TEST BANK for Health Psychology: Biopsychosocial Interactions 8th Edition by Edward Sarafino and Tim

Chapter 1 TEST QUESTIONS True or False F

1.

Advances in medical treatment were responsible for a sharp decrease in infectious diseases at the turn of the 20th century.

2.

Today, accidental injury is the leading cause of death in children and adolescents in the United States.

3.

During the Middle Ages, the influence of the Church resulted in many major advancements in medical knowledge.

4.

“Risk factors” are those biological or behavioral characteristics that are known to cause a disease.

5.

In the past, practitioners of psychosomatic medicine generally used a psychoanalytic model to explain a physical symptom.

6.

One of the goals of health psychology is to have an effect on public policy.

7.

The biopsychosocial model of health and illness is actually an extension of the biomedical model.

8.

The "systems" approach assumes simple systems are embedded within complex systems.

9.

Although sociocultural research has found differences in health beliefs across cultures, disease patterns themselves do not differ.

10.

Quasi-experimental designs allow us to make causal conclusions from existing groups.

(4)

T (5)

F (6)

F (9)

T (10)

T (11)

T (13)

T (15)

F (20)

F (25)

1

Matching Match one of the following with descriptions given in questions one to five. a. Hippocrates b. Plato c. Galen d. St. Thomas Aquinas e. Descartes c (6)

1. From his work, which included dissection, this second century physician felt that pathologies could be localized in parts of the body.

d

2. An Italian philosopher, he saw the mind and body as an interrelated unit.

(6)

b (5)

a (5)

e (6)

3. He was among the Greek philosophers to propose that the mind and body are separate entities.

4. Called "the father of medicine," his humoral theory for the origin of disease was influential for centuries.

5. He described in mechanical terms the functioning of the body's actions and sensations such as pain.

Match the following with descriptions given in questions 6 through 10 a. epidemiology b. public health c. medical sociology d. medical anthropology e. health psychology e (12)

6. Provides direct service to patients in the management of their illnesses or engages in research and teaching.

a

7. Concerned with the incidence and prevalence of illnesses.

(17)

b

8. Organizes health education or provides community health services.

(18)

c

9. May conduct studies of health care services and how they are organized.

(18)

d

10. May conduct studies on the medical practices in different cultures.

(18)

2

Multiple Choice c 1. Claudia goes to the university health center complaining of a sore throat and (2) headache. A blood test reveals that her white blood cell count is high, and a throat culture reveals a streptococcus infection. Which of the following is true? a. Claudia’s high white blood cell count is a symptom of illness. b. Her sore throat is a sign of illness. c. The results of the blood test and throat culture are signs of illness. d. Her headache and high white blood count are symptoms of illness. d (2)

c (2)

b (2)

a (2)

d (3-4)

d (4)

2. Common definitions of health include a. optimal weight and endurance. b. absence of signs of malfunctioning. c. absence of subjective symptoms of disease. d. both b and c.

3. In his continuum of illness and health, Aaron Antonovsky suggested that a. wellness and illness are independent concepts. b. medical treatment affects only the wellness side of the continuum. c. his model represents differing health statuses. d. lifestyle has little impact on health or illness.

4. In discussing the illness and health continuum, Antonovsky emphasizes a. illness more than health. b. a revised focus toward what helps people stay healthy. c. the psychosocial factors that contribute to illness. d. the role of poverty in health care.

5. The term "health", as used by the author of the textbook, is best described as a. a positive state of mental, social, and physical well-being. b. the absence of illness. c. the absence of disease risks. d. lack of a terminal condition.

6. Infectious diseases were: a. more frequently fatal in the past than they are now. b. brought over to North America by European settlers. c. the greatest threat to American health in the 19th century. d. all of the above 7. The decline in the death rate from infectious diseases by the end of the 19 th century was largely the result of a. the development of antibiotics. b. advances in medical treatment. c. changing definitions of disease states in the medical community. d. preventive measures.

3

a (4)

b (5)

d (5)

c (5)

a (6)

c (6)

8. A person living in the United States today a. is more likely to die of a chronic disease than any other cause of mortality. b. has a shorter life span than someone who lived in the 19th Century. c. is likely to be at high risk of dying of infections. d. has an average life expectancy over 90 years.

9. The procedure referred to as trephination a. is effective in the treatment of chronic disease. b. is believed to have been done in the past for superstitious reasons. c. is frequently used today in the treatment of infectious diseases. d. was based on the humoral theory of illness.

10. Hippocrates, the "Father of Medicine" a. suggested that eating a good diet would promote good health. b. proposed the humoral theory of illness and wellness. c. defined health as a balance of humors. d. all of the above.

11. A "humor" is a a. type of emotional response. b. spiritual state. c. a bodily fluid. d. all of the above 12. A main contribution of Galen to knowledge about illness a. was to discover that illness can be localized in specific parts of the body. b. was to reject the humoral theory of Hippocrates. c. was not appreciated until the 20th century. d. was to reject the mind/body split.

13. The position of Rene Descartes on the mind/body problem can best be described as: a. agreeing with both Aquinas and Plato that the mind and body are unitary. b. agreeing with Aquinas and disagreeing with Plato that the mind and body are unitary. c. agreeing with Plato and disagreeing with Aquinas on the unitary nature of mind and body. d. placing little to no emphasis on the mind.

4

b (7)

a (7)

c (7)

b (8)

d (9)

b (9)

14. Which of the following was NOT an advance in science and medicine in the 18th and 19th centuries? a. The growing use of dissection in autopsies to aid in the acquisition of knowledge. b. The rejection of the belief that the mind and body are separate. c. The discovery that microorganisms cause certain diseases d. New surgical and anesthetic techniques.

15. The proposition that all diseases can be explained by disturbances in physiological processes a. is the basis of the biomedical model. b. is no longer the dominant view in the field of medicine. c. has never been widely accepted. d. is consistent with an emphasis on psychosocial factors.

16. Dr. Lee believes that disease occurs independently from our psychological and social experience. Dr. Lee believes in the _____ theory. a. humoral b. biopsychosocial c. biomedical d. trephination 17. Which of the following statements about chronic disease is true? a. Significant advances have been made in their treatment, to the point where they are no longer dangerous. b. Although we know more about the causes of chronic diseases, advances in their treatment have been modest. c. Psychological and social factors have little to do with these diseases. d. Gains and survival rates from cancer between 1950 and 1987 are due to improved medical techniques.

18. Which of the following is NOT a risk factor for an individual developing cancer? a. high alcohol use b. high fat diet c. cigarette smoking d. all of the above are risk factors 19. Risk factors for a health problem a. directly cause diseases. b. are associated with diseases. c. are largely unknown today. d. are usually easily cured with medication.

5

d (9)

d (9)

b (9)

c (9)

d (10)

d (10)

20. Melody has been having a great deal of difficulty in her attempt to quit smoking. Which of the following might be reasons for her lack of success? a. She thinks getting cancer is not likely. b. Her friends all smoke and don't think it’s such a big problem. c. She is addicted to nicotine. d. all of the above 21. Smoking has been identified as a risk factor in each of the following health problems except a. stroke. b. cancer. c. chronic lung disease. d. obesity.

22. In Belloc and Breslow's study of longevity and health practices a. longevity was not statistically related to most health behaviors. b. the health of older participants who practiced all seven health habits was similar to that of much younger participants. c. maintaining an appropriate weight was the best predictor of health. d. eating multiple small meals was important.

23. Which of the following is NOT one of the healthful behaviors studied by Belloc and Breslow (1972)? a. never smoking cigarettes b. never or only occasionally eating between meals c. taking one aspirin per day d. sleeping 7 to 8 hours a day 24. People whose personalities include high levels of _____ seem to be "disease-prone." a. anger & hostility b. depression c. anxiety d. all of the above 25. Considering the psychosocial characteristics of the following people, which one is most likely to develop an illness? a. Fernando, a banker who works long hours. b. Linda, a student who occasionally feels a bit sad and homesick. c. Ling, an athlete who experiences mild levels of anxiety before her competitions. d. John, an anxious and pessimistic news director who frequently "blows up" at his staff.

6

c (10)

a (10)

c (11)

a (11)

d (11)

b (11)

26. Jane feels a numbness in her hand and has been to several doctors, who have found no organic cause for her problem. She might be suffering from a. trephination. b. behavioral modification. c. conversion hysteria. d. psychoanalysis.

27. Medical history notes for a young woman with a skin rash refers to her "conflicting feelings about being physically close to her husband". Her physician seems to accept a _____ explanation for her illness. a. psychosomatic b. behavioristic c. public health d. humoral 28. Which of the following approaches would a specialist in behavioral medicine be most likely to use in treating a chronic headache? a. medicine b. psychoanalysis c. biofeedback d. psychotherapy 29. The work on biofeedback by physiological psychologists has shown us that a. even internal functions like heart rate and blood pressure can be controlled with psychological methods. b. the mind/body dichotomy really exists and can be measured. c. psychoanalysis is effective in the treatment of high blood pressure. d. biofeedback is an ineffective method of therapy.

30. Which of the following is the least likely to be studied by a modern health psychologist? a. why people do not use seat belts b. how to design a media campaign to encourage healthful lifestyles c. how patients are affected by characteristics of hospitals and nursing homes d. how to differentiate organic symptoms from conversion hysteria 31. Which of the following is not an example of an indirect way that health psychologists help patients? a. Conducting research to discover information about lifestyles that affect health. b. Providing therapy to a patient to assist in adjustment to a chronic illness. c. Holding a training workshop for medical professionals regarding psychosocial characteristics of patients.

7

d. Designing new behavior change programs that will affect people’s health.

8

b (12)

d (13)

d (13)

a (15)

b (17)

c (17)

32. Mei-Lin has lost the use of her legs after being in a biking accident. Her health psychologist is working with her to cognitively redefine the experience as a challenge rather than a disaster. This technique is classified as a(n) _____ method. a. ineffective b. cognitive c. behavioral d. psychoanalytic 33. A biopsychosocial approach to dealing with an adolescent girl's weight problem would be likely to consider a. her family history. b. how her weight problem affects her friendships. c. how she feels emotionally about her weight problem. d. all of these 34. Which of the following is true regarding the role of emotions in health and illness? a. People with positive emotions take better care of their health. b. Fear prevents some people from obtaining medical care. c. Recovery from illness can be affected by emotions. d. all of the above 35. Which of the following is NOT true of the systems concept in health psychology? a. It takes into account an unchanging, interrelated group of parts. b. By definition, a person qualifies as a system. c. It is consistent with the biopsychosocial model. d. Events in one system affect events in other systems.

36. Compared with older individuals, children a. experience the same number of chronic diseases as adults. b. suffer from relatively few chronic diseases. c. are more responsible for their own health. d. have cognitive skills similar to those of adolescents and adults.

37. The life-span perspective in health psychology reveals that adolescents a. will be healthier than children because they are exposed to fewer infectious diseases. b. typically follow the example of their parents more than their friends. c. are powerfully influenced by peer pressure, often leading to poorer health practices. d. respond to illnesses much like the elderly do.

9

c (17)

b (17)

a (18)

c (18)

d (18)

a (19)

38. Greg is a 15 year old who was diagnosed as a diabetic at age 4. For the first time, he now is not following his health regimen. The most probable explanation is a. he doesn't understand what he should do. b. he secretly doesn't want to be healthy. c. social pressures to avoid being "different" prevent him from taking proper care of himself. d. he may be forgetting what to do and should have a neuropsychological examination.

39. When reporting the decrease in deaths from AIDS, an epidemiologist is discussing AIDS’ a. morbidity. b. mortality. c. incidence. d. prevalence.

40. An epidemiologist writes a report discussing the total number of previously reported and new cases of AIDS for the past 5 years. He is reporting on the disease's a. prevalence. b. morbidity. c. incidence. d. mortality.

41. Dr. Yi is collecting data on the number of new cases of cholera in Beijing during the summer of 1997. Dr. Yi is studying the __________ of cholera. a. prevalence. b. morbidity. c. incidence. d. epidemic.

42. An epidemic usually refers to a situation in which a. many people die from a disease. b. a disease receives greater publicity. c. the mortality rate of a disease increases. d. the incidence rate of a disease has increased rapidly.

43. Wilbur has had a stroke and is now undergoing treatment by exercising and receiving electrical stimulation to his severely weakened muscles. The professional performing this treatment is most likely a a. physical therapist. b. licensed practical nurse. c. doctor. d. medical anthropologist.

10

a (20)

d (20-21)

b (21)

44. Cultural differences in illness patterns have been reflected by a. higher prevalence of stomach cancer in Japan than in the USA. b. uniform cancer rates across the USA. c. the devaluation of the importance of good health in the USA. d. the universality of illnesses.

45. According to the textbook author, culture influences a. beliefs regarding the causes of health and illness. b. accepted practices for curing illness. c. norms or expectations on what to do when one is ill. d. all of the above.

46. Religious beliefs and practices in the USA a. invariably lead to poorer health. b. may either promote healthful living, or deter it, depending on the religion. c. invariably promote good health. d. have declined with the rise of health psychology.

c

47. Which of the following is not necessarily a component of a useful theory?

(21-22) a. It relates previously seemingly unrelated information. b. It enables us to make predictions. c. It has been proven to be correct. d. It organizes known facts. d (22)

b (23)

a (23)

48. In a study of the effects of an anti-inflammatory drug on chronic jaw pain, one group receives an inactive substance in the form of a pill. This group receives a. the independent variable. b. the dependent variable. c. a control. d. a placebo.

49. The method of experimental design in which the subject and the experimenter are unaware of which group they are assigned is called the a. experimental control. b. double-blind procedure. c. nonexperimental method. d. quasi-experimental approach.

50. Which of the following illustrates a difference between experimental and non-experimental approaches to research? a. Only experimental methods can imply causation. b. In nonexperimental methods, the researcher manipulates an independent variable. c. Only experimental methods measure dependent variables

11

d. Nonexperimental methods test cause and effect relationships.

a (24)

b (24)

d (24)

51. Nonexperimental or correlational studies a. can generate predictive information. b. are not usually useful because they can't lead to causal inferences. c. are not usually done anymore. d. involve the manipulation of independent variables.

52. Researchers reported that there is a strong relationship between height and IQ: as height goes up, IQ goes up. They are reporting a. a negative correlation. b. a positive correlation c. a non-linear relationship. d. no correlation.

53. A student researcher writes in his report that his statistical analysis revealed a correlation coefficient of +2.13 between the two variables in his study.

His reported correlation coefficient a. indicates a negative correlation. b. indicates a positive correlation. c. is a significant result. d. is an error.

d

54. A _____ study would NOT be an example of a quasi-experimental study.

(24 - 26) a. retrospective b. prospective c. longitudinal d. correlational a (25)

c (26)

55. To study the effects of cigarette smoking on breast cancer, 500 healthy teenaged girls were recruited to participate in a study that tracked their smoking (or nonsmoking) behavior and cancer incidence for five decades. This is an example of a. a prospective study. b. an experiment. c. a retrospective study. d. a single-subject approach.

56. Suppose that a recent study found an increase in heart and lung disease among people aged 50-60. Further study revealed that, compared to people 20 years younger, these individuals tended to smoke more during their young adulthood, because they were not aware of the health effects of smoking at that time. This difference between individuals raised at different times is an example of a. the placebo effect

12

b. a cross-sectional approach c. a cohort effect d. a prospective study

c (27)

b (28)

d (29)

57. Dr. Martinez is conducting an in-depth study of a patient exposed to farm pesticides. Dr. Martinez is probably using a a. cross-sectional design. b. experimental design. c. single-subject design. d. twin study.

58. A reasonable assumption that can be made about monozygotic twins is a. they are likely to have many genetic differences. b. differences between them are environmentally determined. c. they will be reared in identical environments. d. they are always same sexed.

59. In deciding which research methods to use, a researcher might keep in mind that a. it is never appropriate to use experimental and nonexperimental methods in the same study. b. nonexperimental methods can still support causal explanations. c. nonexperimental methods are rarely helpful in science. d. experimental and nonexperimental methods can be effectively combined in the same study.

13

Short Answer Questions 1. Provide a brief summary of Antonovsky's illness-wellness continuum. How does it differ from traditional definitions of health?

2. Review the two primary perspectives of the mind-body problem. How is the debate relevant to a discussion of health and illness?

3. Your job is to work with pediatric cancer patients. What developmental factors must you keep in mind as you proceed with your work?

Essay Questions 1. Ten-year-old Juan has been diagnosed with diabetes. Describe his likely experience living with the disease from a biopsychosocial perspective.

2. Compare and contrast the disciplines of psychosomatic medicine, behavioral medicine, and health psychology.

3. You are interested in testing the effectiveness of a newly developed treatment for back pain. Outline your approach to your research project.

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Chapter 2 TEST QUESTIONS True or False F

1.

The transmission of messages through the axon ordinarily follow the order from axon, to cell body, to dendrite.

2.

Damage to the myelin sheath tends to produce little noticeable effect in motor functioning.

3.

The thalamus is known as the chief relay station in the brain because it directs sensory information to various parts of the brain and motor information to the skeletal muscles.

4.

Insufficient production of insulin results in diabetes mellitus.

5.

In the digestive system, enzymes are active only in the small intestine.

(32)

F (33)

T (35)

T (42)

F

(42 - 44)

F

6.

The basal metabolic rate is the number of calories burned when our bodies are at rest and is higher in males than females.

7.

The chemical processes in metabolism require oxygen.

8.

Blood pressure is a phenomenon that results from the fact that the circulatory system is a closed system.

(46)

T (47)

T (53)

T

9.

Organ transplants fail because the immune system identifies the transplanted tissue as an antigen.

(54)

F

10.

The thalamus is the maturation site for white blood (T) cells.

(58)

37

Matching Match one of the following with descriptions given in questions one to five. a. frontal lobe b. temporal lobe c. parietal lobe d. occipital lobe e. thalamus e (35)

1. Serves as the chief relay station for sensory messages coming in and for motor commands out to the skeletal muscles

b

2. Involved in hearing and memory

(35)

a

3. Contains the motor cortex

(34)

d

4. The primary visual cortex

(35)

c

5. Involved in body sensations such as of pain, cold, heat, and touch

(35)

Match one of the following with the descriptions given in questions six to ten. a. killer T cells b. memory T cells c. delayed-hypersensitivity T cells d. helper T cells e. suppressor T cells e

6. Operate to slow down or stop immunity processes.

(58)

a (57)

d

7. Directly attack cancerous cells, transplanted tissue and cells invaded by antigens.

(58)

8. Report invasions and stimulate lymphocyte production in the spleen and lymph nodes.

c

9. Produce lymphokines, which stimulates other T-cells to grow.

(57)

b (57)

10. The fact that one usually has mumps only once in life is the result of these cells.

38

Multiple Choice d (32)

a (32)

c (32)

b (33)

d (33)

b (33)

1. Which of the following is NOT a part of a neuron? a. axon b. dendrite c. synaptic knob d. septum 2. Specialized nerve cells called _____ are responsible for communication in the nervous system. a. neurons b. glial cells c. transmitter cells d. C cells 3. Chemical messengers called neurotransmitters a. transmit messages along the axon. b. may inhibit, but not excite a neuron. c. may either inhibit or excite a neuron. d. are found only in the dendrite.

4. The neurological disease called multiple sclerosis a. results from the deterioration of the myelin sheath. b. produces a lack of motor coordination. c. is caused by neural tangles. d. both a and b 5. Which of the following occurs to the brain as we age? a. New neurons continue to form. b. Glial cells increase in number. c. Myelination increases. d. both b and c 6. Chronic poor nutrition early in life does which of the following? a. It has little to no long lasting effects on motor and intellectual performance. b. It results in impaired development of myelin, glial cells, and dendrites. c. It affects adult brain deterioration but not childhood motor and mental functioning. d. It affects only motor functioning in young children.

39

c (34)

d (35)

c (36)

d (36)

b (37)

c (38)

7. Which of the statements below accurately describes the roles of the right and left hemispheres of the brain in most people? a. They perform essentially the same functions. b. The left hemisphere controls vision and the right hemisphere controls body balance. c. The left hemisphere controls language whereas the right controls emotions. d. In adults the functions of each hemisphere are interchangeable.

8. Following a sharp blow to the back of her head, Shelley developed partial blindness. Which part of her brain was most likely injured? a. cerebellum b. frontal lobe c. parietal lobe d. occipital lobe 9. Marty's neurologist suspects his obesity might be due to damage in his brain. Which structure does he suspect is damaged? a. parietal lobe b. thalamus c. hypothalamus d. brain stem 10. Michael J. Fox and Mohammed Ali are two famous persons with Parkinson's disease. They very likely experience _____ due to damage to their _____. a. seizures; reticular system b. trouble breathing; medulla c. ataxia; cerebellum d. tremors; midbrain 11. Alice, a childhood victim of polio, requires an artificial breathing device due to damage to her _____. a. pons b. medulla c. hypothalamus d. midbrain 12. Results of studies on biofeedback treatment for paralysis due to stroke indicate a. psychotherapy is a more effective intervention than biofeedback. b. biofeedback works only if conducted daily. c. as few as two biofeedback sessions per week improved muscle function in a 6 week trial. d. surgery combined with biofeedback is necessary for successful treatment.

40

b (38)

c (40)

d (40)

a (41)

c (41)

a (42)

13. Teddy is afraid of needles and injections. Whenever the nurse attempts to give him an injection, he screams and flails his arms and legs wildly. His heart rate increases, and he begins to sweat profusely, which indicates activation of the a. cerebral cortex. b. sympathetic nervous system. c. parasympathetic nervous system. d. pituitary gland.

14. The endocrine system is to _____ communication as the nervous system is to _____ communication. a. chemical; mechanical b. cellular; systemic c. chemical; electrochemical d. local; global 15. The "master gland" of the endocrine system, the pituitary gland: a. controls the secretion of other glands. b. releases hormones into the blood. c. releases ACTH, which affects emergency reactions. d. all of the above 16. Which pituitary hormone is released during an emergency? a. ACTH (adrenocorticotropic hormone) b. cortisol c. epinephrine d. norepinephrine 17. When you leap out of the path of a speeding car, the adrenal hormone _________ is released, causing an increase in respiration and heart rate. a. insulin b. ACTH c. epinephrine d. thyroxine 18. Dwarfism and intellectual deficiency are often the result of a. hypothyroidism. b. high levels of cortisol in the blood. c. a diseased pancreas. d. excessive secretion of adrenal hormones.

41

b (42)

d (42)

c (43)

c (44)

d (44)

d (44)

19. A co-worker has recently behaved in a restless and irritable manner and seems confused. A possible physical cause for such behavior is a. a diseased thymus gland. b. excessive thyroid secretion. c. too little thyroid secretion. d. none of the above 20. The actual digestive process begins in the a. liver. b. esophagus with the secretion of certain enzymes. c. duodenum. d. mouth.

21. Research on sex differences in the organ systems and glands indicates that a. differences between males and females are learned and not physiological. b. females do not exhibit the symptoms of Grave's disease. c. males actually secrete more hormones under stress than females do. d. there are no statistically significant differences in these systems.

22. The major gastric juices produced in the stomach are a. pepto and bismol. b. hydrochloric acid and peristalase. c. hydrochloric acid and pepsin. d. insulin and bile.

23. In the small intestine, which does NOT occur? a. The food mixture becomes alkaline. b. Enzymes are received from the pancreas. c. Most ingested materials the body uses are absorbed into the bloodstream. d. Storage of feces takes place.

24. Most of the ingested substances our bodies use are absorbed into the bloodstream through the lining of the a. colon. b. stomach. c. esophagus. d. small intestine.

42

a (45)

a (45)

b (45)

d (46)

d (46)

d (46)

d (47)

25. Which of the following is not typically a disease of the liver? a. ulcers b. cirrhosis c. hepatitis d. anemia 26. Which of the following diseases of the liver is not transmitted by sexual contact? a. hepatitis A b. hepatitis B c. hepatitis C d. All the above diseases are transmitted by sexual contact.

