individual considers the resources and skills needed to deal with the event, the individual is conducting a secondary appraisal. 4. This is incorrect. Judging an event as pleasurable is a part of the primary appraisal process. CON: Stress 15. Miller and Rahe (1997) identified a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool? Townsend PMHN, 10e Chapter 1 - ETB 1. Specific physical and psychological illnesses are not identified. 2. Numerical values associated with specific life events are randomly assigned. 3. Stress is viewed as a solely physiological response. 4. An individual’s personal perception of the event is excluded. ANS: 4 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Explain the relationship between stress and diseases of adaptation. Page: 5 Heading: Stress as an Environmental Event Integrated Processes: Nursing Process: Evaluation Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. Several physical and psychological illnesses are part of the questionnaire 2. This is incorrect. The numerical values associated with specific life events are not randomly assigned. 3. This is incorrect. Stress is seen as both a physiological and a psychological response. 4. This is correct. Individuals differ in response to life events, and this is not considered in many life changes questionnaires. CON: Stress 16. A client tells the nurse, “I experience stress on a regular basis. Why do I feel so terrible this time?” Which is the nurse’s most appropriate response? 1. “Genetics has nothing to do with your temperament or feelings.” 2. “Your reactions to past experiences influence your current feelings.” 3. “Your stress level is lower when you are in good physical health.” 4. “You’ll experience less stress if you use appropriate coping skills.” ANS: 2 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Explain the concept of stress as a transaction between the individual and the environment. Page: 7 Heading: Stress as a Transaction Between the Individual and the Environment > Predisposing Factors Integrated Processes: Nursing Process: Implementation Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Townsend PMHN, 10e Chapter 1 - ETB Concept: Stress Difficulty: Moderate Feedback 1. This is incorrect. Genetic influences do impact the way a person responds to stress and influences temperament and feelings. 2. This is correct. Past experiences are occurrences that result in learned patterns that can influence an individual’s current adaptation response. They include previous exposure to the stressor or other stressors in general, learned coping responses, and degree of adaptation to previous stressors. 3. This is incorrect. Stress levels are not lower when one is in good physical health; however, one who is in good physical health has more reserves to deal with the stressful event. 4. This is incorrect. Adaptive coping responses help to deal with stressful events; however, this does not mean one will experience less stress. CON: Stress 17. A nurse is providing education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety? 1. Diagnostic blood tests 2. Awareness of factors creating stress 3. Relaxation exercises 4. Identification of support systems ANS: 2 Chapter: Chapter 1, The Core concept of Stress Adaptation Objective: Discuss adaptive coping strategies in the management of stress. Page: 8 Heading: Stress Management > Adaptive Coping Strategies Integrated Processes: Teaching and Learning and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Comprehension [Understanding] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. Diagnostic blood tests are not part of the initial steps in anxiety and stress management. 2. This is correct. The initial step is awareness that stress is being experienced and awareness of factors that create stress. 3. This is incorrect. Relaxation exercises can be implemented after the client becomes aware of factors that create stress. Townsend PMHN, 10e Chapter 1 - ETB 4. This is incorrect. Identifying support systems can be implemented after the client becomes aware of factors that create stress. CON: Stress 18. A 32-year-old person is speaking to the office nurse at an initial visit. The nurse asked, “What brings you in today?” The client replied, “I have been having headaches three to four times a week for the past month or so. I’m not sleeping well and feel tired most of the time. I work 60 hours per week and am going through a divorce.” The nurse determines the client’s symptoms represent which of the following? 1. Adaptive coping 2. Maladaptive coping 3. Problem-solving 4. Self-awareness ANS: 2 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Define adaptation and maladaptation. Page: 8 Heading: Core Concepts Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Easy Feedback 1. This is incorrect. An adaptive response to stress is a behavior that maintains the integrity of the individual. 2. This is correct. When behavior disrupts the integrity of the individual, it is perceived as maladaptive. Maladaptive responses are considered negative or unhealthy. 3. This is incorrect. Problem-solving is an adaptive approach to dealing with stress. 4. This is incorrect. Self-awareness is an adaptive approach to dealing with stress and likely won’t result in the symptoms the client is describing. CON: Stress 19. The emergency department nurse is providing discharge instructions to a 23-year-old man who was injured in a motor vehicle crash. The client stated, “My heart was racing when I saw the car coming through the red light was going to hit me. I didn’t know my heart could go that fast!” Which is the nurse’s best response? 1. “Don’t worry, your heart is strong because you are young and in good health.” Townsend PMHN, 10e Chapter 1 - ETB 2. “Everyone gets scared when they realize another car is going to hit them.” 3. “You had a panic attack when you saw the car that hit you was not going to stop.” 4. “Your body responded to the stress of knowing the car was going to hit you.” ANS: 4 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Identify physiological responses to stress. Page: 3 Heading: Stress as a Biological Response Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1. This is incorrect. The nurse’s response in this example is nontherapeutic. 2. This is incorrect. The nurse’s response does not explain the reason for the client’s rapid heart rate. 3. This is incorrect. The client did not experience a panic attack. This was a normal response to the situation. 4. This is correct. The client experienced a physical reaction to the stressor of the impending car crash. A stressor is a biological, psychological, social, or chemical factor that causes physical or emotional tension. The client’s increased heart rate was a physical response during the alarm reaction stage of the fight-or-flight syndrome. CON: Stress 20. The nurse in the intensive care unit (ICU) is giving report to the nurse on the cardiac step-down unit. The nurse states, “The client is a 48-year-old admitted 3 days ago for chest pain and a stent placement. Vital signs are stable, but I am worried about her stress level. She said she just moved here due to a job transfer, and her spouse stayed behind to sell the house. She told me they have a high insurance deductible, and she is worried about the hospital bill.” Which factor has the most significant influence on the client’s health? 1. Coping skills 2. Existing conditions 3. Individual vulnerability 4. Perceived threat ANS: 2 Chapter: Chapter 1, The Concept of Stress Adaptation Objective: Identify physiological responses to stress. Page: 7