27. Serum hepatitis, or hepatitis B, is often transmitted through a. stress or poor diet. b. transfusion of infected blood or using contaminated needles. c. handling or eating contaminated food. d. kissing and fondling.

28. The basal metabolic rate is a. not affected by the size of the body. b. exactly the same regardless of gender. c. constant across the life span. d. none of the above 29. Lower basal metabolic rates are associated with a. males more than females. b. those who live in cold climates. c. individuals under stress. d. increasing age.

30. Bearing in mind the factors that affect metabolism, the best advice for an individual desiring to lose weight would be a. to eat more food so as to stimulate your digestive system and therefore increase your BMR. b. eat less. c. exercise more to raise metabolism above basal rate. d. both b and c.

31. The act of breathing (respiration) does which of the following? a. Supplies the body with oxygen. b. Supplies a necessary component for metabolism. c. Helps us get rid of a specific waste product. d. all of the above

43

a (47)

b (48)

b (48)

b (49)

c (50)

a (50)

c (51)

32. Select the correct sequence of the passage of air in the respiratory system. a. trachea, bronchial tubes, bronchioles, alveoli b. trachea, bronchial tubes, alveoli, broncioles c. trachea, bronchioles, bronchial tubes, alveoli d. bronchial tubes, trachea, broncioles, alveoli 33. Breathing rate is controlled by the a. lungs. b. medulla. c. bronchioles. d. hypothalamus.

34. Which bodily action(s) do not serve to protect the respiratory system? a. sneezing b. hiccuping c. coughing d. mucociliary escalation and swallowing 35. Which of the following is not a disease or disorder of the respiratory system? a. cystic fibrosis b. hypertension c. pneumoconiosis d. asthma 36. The oxygenation of blood takes place in the a. atriums b. ventricles c. lungs d. aorta 37. Which bodily organs cleanse the blood of impurities? a. kidneys and liver b. liver and gall bladder c. gall bladder and lungs d. right atrium and right ventricle 38. Taking into account the laws of fluid dynamics, which of the conditions below would not typically result in increased blood pressure? a. decreasing blood vessel elasticity b. thinner blood vessels c. thinner blood d. all of these would result in increased blood pressure

44

b (51)

b (51)

d (52)

b (52)

c (52)

a (53)

d (54)

39. Which of the following results in an immediate decrease in blood pressure? a. exercise b. standing up quickly c. cold weather d. emotional arousal 40. After a recent physical, your physician tells you that your blood pressure is 120/80. You are a. hypertensive. b. normotensive (normal). c. hypotensive. d. just nervous because you're at the doctor's office.

41. Which of the following is not a risk factor for hypertension? a. race b. gender c. age d. all of these are risk factors 42. Which of the following statements about red blood cells is not true? a. They are formed in the bone marrow. b. Their primary function is to fight infection. c. They are carriers of hemoglobin. d. They live for about 3 months.

43. Which of the following is true regarding leukocytes? a. They contain hemoglobin. b. They assist in the clotting process. c. Their primary function is to help fight infection. d. They are actually red blood cells damaged by anemia.

44. The most abundant lipid in the body is a material formed of glycerol and fatty acid called a. triglyceride. b. cholesterol. c. thrombosis. d. glycid.

45. John stepped on a nail a few days ago and has developed a bacterial infection that his immune system is fighting. The bacteria in his body that triggered an immune response are called a. allergens. b. enzymes. c. white blood cells. d. antigens.

45

c (54)

c (55)

d (56)

b (56)

a (56)

a (57)

d (58)

46. Which of the following are not antigens? a. viruses b. bacteria c. leukocytes d. protozoa 47. The "home base" organ for white blood cells is the a. lymph nodes. b. heart. c. spleen. d. thymus.

48. Macrophages and neutrophils are a. specialized T cells. b. involved in cell-mediated immunity. c. lymphocytes. d. involved in non-specific immunity.

49. Which of the following statements regarding AIDS is not true? a. It does not kill directly. b. Although millions of people have the disease worldwide, most of the deaths have occurred in the United States. c. It is caused by a virus. d. It affects T cells.

50. The key distinction between phagocytes and lymphocytes is a. phagocytes are involved in nonspecific immunity and lymphocytes in specific immunity. b. phagocytes are red blood cells. c. lymphocytes do not attack specific antigens. d. phagocytes cannot be replenished.

51. The "t" in T cells refers to their site of maturation, the ______. a. thymus b. thyroid c. tongue d. tonsils 52. One of your body's first lines of defense against infection is a. good hygiene. b. antiseptics. c. antibiotics. d. your skin.

46

d (58)

b (59)

c (59)

d (59)

53. Antibody-mediated immunity differs from cell-mediated immunity a. in no significant way. b. because of its use of T cells. c. because antibody-mediated immunity attacks antibodies within the body's cells. d. because antibody-mediated immunity attacks antigens in bodily fluids rather than infected body cells.

54. Evidence indicates that stress and illness are related because stress a. suppresses the respiratory system. b. suppresses the immune system. c. leads to increased damage to the hypothalamus. d. increases our basal metabolism rate which makes us age faster.

55. Kiecolt-Glaser and her colleagues found that killer T cell activity a. was unrelated to stress. b. was directly related to the presence of antigens. c. was low in highly stressed individuals. d. was higher in highly stressed individuals.

56. Studies have shown immunosuppression in which of the following conditions? a. Following stressful final exams. b. Immediately after the death of a spouse. c. Among women unsatisfied in their marriage. d. all of the above

47

Short Answer Questions 1. Compare and contrast the communication systems in the endocrine system versus the nervous system.

2. Discuss the issue of individual variability in internal systems between people. Provide evidence to support your answer.

3. Compare and contrast cell-mediated immunity and antibody-mediated immunity.

Essay Questions 1. Derek has just been bitten by a dog. Explain what is happening within two of the systems of his body as a result.

2. This chapter describes a number of diseases or disorders that can occur in the six systems reviewed. What linkages exist between the discussion in this chapter and the discussion of common definitions of health and illness in Chapter 1?

3. Leanne has high blood pressure. Discuss the mechanical, psychological, environmental, and demographic factors that may be an influence on her condition.

48

Chapater 3 TEST QUESTIONS True or False T

1.

Threat is the expectation of future harm.

2.

The assessment of our resources available for coping with an event is called primary appraisal.

3.

A cognitive appraisal is necessary in order for stress to occur.

4.

Albert Ellis believes that a person's irrational beliefs increase their stress.

5.

As a rule, life transitions are not stressful.

6.

The first stage of the General Adaptation Syndrome is the stage of resistance.

7.

Selye believed that the physiological pattern of response to different types of stress was the same.

8.

The three types of conflict are approach/approach, approach/avoidance and avoidance/avoidance.

9.

Children under five tend to grieve less over the loss of a parent than an adolescent.

10.

A near perfect positive correlation exists between social readjustment and illness.

(64)

F (64)

F (65)

T (65)

F (65)

F (67)

T (68)

T (73)

T (75)

F (81)

37

Matching.

Match the following people with the descriptions in one through five a. Walter Cannon b. Hans Selye c. Holmes and Rahe d. Marianne Frankenhaeuser e. Richard Lazarus b

1. Described the General Adaptation Syndrome to chronic stress.

(67)

d

2. Examined the effects of effort and distress on stress.

(69)

a

3. In 1929, described the body's reaction to emergencies.

(67)

e

4. Related stress to cognitive appraisal.

(63)

c

5. Related illness to social readjustment.

(79)

Match the following with the descriptions in questions six through ten. a. Polygraph b. Social Readjustment Scale c. Corticosteroids and catecholamines d. Daily Hassles scale e. Uplifts scale d

6. Measures day-to-day unpleasant or potentially harmful events.

(82)

a

7. An electronic/mechanical measure of physiological changes.

(78)

e (82)

8. Was developed in the belief that pleasant events might lessen the effects of hassles on health.

c

9. Indicates the results of stress as expressed by the adrenal glands.

(78)

b

10. Provide the relative weighting of the stressfulness of different life changes.

(80)

38

Multiple Choice b (62)

a (62)

b (62)

c (62)

c (63)

c (62)

d

1. Which of the following statements about stress is true? a. Stress is an uncommon experience. b. Stress may be only a mild condition. c. All individuals experience stress equally. d. Stress is always of short duration.

2. A stressor may be correctly defined as a. an event that is physically or psychologically challenging. b. a person under stress. c. a medication taken to relieve stress. d. none of the above 3. Marianne is preparing to give an oral report for her psychology class. Her stomach is tight and she perspires when she thinks about giving the report.

She describes these feelings as stress. This description focuses on stress as a. stimulus. b. response. c. transaction. d. chemical reaction.

4. A person's psychological and physiological response to a stressor is called a. a transaction. b. discrepant behavior. c. strain. d. avoidance 5. The process approach to stress includes what component in addition to stressors and strains? a. the environment only b. chronic living circumstances c. the relationship between the person and environment d. major life events 6. The continuous interactions and adjustments between a person and the environment are called a. stressors b. strains c. transactions d. appraisals

7. Which is not one of the four components of the definition of stress?

39

(63)

b (63)

b (63)

c (64)

a. person-environment transaction b. perception of a discrepancy c. biopsychosocial resources d. biological markers of stress 8. David complains that he has "too much to do and not enough time to do it."

His experience of stress represents the discrepancy between a. stressors and strains. b. demands and resources. c. heredity and environment. d. biological and psychological systems.

9. Alice is a highly skilled computer specialist but spends the majority of her time conducting minor systems checks. The resulting boredom she experiences is stressful because a. it creates an overutilization of available resources. b. it creates an underutilization of available resources. c. a lack of activity always creates stress. d. she will soon forget about her available resources.

10. Richard Lazarus' cognitive appraisal model of stress is important because of its emphasis on a. changing actual environmental stressors. b. identifying physiological effects of stress. c. the role of perception in stress. d. the role of praise in reducing stress.

a

11. As you drive to school, the radio informs you that there is a traffic accident (64) on an expressway near you. You determine that you will not be affected since you will exit well before any traffic jam will occur. The thought process in which you are engaging is called a. primary appraisal. b. secondary appraisal. c. final appraisal. d. a and c only

a

12. Assessing a potentially stressful event in comparison to previous personal situations is called a. primary appraisal. b. secondary appraisal. c. threat impact analysis. d. rational emotion.

(64)

c (64)

13. Manuel has been accepted to medical school, which he sees as a real opportunity to use his knowledge in biology and his skills with people. This 40

situation represents the concept of _____ in the cognitive appraisal process. a. threat b. harm-loss c. challenge d. transaction b (64)

d (64)

b (64)

c (65)

a (65)

b (65)

14. One example of a vicarious transaction that might cause stress would be a. fighting in a boxing match. b. watching a couple argue at a party. c. arguing with a bank teller over the balance of your checking account. d. failing a midterm exam.

15. Which of the following conclusions has been reached by studies of people’s empathizing with other individuals in stressful situations? a. People can experience stress vicariously. b. Empathic stress reactions depend on primary appraisal. c. Vicarious stress is unaffected by appraisal processes. d. Both a and b.

16. Ongoing assessment of available coping resources is called a. primary appraisal. b. secondary appraisal. c. cope-threat analysis. d. biofeedback.

17. Which of the following statements about cognitive appraisal and stress is NOT true? a. Primary and secondary appraisals are highly interrelated. b. Secondary appraisal doesn't always follow primary appraisal in time. c. Stress cannot be experienced unless cognitive appraisal occurs. d. Stress conditions often depend upon the outcome of our appraisals.

18. People with positive self-esteem may experience less stress because a. demands are perceived as challenges rather than threats. b. threatening situations are more highly motivating to these individuals. c. people with good self-esteem have slower physiological responses to stressful situations. d. they have an overly inflated sense of self-confidence.

19. When Paul's girlfriend breaks up with him he reacts by saying "I'll never be happy. No one will ever love me!" According to Albert Ellis, Paul's _____ beliefs are increasing his stress.

41

a. negative b. irrational c. transactional d. self-pitying a (66)

c (66)

d (66)

b (67)

d (67)

b (67)

20. Janelle is fired from her job. Which of the following characteristics of stressful situations, as described in the text, does her situation reflect? a. low desirability b. ambiguity c. difficult timing d. posttraumatic stress disorder 21. In his new job, Harold has been given very unclear guidelines about his responsibilities. The stress he feels is probably related to a. low controllability. b. secondary appraisal. c. situation ambiguity. d. social readjustment.

22. Kevin was one of the few survivors of Hurricane Katrina in his New Orleans neighborhood. Since the hurricane he has had difficulty sleeping, gets extremely anxious when hurricane warnings are issued and keeps reliving memories of his escape during Katrina. Kevin is likely to be suffering from a. a malfunctioning hypothalamus-pituitary adrenal axis. b. harm ambiguity. c. a disease of adaptation. d. posttraumatic stress disorder.

23. Walter Cannon's description of the body's reaction to emergencies has been called the a. parasympathetic response. b. fight-or-flight response. c. general adaptation syndrome. d. cognitive appraisal approach.

24. Walter Cannon proposed that the fight-or-flight response a. is related to epinephrine secretion. b. is preparatory in nature. c. may be harmful if prolonged. d. all of the above

25. The sympathetic nervous system and the endocrine system directly mediate a. only a few of our noticeable stress reactions. b. physiological reactions to stress.

42

c. cognitive stress reactions. d. primary but not secondary appraisals. a

26. The correct sequence of stages in the general adaptation syndrome is (67-68) a. alarm, resistance, exhaustion. b. resistance, alarm, exhaustion. c. alarm, exhaustion, resistance. d. exhaustion, resistance, alarm. a (67)

c (67)

b (68)

c (69)

a (69)

27. Which general adaptation syndrome stage is most like the fight-or-flight response? a. alarm b. secondary appraisal c. exhaustion d. adaptation 28. Selye called the series of physiological reactions the body makes under long-lasting stress (the) _____ syndrome. a. fight-or-flight b. secondary appraisal c. general adaptation d. alarm 29. Which of the following statements about the general adaptation syndrome is correct? a. It includes the role of psychosocial factors. b. It assumes that all stressors produce the same physiological reactions. c. It largely ignores biological responses to stress. d. It assumes that children do not go through the same stages as adults.

30. Mason's work with stressors and hormones showing the sensitivity of hormonal secretions to psychological influences is evidence against Selye's notion of a. the general adaptation syndrome. b. the alarm stage. c. the nonspecificity of the GAS. d. the resistance stage.

31. According to the research by Frankenhaeuser and her colleagues, increased catecholamine and cortial secretion is usually associated with experiences involving a. effort with distress. b. effort without distress.

43

c. distress without effort. d. neither effort or distress. b (69)

b (69)

b (69)

d (70)

a (70)

32. According to the research by Frankenhaeuser and her colleagues, increased catecholamine secretion only may be associated with experiences involving a. effort with distress. b. effort without distress. c. distress without effort. d. both effort and distress.

33. In their study of the relationship of achievement tests in elementary school to stress, Tennes and Kreye found that stress significantly increased for a. all children on test days. b. children with above average intelligence but not for those with low intelligence. c. children with low intelligence but not for those with above average intelligence. d. none of the children showed increased stress on test days.

34. Research on the influence of intelligence on the stress experienced by children taking achievement tests showed a. it has no effect. b. more intelligent children were more stressed than less intelligent children. c. less intelligent children were more stressed than more intelligent children. d. males were more stressed than females regardless of intelligence.

35. Research on children exposed to chronic noise levels at home showed that they had a. difficulty knowing which sounds to tune out. b. increased ability to discriminate between words. c. difficulty knowing which sounds to attend to. d. both a and c

36. Cohen and his colleagues concluded that children who live in noisy environments may a. develop generalized cognitive deficits. b. increase their ability to distinguish sounds. c. suffer physiologically but not cognitive deficits. d. learn to ignore relevant information.

44

d (70)

b (70)

d

37. What is one effect of epinephrine and norepinephrine on memory? a. They impair all types of memory. b. They enhance memories of neutral events. c. They interfere with memories of neutral events. d. They enhance memories of stressors.

38. Which statement regarding stress and cognition is NOT true? a. Cognitions can affect the experience of stress. b. Thinking about the stressful incident constantly reduces the stress. c. Stress can affect cognitions. d. Chronic stress can result from cognitive processes.

39. Two babies, one 2 months old and the other 19 months old, are stung by

(70-71) bees. The older baby's emotional response is likely to be _____ whereas the

younger baby is likely to show _____. a. distress; anger b. distress; distress c. anger; anger d. anger; distress b (71)

d (72)

c (73)

40. Negative social behaviors tend to increase when stress is accompanied by a. depression. b. anger. c. resistance. d. poor impulse control.

41. Frank just received a reprimand at work for sloppy performance whereas Nancy had a terrible argument with her best friend. Research supports which of the following statements regarding their likely stress levels? a. Frank is probably experiencing much more stress than Nancy. b. Nancy is probably experiencing much more stress than Frank. c. Neither is likely to experience stress. d. Frank and Nancy are likely to have similarly high stress levels.

42. A medieval knight met a dragon while he was crossing a bridge over a huge chasm. He perceived that his only options were to charge into battle with the deadly beast or leap from the bridge. He was experiencing a(n) a. approach-approach conflict. b. approach-avoidance conflict. c. avoidance-avoidance conflict. d. knightmare.

45

b.

(73)

b (73)

d (73)

d (74)

c (75)

d (75)

43. Krystal has learned that she has a carcinoma that is best treated by a radical surgery that involves removal of her right eye and cheekbone, which would be quite disfiguring. However, if she doesn't undergo surgery, her chances of survival are quite poor. Krystal is experiencing a. an approach/approach conflict. b. an approach/avoidance conflict. c. an avoidance/avoidance conflict. d. harm ambiguity.

44. Which of the following statements about "temperamentally difficult" children is NOT true? a. Only about 10% of children are classified as "temperamentally difficult." b. They show predictable sleep patterns. c. They resist new foods. d. They react negatively to new people.

45. The Davises are getting a divorce. Which of the following is the best strategy for helping their children cope with the situation? a. Move to a new area so the children can "start over." b. Tell the children every detail of the situation no matter how painful to them. c. Keep the impending divorce from the children for as long as possible. d. Make sure the children have regular contact with both parents.

46. The stress experienced by a family when an adult is ill a. may result from a strain on finances. b. diminishes with recovery. c. may restrict the family's time. d. all of the above.

47. Which of the following statements about a child's grief at the loss of a loved one is true? a. Adolescents seem to grieve the least. b. All age levels of children seem to grieve with equal intensity. c. Children under age 5 seem to grieve the least. d. A child's concept of death remains the same from age 4 to 8.

48. Which of the following statements regarding bereavement is true? a. Young children grieve longer and more intensely than older children. b. Parents with more children grieve the loss of a child more than parents with a single child who can regain their pre-parenting freedoms. c. Older couples grieve spousal loss more than younger couples because they have lived with each other longer. d. None of these statements is supported by the research in the text.

46

b (75)

a (75)

d (77)

c (77)

b (78)

b (78)

c

49. According to the research cited in the text, the loss of one’s spouse would be most stressful for which of the following age groups? a. An adult at any age. b. People approaching or in early adulthood. c. People in mid-life. d. People in old age.

50. Research has found that excessive workloads are associated with a. increased accidents and health problems. b. high unemployment and absenteeism. c. greater cognitive appraisal. d. happier marriages.

51. Research has found that retirement is associated with a. loss of identity. b. higher spousal stress. c. expectations of freedom and leisure d. all of the above 52. The effects of local environmental hazards such as Three Mile Island have a. little effect on stress levels of local residents. b. created greater stress in those who hear about the event than in those who actually experience it. c. lasting, long-term negative effects on those who experience it. d. intense short-term but no long-term negative effects on local residents.

53. You are a researcher and need to include a physiological measure of stress in your next experiment. Which of the following could you use? a. an SRRS b. polygraph c. the GAS scale d. the Daily Hassles scale

54. Advantages of measuring physiological arousal to assess stress include all of the following except a. reliable measures. b. low cost. c. objective measures. d. easily quantifiable measures.

55. According to the findings on life events and age by Goldberg and Comstock, 47

(80)

which of the following people would have been likely to report the fewest stressful life events in the year prior to the study? a. Ann, a single person in her 20s b. Bob, recently divorced in his 40s c. Wayne, a married person in his 60s d. all of the above were likely to have a very small number of stressful life events

d

56. Subjects' scores on the SRRS and illness do not correlate very highly. The best explanation for this finding is a. stress and illness actually are unrelated. b. some of the questions on the SRRS are vaguely worded. c. illness may occur for many reasons other than stress. d. both b and c

(81)

d (82)

b (82)

c (82)

b

57. The most frequent daily hassles found by Lazarus and his coworkers included all of the following except a. rising prices. b. home maintenance. c. too many things to do. d. getting a task completed.

58. Research on the relationship of hassles and uplifts to health has shown a. no real relationship of either factor to health. b. some relationship of hassles to health. c. some relationship of uplifts to health. d. uplifts help protect from the effects of hassles.

59. The best way of summarizing the relationship of stress to health is a. stress and health are consistently and strongly related b. stress and health are unrelated. c. stress and health are consistently and moderately related. d. stress is the primary component in the development of illness.

60. Taking into account only the relationship between stress and performance, (84) on which test are you most likely to perform the best? a. A practice exam which has no bearing on your grade. b. A mid-term which counts 25% of your grade. c. A final exam which is 100% of your grade. d. Stress and performance have been proven to be unrelated.

48

Short Answer Questions 1. Discuss the relationship between primary and secondary appraisal.

2. Compare and contrast Cannon's fight-or-flight response with Selye's general adaptation syndrome.

3. Using concepts from the text to answer this question, what stress factors might be affecting your performance on this exam?

Essay Questions 1. Angelina and Warren, college juniors in their early 20s, unexpectedly find that they are about to become parents for the first time. Angelina is ecstatic about the situation whereas Warren is pretty distressed. Using the cognitive appraisal approach, describe some of the factors that might be contributing to their varying experiences.

2. Michael has started a new job and is experiencing a great deal of stress. What are some of the situational and personal factors that might be affecting him physically, psychologically, and emotionally?

3. Consider that you are a consultant to a stress researcher. She is beginning a new study and wants to incorporate some measures of stress. What advice would you give her?

49

Chapter 4 TEST QUESTIONS True or False F

1.

Informational support includes direct assistance such as when people lend money.

2.

If individuals believe that they are capable of coping with an illness, their recovery is not statistically affected by the addition of social support.

3.

Cognitive control strategies involve taking concrete actions to reduce the impact of a stressor.

(89)

T (92)

F (94)

T

4.

Pessimists are likely to adopt a set of internal-stable-global attributions (96) to explain negative life events.

F

5.

At the present time, all the research evidence indicates that hardiness is linked to good health.

6.

The Structured Interview for assessing Type A behavior is widely used because of its ease of administration and low cost.

7.

Release of hormones such as the catecholamines and corticosteroids appear related to atherosclerosis as well as diminished immune system functioning.

8.

Essential or primary hypertension is the result of a disorder in a body system such as the kidneys.

9.

Obesity, alcohol use, low levels of physical activity and a positive family history of hypertension are all related to the development of hypertension.

10.

Current research suggests there is little connection between moderate (114) stress and later development of cancer.

(99)

F (100)

T (104)

F (111)

T (112)

T

37

Matching Match the concept with the characteristics listed in questions one to five. a. Type A behavior b. hardiness c. resilience d. stamina e. internal locus of control b (98)

d (99)

a (100)

c

1. The belief that one can influence events in their lives and have a sense of purpose or involvement in the events of their lives.

2. In old age, has been characterized as "a triumphant positive outlook during periods of adversity".

3. A behavior pattern marked by a sense of time urgency, hostility and selfcritical competitiveness.

(98)

4. Children with these characteristics are able to resist the adversities of life and grow up well-adjusted even in extreme conditions.

e

5. Marked by believing one is responsible for successes and failures.

(94)

Match the disorder with the characteristics in questions six through ten a. atherosclerosis b. cardiac arrhythmia c. migraine d. essential hypertension e. leukemia c (110)

6. Results from the constriction and dilation of blood vessels, and may be preceded by an aura.

d

7. Medically defined as blood pressure exceeding 140/90.

(111)

b

8. Heart flutters or fibrillation.

(105)

a (104)

9. May result in a "heart attack" due to the narrowing of the coronary arteries by fatty plaques.

e

10. A type of cancer in which white blood cells proliferate rapidly.

(114)

38

Multiple Choice b (88)

1. The perceived comfort and caring a person receives from other people or groups is referred to as a. eustress. b. social support. c. social network. d. self-esteem.

c

2. Which of the following is NOT one of the four basic types of social support?

(88-89) a. emotional b. informational c. attitudinal d. tangible a (89)

a (89)

d (89)

d (89)

3. When Joe's teacher unexpectedly required him to take on an extra project for a class that requires him to do additional work in the library at nights, his family agreed to provide child care for his 6-year-old. In doing so, they were offering a. tangible or instrumental support. b. attitudinal support. c. esteem support. d. informational support.

4. Janet was recently diagnosed as having leukemia. Research indicates that she might be in particular need of a. emotional and esteem support. b. cognitive expressive support. c. esteem support. d. esteem and informational support.

5. Cutrona's study of college students indicated that the LEAST frequently offered type of support was a. emotional. b. informational. c. esteem. d. tangible.

6. Which of the following is NOT a frequently suggested factor in whether people receive social support? a. their own assertiveness b. a need for independence c. discomfort in confiding in others d. educational background

39

d (89)

d (90)

d (90)

c (91)

b (92)

a (92)

b

7. Which of the following are factors that influence providing support? a. having appropriate resources or skills to help b. having too much stress of one’s own to deal with c. insensitivity to the needs of others d. all of the above 8. Which of the following statements about receiving support is true? a. Women receive more support from their spouses than men do. b. Black Americans have the largest social networks of any sociocultural groups. c. The composition of social networks does not vary much across sociocultural groups. d. In minority groups, men's networks are larger than are women's.

9. Which group tends to focus on extended families as their social network? a. European American women b. African American men c. Asians d. Hispanics

10. The best way of expressing the relationship between social support and mortality rate is that a. they have no relationship. b. social support increases mortality rate. c. high social support is correlated with a lower mortality rate. d. social support definitely causes lower mortality.

11. Deanna is convinced that she can cope on her own with the emotional demands of her illness. What is true about the value for social support for Deanna? a. She would benefit most from the support of her spouse. b. She is unlikely to benefit from social support. c. She would benefit most from the support of hospital staff. d. She would benefit most from the support of female friends.

12. Cynthia believes that, while having a good social support network helps her a great deal in times of stress, it really doesn't affect her well-being during other less stressful times of her life. She seems to be endorsing the _____ hypothesis regarding social support and health. a. buffering b. direct effects c. stress reduction d. tangible 13. According to the buffering hypothesis, the protective effect of social support 40

(92)

occurs a. in low stress situations. b. in high stress situations. c. in moderate stress situations. d. without regard for level of stress.

c (92)

d (93)

c (93)

a (93)

b (94)

b (94)

14. The notion that social support is beneficial to health regardless of the level stress experienced is called the _____ hypothesis. a. buffering b. social network c. direct effects d. social support 15. For social support to reduce stress most effectively, which of the following conditions needs to be met? a. We need to notice that it is being given. b. We need to perceive that it is supportive. c. It needs to match the demands of the situation. d. All of the above.

16. According to recent research, which of the following statements is true regarding the relationship between marriage and health? a. Being married definitely carries health benefits. b. Being divorced or single increases the likelihood of heart disease due to loneliness. c. Being married, in and of itself, does not produce a health benefit. d. Being married actually produces higher levels of stress and therefore is less beneficial to one's health.

17. When are social ties detrimental to our health? a. When other people interfere with our efforts to engage in healthful activities. b. When others encourage our own healthy behaviors. c. When others engage in healthy behaviors themselves. d. When our social network overprotects us.

18. Throughout her pregnancy, Karla has taken natural childbirth classes where she has learned breathing techniques to use during labor. She has engaged in _____ control. a. cognitive b. behavioral c. informational d. decisional 19. Al-omari deals with the stress of his daily painful skin medical treatments, by imagining himself walking across campus again with his friends, 41

laughing and joking with them. Al-omari is using which type of control? a. decisional b. cognitive c. behavioral d. informational c (94)

b (94)

d (94)

d (95)

c (94)

d (95)

20. The type of personal control which leads to the most consistently beneficial effect on reducing stress is _____ control. a. social support b. behavioral c. cognitive d. emotional 21. Which of the following attributions concerning one's failure on an exam is representative of internal locus of control? a. "The teacher hates me." b. ''I didn't study enough.'' c. " I guess it just wasn't my lucky day." d. ''Those exam questions were just too difficult.''

22. Which of the following is necessary to develop high levels of self-efficacy? a. A high level of internal control. b. A belief that a behavior will be effective. c. Believing that one has the skills and resources available to perform the behavior well. d. Both b and c are necessary.

23. Across the life span, our sense of personal control a. changes as we age. b. is affected by the process of social learning. c. becomes more external as we reach older age. d. all of the above 24. Pennebaker’s research on the impact of disclosure has found that having people talk or write about negative events a. increases stress significantly. b. is more effective than relaxation in reducing stress. c. has a modest but positive effect on reducing stress. d. has no effect on stress reduction.

25. Which of the following statements about personal control is true? a. Locus of control has relatively little impact on rehabilitative behaviors. b. Boys and girls tend to have the same levels of external locus of control.

42

c. Minority and economic status are not related to locus of control. d. Limited access to power and financial advancement is linked to an external locus of control. a (95)

d (96)

a (96)

c (97)

c (98)

b (98)

26. According to Seligman, learned helplessness is a principal characteristic of a. depression. b. anxiety. c. schizophrenia. d. internal locus of control.

27. Which combination of attribution types is most likely to result in an individual becoming depressed, feeling helpless, and losing self-esteem? a. external, unstable, specific b. external stable, specific c. internal, unstable, global d. internal, stable, global 28. Pessimistic people who believe that they have little personal control a. have more illnesses. b. have better health habits c. are more likely to seek a doctor's care for treatment of hypertension. d. do a good job in controlling their own stress.

29. Suppose for a moment that "George" was one of the older adults in the Langer & Rodin (1976) study on nursing homes and was assigned to the experimental group (i.e., he had a plant he cared for). On the basis of the research findings, a year and a half later, he was more likely to be _____ than control condition participants. a. deceased. b. a member of the gardening team. c. alive and healthier than control condition participants. d. alive but no healthier than control condition participants.

30. Kobasa and Maddi proposed that hardiness includes the three characteristics of a. coherence, commitment, and resilience. b. control, coherence, and commitment. c. control, commitment, and challenge. d. love, honor, and truth.

31. Children who thrive in spite of terrible conditions are said to have a. depression. b. resilience. c. sociability. d. tolerance for ambiguity.

43

d (99)

d (99)

a (100)

c (100)

d (100)

c (100)

d (100)

32. Research has revealed that the concept of hardiness a. has received consistent research support. b. has received inconsistent support. c. is assessed with tests that may actually measure negative affect. d. both b and c 33. Harold is competitive, self-critical, easily angered, and very impatient.

He could be described as having a(n) a. external locus of control. b. hardy personality. c. internal locus of control. d. Type A behavior pattern.

34. A trained interviewer who intentionally annoys and interrupts her clients is probably looking for signs of a. Type A behavior. b. coherence. c. internal locus of control. d. external locus of control.

35. The Jenkins Activity Survey is a self-report instrument used to measure a. resilience in children. b. locus of control. c. Type A behavior. d. self-efficacy.

36. Evidence on the relationship of stress to Type A behavior suggests that a. Type A people interpret stressors as threats to personal control. b. Type A people experience stress quickly and strongly. c. Type A people show greater reactivity to stressors compared to Type B individuals. d. all of the above 37. The physiological portion of the response to stress is called a. hypertension. b. hardiness. c. reactivity. d. resilience.

38. Which of the following statements best reflects the findings from studies of reactivity during stress? a. The Type A reactivity pattern does not appear until the adult years. b. There is no correlation between reactivity and income or education level. c. There are no reactivity differences between Type A and Type B people. d. Reactivity differences between Type A and Type B participants depend 44

on gender. c (101)

d (101)

d (101)

b (102)

c (103)

39. The decline researchers have found in Type A behaviors in old age is most likely due to a. Type A people learning more Type B behaviors as they age. b. social disapproval for this behavior pattern and thus change due to social pressures to do so. c. the earlier ages of death for Type A individuals. d. all of the above 40. Which statement best expresses the findings on the relationship between Type A behavior and health? a. No relationship has emerged in the best research. b. There is a strong link between Type A behavior and all kinds of illness. c. Only a few studies have been done so its best to conclude that there is no evidence available. d. There is a link between Type A behavior, as it is measured by the Structured Interview, and coronary heart disease.

41. Which of the following factors is related to the development of Type A behavior pattern? a. early temperament b. noncompetitive situations c. genetics d. both a and c 42. Which of the following has been described as the "deadly emotion" for Type A people? a. competitiveness b. hostility c. jealousy d. impatience

43. In the study where subjects with high and low stress received nasal drops containing the common cold virus, results indicated a. no consistent relationship between catching a cold and stress level. b. both groups were likely to develop a cold. c. subjects in the high stress group were much more likely to catch a cold than those in the low stress group. d. placebos were able to produce cold symptoms.

45

b (103)

d (104)

c (105)

44. Regarding the relationship between stress and illness, the _____ is to body physiology as _____ is to individual behavior. a. indirect route; direct route b. direct route; indirect route c. direct route; direct route d. indirect route; indirect route 45. The link between stress and cardiovascular disease may be the result of the greater _____ when people are under chronic, severe stress. a. wear and tear on body systems b. concentrations of activated platelets in the blood c. progression of atherosclerosis. d. all of the above 46. Sudden death (voodoo death) usually involves a. a history of malnutrition. b. intense religious beliefs. c. cardiac failure with an underlying cardiovascular disorder. d. the presence of an extreme stressor regardless of the person's cardiac health.

d

47. Which of the following statements reflects how stress affects the immune (106) system? a. Stress has no influence on the immune system. b. Increased cortisol and epinephrine actually improve T cell functioning. c. Because of the presence of cortisol, T cells confuse mutant cancer cells with healthy cells and ignore them. d. High levels of stress reduce the production of the enzymes that repair damaged DNA.

c

48. Positive emotions have been found to ____ immune function whereas negative emotions have been found to ____ immune function. a. improve; improve b. reduce; reduce c. improve; reduce d. reduce; improve

(106)

a (108)

d

49. In studies investigating the impact of optimism on immune function, findings indicate that: a. the influence of optimism depends on whether the stressor is short-term or chronic. b. optimism always increases immune function. c. optimism is not related to immune function. d. none of the above were found.

50. Research findings that immune function can be conditioned suggests that: 46

(108)

b (109)

d (110)

b (110)

a (111)

d (110)

c (112)

a. immune function can be impaired via conditioning. b. immune function can be boosted via conditioning. c. conditioning affects immune functioning only for chronic stressors. d. both a and b.

51. When investigators filtered house dust into asthmatic children's hospital rooms they discovered that a. it triggered asthmatic attacks in almost all of the children. b. none of the children had asthmatic attacks. c. many children had asthmatic attacks but most didn't. d. the children weren't allergic to house dust after all.

52. Which statement best describes the relationship between stress and headache? a. All headaches have been found to be stress-related. b. All headaches are caused by some organic problem. c. Intense stress will always produce headaches. d. Stress is only one factor in headaches.

53. Research on the relationship between stress and psychophysiological disorders has found a. a definite and strong causal relationship for most disorders. b. that the nature of the relationship is unclear. c. that stress has no relationship with these disorders. d. that these disorders are caused solely by organic dysfunction.

54. When people receive a diagnosis of essential or primary hypertension it means that a. the mechanisms that cause their hypertension are unknown. b. their hypertension is caused by disorders in essential body systems. c. there are identifiable biomedical causes for their disease. d. they have heart disease.

55. Cases of high blood pressure that are caused by disorders of other body systems are called a. hypertensive defects. b. primary hypertension. c. atherosclerosis. d. secondary hypertension.

56. Studies comparing individuals from crowded versus uncrowded neighborhoods found a. no real differences in hypertension levels.

47

b. no similarity to findings from animal studies on crowding. c. residents from crowded neighborhoods had higher heart rate and blood pressure increases during stressful tasks than did residents from uncrowded neighborhoods. d. residents from uncrowded neighborhoods had higher heart rate and blood pressure increases during stressful tasks than did residents from crowded neighborhoods. c (112)

d (113)

b (114)

57. Fredrikson & Matthews (1990) found some trends in their metaanalysis of studies on reactivity and hypertension. Which of the following was among their findings? a. Gender is not related to reactivity. b. Ethnicity is not related to reactivity but is related to hypertension. c. Patients with mild hypertension respond differently to psychological stressors than patients with severe hypertension. d. Regardless of hypertension severity, reactivity has its strongest relationship with passive psychological stressors.

58. Which of the following findings support the idea that CHD is a “disease of modernized societies”? a. People live longer in advanced societies and thus have a higher likelihood of developing CHD. b. People in advanced societies probably have higher levels of the risk factors for CHD. c. People in advanced societies probably have less social support networks than do people in less advanced societies. d. all of the above

59. The significance of the observation that dozens of disease forms share the basic characteristic of unrestrained cell growth which we refer to as cancer is that a. stress can't possibly be related to all these diseases. b. the search for causes of these diseases is difficult. c. the medical community has a hard time communicating due to a lack of common terminology. d. all of the above

d 60. Research on cancer and high levels of stress leads to which of the following conclusions?

48

(115)

a. There is a clear link between stress and the later development of cancer. b. Retrospective studies are the best methods for investigating the link between stress and cancer. c. Stress reduction interventions have little effect on cancer patients. d. Stress is most likely linked to cancer because of its effect on the immune system.

Short Answer Questions 1. Your Aunt Yvonne has to give a presentation to her boss and is very nervous about doing so. In what ways might you give her social support that could help to reduce her stress?

2. Compare and contrast the buffering and direct effects hypotheses.

3. Discuss the sub-scales of the Multidimensional Health Locus of Control scale from the standpoint of internal/external LOC.

Essay Questions 1. This chapter focuses on a variety of personal characteristics that contribute to the experience of health. If you were a parent, which characteristics would you seek to develop in your children and why? In what ways would you foster this development?

2. Your friend has just been told that he has Type A behavior pattern. Help him understand the concept and the various factors that contribute to its development and maintenance.

3. If you were asked to arrive at a general conclusion regarding the relationship between stress and illness, what would it be? Support your answer with evidence.

49

Chapter 5 TEST QUESTIONS True or False F

1. According to Richard Lazarus, emotion-focused coping is aimed at controlling stress by either reducing demands of the situation or expanding resources to deal with it.

(119)

F

2.

(120)

T

3.

To date, efforts to develop a reliable and valid research instrument to measure coping have not been very successful.

(121)

T

4. Mr. Goode is a well-known accountant in town who makes a large salary and is president of the Chamber of Commerce. We might expect his social network to contain many non-kin members.

(124)

F

5. The Amish provide bereaved community members with intense social support for one month only and then have firm expectations that the person is to handle this stressor on his or her own.

(126)

F

6.

Time management techniques are rarely part of a stress management program.

7.

Research has indicated that progressive muscle relaxation is effective with children or adolescents.

8.

Biofeedback has been demonstrated to be more cost-effective and useful than relaxation training alone.

9.

Cognitive therapy might be best characterized as a type of modeling or observational learning technique.

10.

Children between the ages of 7 to 14 are more suggestible to hypnosis (136) than adults.

(126)

T (129)

F (131)

F (133)

T

Marla has just been told she has a serious disease, but tells her best friend that the doctor must be mistaken. She is using the defense strategy known as intellectualization.

37

Matching Match the methods of coping listed with their description in numbers one to five. a. progressive relaxation b. denial c. cognitive restructuring d. time management e. informational control c

I. “This situation is unpleasant, but maybe some good will come of it.”

(133)

d

2. Includes setting goals and making lists in order to control stress.

(126)

a

3. Involves tensing specific muscle groups.

(129)

(128)

4. “The doctor told me that I’ll feel some unusual pressure in my back during this procedure. I’ve got to remember that.”

b

5. “I can’t possibly have cancer!! Your test must be inaccurate!”

e

(120)

Match the following techniques with their descriptions in six through ten. a. systematic desensitization b. biofeedback c. modeling d. cognitive therapy e. stress-inoculation training b

6. Questioned due to the cost and complications of the equipment necessary (131) as compared to benefits received.

e (135)

7. Designed by Meichenbaum, this program involves steps of conceptualization, skills acquisition and application.

a

8. Involves the use of progressive muscle relaxation paired with a fear hierarchy.

(130)

c (133)

d

9. Little Ashley was afraid of clowns until she saw her older brother Joshua shake one's hand.

10. Based on the belief that our incorrect or maladaptive attitudes need to be (134) disputed.

38

Multiple Choice d (118)

b (118)

b (118)

d (118)

d (119)

b (119)

1. Which of the following persons is likely to experience stress? a. 5 year-old Amy b. 15 year-old Jason c. 40 year-old Leslie d. all of the above people 2. A perceived discrepancy between the demands of a situation and the resources of a person is involved in a. disease. b. stress. c. happiness. d. none of the above 3. Which of the following is true about the relationship between perceived discrepancy and the experience of stress? a. Although it was believed for some time that a positive relationship existed between the two, new research indicates that no relationship exists. b. Efforts at coping are done to reduce perceived discrepancies. c. When we are stressed, our ability to perceive discrepancies between demands and resources declines severely. d. Only actual discrepancies, not perceived discrepancies, are related to the experience of stress.

4. Which of the following is NOT true about the coping process? a. It may include avoiding a potentially stressful situation. b. It involves ongoing transactions with the environment. c. It is not a single event. d. It does not include avoidance behavior.

5. According to Lazarus, coping serves to a. alter the problem. b. regulate our emotional response to the problem. c. prevent stress completely. d. both a and b 6. Which of the following is NOT an example of behavioral coping? a. using alcohol b. denying unpleasant facts c. watching TV to distract attention from a problem d. seeking support from friends

39

b (119)

d (119)

b (119)

d (120)

d (120)

b (121)

7. Greg has immersed himself completely in his job since the death of his wife. He is likely to be engaging in a. problem-focused coping. b. emotion-focused coping. c. drug abuse. d. denial of her death.

8. Which of the following is NOT an emotion-focused coping approach? a. trying to see the positive side of a stressful situation b. taking one's anger out on another person c. getting busy with other things to keep one's mind off a problem d. trying to find out more about the stressful situation 9. Which of the following persons is engaging in cognitive redefinition? a. Ted lectures himself about not getting medical treatment sooner. b. Maggie tells herself that she is much better off than Alice because her own condition is not as serious. c. Carlos gets opinions from several specialists before deciding on a treatment. d. Daphne goes out with friends every night so she doesn't have to think about her upcoming surgery.

10. Which of the following statements is true about avoidance approaches? a. They are rarely used as coping strategies. b. They are beneficial at all stages in the coping process. c. In general, they are more effective than attention-promoting strategies. d. They are most beneficial during the first few weeks of a prolonged stress experience.

11. Problem-focused coping is LEAST likely to be used under which of the following situations? a. job loss b. final exams c. interpersonal conflicts d. death in the family 12. Can both problem-focused and emotion-focused coping be used together? a. Yes, they can but it’s generally unwise to do so. b. Yes, they can and this is frequently done. c. No. Problem-focused coping is always best to use. d. No. Emotion-focused coping is always best to use.

40

d (121)

a (122)

b (122)

13. Which of the following are problems with instruments thus far developed to measure overall coping? a. They expect coping to correlate well with mental or physical health. b. They are generally retrospective measures. c. They aren’t accurate measures of coping. d. all of the above 14. Positive emotions affect coping by a. helping us sustain our coping efforts. b. distracting us from our stress. c. reducing the effectiveness of our coping efforts. d. helping us find meaning to our suffering.

15. When a person copes with stress by actively processing and expressing their feelings, they are engaging in a. denial. b. emotional approach. c. problem-focused coping. d. stress inoculation.

d

16. Which of the following statements regarding the use of coping strategies is (122-123) true? a. People tend to use the same coping strategy regardless of the type of stressor they confront. b. There is no relationship between coping strategies and genetic influence. c. People never use the same strategy twice, even for the same stressor. d. No one coping method is used or is effective in all stressful situations. c (123)

b (123)

17. Compared to middle-aged adults, older adults tend to see stressors as a. easy to change. b. nothing to worry about. c. difficult to change. d. easily addressed by problem-focused coping strategies.

18. According to research men and women differ in their use of problemfocused v. emotion-focused coping EXCEPT when a. no young children live in the household. b. they are similar in occupation and education level. c. they are similar in age. d. they are similar in marital status.

41

d (123)

a (124)

d (125)

a (125)

c (125)

19. According to the text, disadvantaged persons are more likely to experience a. the belief that they have little control over events in their lives. b. more stressful events. c. less effective coping. d. all of the above 20. Which of the following statements about social networks is true? a. Women use their social support networks more effectively. b. The elderly are likely to have extensive social support networks. c. The nature of social support networks is not related to social prestige, income or education level. d. The use of social and helping organizations as support networks is no greater now than it was decades ago.

21. What do we know from research on self-help groups about their effectiveness? a. Groups that have been around the longest, like Alcohols Anonymous are the most effective. b. Only women benefit from being in such groups. c. Being in a self-help group only helps early in a stress crisis. d. Researchers really don’t have good data on which support groups work best.

22. According to the text, what role does a community have in enhancing social support? a. It can actively increase opportunities for social support by creating programs and making facilities available for group gatherings. b. Communities can do the most by leaving social support up to private and social service agencies. c. Most people seeking social support find community efforts to be ineffective. d. Most people seeking social support find community efforts to be intrusive.

23. Debbie has developed a "what's the use" attitude toward her efforts to stop smoking and has stopped participating in her treatment program. Which type of psychological support does she need most? a. relaxation exercises b. biofeedback training c. self-efficacy enhancement d. all of the above

42

d (125)

b (127)

b (127)

a (127)

b (128)

24. Allowing workers to have some control over their work hours, which tasks to work on, and the order in which they do them are examples of a. avoidance. b. intellectualization. c. stress-driven coping. d. enhancing personal control.

25. Which of the following is not a part of effective time management? a. Goal-setting. b. Delaying urgent new tasks until the next day. c. Establishing a schedule. d. Prioritizing the day's activities.

26. Which of the following is an accurate assessment of the research findings on the relationship between anxiety and exercise? a. There is no effect of exercise on anxiety. b. Exercise and decreased anxiety are correlated, but the cause of this relationship is not clear. c. Exercise seems to increase anxiety in some cases. d. Exercise has positive effects only in the young.

27. Which of the following is an accurate conclusion based on the research findings regarding the relationship between exercise and physiological measures? a. Regular exercise lowers heart rate and blood pressure. b. Exercise lowers heart rates but not blood pressure. c. Stress has the same health impact on people regardless of fitness level. d. Sports exercise promotes the greatest reduction in heart rate.

28. Irving Janis suggested that preoperative fear is related to postoperative recovery and adjustment. What was the nature of the relationship he suggested? a. Low levels of preoperative fear are related to worsened recovery and adjustment. b. High levels of preoperative fear are related to worsened recovery and adjustment. c. Preoperative fear is related to poor recovery but only in children or the elderly. d. Preoperative fear affects postoperative adjustment but has little impact on recovery.

43

d (128)

c (128)

d (128)

a (128)

29. The most clearly effective methods in preparing people for the stress of surgery a. involve hypnosis. b. are psychotherapies. c. involve drug treatment. d. enhance feelings of control.

30. Using a deep breathing technique to control pain during an invasive procedure is an example of a. hypnosis. b. biofeedback. c. behavioral control. d. cognitive control.

31. Teresa, who has breast cancer, has read several books on treatment for breast cancer and has watched a video on mastectomy surgery. She is exercising a. hopelessness. b. behavioral control. c. cognitive control. d. informational control.

32. Which statement regarding informational control of anxiety is NOT true? a. More information always reduces anxiety. b. You can "know too much,'' and actually increase anxiety. c. Informational control has limits when the patient is a child. d. both b & c

c

33. When it comes to providing young children with information prior to a medical (128) procedure, what strategy seems to be most effective? a. Providing the information only to their parents. b. Letting them handle all the surgical tools before the surgery. c. Providing them with information about the sensations they will experience. d. Telling them that crying will ease their fear.

a (129)

34. Benzodiazepines and beta-blockers are a. pharmacological methods of stress management. b. highly recommended for long term use. c. informational-control methods. d. forms of psychosocial stress interventions.

44

b (129)

c (129)

b (146)

a (129)

c

35. Benzodiazepines are to ____ nervous system as beta-blockers are to _____ nervous system. a. sympathetic; parasympathetic b. central; peripheral c. peripheral; central d. parasympathetic; sympathetic 36. Which of the following are true regarding beta-blockers? They a. cause extreme drowsiness and thus are rarely used. b. are used less frequently than benzodiazepines. c. block the actions of epinephrine and norepinephrine. d. block the activation of the parasympathetic nervous system.

37. The technique of progressive muscle relaxation involves a. progressively increasing the use of muscle relaxants such as betablockers. b. alternately tightening and relaxing specific muscle groups. c. alternating between relaxation exercises and the use of beta-blockers. d. the use of hypnosis.

38. Conclusions regarding the use of progressive muscle relaxation in stress reduction interventions suggest that a. a quick version may be used once the regular procedure has been mastered. b. these techniques work only on adults. c. these techniques work only on children. d. it has been found to be only modestly effective in reducing stress.

39. Which of the following is NOT true of systematic desensitization? a. It is based on classical conditioning. b. It incorporates the use of muscle relaxation. c. It uses psychoanalytic theories. d. It can be used with both adults and children.

(130-131)

a (130)

40. Rodney is extremely afraid of snakes. To deal with this problem, he is first shown a picture of snakes and told to relax while looking at it. He is likely receiving the treatment known as a. systematic desensitization. b. psychoanalysis. c. biofeedback. d. cognitive restructuring.

45

d (130)

c (130)

b (131)

41. Systematic desensitization is based upon the view that fears are learned through the process known as a. operant conditioning. b. modeling. c. behavioral control. d. classical conditioning.

42. A graded sequence of approximations to a feared stimulus is called a. a classical situation. b. systematic desensitization. c. a stimulus hierarchy. d. imagery.

43. In systematic desensitization, the next higher step in a stimulus hierarchy is presented when the a. person's fear is greatest. b. person is calm during the previous step. c. person has gone to sleep. d. fee for the previous step is paid.

a

44. In the process of counterconditioning, feelings of calm are considered to (131) be a. both the UR and the CR. b. both the US and the CS. c. both the US and the UR. d. the CR only.

d

45. Biofeedback uses the principles of ___________ to treat fears a. psychoanalysis. b. informational control. c. classical conditioning. d. operant conditioning.

(131)

d (131)

d (131)

c

46. Studies on the effectiveness of biofeedback indicate that a. biofeedback is an ineffective intervention. b. muscle relaxation is far superior to biofeedback. c. children are unable to benefit from biofeedback. d. children are better biofeedback subjects than adults.

47. Findings regarding children and biofeedback include the observations that a. their shorter attention span may create a problem in sessions. b. a small percentage of young children are frightened of the equipment. c. children are more likely than adults to practice their training at home. d. all of the above 48. Dr. Murphy believes that his patient, Samuel, has learned his fear of 46

(133)

snakes from watching his mother's negative reactions to snakes. Dr. Murphy believes in a _____ explanation of stress-related behavior. a. behavioral control b. biofeedback c. observational learning d. classical conditioning

a

49. Melamed used modeling procedures to reduce stress in young people anticipating surgery. She found that young children with previous experience with surgery a. showed increased anxiety if they were under the age of 8. b. did not understand the procedures. c. had the greater anxiety reduction than the older participants. d. were more responsive to in vivo experiences than symbolic representations.

(133)

c (133)

c (133)

d (134)

b (134)

50. The process of replacing stress-provoking thoughts with thoughts that are more constructive is called a. systematic desensitization. b. intellectualization c. cognitive restructuring d. rationalization 51. The concepts of "musterbating" and "can't-stand-itis" are forms of _____ ways of thinking according to Albert Ellis. a. illogical b. stressed c. irrational d. restructured 52. In Beck's cognitive therapy approach the focus is on a. changing maladaptive thought patterns. b. helping clients see that they are not responsible for all the problems they encounter. c. treating erroneous beliefs as though they are hypotheses to be tested. d. all of the above 53. Allen’s doctor is teaching him a cognitive technique to reduce his stress in which he is learning to identify stressful life situations, generate lists of possible solutions to the situations and decide on best courses of action to resolve them.

Allen is learning a. biofeedback. b. problem-solving training. c. stress inoculation. d. cognitive restructuring.

47

b (153)

a (135)

c (135)

a (136)

d (137)

54. Meichenbaum's stress inoculation training includes which of the following processes? a. hypothesis testing and relaxation b. conceptualization, skills acquisition & rehearsal, skills application. c. modeling and biofeedback. d. symbolic modeling and cognitive restructuring.

55. Dr. Smith believes that the most effective way to treat stress is to use many different techniques since stress and coping are complex experiences. She believes in the use of _____ approaches. a. multidimensional therapy b. rational-emotive therapy c. systematic desensitization d. stress inoculation 56. Which of the following statements is true regarding the use of massage as a stress reduction technique? a. It has not been found to be effective in reducing stress but does seem to improve immune function. b. Light massage works better than deep tissue massage. c. Deep tissue massage has been linked to stress reduction and improved immune function. d. There is no research evidence to support the use of massage as a stress reduction technique.

57. Research comparing meditating and nonmeditating participants found a. Meditating participants had greater decreases in blood pressure and lower levels of anxiety. b. Nonmeditating participants had greater decreases in blood pressure, heart rate, and respiration rate. c. There were no differences in blood pressure, heart rate, or respiration rate between the two groups. d. Meditation only works to reduce blood pressure while the person is meditating.

58. Research on the use of hypnosis in stress reduction has found that a. it works better than many other methods in reducing stress. b. treatment depends on how suggestible participants are to hypnosis. c. hypnosis is not necessarily more effective than other relaxation techniques. d. both b and c.

48

d (137)

b (139)

59. In their Type A behavior reduction program, Ethel Roskies and her colleagues used which of the following approaches? a. hypnotism b. psychotherapy c. relaxation d. multidimensional 60. Which statement regarding psychological approaches in the treatment of hypertension is NOT true? a. Psychological approaches can be used without drugs to treat hypertension. b. Untrained people can easily lower their own blood pressures by trying to relax. c. Relaxation by itself is not always helpful in lowering blood pressure. d. Progressive muscle relaxation, biofeedback, and meditation have all been demonstrated to reduce blood pressure.

Short Answer Questions 1. Compare and contrast emotion-focused and problem-focused coping.

2. Compare and contrast systematic desensitization with biofeedback.

3. Compare and contrast problem-solving training with stress inoculation training.

Essay Questions 1. You require surgery sometime in the near future. Using what you've learned in this chapter, how will you prepare for this stressful event?

2. Discuss the effectiveness of the 3 methods of stress management reviewed in the chapter.

3. Consider the idea that the various methods of coping discussed in the chapter represent a multidimensional approach to coping. Defend or refute this notion.

49

Chapter 6 TEST QUESTIONS True or False F

1.

Changing health habits is likely to reduce mortality rates only partially.

2.

Sick role behavior as defined in the text would describe an individual who seeks out treatment for the purpose of getting well.

3.

People’s health habits are extremely stable and do not change over time.

(142)

T (143)

F (144)

F 4. parents

Dan is caught smoking by his parents, who are psychologists. His

(149)

decide to make Dan stay in his room so that the behavior will stop.

This is an example of negative reinforcement.

T

5.

The Health Belief Model proposes that people will take some health-related action if a threat is perceived and if the perceived benefits of acting outweigh the perceived costs.

T 6.

Although

John has just begun thinking about quitting smoking cigarettes.

(154)

he is thinking about changing, according to the stages of change

(151)

model, if he were to actually attempt a quit effort at this point his chances of success are slim.

F 7. remain

Across their life span, people’s preventive needs and goals tend to

(157)

fairly constant.

F

8.

Biological factors and poverty have only a small impact on health promotion programs with diverse populations.

9.

Fear-arousing warnings, such as those found on packs of cigarettes, are a special case of loss-framed messages.

10.

Worksite wellness programs such as the Live for Life program have been shown to reduce health risk behaviors, job stress, absenteeism, and medical claims.

(161)

T (164)

T (167)

37

Matching Match one of the following with the examples in numbers 1-5. a. positive reinforcement b. negative reinforcement c. extinction d. punishment e. modeling b 1. When Bob is under stress he experiences heartburn, which he relieves through the (148) use of antacids. a (148)

e (149)

2. Dr. Peterson gives his patients a new toothbrush and tasty mouthwash for attending regular dental checkups.

3. Frank took up golf because his fellow executives all played, and his wife Cheryl started taking walks because her friends in the neighborhood go on

walks. d (149)

c (148)

4. Sharon got sick the first time she tried a cigarette and never smoked again.

5. Sylvia was placed on medication to control her high blood pressure. After several weeks, she could feel no difference so she stopped taking her pills.

Match the following with a characteristic found in 6-10. a. theory of planned behavior b. conflict theory c. health belief model d. stages of change model e. motivated reasoning d

6. Involves spiraling toward successful change.

(154)

e 7. When desires and preferences influence judgments about new information.

(155)

a (152)

8. As applied to health behaviors, interested in studying intentions that are determined by attitudes regarding the behavior, the influence of beliefs of others, and ability to control a behavior.

c 9. Health behaviors are determined by the perceived seriousness of the threat (151) and perceived cost of the behavior. b

10. The view that health challenges may be perceived as 38

(156)

either a threat or opportunity.

39

Multiple Choice c (141)

d (142)

b (142)

a (142)

d (143)

b (144)

1. The current trend of raising health consciousness is a. unprecedented in history. b. unlikely to affect mortality rates. c. similar to another such movement in the mid-1800s. d. no different than the way people have always behaved.

2. If people adopted lifestyles that promoted wellness, how would the rate of illness and early death be affected? a. Neither would not be affected in any way. b. Rates of illness would be affected but not rates of early death. c. Rates of early death would be affected but not rates of illness. d. Both would be reduced.

3. Even if people adopted all recommended health behaviors and cures were found for major diseases, the upper limit of the average life expectancy of people in technologically advanced countries is likely not to exceed: a. 75 years. b. 85 years. c. 90 years. d. 95 years.

4. How have the ten leading causes of death changed from the late 1960's to today? a. Deaths from diseases of early infancy are no longer in the top ten. b. Deaths from cancer and lung disease have decreased. c. Deaths from heart disease and stroke have increased. d. AIDS has become one of the top ten leading causes of death today.

5. Ted complains to his friends about recurring pain in his shoulder and has been looking up information on the Internet about possible causes for his pain. Ted's behavior is an example of _____ behavior. a. well b. sick-role c. irrational d. symptom-based 6. You call your boss to let her know you won't be in today because you have the flu. You stay home where you take the appropriate medicines, rest, and drink plenty of fluids. Your behaviors are examples of _____ behaviors. a. rational b. sick-role c. symptom-based d. cognitive 40

a

7. According to the research on cultural differences in response to symptoms (144) and health behaviors, which of the following persons is most likely to be affected by their family’s culture of origin? a. James, a recent immigrant. b. Frank, a fifth generation immigrant whose ancestors came from China. c. Both are affected equally. d. Neither are affected. b (144)

a (144)

8. The greatest percentage of adults engage in which of the following healthrelated behaviors? a. Rarely snack. b. Eat breakfast almost every day. c. Exercise regularly. d. Average two or more drinks per day.

9. Which of the following statements about health habits/behaviors is supported by research? a. Health habits tend not to be linked to one another. b. Health habits always remain stable over time. c. One single set of attitudes tends to govern our health behaviors. d. Very few people practice health habits on a regular basis.

d 10. Which of the following statements about testicular cancer is not accurate?

(145) a. It affects mostly younger men. b. It has a high cure rate if treated early. c. It can be detected early by monthly testicular self-examinations. d. It is more prevalent than breast cancer. d (145)

d (145)

11. Which of the following statements about breast self-examination (BSE) is not accurate? a. Most American women know about BSE but don't practice it on a monthly basis. b. The low practice of BSE may be due to low confidence, fear, embarrassment, and lack of knowledge about its importance. c. Simple reminders could increase the frequency of BSE practice. d. BSE results in only a modest level of breast cancer detection.

12. Which is an example of an environmental preventive approach to tooth decay? a. repairing cavities b. demonstrating good brushing technique c. reinforcing children for brushing their teeth d. fluoridation of local water supplies 41

c 13. Showing your children how to drive a car safely is an example of a(n) _____ (145) approach to prevention. a. environmental measure b. tertiary c. behavioral influence d. precontemplation a (146)

d (146)

b (146)

d (146)

14. A local physician encourages his patients to eat an appropriate diet, exercise, not smoke, use seat belts, and get plenty of sleep. This doctor is encouraging a. primary prevention. b. secondary prevention. c. tertiary prevention. d. behavior modification.

15. Which of the following is NOT an example of primary prevention? a. using a condom b. engaging in regular exercise c. pre-conception genetic counseling d. taking a prescribed blood pressure medicine 16. After finding a lump during her monthly BSE, Maggie is on her way to receive a mammogram. Maggie's trip to the lab is an example of a. primary prevention. b. secondary prevention. c. tertiary prevention. d. behavior modification.

17. Which of the following is NOT an example of secondary prevention? a. following a prescribed diet to control blood pressure b. school hearing or vision tests c. an annual physical examination d. physical therapy following a stroke

c are

18. Actions taken to reduce the damage of a disease or rehabilitate a patient

(147)

generally referred to as a. primary prevention. b. secondary prevention. c. tertiary prevention. d. cognitive restructuring.

42

a (147)

d (147)

19. Which is an example of tertiary prevention? a. a cardiac rehabilitation program for people who have recently had a heart attack b. regular dental checkups for children with healthy teeth c. going to the doctor when you have a sore throat d. being in a monogamous sexual relationship 20. Which of the following people is engaging in tertiary prevention? a. David, who schedules and attends annual physical checkups with

his physician b. Linda, a healthy woman who works out at the gym 4-5 times per week c. Frank, who has just tested negative for HIV d. Amy, who receives chemotherapy for breast cancer d (147)

21. Which is an important factor in determining whether a person will adopt a wellness lifestyle? a. encountering few barriers to changing behaviors b. motivation to engage in the new behaviors c. knowledge and skills to change an existing behavior d. all of the above

b 22. Woo is attempting to lose weight. Which of the following interpersonal factors (147) will support his effort? a. His girlfriend doesn’t agree with the diet he has chosen. b. He has a close friend who supports his new diet and weight loss goals. c. His coworkers don’t understand why he’s so concerned about his weight. d. His lack of a strong social network d (148)

23. When a community attempts to reduce illness and injury, it may need to address which of the following problems? a. diversity of age and sociocultural background of its citizens b. funding for public health programs c. creating a balance between the health and economic needs of the community d. all of the above 43

a (148)

b (148)

c (149)

d (149)

24. Which of the following statements is true regarding the relationship between heredity and health behaviors? a. Heredity may influence some health-related behaviors. b. Heredity has little to no influence on health-related behaviors. c. Heredity is the best predictor of health-related behaviors. d. Little to no research exists on this relationship.

25. Wendy says she smokes because it makes her less nervous. Her smoking behavior is being maintained through a. positive reinforcement. b. negative reinforcement. c. punishment. d. extinction.

26. Sam's parents punish him when he doesn't wear his bike helmet while riding his bike. What best predicts if this punishment will affect Sam's future helmet-wearing behavior? a. The type of punishment he receives. b. The severity of the punishment. c. Sam's expectation that the punishment will be repeated if he doesn't wear the helmet. d. The quality of accompanying explanations made by Sam's parents.

27. Observing a model is most likely to affect our behavior when the model is a. an older person. b. a high status person. c. a person similar to us. d. b & c

c the

28. Anna, a habitual smoker, lights up a cigarette after eating dinner. When

(149)

phone rings in the other room, she answers it and lights up another cigarette from the pack by the phone. She is surprised later that she didn't realize she had two cigarettes going at once. It appears her smoking behaviors are governed by the _____ of her behavior. a. consequences b. social approval c. antecedents d. genetic influence

d 29. You want your children to grow into healthy adults. Which of the following (149) practices will facilitate that? a. changing bad health habits in your children as early as possible 44

b. engaging in healthy practices yourself c. telling your children that having good health is important to you d. all of the above b (150)

a (150)

b (151)

30. Results from a study of hypertensive patients' perceptions of symptoms found that these patients a. make accurate estimates of their blood pressure levels. b. are poor estimators of their own blood pressure. c. estimate their blood pressure well, but not as well as normotensives. d. rarely change their medication-taking behaviors in light of the symptoms they experience.

31. Weinstein's research on beliefs about individuals' future health found that people tend to a. be overly optimistic about future health. b. be overly pessimistic about future health. c. exaggerate the severity of health risks. d. seldom think about their future health.

32. Manuel has just experienced a severe health scare regarding his heart.

According to Weinstein, Manuel is likely to a. display unrealistic optimism about his future health. b. show unrealistic pessimism about his future health. c. show no change in attitudes. d. become very realistic about his health.

d 33. Which of the following is NOT a factor in people's perceived threat of illness (151) or injury? a. perceived seriousness of the health problem b. perceived susceptibility of the health problem c. reminders or alerts regarding a health problem d. unrealistic optimism d (151)

a (152)

34. Applying the health belief model, women who do regular breast self-examinations (BSEs) a. believe they are susceptible to breast cancer. b. believe developing breast cancer would have serious effects. c. believe the benefits of BSE's outweigh the costs. d. all of the above 35. Which of the following statements regarding research on the health belief model is true? a. Research supports the major theoretical components of the model. b. The model has received support for a very limited scope of health behaviors.

45

c. The “cues to action” component has received no support. d. Very little research has been done on the model. c (152)

d (152)

36. One of the shortcomings with the health belief model is a. the lack of research designed to test the model. b. that it only accounts for habitual behaviors. c. that there is no standard way of measuring its components. d. that more recent models suggest it is simply wrong.

37. The theory of planned behavior is based on the fundamental notion that a. people develop behavioral intentions before engaging in voluntary behavior. b. behavioral intentions are the best predictors of actual behavior. c. expectations of success influence behavior. d. all of the above.

b 38. Annie’s parents strongly disapprove of her smoking habit. Which component (153) of the theory of planned behavior is reflected in this variable? a. Annie's personal attitude b. subjective norms c. perceived personal control d. perceived severity c (153)

39. Jason says he would like to exercise more but simply doesn't have the money to pay for a gym membership. His behavioral intention is being most affected by a. personal attitude. b. attitudes of important others. c. low personal control. d. low motivation to comply with the wishes of others.

a 40. According to the stages of change model, people go through five stages of (154) intentional behavior change in the following order: a. precontemplation, contemplation, preparation, action, maintenance b. preparation, precontemplation, contemplation, action, maintenance c. preparation, action, precontemplation, contemplation, maintenance d. precontemplation, contemplation, preparation, maintenance, action e. maintenance, precontemplation, contemplation, preparation, action c (154)

41. Which of the following represents an effort to move a person from one stage of change to another?

46

a. describing in general terms how they will change their behavior b. having them stay in the precontemplation stage c. matching the change strategy to the stage they are in d. if they are in the precontemplation stage, having them talk with someone who has successfully changed their own behavior d

42. JillAnn believes it unlikely that she could contract a sexually transmitted disease from her new boyfriend because he’s so nice to her. JillAnn's reliance on irrelevant information in making sexual health decisions is a form of a. precontemplation. b. reasoned action. c. rational thinking. d. motivated reasoning.

(155)

d 43. Willy has been drinking and finds himself in a situation where he can have (156) sex with someone he just met at a bar. Which of the following predicts if he will engage in sexual actions with this virtual stranger? a. If he has friends who have had sex under similar circumstances. b. If he thinks having sex will reflect positively on how sexually attractive he is to others. c. If he done this before. d. all of the above a (156)

44. Conflict theory emphasizes the impact of ___________ on all major decisions. a. stress b. irrational thinking c. emotional stability d. complete information

b 45. According to conflict theory, the only consistently adaptive decision-making (156) pattern in the face of health risks is a. hypervigilance. b. vigilant coping. c. unconflicted change. d. defensive avoidance. a (158)

46. Health goals during gestation and infancy tend to include which of the following? a. helping the parents to achieve the knowledge and capacity for the physical, emotional, and social needs of the baby b. establishing healthy behavioral patterns for nutrition, exercise, 47

recreation, and family life c. anticipating and guarding against the onset of chronic disease d. prolonging the period of effective activity and ability to live independently d (158)

a (159)

d (159)

a (160)

b (161)

d (161)

47. Which of the following has been referred to as "nature's vaccine"? a. penicillin b. exercise c. a good heredity d. breast milk 48. The leading cause of death during childhood and adolescence is a. accidents. b. impaired immune functioning. c. childhood diseases. d. birth defects.

49. Which of the following health-related cognitions or behaviors is less likely in older adults than in younger adults? a. starting new health risk activities since they don’t have long to live and want to enjoy themselves b. practicing fewer health behaviors c. getting regular medical checkups d. getting regular exercise 50. Research on gender and health has shown that women a. tend to live longer than men. b. have fewer health problems than men. c. tend to get more exercise than men. d. (excluding pregnancies) use medical services less than men.

51. Research on social class, ethnicity, and health shows a. social class is not related to health status. b. higher disease incidence in African-Americans, American Indians, and Hispanics as compared to European Americans. c. equal knowledge of risk factors for disease regardless of social class. d. all of the above 52. According to the text, which of the following would significantly increase health in diverse populations? a. reducing poverty b. creating information approaches to reach populations with low literacy rates c. making health-promotion services culturally sensitive 48

d. all of the above b 53. A common approach in mass-media health promotion campaigns includes (162) a. information about using the Internet. b. communication of negative consequences of unhealthy behaviors. c. self-help clinics. d. both b and c d (165)

d (166)

54. Using fear-arousing messages can be most effective under which of the following conditions? a. when the seriousness of the health problem is emphasized b. when combined with messages that indicate people can perform healthful behaviors c. when used in combination with gain-framed messages d. both a and b

55. Which of the following factors influence the effectiveness of reinforcers for increasing health behaviors? a. type of reward b. income level of the person c. sociocultural background of the recipient d. the person’s gender

c 56. Thelma is upset with herself because she’s just eaten a piece of chocolate (166) cake and thinks she’s completely “blown” her diet plan. She decides that she just isn’t cut out for diets and eats the rest of the cake. This is an example of _____ (if Thelma believed she shouldn’t eat any cake at all while on her diet). a. lapse b. relapse c. abstinence-violation effect d. motivated reasoning c (166)

d

57. Which of the following represents a benefit of school health programs? a. They can be used in place of physical education programs that are more costly. b. They can easily be taught by even beginning school teachers. c. They help children establish healthy behaviors early. d. They are more effective in developing countries than in industrialized countries.

58. According to the textbook, worksite health programs 49

(167)

d (168)

a. take advantage of peer and employer support for motivational purposes. b. are cost effective for businesses and employees. c. can create environmental support to foster behavior change. d. all of the above 59. Overall, evidence on the effectiveness of community-based wellness programs suggests that: a. such programs tend to produce modest changes. b. any program that produces modest change in the health behavior of a population is likely to have a large impact on disease. c. such programs work best in older populations. d. all of the above

Short Answer Questions 1. Compare and contrast primary, secondary, and tertiary prevention. Given an example of each approach to prevention.

2. Discuss the similarities and differences between the Health Belief model and the Theory of Planned Behavior.

3. Briefly describe conflict theory and discuss how it incorporates stress into its model.

Essay Questions 1. Jeff has just had a heart attack. Using one of the cognitive theories of change, describe how cognition will affect Jeff’s efforts to make lifestyle changes.

2. Suppose you want to develop a health promotion program at your school to reduce alcohol consumption. Using information from this chapter, what factors would you attempt to incorporate into your promotion program?

3. Review and discuss the prevention programs developed to provide effective intervention regarding HIV exposure.

50

Chapter 7 TEST QUESTIONS True or False T

1.

Users who go on to become addicted to a substance usually become psychologically dependent on it first.

F 2.

1960's,

Since the Surgeon General's report on the dangers of smoking in the

(177)

cigarette manufacturers have suffered major declines in sales.

(175)

F

3.

Nicotine is the active ingredient in tobacco smoke that has been linked to cancer.

4.

The nicotine regulation model falls short of explaining why people still crave cigarettes months and even years after they quit smoking.

5.

Lifetime prevalence rates indicate that approximately 17% American adults abuse alcohol.

6.

Cocaine may have harmful effects on the cardiovascular system.

7.

Stanley Schachter (1982) interviewed ex-smokers and found that over 60% who tried to quit were unsuccessful.

8.

Long-term alcoholics and problem drinkers who drink at lighter levels can both successfully use controlled drinking strategies.

9.

The treatment strategies in Alcoholics Anonymous have been found to be more effective than other treatment interventions delivered by professional

(182)

T (182)

T (188)

T (195)

F (198)

F (201)

F (203)

therapists.

F (205)

10.

Incorporating a person’s physician into their intervention program for reducing substance abuse is likely to prevent the person from wanting to participate and reduce the effectiveness of the program.

37

Matching Match the techniques with their descriptions in 1-5: a. aversion strategies b. self-monitoring c. stimulus control d. response substitution e. behavioral contracting d (203)

1. Involves replacing a problem behavior with a behavior incompatible with the problem.

a

2. May involve satiation or imagined negative scenes.

(201)

e

3. Specifies what rewards and punishers are applied in controlling a behavior.

(203)

b (203)

4. Records are kept on the problem behavior such as the times, places, and circumstances of each occurrence.

c

5. May involve removing ashtrays or matches from the home of a smoker.

(203)

Match the following agents with their descriptions in 6-10: a. emetine b. morphine c. barbiturate d. marijuana e. methadone d

6. A hallucinogen which causes perceptual distortions.

(193)

b

7. A narcotic or pain reducing substance.

(193)

a

8. Like Antabuse, may be used in the treatment of alcohol abuse.

(202)

c

9. Depressant which decreases arousal and increase relaxation.

(193)

e

10. A chemical which blocks the effects of heroin.

(204)

38

Multiple Choice d (175)

a (175)

a (175)

a (175)

b (175)

d (175)

1. The definition of addiction has come to include a. physical dependence. b. psychological dependence. c. repeated consumption of a substance. d. all of the above 2. Howard has developed a physical dependence on nicotine, which means a. his body requires it for "normal" functioning and he'll most likely experience withdrawal symptoms if he tries to quit smoking. b. he is probably experiencing serious interpersonal problems because of this substance. c. he very likely is failing to fulfill important obligations to others. d. he probably feels compelled to smoke cigarettes.

3. The process in which the body requires increasingly large doses of a drug to achieve the same effect is best described as a. tolerance. b. withdrawal. c. dependence. d. addiction.

4. In the past Randi had only to drink two beers before she felt a "buzz." Now she must drink five or more beers to get that "buzz." Randi is exhibiting a. tolerance. b. withdrawal. c. psychological dependence. d. addiction.

5. Nora has been feeling irritable since she quit smoking last week. She is experiencing symptoms of _____. a. tolerance. b. withdrawal. c. dependence. d. abuse.

6. According to the text, the potential for psychological dependence is lowest for a. marijuana. b. heroin. c. cocaine. d. LSD.

39

b (175)

c (176)

c (176)

d (177)

a (177)

c (177)

7. Steve shows a persistent pattern of drinking too much and often drives drunk.

He meets the criteria for the diagnosis of a. physical dependence. b. substance abuse. c. withdrawal. d. tolerance.

8. Mary drinks to reduce the stress she feels at the end of a long day whereas John drinks simply because he "likes the taste of a good beer." Mary's drinking is maintained by _____ reinforcement whereas John's is maintained by _____ reinforcement. a. positive; positive b. positive; negative c. negative; positive d. negative; negative 9. Samuel has intense cravings for a cigarette when he sees his friend, George.

According to the text, the sight of George serves as a __________. a. positive reinforcement b. negative reinforcement c. substance-related cue d. tolerance cue 10. Steve grew up seeing his parents and their friends having fun at annual Super Bowl parties at which large amounts of alcohol were consumed. According to expectancy theory, Steve is likely to develop ____ attitudes toward alcohol via ____. a. negative; social learning b. positive; classical conditioning c. negative; classical conditioning d. positive; social learning 11. Which of the following statements about the influences of heredity on addiction is not true? a. Smoking and alcoholism share the same genetic markers. b. The specific genes responsible for smoking have been identified. c. The specific genes responsible for alcoholism have been identified. d. If one identical twin smokes, the co-twin is also likely to smoke.

12. Which of the following statement regarding cigarette smoking is true? a. It is at an all-time high in the USA. b. It has declined to the point that many tobacco companies now face bankruptcy. c. It reached its greatest popularity in the U.S. in the mid-60's. d. It was introduced to America by Columbus.

40

b (178)

a (179)

c (179)

c (181)

13. Which of the following smokers is in the age level with the highest percentage of smokers in the USA? a. Daniel, age 45 b. Greg, age 25 c. Samantha, age 12 d. Caroline, age 60 14. Which of the following statements about smoking prevalence is true? a. Black men over the age of 45 are more likely to smoke than White men of the same age. b. Hispanics are more likely to smoke than persons from any other race/ethnicity group. c. Smoking rates increase with education. d. Smoking rates are highest in high income individuals because they can afford to buy cigarettes.

15. Which of the following persons is most likely to continue smoking beyond a few cigarettes? a. Joseph, whose parents don't smoke b. Lynn, whose friends all think smoking is "uncool" c. Conrad, a rebellious, risk-taking adolescent d. none of the above 16. Research on stress and smoking has led to each of the following conclusions except a. smoking is commonly identified as a way to reduce stress. b. adult smoking increases with stress. c. smoking is a good long-term tension reducer. d. smokers report less anxiety if allowed to smoke.

d 17. Which of the following statements reflects the biological influences on smoking?

(181) a. No relationship between heredity and smoking has been discovered. b. Heredity influences the ease with which a person becomes dependent on tobacco. c. Heredity may influence the strength of physical dependence on tobacco. d. both b and c. c (182)

18. Which substance in inhaled cigarette smoke is readily absorbed into the bloodstream and reduces the ability of the blood to carry oxygen? a. tar b. nicotine c. carbon monoxide d. carbon dioxide

41

d (182)

a (182)

a (182)

b (184)

d (185)

a

19. Nicotine, the addictive substance in cigarettes: a. triggers catecholamine release. b. acts as a stimulant. c. is found naturally only in tobacco. d. all of the above 20. The idea that smokers pace their smoking to maintain the levels of nicotine in their blood is most consistent with which of the following theories? a. nicotine regulation b. psychosocial c. psychological dependence d. biobehavioral 21. Researchers have found that when habitual smokers are provided with low-nicotine cigarettes they: a. smoke more to maintain their nicotine intake b. smoke about the same number of cigarettes. c. smoke less because of low-tar cigarettes taste awful. d. are very likely to stop smoking after a short period of time.

22. Which of the following is true regarding the relationship between prevalence of lung cancer and smoking? a. Lung cancer has decreased in prevalence and thus its relationship with smoking is unclear. b. Rates of lung cancer mortality started to rise about 20 years after the increase in smoking. c. The gap between women and men who smoke in mortality due to lung cancer remains the same as it was 40 years ago. d. Mortality rates due to lung cancer are the same as in the days of Christopher Columbus.

23. Which is not true about passive smoking? a. It can cause cancer in healthy nonsmokers. b. Children of smokers have more respiratory infections than children of nonsmokers. c. The smoke that comes from the end of a burning cigarette contains high concentrations of carcinogens. d. Designating some tables in the corner of a restaurant as smoking tables and the rest as nonsmoking eliminates the exposure of nonsmokers to the harmful effects of smoke.

24. Risk factors that link smoking to cardiovascular heart disease (CHD) include 42

(185)

c (185)

a (187)

c (187)

d (188)

b (188)

a. having a lifestyle that includes other risk factors. b. low blood pressure which causes the nicotine to be metabolized more slowly. c. being a female. d. having relatively low stress levels in one's life.

25. The substances in cigarettes which contribute to cardiovascular disease are a. tar and carbon. b. winston and salem. c. carbon monoxide and nicotine. d. filters and menthol.

26. The movement in America which advocated total abstinence from alcohol was called a. temperance. b. behavior modification. c. behaviorism. d. the Roaring 20's.

27. Which of the following statements is true regarding gender differences in alcohol consumption? a. Men drink more than women only in adolescence. b. Men drink more than women during adolescence but women drink more during adult life. c. Men drink more than women throughout the lifespan. d. Women drink more than men only in adolescence.

28. Historically, _____ occurs more in countries that incorporate drinking into daily life, whereas _____ occurs more in countries that restrict alcohol use. a. alcoholism; problem drinking b. problem drinking; alcoholism c. intoxication; daily drinking d. daily drinking; intoxication 29. The phrase "lifetime prevalence rate" refers to a. number of new cases in a year. b. proportion of individuals who have experienced the problem at any point in their lifetime. c. another term for mortality rate. d. another term for morbidity rate.

43

c (189)

d (190)

a (191)

b (192)

a (192)

d (194)

30. Most problem drinkers are a. college students. b. unemployed. c. married. d. separated from their families.

31. Which of the following concepts accounts for the fact that Hank tries to keep pace with his friends in terms of number of drinks consumed when they are out together at a bar? a. abstinence violation effect b. substance-related cues c. negative reinforcement d. modeling 32. James has a history of alcoholism in his family. Which of the following might happen to James that would be less likely to happen to his friends without a similar family history? a. stronger cravings for alcohol after his first drink b. stronger dislike for the taste of alcohol c. lower tolerance for the effects of alcohol d. his family history will not have any impact on his drinking 33. Jose has had 5 glasses of beer and decides he needs to drive to the grocery store. He says to his roommate “I always sober up as soon as I get behind the wheel.” He is _____ the effects of alcohol on his ability to drive. a. over-estimating b. under-estimating c. accurately estimating d. cognitively restructuring 34. Heavy drinking has been linked to all of the following health problems except a. asthma. b. cirrhosis. c. brain damage. d. high blood pressure.

35. Which of the following drugs is the most commonly used drug in the US? a. cocaine b. barbiturates c. heroin d. marijuana

44

d (194)

a (195)

36. The strongest factor in determining teenagers’ decreasing use of drugs is a. stress b. genetics c. drug availability d. beliefs about the harmfulness of drugs.

37. Factors that predict the movement from drug use to drug abuse include a. rebelliousness and sensation seeking. b. rebelliousness and genetics. c. high levels of social conformity and social learning. d. impulsivity and stress.

b 38. In comparison to the research on the effects of smoking and drinking on health, (195) the research on effects of drug use on health is a. well documented. b. not well documented. c. rapidly catching up. d. hampered by negative public opinions. c (195)

d (195)

a (196)

39. Which statement is accurate regarding long-term effects of marijuana and and tobacco use? a. They both are linked to CHD. b. They both are linked to the development of cancer. c. They both are linked to lung damage. d. Marijuana use has no long term effects on health.

40. Which of the following effects of using crack cocaine are linked to increased risk for stroke and heart attack? a. blood vessel constriction b. increase in heart rate c. cardiac arrhythmia d. all of the above 41. Prevention programs are currently being designed to deal with the use of multiple substances. What are the primary reasons for doing so? a. initial use of all three substances occurs in adolescence and for similar reasons b. cost and convenience c. for convenience reasons only d. this is how prevention programs have always been delivered

45

a (196)

c (197)

b (197)

c (198)

42. Setting legal drinking ages and restricting sales of alcohol to certain times of are examples of a(n) _____ approach to prevention. a. public policy or legal b. behavior modification c. health promotion and education d. early intervention 43. Successful programs designed to prevent teenage drug abuse have incorporated which of the following components? a. A mass media campaign that emphasizes the negative consequences of drug use. b. Project DARE. c. Social influence and life skills training. d. Stress reduction.

44. According to the text, which of the following is the primary focus in “family involvement” approaches? a. getting parents to stop smoking b. getting parents more actively involved in supervision of their children c. getting parents to use more harsh punishment d. increasing parental understanding of modern youth 45. Attempting to quit smoking on one's own is a. rarely successful. b. equal in success rate compared with a structured program. c. one of the most common ways to quit smoking. d. effective only if the person uses satiation too.

c quit

46. Which of the methods below was not used by the majority of people trying to

(199)

smoking in a stop-smoking contest? a. Quitting ''cold turkey''. b. Going it alone. c. Providing material rewards for success. d. Using oral substitutes.

d

47. Which of the following is a problem with employee assistance programs? a. They identify substance abuse problems only after they become severe. b. Most employees with substance abuse problems don’t use them. c. Employees with substance abuse are often concerned their employer will find out and thus don’t use the program. d. all of the above

(199)

46

c (200)

a (200)

d (201)

a (202)

c (203)

c (203)

48. According to the stages of change model, what is the critical transition point for readiness to attempt stopping the use of a substance? a. the shift from precontemplation to contemplation b. the shift from preparation to action c. the shift from contemplation to preparation/action d. none of the above 49. Melinda is entering a stop-smoking program that uses reinforcement as part of the program. Her friend, Jan, is entering a program that does not use reinforcement. Which person is more likely to be successful? a. Melinda b. Jan c. both will be successful d. neither will be successful 50. Present research indicates that alcoholics who can drink in moderation and in a controlled fashion are a. relatively common. b. generally rare. c. only found among long-term alcoholics who have increased their tolerance for the drug. d. usually young, with a short-term drinking problem.

51. Kyle is taking the drug known as emetine. He can expect which of the following effects from the drug? a. Nausea if he drinks alcohol while he's taking it. b. Perceptual distortions since it is a hallucinogen. c. Decreased arousal and increased relaxation. d. Pain relief.

52. According to recent research, how effective is Alcoholic Anonymous in reducing alcohol use? a. AA’s effectiveness is still unknown at present. b. AA is as effective as other current methods. c. AA is less effective than other methods. d. AA is more effective than other methods.

53. Todd removes all ashtrays from his car and home to help him to stop smoking. He is using a strategy called: a. behavioral contracting. b. response substitution. c. stimulus control. d. self-deception.

47

b (203)

c (204)

d (204)

c (205)

54. Frank's favorite cigarettes of the day and the hardest to give up are those he has right after dinner. Frank decides to begin taking a walk after dinner instead of smoking. This is an example a. behavioral contracting. b. response substitution. c. stimulus control. d. self-deception.

55. What is one of the major problems with using Antabuse as part of a treatment program to get people to stop drinking? a. It doesn’t work on most people. b. It’s cruel to make people nauseous. c. It’s difficult to get people to take it consistently. d. It substitutes one addiction for another.

56. You are a smoker who has decided to quit. Which of the following programs would likely be most effective for you? a. quitting ''cold turkey'' b. using a nicotine patch c. providing material rewards for success d. a multidimensional program 57. Maria has just finished formal treatment for her addiction to cocaine. If she experiences a relapse, when is the most likely time that will happen? a. within the next few weeks b. at the one year point following treatment c. at the seven year point following treatment d. relapse is highly unlikely

b 58. Of the following people, who is most likely to relapse following their stopsmoking (205) program? a. Mark, a light smoker b. Gina, a heavy smoker c. Bill, whose wife is very supportive of his quit attempt d. Jill, who is very sure she will be effective in her quit attempt c

59. According to research, when smokers relapse what phenomenon is observed? a. They are able to immediately attempt another quit effort and be successful. b. They usually give up trying to quit entirely. c. They decrease their perceptions of the health risks of smoking. d. They switch to a low tar cigarette.

(206)

48

d (206)

60. Marlatt’s relapse prevention method involves which of the following? a. involvement of a therapist b. practicing coping skills in actual high-risk situations c. identification of high-risk situations d. all of the above

Short Answer Questions 1. Discuss the relationships between the terms addiction, physical dependence, tolerance, withdrawal, psychological dependence and substance abuse.

2. Sometimes people label others as an "alcoholic" erroneously. Based on the definition from the text, what criteria would need to be met for this term to be accurate? How is it differentiated from problem drinking?

3. Distinguish between the various types and effects of the different categories of drugs.

Essay Questions 1. Your aunt is concerned that her adolescent daughter might begin smoking. Based on the information you've gained from this chapter, what suggestions might you give her regarding prevention?

2. Your neighbor, a 35 year-old 2-3 pack-a-day smoker for the past 15 years, has finally decided he wants to quit smoking and has asked for your advice on how to go about doing so. What information could you give him regarding smoking cessation techniques and their likelihood for success?

3. You may have noticed the similarity in treatment approaches for attempting to prevent and/or get people to quit using tobacco, alcohol, and chemical substances described in this chapter. Give an overview of the major approaches used in prevention or treatment.

49

Chapter 8 TEST QUESTIONS True or False F

1.

Fiber is a nutrient used in metabolism.

2.

High density lipoproteins (HDL) are associated with a decreased likelihood of the build-up of fatty plaque in blood vessels.

3.

Doug eats animal meats at every meal, whereas Susan eats a diet rich in fruits, fiber and vegetables. Considering their eating patterns, it is likely that Susan is at a lower risk for cancer than is Doug.

4.

Karl who was overweight as a child and adolescent is equally likely to be an obese adult as his wife Nancy, who was trim in her youth but gained weight during pregnancy.

5.

Individuals who lose weight and regain it will find it easier to subsequently lose weight again.

6.

Anorexia nervosa is characterized by binge eating followed by purging.

7.

Continuous exercise requiring high levels of oxygen is called aerobic exercise.

8.

The most common reason people give for not exercising is that they simply don't have the time.

9.

The total number of years lost from unintentional and intentional injuries combined is the same as the total number of years lost from heart disease, cancer and stroke combined.

10.

Driver education courses are the single most important factor in reducing traffic accidents.

(211)

T (213)

T (215)

F (220)

F (224)

F (229)

T (232)

T (235)

T (238)

F (239)

37

Matching Match the following classification of food components (a-e) with an example or description listed in items 1-5: a. carbohydrates b. lipids c. proteins d. vitamins e. minerals e

1. Calcium and potassium

(211)

d (211)

2. Fruits and vegetables such as spinach, broccoli, cantaloupe or apricots contain beta-carotene which the body converts to one of these

b

3. Cholesterol

(210)

a

4. Glucose and lactose

(210)

c

5. Composed of amino acids

(210)

Match the following weight loss techniques (a-e) with their descriptions in items 6-10: a. Weight Watchers b. Scarsdale diet c. Behavioral techniques d. Bariatric surgery e. Worksite weight-loss programs e (225)

c

6. Plagued by high drop-out rates and producing small weight loss unless combined with competitions.

(225)

7. With the exception of medical treatments, some of the most effective methods for losing weight.

b

8. A fad diet

(225)

d

9. The most drastic medical treatment for obesity.

(227)

a (226)

10. A self-help approach that uses behavioral techniques, nutritional information, and group meetings.

38

Multiple Choice a (210)

c (210)

b (210)

d (211)

c (211)

b (211)

b (211)

1. Simple sugars are to _____ as amino acids are to _____: a. carbohydrates; proteins b. fats; vitamins c. proteins; fiber d. vitamins; minerals 2. Cholesterol and saturated and unsaturated fats are classified as a. carbohydrates. b. a special class of proteins. c. lipids d. fat-soluble vitamins 3. Amino acids are components of ____ that are responsible for _____. a. minerals; nerve transmission b. proteins; synthesis of new cell material c. lipids; providing energy d. vitamins; converting nutrients into energy 4. Calcium and iron are classified as a. inorganic proteins. b. amino acids. c. lipids. d. minerals.

5. Which of the following is not considered a nutrient? a. fats b. proteins c. fiber d. minerals 6. Amanda has just found out she is pregnant. She should do which of the following: a. Nothing. Her typical diet should be just fine. b. Take recommended supplements due to her greater need for all nutrients. c. Take more iron, but no other additional nutrients. d. Take more vitamins but less iron.

7. People can get all the nutrients and fiber they need a. only by taking vitamin supplements. b. by eating healthy diets. c. by eating only a vegetarian diet. d. by eating high protein diets.

39

b (211)

d (211)

c (212)

d (212)

a (212)

c (213)

c (213)

8. Larry has decided to protect his health by taking large doses of vitamins A & D. This is a ___ idea since large amounts of these vitamins _____. a. good; have proven to be cures for some cancers b. bad; may harm the liver and kidneys c. good; are aphrodisiacs d. bad; are only excreted as waste 9. Who is most likely to be affected by food additives? a. People who are allergic to them. b. Everyone, since additives tend to be harmful to our health. c. Children. d. Both a and c.

10. Which cultural group avoids eating dietary fat the most? a. Americans b. Israelis c. Columbians d. Japanese 11. Which is NOT true of changes in the American diet since 1980? a. Consumption of red meat has decreased. b. Consumption of fish has increased. c. Consumption of fruits and vegetables has increased. d. Consumption of sugars has decreased.

12. Evidence indicates that a preference for sweet tastes is a. biological. b. learned. c. not present in most babies. d. present only in America children.

13. The main dietary contributor to atherosclerosis is a. salt. b. caffeine. c. cholesterol. d. fiber.

14. The type of lipoprotein associated with decreased cholesterol deposits in blood vessels is a. low-density (LDL) b. very low density (VLDL) c. high-density (HDL) d. very-high-density (VHDL)

40

d (214)

b (215)

d (215)

c (215)

b (215)

d (214)

d (216)

15. Cholesterol level in the blood is influenced by a. diet. b. heredity. c. smoking. d. all of the above.

16. The dietary substance most strongly associated with hypertension is a. cholesterol. b. sodium. c. caffeine. d. fiber.

17. Which one of the following people is most likely to experience hypertension and coronary heart disease? a. Joseph, who drinks no coffee. b. Frederick, who drinks only decaffeinated coffee. c. Michael, who drinks 3 cups of coffee each morning. d. None of the above.

18. High fat and low fiber diets are particularly associated with cancer of the a. liver b. colon c. throat d. stomach 19. Early studies found that diets rich in _____ are associated with lower cancer risk. This finding is not _____. a. fat; supported b. beta-carotene; definitive c. lipids; supported d. sodium; definitive 20. How might an individual reduce his/her serum LDL levels? a. Use vegetable oils containing coconut or palm oil. b. Avoid polyunsaturated oils and consume only saturated fats. c. Eat more eggs at breakfast. d. Substitute monounsaturated fats for other fats in the diet.

21. Recent research with animals has shown that reducing caloric intake by 30% a. decreases metabolism. b. slows the aging process. c. increases longevity. d. all of the above.

41

c (217)

c (217)

b (217)

d (217)

b (219)

c (219)

a (219)

22. In a study of overweight girls and boys, self-esteem levels a. were not affected by weight levels. b. went down for boys but not for girls over time. c. went down for both boys and girls but raised as boys got older. d. went down for girls but not for boys over time.

23. We tend to judge the desirability of our weight based on the criteria of: a. attractiveness and BMI. b. actual weight and BMI. c. attractiveness and healthfulness. d. stamina and body shape.

24. The body mass index (BMI) is used to a. measure an individual’s bulk or stockiness. b. determine whether a person is overly fat. c. determine an individual’s cholesterol levels. d. all of the above 25. People are classified as obese when their BMI exceeds _____. a. 10 b. 20 c. 25 d. 30 26. The common belief that "glandular problems" lead to obesity is true a. in most cases. b. in only a small percentage of people. c. only for males. d. only for females.

27. Which of the following statements regarding self-reported eating is not true? a. Underreporting is very common. b. Women are more inaccurate than men. c. Obese people report eating more than normal-weight people. d. Heavy and normal weight people may differ in the accuracy of their reports.

28. The theory that the body has a certain weight that it strives to maintain is called: a. set-point theory. b. restraint theory. c. equilibrium theory. d. maintenance theory.

42

d (220)

d (220)

d (220)

a (221)

a (220)

b (221)

29. The mechanism in the brain thought to control body weight is a. the medulla. b. the endocrine gland. c. the frontal lobe. d. none of the above.

30. High serum levels of insulin influence which of the following? a. Sensations of hunger. b. Pleasantness of sweet tastes. c. How much we eat. d. all of the above 31. Which of the following facts about fat cells are true? a. Their number increases mainly in childhood and adolescence. b. Their number can increase but not decrease. c. They are related to the body's set point. d. all of the above 32. Two people, one obese and the other normal weight, are at a dinner party where some very bad-tasting food has just been served. Who is likely to eat the most? a. The normal-weight person. b. The obese person. c. They will eat the same amounts of food. d. Neither is likely to eat anything.

33. Nan, a restrained eater, is upset that she didn't follow her diet today by having a sugary snack. Which of the following is she most likely to do according to the restraint theory? a. Overindulge since she's already "blown it". b. Stop eating once she realizes she violated her diet. c. Go for a jog to take her mind off her diet. d. Resolve to try harder in the future on her diet plan.

34. Which of the following statements about the relationship between weight and health is NOT true? a. Obesity is positively correlated with increasing risk for disease. b. A small ratio of waist to hip girth is associated with higher rates of disease. c. Compared to those who are sedentary, heavy people who are fit have lower risk for death and illness. d. Overweight and normal weight people rate their health the same.

43

d (222)

d (223)

c (225)

b (226)

c (226)

d (226)

35. Prevention programs for overweight should begin in childhood because: a. this is the best time to prevent the development of excess fat cells. b. children and adolescents who are obese are more likely to be obese as adults. c. children have an easier time exercising. d. both a and b.

36. Parents may help their children maintain a healthy weight by; a. encouraging regular exercise and discouraging TV viewing. b. monitoring their children’s BMI. c. controlling the types of food that are present in the home. d. all of the above.

37. Besides medical treatment, the most effective method(s) for losing weight is/are a. dieting. b. exercise. c. behavioral methods. d. yo-yo or crash diets.

38. Which of the following is NOT used in behavioral weight loss programs? a. Nutrition and exercise counseling. b. Liposuction. c. Stimulus control training. d. Altering the act of eating.

39. Bob has tried diet programs in the past but has had trouble maintaining his diet plan when he goes away on business trips and has to eat at restaurants. Which of the following is an example of how he could deal with this problem using problem-solving training? a. Not worrying about it. A few days off his diet is no big deal. b. Decide to fast during business trips. c. Asking the wait staff at the restaurant how foods are prepared and selecting low-calorie ingredients and preparation methods. d. Exercise more immediately prior to and following business trips.

40. Research on work-site weight-loss programs indicates that the most needed factor to ensure their success is a. proper nutrition information b. a strong aversive component c. use of self-monitoring d. motivational techniques such as weight-loss competitions

44

d (227)

d (228)

d (229)

b (229)

c (231)

a (232)

c (232)

d

41. Very-low-calorie diets (VLCD's): a. are used mainly for those who are obese b. can have serious side effects, such as cardiac problems c. are used only when other approaches have failed d. all of the above 42. Uri has successfully completed a weight-loss program and now wants to make sure he is able to maintain his weight loss. Which of the following will aid him in his maintenance efforts? a. Continue his exercise regimen. b. Permanently eat a lower-calorie and fat diet. c. Use behavioral methods to avoid relapse situations. d. all of the above 43. Which of the following statements regarding anorexia nervosa is true? a. It is most common in females. b. It is marked by intense fears of becoming fat. c. It is characterized by a weight loss of at least 25%. d. all of the above 44. Which of the following statements regarding bulimia nervosa is NOT true? a. It is more prevalent than anorexia nervosa. b. Bulimics rarely think this eating pattern is abnormal. c. A person may exhibit some bulimic behaviors without being diagnosed as a bulimic. e. It has been recognized as a clinical syndrome since the 1970s.

45. Which of the following treatments for bulimia nervosa is most effective? a. Antidepressants b. Aversive techniques c. Cognitive/behavioral plus antidepressants d. Aversive plus behavioral contracting 46. Weight-lifting and push-ups are forms of _____ exercise. a. isotonic b. isometric c. isokinetic d. aerobic 47. Dancing can be a great form of ______ exercise. a. isotonic b. isometric c. aerobic d. isobaric 48. Which of the following is not a demonstrated effect of exercise?

45

(233)

d (235)

a (235)

b (238)

b (238)

c (238)

a

a. Weight loss. b. Enhanced self-esteem. c. Stress reduction. d. All of these are effects of exercise.

49. Which group does not tend to exercise frequently? a. People who believe they are susceptible to illness. b. Young adults. c. Members of the upper SES. d. Older people.

50. Which of the following factors is least likely to influence older adults' participation in exercise? a. Their physical functioning. b. Exaggerated notions of risk of exercise. c. Limited previous involvement in exercise. d. Sedentary social role models.

51. An important factor in getting a person to start and stay with an exercise program is a. the convenience of the program. b. their readiness to begin a program. c. their physical ability. d. their knowledge about exercises and health.

52. The most frequent accidental fatalities involve a. domestic accidents. b. traffic accidents. c. air travel. d. fires.

53. When comparing the years lost due to unintentional and intentional injuries to years lost due to heart disease, cancer, and stroke, research finds: a. more years are lost due to disease than to injury. b. more years are lost due to injury than to disease. c. the years lost are similar. d. neither result in significant years lost.

54. Of the following, which strategy has been least effective in reducing traffic (239) accidents? a. Driver training courses. b. Auto design changes. c. Highway marking changes. d. Raising the driving age.

46

c (238)

d (239)

d (240)

b (240)

a (240)

b (241)

55. Which of the following statements regarding the use of seat belts is true? a. Seat belt use is unrelated to traffic fatalities. b. Seat belt use has been unaffected by the passage of laws requiring them. c. After the passage of laws requiring them, seat belt use increased significantly. d. Only about 15% of drivers use their seat belts.

56. Before going on an afternoon hiking trip, fair-skinned Joel uses plenty of sunscreen on exposed areas of his body. The use of sunscreens a. may prevent premature aging of the skin and skin cancers. b. is recommended for exposure of over an hour. c. is recommended by dermatologists. d. all of the above 57. The odorless radioactive gas radon: a. may be reduced by properly ventilating basements b. enters the house from the ground c. may cause lung cancer d. all of the above 58. Exposure to asbestos is strongly connected to a. hypertension b. lung cancer c. heart disease d. brain damage 59. "Right to Know" laws require that a. Employers notify and train employees on the use of hazardous materials. b. Employees have the right to refuse handling hazardous materials. c. Communities have the right to inform only those who really need to know about the presence of dangerous hazards. d. Communities are freed from the requirement of informing inhabitants of the presence of dangerous hazards.

60. Exposure to carcinogenic substances a. invariably leads to cancer. b. is not usually dangerous in small or infrequent doses. c. no longer occurs in today’s environment. d. might be outweighed in risk by benefits.

47

Short Answer Questions 1. Briefly describe the five components of food and explain their role in metabolism.

2. Your couch potato friend tells you that exercise is grossly overrated. Refute his armchair logic.

3. Explain the significance of "Right to Know" laws.

Essay Questions 1. Develop and elaborate an argument that supports the statement that weight is a biopsychosocial phenomenon.

2. You have just been hired to develop a successful weight reduction and exercise program for your company. Outline the basics of your plan.

3. Discuss the general trends in effective safety intervention programs.

48

Chapter 9 TEST QUESTIONS True or False F

1.

In the United States, home health care has become popular only because of the cost of health procedures.

2.

Bert had some symptoms about which he was concerned. He asked his wife and co-workers about them and was urged to contact a doctor.

These people constituted a lay referral system.

(245)

T (251)

F

3. Although women contact their physicians more frequently (on average) than do men, this is due to the increased visits necessitated by pregnancy and childbirth. Taking pregnancy into account, the utilization rates of medical services are the same for the sexes.

(252)

T

4.

Lack of knowledge regarding prevention and personal beliefs about low susceptibility to illness have been shown to affect the use of health services in low-income people.

5.

Your friend, Tim, has to undergo painful back surgery. The Health Belief Model would predict that he will be reluctant about the surgery unless some definite improvement in his back pain was possible.

6.

Wayne has a rash on his leg and is trying to decide if he should get some over-the-counter ointment at the pharmacy or go to a dermatologist.

Wayne is experiencing illness delay.

(253)

T (254)

T (255)

F

7. Patients rate physician characteristics such as sensitivity and warmth as more critical than physician competency levels.

(261)

T

8.

Practitioners tend to overestimate the degree to which patients comply with medical treatments.

9.

In terms of the sheer amount of information physicians should give to patients, more is generally better.

(264)

F (265)

37

Matching Match the institution listed below with the descriptions in items 1-5. a. hospitals b. nursing homes c. home health care d. preferred provider organizations e. health maintenance organization b

1. provide care for individuals needing long-term medical and personal care

(245)

a

2. The most complex facilities in the health care system

(244)

d

3. A group insurance plan with negotiated fees for services

(246)

e

4. Involves prepaid medical services with a salaried physician

(246)

c (245)

5. A less expensive option than inpatient care for individuals with chronic illnesses

Match the following concepts with their descriptions in items 6-10: a. lay referral system b. health belief model c. commonsense model of illness d. treatment delay e. mass psychogenic illness b (254)

a

6. Perceived threat depends on perceived susceptibility and perceived seriousness

(251)

7. Help interpret a symptom, give advice about seeking medical attentions and recommend a remedy

d

8. Major factor is not having pain

(255)

e (249)

9. Widespread symptom perception among a large group of individuals with no confirmed medical basis for the symptom.

c

10. Ideas and expectations about illnesses developed through experience.

(251)

38

MULTIPLE CHOICE b (244)

a (244)

1. The chief advantage of a health care system organized into specialties is a. good patient-doctor communication b. patients receive the best expertise for each aspect of each problem c. lower expense d. faster delivery of services 2. The most complex facilities in the health-care system are a. hospitals b. nursing homes c. doctors' offices d. emergency clinics

a

3. Hospitals are to _____ as nursing homes are to _____.

(244-45) a. emergency care; long term care b. long term care; emergency care c. inpatient services; home health care services d. outpatient services; inpatient services d (245)

d (245)

c (246)

4. The shift from outpatient services occurred for which of the following reasons? a. Declining number of hospitals. b. Lack of quality health care in this country. c. An increasing number of healthy people. d. Rising costs of hospital and nursing home services.

5. Which of the following statements about outpatient services is true? a. Their use has been declining in recent years. b. Outpatient services are much more expensive than inpatient services due to their technology-intensive services. c. Outpatient services has had no effect on nursing home admissions. d. Technological advances have made outpatient services a possibility for more patients.

6. Research on health maintenance organizations (HMOs) and conventional private-practice health care has shown a. private practice care to be superior. b. HMOs provide superior care. c. patients using HMOs face major obstacles getting the treatment they need d. private-practice patients have more illnesses.

39

c (246)

d (246)

d (246)

d (246)

d (247)

c (248)

7. Which of the following statements is a finding of research on HMOs and private-practice care? a. Private-practice patients are more likely to visit their physician. b. HMO patients express more satisfaction with their physicians. c. Hospital admission rates are lower for HMO patients. d. HMOs provide a better quality of service than private-practice clinicians.

8. Marie's place of employment is enrolled in a managed-care plan in which she is encouraged to choose health care providers from a list of affiliated physicians and hospitals who offer their services at a discount to employees.

Marie's company is enrolled in a. a Medicaid program. b. a Medicare program. c. a home health care program d. a preferred provider organization 9. Compared to fee-for-service patients, HMO patients are more likely to a. be satisfied with the care they receive. b. be admitted to the hospital. c. face few obstacles to treatment. d. receive preventive examinations.

10. Which is a limitation of the American health care system? a. It is not accessible to all Americans. b. It offers too many managed-care alternatives, which confuses consumers. c. Health care is distributed unequally, even among those who are insured. d. All of the above are true.

11. Studies of the correlation between self-estimates and physiological measures of heart rate and nasal congestion show that a. people consistently detect only large changes in both. b. people accurately estimate heart rate but not nasal congestion. c. people accurately estimate nasal congestion but not heart rate. d. none of the above 12. Studies of heat and pain thresholds have shown that a. people feel pain at widely varying temperatures. b. heat does not cause pain. c. almost all individuals report pain at rather uniform temperatures. d. all individuals report pain at 30 C.

40

c (248)

c (248)

d (248)

d (249)

c (249)

d (249)

13. Linda could be described as an internally-focused individual. Which of the following behavioral patterns would she be most likely to demonstrate? a. Reporting less pain than do other people. b. Being more accurate in her perception of internal body changes. c. Overestimating changes in her bodily functions. d. Reporting faster recovery from illness than do other people.

14. Which individual below is most likely to notice internal sensations such as pain? a. An Olympic athlete sprinting for the finish. b. A police officer in pursuit of a felon. c. A single person at home reading a boring textbook. d. All will notice internal sensations equally.

15. As part of a study on joint pain, Bill has received an inert substance to control his pain. Bill has received a _____ and his pain is likely to _____. a. analgesic; go down b. mild tranquilizer; go up c. mild tranquilizer; be unaffected d. placebo; go down 16. Which of the following demonstrates the effect of cognitive factors on symptom perception? a. Research on premenstrual symptoms. b. Psychogenic illness. c. Medical student's disease. d. All of the above.

17. A high school student fainted after eating the "mystery meat special" in the cafeteria. Upon witnessing this, thirty other students who had eaten the same thing subsequently fainted. Tests showed no harmful substances in the air or in the "mystery meat." These students were likely suffering from a. food poisoning. b. the placebo effect. c. psychogenic illness. d. conversion hysteria.

18. Which of the following is a contributor to psychogenic illness? a. Modeling. b. Stress. c. Emotional factors. d. All of the above.

41

b (249)

a (248)

a (251)

b (251)

a

19. When comparing disability from chronic low back pain in six different countries, in which country was the greatest impairment reported? a. Japan. b. United States of America. c. Italy. d. Mexico.

20. Janet's family has a history of breast cancer. When she notices a small lump in her breast, she attributes it to premenstrual symptoms. According to conflict theory, Janet may be engaging in a. hypervigilant coping. b. medical student's syndrome. c. psychogenic illness. d. Zola's denial.

21. Commonsense models involve all of the following components except: a. adherence b. illness identity c. causes and underlying pathology d. time line 22. Dwayne believes that he can tell by the feeling in his head when his blood pressure is high. He says the feeling goes away quickly if he takes his medicine but can last all night when he doesn't take his medicine. Dwayne is using a a. health regimen. b. commonsense model. c. medical technique. d. natural barometer.

23. Rare diseases are perceived as _______ than common ones.

(251)

a. more serious b. less serious c. more likely to be genetically linked d. more prevalent d (251)

24. People with faulty commonsense models of illness are affected in which of the following ways? a. They may not seek appropriate treatment. b. They may not adjust well psychologically to an illness they develop. c. They may be less likely to follow doctor's advice. d. All of the above.

42

b (251)

b (251)

b (251)

c (251)

c (252)

b (251)

a (252)

25. Which of the following is NOT a function of a lay referral system? a. Help interpret symptoms. b. Perform minor medical procedures. c. Recommend remedies. d. Recommend consulting another lay referral person.

26. Before many people seek medical attention they seek advice from friends, relatives or coworkers. These individuals constitute a. an extended family. b. a lay referral system. c. a PPO d. an HMO. 27. Which of the following is NOT true regarding lay referral networks? a. The actions they recommend tend to be more accurate than physicians. b. Their recommendations are likely to make conditions worse. c. Their recommendations can lead to delay behaviors. d. Most people in the United States never rely on lay referral networks.

28. The first health professional with whom many people consult is a. a dentist. b. a chiropractor. c. a pharmacist. d. a member of their lay referral network.

29. Which of the following is NOT usually classified as an acute condition? a. Flu. b. Fractures. c. Arthritis. d. Sprains.

30. Which of the following is NOT usually classified as a chronic condition? a. Arthritis. b. Flu. c. Asthma. d. Diabetes.

31. Which age group is most likely to visit a physician for chronic disease treatment? a. the elderly b. adults of all ages c. children d. infants

43

d (252)

a (252)

a (253)

b (253)

a (253)

c (254)

32. Which of the factors below is not correlated with the frequency of usage of health care services? a. Gender. b. Socioeconomic status. c. Income. d. All of these are correlates with health care usage 33. The difference in health care system usage between males and females a. may exist because of the hesitance of men to admit having symptoms. b. disappears if visits for pregnancy are controlled for. c. illustrates the poor health of females in general. d. demonstrates that males are healthier than females.

34. Social programs like Medicare and Medicaid a. help account for the increase in physician visits in the late 60's. b. were introduced in the mid-50's. c. are impediments to health care utilization. d. all of the above 35. The lower frequency of health care usage by the lower classes is accounted for partially by a. a lower incidence of disease. b. mistrust of the health care system. c. availability of a regular health care source. d. the high quality of physicians attracted to low-income regions.

36. Iatrogenic conditions are a. health problems as a result of medical treatment. b. present only if practitioners make mistakes. c. congenital heart defects. d. likely to affect the heart.

37. According to the health belief model, which of the following initiates a decision making process to seeking medical care? a. Perceiving benefits to be greater than costs. b. Perceiving costs and seriousness of disease to be significant. c. The presence of threatening symptoms. d. The availability of accessible health care.

44

b (255)

d (255)

a (255)

b (248)

c (255)

b (256)

38. According to research, what is the role of emotions in seeking health care? a. They always increase the likelihood that a person seeks health care. b. individuals perceive diseases, such as cancer, to be so serious that they avoid seeking medical examinations out of extreme fear and anxiety c. Emotions tend not to impede seeking medical care. d. Fear is the single more important variable that prevents people from seeking medical care.

39. Expectations of pain a. keep 5% of Americans from visiting the dentist. b. often relate to reluctance to seek cancer care. c. are perceived as part of cancer. d. all of the above 40. Larry finally decides to go to the doctor about his persistent cough after about 2 weeks of steady prodding and encouragement by his wife and daughter.

His treatment has likely been triggered by a. sanctioning. b. interpersonal crisis. c. perceived interference. d. final incentives 41. The time a person takes to interpret a symptom as a sign of illness is called a. treatment delay. b. appraisal delay. c. illness delay. d. utilization delay.

42. The time taken after recognizing a sign of illness until deciding to seek medical attention is called a. treatment delay. b. appraisal delay. c. illness delay. d. utilization delay.

43. Researchers have found that a major non-illness life problem or event will tend to a. decrease total treatment delay of an illness. b. increase total treatment delay of an illness. c. decrease the likelihood of illness. d. increase impulse delay.

45

c (256)

b (257)

b (258)

d (258)

b (259)

d (260)

44. The absence of pain is a major factor in treatment delay. A serious problem associated with this fact is a. it increases the ultimate cost of health care. b. pain is a major symptom of all diseases. c. pain is not a major symptom of many serious diseases. d. disease and pain are unrelated.

45. An accurate conclusion regarding the effectiveness of alternative medicines is that a. most physicians use them as frequently as they do prescription medications. b. some methods appear to have medical value. c. they have absolutely no value and shouldn't be used. d. there is an abundance of scientific evidence for their effectiveness.

46. Those exhibiting hypochondriasis tend to a. recognize real symptoms of illness. b. associate real but benign bodily sensations with illness. c. make up or imagine bodily sensations. d. neglect to use the health care system.

47. The condition known as chronic fatigue syndrome is a good example that a. if a medical test can't measure symptoms, the patient is probably hypochondriacal. b. some illnesses are purely psychosomatic. c. some medical problems simply can't be confirmed yet by medical tests. d. chronic fatigue syndrome is not a medically confirmed condition 48. Which patient will most likely adjust to their recovery better and recover faster? a. Luisa, whose doctor insists that she follow the prescribed regimen. b. Melba, who takes an active role in deciding about treatment. c. Alma, who prefers to let her physician make all the decisions. d. All will recover equally well and at the same rate.

49. Which of the behaviors is NOT associated with a "doctor-centered'' style of relating? a. Use of medical jargon. b. Focus on the first problem mentioned by the patient. c. Asking questions that require only brief answers. d. Open-ended questions.

46

c (262)

d (263)

b (264)

a (264)

a (265)

c (267)

50. Perhaps the most important medical benefit of a more patient-centered approach is a. greater patient understanding. b. increased likelihood of healing. c. greater amounts of diagnostic information. d. decreased appointment cancellations.

51. Patients describe symptoms for the same health problem differently because a. they differ in the attention they pay to internal states. b. they may emphasize a symptom they believe reflects serious illness. c. they may downplay a symptom they believe reflects serious illness. d. all of the above 52. The dissatisfaction with the term "compliance" is a. that patients rarely follow recommendations anyway. b. its suggestion that patients reluctantly submit to physicians' authoritarian demands. c. not a common position in health psychology. d. only discussed in psychology and not in medicine.

53. Findings on medical adherence indicate that a. doctors overestimate adherence b. patients honestly report their adherence. c. overall adherence rate is 90%. d. adherence is very easy to measure.

54. Which of the following has research shown to play the smallest role in medical regimen noncompliance? a. Patient personality traits. b. Complexity of regimen. c. Duration of regimen. d. Illness severity as judged by patients.

55. Which group is most likely to take their medicine as prescribed? a. Adolescent diabetics. b. Female diabetics who are concerned with controlling their weight. c. Arthritic patients over age 55. d. Adolescents taking antibiotics.

47

d (267)

c (268)

a (269)

c (269)

d (272)

56. Which of the following is an example of rational nonadherence? a. Lindy, who stops her diet because she isn't losing weight. b. Vanessa, who stops buying her medicine because she doesn't have the money. c. Mike, who skips chemotherapy because it makes him so sick he doesn't feel he can spend quality days with his children. d. all of the above 57. Research on patient memory as related to their interactions with practitioners shows a. intelligent patients remember more than less intelligent ones. b. older patients remember less than younger ones. c. patients remember what they're told first. d. patients remember most of what their doctors say.

58. Research on medical consultations shows that about _______ of the time is spent giving information to the patient. a. 10% b. 25% c. 50% d. 65% 59. Which of the following statements best represents conclusions regarding the impact of nonadherence on health outcomes? a. Nonadherence has little to no impact on health outcomes. b. Nonadherence tends to make most medicine-taking schedules completely useless. c. The impact of nonadherence depends on the particular health problem and treatment prescribed. d. Studies of nonadherence have been inconclusive.

60. Which of the following is NOT a feature of a chronic care model? a. How care is organized. b. Having guidelines and training for identifying and carrying out treatment. c. Providing self-management support. d. Incorporating a lay referral network.

48

Short Answer Questions 1. Compare and contrast inpatient treatment modalities.

2. Compare and contrast the US versus Canadian health care systems.

3. What factors in the practitioner-patient interaction relate to patient adherence to the practitioner’s advice?

Essay Questions 1. Imagine for a moment that your eye has been watering for the past 2 hours. What factors will determine if you go to the doctor?

2. Discuss how a person’s ideas about illness influence seeking medical care.

3. Newly hired by a health care clinic, what advice do you have for your boss regarding ways to increase adherence among the clinic’s patients?

49

Chapter 10 TEST QUESTIONS True or False F

1.

By the end of the nineteenth century, hospitals had evolved to the point that only the wealthy could afford to use them.

2.

Despite modern techniques, it is estimated that roughly 5% of patients contract an infection while hospitalized.

3.

The use of depersonalization by medical staff may be a method of self-protection from the stress of caring for another human with serious health problems.

4.

Maslach and Jackson (1982) in a study of burnout discovered that nurses showed the greatest degree of depersonalization and physicians reported the greatest dissatisfaction with their sense of accomplishment.

5.

Becoming overly-compliant and exacting in following medical orders in the hospital are symptoms of reactance.

6.

Problem-focused coping is used to try to cope when the problem is seen as unchangeable and the stressors cannot be reduced.

7.

In Taylor's (1979) view, good patients are often just in a state of helplessness.

8.

The breathing techniques taught as part of the Lamaze preparation for childbirth is an example of behavioral control.

9.

When "monitors" are given little information about upcoming medical procedures, their anxiety tends to increase.

10.

The Minnesota Multiphasic Personality Inventory is useful in medical settings because of its specific orientation to health values and behaviors.

(275)

T (278)

T (281)

F (281)

F (282)

F (284)

T (284)

T (288)

T (289)

F (295)

37

Matching Match the following terms with their description in items 1-5: a. hospital administrators b. medical director c. staff or attending physicians d. residents e. nurses c

1. Have been granted "admission privileges" by a committee of physicians.

(276)

e

2. Non-physician employees of the hospital with patient care responsibilities.

(277)

a

3. Non-medical employees of the hospital without patient care responsibilities.

(276)

b

4. The Chief of Staff.

(276)

d

5. Medical school graduates employed in teaching hospitals.

(277)

Match the following instruments or preparation strategies with their description in items 610: a. Lamaze b. Minnesota Multiphasic Personality Inventory c. Millon Behavioral Health Inventory d. The Psychosocial Adjustment to Illness Scale e. video preparation c (295)

a

6. Gives information regarding a patient's basic coping style and psychogenic attitude.

(288)

7. Teaches natural childbirth techniques that promote informational, behavioral. and cognitive control.

b

8. Contains scales which measure hypochondriasis, depression and hysteria.

(295)

d (295)

9. Assesses patient's health care orientation, vocational environment and domestic environment.

e

10. “Ethan has an operation”

38

Multiple Choice b (275)

b (275)

d (275)

c (275)

a (275)

c (275)

a (276)

1. When most Americans die, they are a. at home. b. in hospitals. c. in accidents. d. diagnosed with an infectious disease.

2. The idea of having special facilities to house and treat the sick probably began with the a. Greeks. b. Romans. c. French. d. American colonies.

3. Which of the following is true regarding the earliest hospitals? a. They also housed the poor and other dependents. b. They were associated with monasteries. c. They served a charitable function. d. all of the above 4. Which change(s) took place in hospitals in the 18th and 19th centuries? a. A deepened association with monasteries. b. Use of X-rays for diagnosis. c. Establishment of wards for different illness categories. d. all of the above 5. The campaign to build the first hospital in the American colonies was led by a. Benjamin Franklin. b. Thomas Jefferson. c. King George III. d. George Washington.

6. Until the 20th century, hospital inhabitants were mostly a. the rich. b. the middle class. c. the poor. d. orphans.

7. The highest authorities in U.S. hospitals are typically a. business and professional people b. nurses c. doctors d. medical researchers

39

d (277)

d (277)

b (278)

b (277)

d (278)

c (278)

d (279)

8. In order to practice medicine in a hospital setting, physicians must have admission privileges granted to them by _____. a. their patients. b. the Medical Director. c. the Board of Directors. d. a committee of physicians.

9. Miguel is a nurse at a nearby hospital. His typical job functions include: a. patient care. b. managing hospital wards. c. receiving directives from physicians. d. all of the above 10. A hospital administrator has ordered a cutback on extra tests but Dr. Smith has just ordered a panel of additional tests for one of his patients. Who is most likely to get caught in between this conflict? a. The Chief of Staff. b. A nurse. c. An orderly. d. Dr. Smith.

11. Which is not an example of an allied health worker in a hospital setting? a. Physical therapist. b. Orderly. c. Lab technician. d. Dietitian.

12. What is the best way a hospital can avoid fragmented patient care? a. Put the medical director in charge. b. Put the chief hospital administrator in charge. c. Put a head nurse in charge. d. Require direct communication between physicians and other allied health workers.

13. The spread of nosocomial infections in hospitals a. has been eliminated due to sterilization techniques. b. has been increased in the last 100 years. c. affect as many as 5-10% of all patients. d. is not a problem mainly due to antibiotics.

14. Guidelines designed to reduce nosocomial infections require a. an Infection Control Committee. b. an epidemiologist. c. an Infection Control Nurse as part of the medical staff. d. all of the above 40

b (279)

d (279)

a (279)

c (279)

c (279)

b (279)

c (279)

15. Research indicates that the hospital personnel least likely to comply with infection control regulations are a. nurses. b. physicians. c. orderlies. d. lab technicians.

16. Hospital personnel feel least comfortable giving corrective feedback to a. patients b. those of lower status. c. those of equal status. d. those of higher status.

17. The system of fee payment adopted by Medicare which calculates the fee based on the average cost of treating patients with the same diagnosis is called a. the prospective payment system. b. income-averaging. c. revenue-sharing. d. none of the above 18. How is a "diagnostic-related group" calculated? a. It is a negotiated fee between hospitals and doctors. b. The American Medical Association calculates it based on epidemiological data. c. It is based on past recovery rates of similar cases. d. It is simply the lowest cost for treating a disease.

19. The primary goal of most hospitals is a. providing long-term care. b. providing rehabilitation. c. treating people quickly and discharging them in good health. d. discharging people as quickly as possible regardless of health status.

20. The average length of hospital stay has been a. increasing for all patients. b. decreasing for all patients. c. decreasing for all but surgical patients. d. increasing for all but surgical patients.

21. Which of the following have contributed to the decline in admissions and lengths of hospital stay? a. Fewer procedures being done on an outpatient basis. b. The increasingly complicated nature of medical procedures. c. Patients being released at earlier stages of recovery. d. The general increase in healthy behaviors in the population.

41

a (279)

d (280)

c (280)

d (281)

d (281)

b (281)

b

22. Evidence generally suggests that decreasing length in hospital stays a. has not been harmful to patients. b. has been harmful to patients. c. has not occurred. d. actually increases expenses.

23. What is the reason patients sometimes fail to get the information that they need in the hospital? a. Test results may not be finished. b. Information is disguised by jargon. c. Doctors are too busy and don't have enough time to provide information. d. all of the above 24. Which of the following statements regarding anxiety is true? a. It ranks second behind depression as the most common emotion felt by hospitalized patients. b. Once patients are admitted to the hospital and "settle in", they seldom experience anxiety. c. The source of anxiety varies in people who have received a diagnosis compared to those who haven't. d. Anxiety is the by-product of anger at one's physician.

25. Irving's doctor ceased to speak to him at all while he was treating him for a skin laceration, instead directing all questions to Irving's wife. Irving was the victim of a. his physician's feelings of perceived inadequacy of professional accomplishment. b. malpractice. c. personalization. d. depersonalization.

26. Medical practitioners may engage in depersonalization a. because of stress. b. because of their hectic schedules. c. to help them deal with their own emotions. d. all of the above 27. Which of the following is not characteristic of ''burnout?" a. Drug and alcohol abuse. b. High job satisfaction. c. High absenteeism. d. Chronic exposure to high stress.

28. Which statement is least likely to be made by a sufferer of "burnout?"

42

(281)

c (282)

a (281)

c (282)

b (282)

b (282)

d

a. "Working with people all day is a strain." b. "I am positively influencing other lives by my work." c. "I worry that this job is hardening me emotionally. " d. "I feel highly stressed."

29. When Hank is in the hospital he expects that he should be pampered and taken care of by the nurses. Hank could be classified as a _____ patient. a. problem b. active c. passive d. good 30. Maslach and Jackson suggested that the low degree of patient depersonalization found in nurses may reflect a. a sex difference in empathy. b. their sensitive training. c. their greater level of patient contact. d. their high pay and status in the medical hierarchy.

31. After his prostate operation, Luis began to complain about everything: his treatment by nurses, the quality of the hospital food, the competence of his Doctor. The medical staff would describe Luis as a _____ patient. a. good c. problem d. senile e. passive 32. Marvella doesn't complain about the constant pain in her abdomen following her surgery but chooses instead to "tough it out." Which is probably NOT true? a. She is a passive patient. b. She will take an active role in her recovery. c. The nursing staff will label her as a "good" patient. d. She will be cooperative and calm with the staff.

33. Mark is angry about the visiting rules at his hospital because it limits the number of people who can visit him at one time. Mark's reaction is a form of a. passivity. b. reactance. c. anxiety. d. emotional exhaustion.

34. How might the medical staff respond to "problem patients"?

43

(283)

d (283)

c (284)

b (284)

c (284)

b (285)

c (285)

c

a. Provide them with reassurance and explanations. b. Ignore their problem behavior. c. Arrange for an early discharge. d. all of the above 35. The anxiety level of most surgical patients: a. remains stable throughout the hospital stay. b. declines immediately prior to surgery. c. increases after surgery. d. none of the above 36. Nancy is distressed by her recent diagnosis with breast cancer. According to research, her distress is (at least in part) very likely due to a. concerns with loss of vigor and physical ability. b. "good" patient behavior. c. concerns with disfigurement. d. reactance.

37. Research on blame attribution and health problems has shown that a. blaming others leads to better adjustment. b. blaming others leads to poorer adjustment. c. blame attribution has little effect on adjustment. d. blaming family members leads to better adjustment than self-blame.

38. Research indicates that feelings of helplessness and depression a. decrease with increased time in the hospital b. are directly related to health c. increase with hospital time, even if health improves d. are not affected by time in the hospital 39. Research on anesthetized patients found that a. they can remember exactly what is said to them. b. they recovered more quickly than patients who hadn't had positive suggestions. c. negative comments are never made during surgery. d. constructive statements heard under anesthesia have no impact on recovery.

40. Having a hospital roommate reduces anxiety under which of the following conditions? a. Only if both roommates are awaiting impending surgery. b. Only if roommates are not having similar surgery. c. Only if one of the roommates has already had successful surgery. d. Only if both roommates are pre-surgical and can share their anxiety with each other through discussion.

41. Which of the following is not true of patients with high preoperative anxiety?

44

(285)

d (286)

a (286)

b (286)

d (286)

d (286)

b

a. They report more pain than those with low anxiety. b. They report more depression during recovery. c. They report less anxiety during recovery. d. They stay in the hospital longer.

42. Generally speaking, the most useful approach to helping patients cope with impending surgery is to a. assure them of the safety of the procedure. b. assure them of the doctor's competence. c. depersonalize them. d. enhance their sense of control.

43. A nurse told Maria that one way she could speed her post-surgical recovery was to cough periodically to minimize congestion. The nurse was encouraging her to engage in a. behavioral control. b. cognitive control. c. informational control. d. remote control.

44. Andrew was counseled to think about the positive aspects of his impending surgery in order to reduce his stress. He was being encouraged to use a. behavioral control. b. cognitive control. c. informational control. d. emotional control.

45. One medical procedure in which a patient has little or no behavioral control is a. endoscopy. b. childbirth. c. post-surgical recovery. d. cardiac catheterization.

46. In preparation for her valve-replacement surgery in her heart, Sherry was shown a video on the surgical procedure and postsurgical recovery. In addition, in private sessions with the clinical health psychologist, she learned to recognize signs of her own anxiety and how to control these. Sherry received training in a. behavioral control b. cognitive control c. informational control d. b and c

47. Research indicates that pain and complication during childbirth 45

(288)

d (288)

c (288)

b (289)

a (290)

c

a. is less likely in cultures that view it as an easy and open process. b. is less likely in cultures where childbirth is viewed as private. c. is not affected by cultural viewpoints. d. is universally high across all cultures.

48. Lamaze training emphasizes a. social support in the form of a birthing coach. b. control enhancement. c. minimal use of medication. d. all of the above 49. Research on natural childbirth supports which of the following statements? a. Most obstetricians do not think it should be used. b. The control techniques actually increase birth anxiety. c. Research is inconclusive because women who select natural childbirth may be different from those who don't. d. Even with Lamaze training, women are likely to use just as much painkilling medication as those who don't use Lamaze.

50. "Monitors" reported the greatest amount of distress under which of the following information conditions? a. High information. b. Low information. c. Written information. d. Verbal information.

51. The most serious source of distress from hospital stays in young children appears to be a. separation from parents. b. fear of the unknown. c. allergic reactions. d. restraint of activity.

52. Cross-cultural studies on separation distress in children have found that

(290)

a. this phenomenon does not occur in medical settings. b. children in many cultures demonstrate separation distress. c. children only show separate distress in long-tern separations. d. separate distress lasts for years in most children.

a

53. When a parent says "If you drink too much soda, you'll stunt your growth" 46

(290)

they are linking _____ with getting sick. a. disobedience b. compliance c. having fun d. anxiety

d

54. Which aspect of hospitalization is likely to be least distressing to an 11 year old? a. worry about the outcome of their illness b. loneliness and boredom c. embarrassment at bodily exposure d. separation anxiety

(291)

c (293)

b (294)

a (295)

b (295)

b (295)

a

55. Information given to children about impending medical procedures a. produces benefits for all children. b. should never include puppets. c. may increase anxiety in some children d. tends to be fairly cost prohibitive.

56. The role of the health psychologist: a. often involves correcting psychological factors which lead to disease. b. has expanded greatly since the 1970s. c. may involve minor surgical procedures. d. involves little contact with other professionals.

57. The MMPI scale that evaluates an individual's tendency to cope with problems by avoidance and developing physical symptoms is a. hysteria b. depression c. hypochondriasis d. schizophrenia 58. Which of the following statements about the Minnesota Multiphasic Personality Inventory (MMPI) is not true? a. It is the most widely used personality test. b. It was developed specifically for use in medical settings. c. It is usually completed in about 1-1/2 hours. d. All of the above are true.

59. Which test assesses a patient's basic coping style and psychogenic attitude? a. Minnesota Multiphasic Personality Inventory b. Millon Behavioral Health Inventory c. Psychosocial Adjustment to Illness Scale d. Medical Compliance Incomplete Stories Test 60. Which is not a characteristic assessed by the Psychosocial Adjustment to 47

(295)

Illness Scale? a. Hypochondriasis. b. Psychological distress. c. Health care orientation. d. Domestic environment.

Short Answer Questions 1. Describe the roles and responsibilities of three occupational jobs in the hierarchy of an American hospital system.

2. Trace the changes that have occurred in hospitals since their early development.

3. Compare and contrast the "good" patient and "problem" patient roles.

Essay Questions 1. Discuss the process of depersonalization and explain how it is related to professional burnout. What are the consequences of depersonalization?

2. Distinguish between the psychological experiences and preparation techniques for surgical versus nonsurgical procedures.

3. Your 8-year-old nephew will be going to the hospital to have his tonsils removed. Help him through the experience by developing a plan based on information from this chapter.

48

Chapter 11 TEST QUESTIONS True or False T 1.

(306)

Organic pain and psychogenic pain differ only in the degree of tissue damage.

F 2.

(308)

Rheumatoid arthritis and cancer cause pain which Turk, Meichenbaum and Genest (1983) might classify as chronic-recurrent.

T 3.

(310)

Sharp, well-localized pain is transmitted along A-delta fibers.

F 4.

(315)

According to gate control theory, the gating mechanism is found in a portion of the thalamus.

F 5.

(309)

You have a really bad sunburn and developed blisters on the worst areas. You have third-degree burns.

F 6.

(319)

Research indicates that placebos have no physiological effect.

T 7.

(319)

Terry suffered from pain following a vasectomy. His wife felt sorry for him and performed many of his chores for him. It is plain that Terry's pain has a secondary gain.

T 8.

(323)

Most research suggests that chronic pain leads to psychological disturbance - not the other way around.

F 9.

(329

The EMG is useful for assessing the muscle tension frequently associated with pain.

T 10.

(330)

One common way of measuring pain in children under the age of five is to observe the pain behaviors they exhibit

37

Matching Match the following with the statements in one through five. a. A-delta fibers b. C-fibers c. serotonin, histamine, bradykinin d. nociceptors e. endogenous opioids b

1. Associated with diffuse, dully burning or aching sensations

(310)

d

2. Nerve endings that respond to pain

(310)

e

3. Endorphin and enkephalin

(317)

c

4. Promote immune system activity and cause inflammation at the injury site

(310)

a

5. Associated with sharp, well‑localized, distinct pain

(310)

Match the following with the statements in six through ten. a. referred b. phantom limb c. causalgia d. neuralgia e. analgesia d

6. Shooting or stabbing pain along the course of a nerve

(310)

a

7. In a heart attack, the pain may be felt in the shoulders, or arms

(310)

e

8. State of not being able to feel pain

(316)

c

9. A burning pain, usually at the site of an old wound

(311)

b

10. A pain experienced in amputees

(311)

38

Multiple Choice a (305)

d (305)

b (306)

b (306)

c (306)

d (306)

1. Congenital insensitivity to pain a. can indirectly lead to death. b. does not exist. c. has numerous health advantages. d. is relatively common.

2. Which of the following statements about pain is true? a. some people are insensitive to pain. b. pain serves a useful purpose. c. pain is the most common medical complaint. d. all of the above statements are true.

3. The experience of pain a. is an uncommon medical symptom. b. is the most compelling force in seeking medical care. c. actually discourages most sufferers from seeking medical care. d. none of the above 4. Damage deep within the body is most likely to be marked by a. no pain at all. b. dull, aching pain. c. sharp pains. d. burning sensations.

5. Discomfort caused by tissue damage is referred to as a. chronic pain. b. phantom pain. c. organic pain. d. psychogenic pain.

6. Timothy has a stabbing pain in his back but his physician cannot find any injury to his spinal column or surrounding muscles. Timothy's pain is likely to be classified as a. chronic pain. b. phantom pain. c. organic pain. d. psychogenic pain.

39

a (307)

a (307)

b (308)

c (308)

a (308)

d (308)

7. Which of the following statements regarding pain is true? a. pain is best characterized along a continuum of organic and psychogenic causes. b. pain always occurs with the presence of tissue damage. c. people with psychogenic pain have different pain experiences than do people with organic pain. d. pain disorders result from very serious tissue damage.

8. Chronic discomfort that is psychogenic in origin is referred to as a. pain disorder. b. malingering. c. chronic-organic syndrome. d. acute pain.

9. Andrea has been experiencing a pain in her back for over a year. She has stopped engaging in all her favorite sports and social activities as a result.

Andrea would most likely be classified as having _____ pain. a. acute b. chronic c. C-fiber d. psychogenic 10. George cut his hand today and is a great deal of acute pain. What else is George likely to experience? a. Increased sleeping. b. A sense of helplessness and hopelessness. c. Increased anxiety. e. An elevated MMPI score.

11. The high levels of anxiety associated with acute pain a. typically subside as pain decreases. b. appears unrelated to the pain. c. are alleviated with brief medical consultations. d. increases with decreasing pain levels.

12. Chronic pain sufferers tend to a. often leave their jobs. b. feel worn down and exhausted. c. become increasingly irritable with their families. d. all of the above.

40

c (308)

b (308)

a (308)

d (308)

b (309)

a (309)

d (309)

b

13. Molly is experiencing a shooting but dull pain in the muscles of her head, neck, and back. This syndrome is referred to as a. acute pain. b. somatoform disorder. c. myofascial pain. d. progressive‑malignant syndrome.

14. Cancer and rheumatoid arthritis are frequently associated with a. chronic-recurrent pain. b. chronic-progressive pain. c. chronic-intractable pain. d. chronic-benign pain.

15. Migraine and muscle tension headaches are most characteristic of which category of chronic pain? a. recurrent. b. intractable. c. benign. d. progressive.

16. Receptor cells specific only to pain a. are destroyed in 3rd‑degree burns. b. are destroyed in 2nd‑degree burns. c. are found in the dermis. d. do not exist.

17. During which of the following phases of burn treatment would a patient experience debridement? a. emergency phase. b. acute phase. c. rehabilitation phase. d. psychological intervention.

18. The primary approach for controlling acute pain due to burn is a. analgesic medication. b. informational control. c. behavioral control. d. cognitive control.

19. Third-degree burns are often marked by a. little initial pain b. nerve ending damage c. destruction of the epidermis and dermis d. all of the above 20. The cutting away of dead tissue in burned areas is called 41

(309)

d (309)

c (310)

d (310)

a (310)

b (310)

a. myofascia. b. debridement. c. the emergency phase. d. the rehabilitation phase.

21. Psychological approaches to pain control in burn patients a. are generally ineffective due to the severity of the pain. b. had the effect of increasing requests for medication. c. avoid discussing tanking and debridement procedures. d. none of the above 22. Afferent nerve endings that respond to pain stimuli and signal injury are called a. algogenic substances. b. substance P. c. nociceptors. d. referred pain fibers.

23. The releasing chemicals that are part of the physiology of pain a. exist naturally in tissue. b. promote immune system activity. c. cause inflammation at the site of an injury. d. all of the above 24. The fatty coating which enables neurons to transmit impulses more quickly is called a. myelin. b. nociceptor. c. algogenic substance. d. A-delta.

25. C fibers are involved in a. acute pain sensations b. dull pain sensations c. sharp, well‑localized pain sensations d. an "average" degree of pain

42

a (310)

d (310)

a (310)

b (311)

a (310)

b (311)

26. Pain originating from internal organs but perceived as coming from other parts of the body is called a. referred pain b. benign pain. c. intractable pain d. recurrent pain 27. Which of the following may typically result in referred pain? a. heart attack b. toothache c. inflammation of the diaphragm d. all of the above 28. Which of the following provides an explanation for the phenomenon known as referred pain? a. people are more familiar with sensations from the skin than from internal organs. b. people who experience referred pain suffer from neurological damage. c. referred pain happens only in those people who have had a limb amputated. d. referred pain is purely a psychological problem.

29. Which of the following is among the characteristics common to neuralgia, causalgia, and phantom limb pain? a. they always occur in the absence of any tissue damage. b. the pain they produce is present long after tissue damage has healed. c. pain intensity remains at the same level as was experienced at the time of tissue damage. d. these pain syndromes rarely last more than 6 months.

30. Randi has been diagnosed with a case of neuralgia. She is most likely to experience a. shooting pain. b. burning pain. c. pain in her back. d. pain that is provoked only by an extremely noxious stimulus.

31. Anthony reports intense burning pain at the site where he was stabbed by an attempted robber some time ago. Anthony may be experiencing a. neuralgia. b. causalgia. c. referred pain. d. hysterical pain.

43

d (310)

b (318)

c (312)

c (312)

a (312)

c (312)

32. Which of the following is pain felt when no noxious stimulation is present? a. neuralgia b. causalgia c. phantom limb pain d. all of the above 33. Masochists are believed to learn to enjoy pain through the process of a. operant conditioning. b. classical conditioning. c. brainwashing. d. experimentation.

34. In his classic work on the meaning of pain in soldiers and surgical patients, Beecher found which of the following? a. soldiers experienced far more pain than surgical patients. b. the soldiers' wounds were probably less extensive than the intensive wounds left by surgery. c. the soldiers were far less likely than surgical patients to request medication. d. the extreme fright experienced by soldiers made their pain worse.

35. According to Beecher, the difference in meaning of pain for soldiers versus surgical patients a. was not related to the amount of pain experienced. b. explained the lower levels of pain reports in soldiers because they were in denial. c. explained the higher levels of pain reports in surgical patients because the surgical event was interpreted as a major life disruption. d. was trivial.

36. Which of the following is true regarding specificity theory? a. it suggested the presence of a pain area in the brain. b. it has been unanimously supported by research. c. it proposed no separate system for perceiving pain. d. it successfully addresses the cause of phantom limb pain.

37. Which of the following is NOT true regarding pattern theory? a. the sensations for pain and touch share common receptors. b. it accurately explained the experiences of neuralgia and causalgia. c. it proposed there is separate system for perceiving pain. d. intense patterns of neural activity are associated with the experience of pain.

44

a (312)

d (312)

a (313)

d (314)

c (314)

b (314)

a (315)

d (315)

38. Specificity theory is to _____ as pattern theory is to _____. a. separate; shared b. chronic; acute c. acute; chronic d. shared; separate 39. The problems with the acceptance of pattern theory include a. the requirement of intense stimuli to trigger pain. b. the overlooking of psychological factors in pain. c. the pain area of the brain does not exist. d. all of the above 40. While under deep hypnosis, people report a. feeling less pain than when in a waking state. b. feeling more pain than when in a waking state. c. no differences in the experience of pain. d. they are distracted.

41. Ischemia is another name for a. the cold pressor procedure. b. phantom limb pain. c. chronic pain. d. insufficient blood flow.

42. Higher pain thresholds are reported by people exposed with which of the following experimental stimuli? a. a lecture or a funny movie. b. a funny movie or a baseball game. c. a relaxing tape or a funny movie. d. white noise or a lecture on pain.

43. Which of the following procedures can be used to measure pain threshold? a. the cold pressor procedure. b. the muscle-ischemia procedure. c. debridement. d. hypnosis.

44. According to gate-control theory, the proposed gating mechanism is located in a. the substantia gelatinosa. b. the periaqueductal gray. c. the gray matter of the brain. d. the thalamus.

45. According to gate-control theory, the gating mechanism receives input from 45

a. transmission cells, the periaqueductal gray, and the spinal cord b. A-delta fibers, transmission cells, and c-fibers c. large-diameter fibers, small-diameter fibers, and transmission cells d. pain fibers, other peripheral fibers, and descending messages from the brain c (316)

b (316)

b (316)

a (317)

d (317)

46. Which of the following closes the gating mechanism according to the gate‑control pain theory? a. depression. b. anxiety. c. medication. d. boredom.

47. According to gate-control theory, who is likely to experience the most pain? a. Arnie, who massaged his shin after he hit it on the coffee table. b. Marge, who is bored and depressed. c. John, who is focusing intently on the good book he is reading. d. Fred, who is watching an exciting baseball game.

48. "Squeaky", a laboratory rat, has an electrode implanted in the periaqueductal gray area of his midbrain. When electrical stimulation is turned on, Squeaky is likely to a. feel pain. b. feel analgesia. c. start vocalizations. d. begin pain behaviors.

49. In stimulation-produced analgesia, a. the release of substance P is blocked. b. substance P is released. c. substance P is manufactured. d. the transmission cells are activated.

50. Franklin fractured his foot during the second half of a soccer match but continued to play for the remainder of the game with little discomfort, due to the release of a. substance P. b. algogenic substances. c. gelatinosa. d. endogenous opioids.

46

a (317)

c (317)

d (319)

b (321)

c (321)

d (321)

c

51. The substances known as endorphins and enkephalins a. play a partial role in analgesia. b. are the chemical agents found in aspirin. c. play no role in analgesia. d. are opiates.

52. Before his tooth extraction, David received an injection of naloxone. He is likely to experience a. hallucinations since it is an opioid. b. analgesia. c. pain. d. sedation.

53. An inert substance that produces an effect is called a. naloxone. b. an opioid. c. a neurotransmitter. d. a placebo.

54. Which set of patients is most likely to have a physiological reaction to pain-related words? a. hypnotized persons. b. those who use emotion-based coping strategies. c. migraine sufferers. d. phantom limb pain patients.

56. Patients with low back pain from which country reported more suffering and disability? a. New Zealand. b. Mexico. c. United States. d. Japan.

57. Which of the following best states the relationship between stress and pain? a. stress and pain are not related. b. stress may cause pain but not vice‑versa. c. pain may cause stress but not vice‑versa. d. stress may cause pain and pain may cause stress.

58. The majority of evidence regarding chronic pain and neurotic

(322) maladjustment as measured by the MMPI indicates that

a. some people have "pain‑prone" personalities. b. psychopathy and pain are not related. c. chronic pain often seems to lead to maladjustment. d. hysteria is the best predictor of chronic pain.

47

d (325)

d (329)

59. Which of the following is a self-report method of pain assessment? a. an electromyograph. b. electroencephalograph. c. UAB Pain Behavior Scale. d. McGill Pain Questionnaire.

60. Which of the following is considered evidence that children experience pain? a. "pain" facial expressions. b. changes in patterns of crying. c. rubbing hurt parts of the body. d. all of the above

Short Answer Questions 1. Provide support for the idea that organic and psychogenic pain should be considered as a continuum.

2. Compare and contrast early theories of pain with the gate-control theory.

3. Explain the role of endogenous opioids in the pain experience.

Essay Questions 1. Your medical school friend has the unfortunate attitude that "pain is all in your head."

Convince her otherwise.

2. Using the gate-control theory, devise a plan to minimize pain during your next visit to the dentist.

3. The text author suggests "all pain experiences involve an interplay of both physiological and psychological factors." Provide a comprehensive statement that supports this viewpoint.

48

Chapter 12 TEST QUESTIONS True or False F

1.

In the United States, only 25% of patients experience high levels of pain following surgery.

2.

With chronic pain, one's personality may become dominated by the neurotic triad of hypochondriasis, depression and hysteria.

3.

In a synovectomy, the surgeon disconnects portions of the peripheral nervous system to prevent pain signals from reaching the brain.

4.

Aspirin and acetaminophen are examples of centrally-acting analgesics.

5.

According to operant approaches, placing medications on a fixed administration schedule should reduce requests for medications.

6.

Distraction and guided imagery work best with mild to moderate pain.

7.

The mechanisms that explain how hypnosis works in the reduction of pain are now clearly understood.

8.

Interpersonal therapy is designed to help people deal with chronic pain by changing the way they interact with and perceive their social environments.

9.

Acupuncture effectiveness has been shown to be totally due to psychological factors.

10.

A physical therapist is most likely to apply exercise, massage, traction, heat and cold as treatments for pain.

(334)

T (335)

F (336)

F (337)

T (340)

T (346)

F (348)

T (349)

F (351)

T (352)

37

Matching Match the following with the descriptions in one through five. a. peripherally acting analgesics b. centrally acting analgesics c. epidural block d. biofeedback e. TENS d

1. May involve recording of EMG.

(350)

c

2. Injection of local anesthetic to area surrounding spinal cord.

(338)

a

3. Examples include aspirin and acetaminophen.

(337)

e

4. Involves electrical stimulation.

(350)

b

5. Examples include codeine, morphine and demerol.

(337)

Match the following pain control techniques with the statements in six through ten. a. operant approach b. acupuncture c. distraction d. redefinition e. interpersonal therapy a

6. Changes the consequences of the pain behavior.

(340)

c (344)

7. Whenever she goes to the dentist, Clare counts the ceiling tiles while the dentist works.

d

8. Appears to be most effective with strong pain.

(346)

e (349)

9. May help an individual understand the role of reacting to others as affecting his or her pain.

b

10. Based on the counter‑irritation principle.

(351)

38

Multiple Choice c (334)

a (334)

a (334)

c (335)

b (335)

a (336)

1. The term clinical pain refers to a. acute pain only. b. pain experienced only in clinical settings. c. pain that requires or receives professional treatment. d. chronic pain only.

2. According to the book, which of the following is a reason to treat clinical pain? a. It may be a sign of progressive disease. b. It increases contact with medical professionals. c. It provides social contacts. d. It changes important health beliefs.

3. Which of the following is true regarding acute pain? a. It often has no survival value. b. It responds poorly to treatment. c. It rarely is influenced by psychosocial factors. d. It does not hurt as much as chronic pain.

4. Which of the following statements best describes the relationship between psychosocial problems and pain? a. Psychosocial problems are experienced most frequently by acute pain sufferers. b. Psychosocial problems tend to precede rather than follow pain experiences. c. Psychosocial problems are more characteristic of chronic pain than acute pain sufferers. d. Psychosocial problems are not related to pain.

5. Which of the following is not associated of chronic pain syndrome? a. Excessive drug use to relieve pain. b. Enhanced marital satisfaction since families are drawn together more closely during this time. c. Disturbed sleep patterns. d. Increased depression.

6. Chronic and acute pain a. require different pain relief techniques. b. do not respond well to drugs. c. are treated with the same techniques. d. do not present unique problems for treatment programs.

39

a (336)

c (336)

d (336)

d (336)

d (337)

a (338)

7. Common pain relievers in 19th century America were a. alcohol and medicinal elixirs laced with opiates. b. antidepressants and Valium. c. Tylenol and ibuprofen. d. twigs and massage.

8. To relieve her pain, Diana's physician has disconnected portions of her spinal cord. Diana is likely to experience a. long lasting, permanent pain relief. b. paralysis but no immediate pain relief. c. an eventual return of her pain. d. none of these 9. The procedure known as synovectomy is most often used in the treatment of a. low back pain. b. acute pain. c. phantom limb pain. d. arthritis.

10. Under what conditions are surgical pain relief methods likely to be used? a. If the patient lives in the United States. b. If the patient is severely disabled. c. When nonsurgical pain treatments have failed. d. All of the above 11. Which of the following characteristics are likely to influence physicians’ decisions regarding which drug and dosage to administer to a patient for pain relief? a. Intensity, location, and cause of the pain b. Characteristics of the patient c. Sociocultural factors d. All of the above 12. Which of the following patients is most likely to be undermedicated? a. 8 year-old Jamie b. 20 year-old Annette c. 20 year-old Kevin d. 60 year-old Mary

40

d (338)

b (338)

d (338)

a (337)

b (337)

b (338)

13. Research regarding the administration of pain‑killers to children shows that a. drugs are given to them less frequently. b. they are given doses below recommended levels. c. their dosages are discontinued earlier than adults. d. all of the above 14. Which of the following is a reason that children are undermedicated? a. The belief that children can't develop addiction. b. Fewer requests for medication from children. c. Concerns that children experience more pain and thus require more medication than is safe. d. Concerns that they are simply seeking attention when they ask for medication.

15. The abbreviation "PRN" refers to a. taking the drug on a fixed schedule. b. a computerized pump that delivers a dose of drug into a vein. c. the practitioner recommending no medication. d. giving the drug as needed to control symptoms.

16. Aspirin is to _____ as morphine is to _____. a. peripheral; central b. central; peripheral c. indirect; local d. local; indirect 17. The class of pain reliever most likely to produce increased tolerance and addiction is a. peripherally acting analgesics. b. centrally acting analgesics. c. local anesthetics. d. indirectly acting drugs.

18. Studies with patient‑controlled analgesia have shown a. high probabilities of abuse. b. low abuse risk. c. they are not effective with cancer patients. d. patients administer the medication as directed.

41

d (338)

d (338)

c (338)

a (339)

d (338)

b (339)

19. Which group is more likely to self-administer more pain-killers than needed? a. Patients who are relatively young. b. Patients with high levels of anxiety. c. Patients who have low levels of social support. d. All of the above 20. Nadine is dying from cancer. Her physician likely to prescribe what medication for her? a. Acetaminophen. b. Novocaine. c. Sedatives. d. Narcotics.

21. Some research regarding the use of narcotic pain‑killers with phantom limb pain indicates that a. addiction usually results. b. increased tolerance usually results. c. pain was reduced without increased tolerance. d. none of the above.

22. Which of the following reflects the clinical caution regarding the use of narcotics for chronic pain? a. Clinical research needs to be done on a wider variety of chronic pain conditions. b. The clinical effects of taking narcotics daily are widely known but seldom considered in treatment. c. Researchers know why low addiction levels occur when such drugs are taken for pain relief but ignore this information. d. Acupuncture is a far more effective treatment.

23. Which of the following is not a frequently cited reason for physicians' preference not to use drugs for long‑term pain control? a. Undesirable side effects from these drugs. b. The possibility of physical dependence. c. Drugs' lack of sufficiency in controlling pain. d. Long term expense of the medications.

24. Research using placebos with headache patients reveals that a. placebos do not affect headache patients. b. important psychological processes influence pain control. c. the placebo effect does not occur in instances of chronic pain. d. the placebo effect is only seen in instances of chronic pain.

42

a (339)

b (339)

c (340)

d (340)

c (341)

25. When referring psychological consultations for chronic pain patients, physicians should a. explain the rationale for the referral to the patient. b. turn the treatment completely over to the psychologist to reduce confusion. c. pay as little attention to the patient's discomfort as possible so as not to reinforce it. d. all of the above.

26. Which of the following is not an advantage of group over individual therapy in pain‑coping? a. More efficient use of therapist time. b. Increased isolation from others. c. The risk that the patient will stop listening to the therapist altogether. d. A new patient social network.

27. A 4‑year‑old burn patient is recovering more slowly than expected. A psychologist observes that medical staff is reinforcing some of the child's behaviors and allowing her to avoid uncomfortable activities. She suggests that medical staff ignore the pain behaviors and reinforce the coping behaviors. The psychologist is advocating principles of a. classical conditioning. b. specificity theory. c. operant conditioning. d. gate-control theory.

28. Which of these is a major goal in the operant approach to treating chronic pain patients? a. Keeping pain behaviors from becoming chronic. b. Reducing reliance on medication. c. Reducing accompanying disability. d. All of the above 29. For which type of chronic pain is the operant approach least likely to be successful? a. recurrent b. intractable c. progressive d. it is not successful with any type of chronic pain

43

a (341)

a (342)

b (342)

a (342)

c (344)

b (343)

30. Among the current limitations to the use of operant procedures for chronic are which of the following? a. Patients return to old pain behaviors when intervention is concluded. b. Almost all chronic pain patients benefit from them so there really are no limitations. c. Operant procedures work well regardless of levels of cooperation. d. Disability compensation has no demonstrable effects on behavioral improvements in pain treatment.

31. Tension headaches can be treated with which type of biofeedback? a. EMG. b. Temperature. c. EKG. d. EEG. 32. Most studies on the effectiveness of relaxation and biofeedback have been conducted on a. phantom limb pain. b. headaches. c. arthritis. d. pain associated with cancer.

33. The age group that seems most likely to benefit from biofeedback and relaxation‑based pain control is a. children and those who show certain physiological patterns b. young adults. c. middle-aged. d. elderly.

34. When getting an injection at the dentist's office, most children think of a. school. b. pleasant thoughts. c. negative emotions and pain. d. escaping the situation.

35. One of the problems with Blanchard’s longitudinal research on headache is a. the lack of a control group. b. the high rate of participant drop-out. c. the use of ineffective pain reduction techniques. d. the inappropriate use of headache diaries.

44

a (344)

a (344)

c (344)

b (344)

c (344)

a (344)

36. Focusing thoughts on the unpleasant aspects of a painful experience tends to a. make the pain worse. b. lessen the pain. c. lead to hypnotic states. d. have no effect on experienced pain.

37. Which is an example of passive coping with chronic pain? a. Canceling a date and going to bed. b. Calling a friend and chatting. c. Working on a crossword puzzle. d. Building a birdhouse.

38. Who is most likely to use an active coping strategy in dealing with chronic pain? a. Sarah, who believes her doctor doesn't know the source of her pain. b. Tim, who believes his pain will continue indefinitely. c. Trudy, who believes she understands the nature of her condition. d. Rodney, who doesn't know what causes his pain.

39. Rochelle suffers from phantom limb pain, ever since her leg was amputated following a car accident. She deals with the constant pain by focusing on her personal exercise and rehabilitation program, lifting weights and swimming several times a day. This is an example of a. passive coping. b. active coping. c. progressive muscle relaxation. d. EMG biofeedback.

40. One conclusion regarding patients’ beliefs about pain is that a. they have little influence on the pain experience. b. they have little to no relationship to coping with pain. c. physicians need to take these beliefs into consideration when treating pain. d. most thoughts about how to deal with pain are positive.

41. Which of the following is not a class of pain‑coping cognitive strategies? a. biofeedback. b. distraction. c. imagery. d. redefinition.

45

c (344)

a (345)

a (345)

c (345)

b (346)

c (346)

42. Distraction efforts at pain control are most effective when the a. pain is strong. b. pain is diffuse. c. pain is mild or moderate. d. the technique commands little attention.

43. Michael thinks about lounging on a beautiful beach to take his mind of the pain of a series of shots at the doctor's office. He is using the cognitive strategy of a. imagery. b. redefinition. c. reflection. d. rejection.

44. Imagery differs from distraction in that it is based upon a. the person's imagination. b. intuitive sense. c. real events. d. real objects.

45. One of the advantages of imagery over distraction is that a. it is successful with severe pain whereas distraction is not. b. it requires little involvement or attention. c. it involves the use of a scene that can be easily carried in one’s head. d. most people are quite adept at imagery.

46. During painful leg‑strengthening exercises following knee surgery, Marvin continued to tell himself that, "It hurts, but this must be done if I am to walk without a limp." He was using the cognitive strategy of a. imagery. b. redefinition. c. distraction. d. remission.

47. According to researchers, the most effective cognitive strategy for strong and chronic pain appears to be a. imagery. b. local anesthetic. c. redefinition. d. distraction.

46

b

48. Which of the following is an important determinant in the effectiveness of cognitive methods on pain reduction?

(346)

a. The severity of the pain. b. The type of illness. c. The cognitive method used. d. all of the above b (348)

b (349)

d (349)

c (349)

b (350)

49. Which of the following statements about hypnosis is most accurate? a. Most people can be easily hypnotized. b. Relaxation strategies are as effective as hypnosis in pain reduction among most people. c. Hypnosis simply does not work at an anesthetic. d. Hypnosis works solely by activating endorphins.

50. The concept of a “pain game” refers to a. an operant conditioning treatment approach. b. playing the role of “suffering person.” c. a distraction technique to takes one’s mind off the pain. d. a physical therapy approach that involves exercise and sporting events.

51. Which statement best summarizes the impact of hypnosis in pain control? a. Patients use distraction and redefinition techniques only when told to do so under hypnosis. b. Cognitive strategies produce more pain relief than does hypnosis. c. The deep relaxation that people who are hypnotized experience is the sole reason for the effectiveness of hypnosis in pain relief. d. Regardless of whether a patient receives hypnosis or relaxation therapy, persons who are high in hypnotic suggestibility benefit the most.

52. Interpersonal therapy is incorporated in pain treatment programs because a. patients learn how to play “pain games” with their family members during the course of treatment. b. patients have the opportunity to discover who is causing them the most trouble in their lives and confront them. c. patients gain insight into the motivations for their behaviors and how their behaviors toward others affect their adjustment. d. pain patients tend to experience psychotic symptoms.

53. The basis for stimulation pain‑reduction therapies is the principle of a. mental imagery. b. counter-irritation. c. operant conditioning. d. classical conditioning.

47

d (350)

c (351)

b (352)

d (352)

d (352)

d (352)

54. Transcutaneous electrical nerve stimulation it based upon the view that counter‑irritation works on the principles of a. operant conditioning. b. classical conditioning. c. specificity theory. d. gate-control theory.

55. Which of the following pieces of evidence fails to support the idea that acupuncture works due to the power of suggestion? a. Acupuncture appears to work better in highly suggestible people. b. Patients who benefit from acupuncture are well indoctrinated. c. Analgesia effects can be demonstrated with acupuncture in animals. d. Gate-control theory cannot account for the effects of acupuncture.

56. Enhancing muscular strength and tissue flexibility to restore range of motion in pain patients is an important goal of a. progressive muscle relaxation. b. physical therapy. c. insight therapy. d. EMG biofeedback.

57. Amanda’s pain therapy includes exercise, traction, and massage. Amanda is most probably seeing a person who specializes in a. transcutaneous electrical nerve stimulation. b. acupuncture. c. group psychotherapy. d. physical therapy.

58. Studies of the relative effects of physical therapy and behavioral/cognitive programs in the treatment of chronic low back pain have shown that a. neither is very effective. b. only physical therapy is effective. c. only behavioral/cognitive programs are effective. d. both approaches show good effects specific to their area of focus.

59. Most backaches are due to which of the following? a. Normal wear and tear on joints in the spine. b. Muscle or ligament strains. c. Lack of exercise. d. all of the above

48

d (354)

60. Compared to patients who don’t attend multidisciplinary pain clinics, patients who do a. still have great difficulty with depression. b. are less likely to be working a year after discharge. c. are more likely to play “pain games.” d. experience far less pain at follow-up.

Short Answer Questions 1. Compare and contrast acute clinical pain with chronic clinical pain.

2. Compare and contrast behavioral versus cognitive methods for pain treatment.

3. Your confused cousin is upset that her son is going away to a pain clinic because she’s heard that all they do there is play “pain games.” Educate your dear cousin on the concept of pain games and how they relate to the pain experience and treatment.

Essay Questions 1. Discuss three issues pertaining to the use of chemicals for acute pain compared to the use of chemicals for chronic pain.

2. Your close friend is debating whether to go to a psychologist who uses biofeedback versus a psychologist who uses hypnosis to treat her chronic back pain. Provide a convincing set of evidence to inform her choice.

3. You have just begun work as a pain specialist in a multidisciplinary program pain clinic. Explain to your closest relative what it is that you do for a living.

49

Chapter 13 TEST QUESTIONS True or False F

1.

The initial shock reaction to the diagnosis of a serious illness according to Shontz (1975) is characterized by a rush of emotions and disorganized thinking.

2.

Ron was in an automobile accident which left him with numerous facial scars and paraplegia. We might expect him to have particular difficulty coping with his symptoms.

3.

Research has determined that using one type of coping skill to consistently deal with a chronic illness produces better results than developing a range of coping skills.

4.

One way to treat asthma is to avoid the triggers of attacks.

5.

Most cases of epilepsy are linked to a specific neurological defect.

6.

Harriet, who became quadriplegic at age 40 when her spinal cord was crushed at the waist‑level, is typical of such injuries.

7.

If a diabetic follows recommended medical regimen it is less likely that they will die from acute complications.

8.

Although there are over 100 forms of rheumatic disease, they all have the. same underlying pattern of causes.

9.

In Alzheimer’s disease, the initial symptoms noticed are personality changes and disorientation.

10.

Tailoring the treatment regimen to suit the patient’s lifestyle is likely to increase treatment adherence.

(358)

T (359)

F (361)

T (364)

F (365)

F (367)

T (371)

F (375)

F (378)

T (380)

37

MATCHING Match the disorders below with their characteristic in one through five. a. insulin‑dependent diabetes mellitus b. non‑insulin dependent diabetes mellitus c. rheumatoid arthritis d. asthma e. gout c

1. May result in joint deformities.

(375)

a

2. The main acute complication of this disorder is ketoacidosis.

(370)

d

3. Appears to result mainly from a response to allergens.

(363)

b

4. Two subtypes exist which are based on the person’s weight.

(370)

e

5. Results from an overproduction of uric acid.

(375)

Match the disorders below with their characteristic in six through ten. a. osteoarthritis b. rheumatoid arthritis c. spinal cord injuries d. epilepsy e. Alzheimer’s b

6. May affect not only the joints, but the heart, blood vessels, and lungs as well.

(375)

d

7. Sometimes accompanied by an aura.

(365)

e

8. Characterized by lesions of nerve and protein fibers.

(378)

c

9. Affects predominantly males under 30 years old.

(367)

a

10. Associated with occupations which are physically demanding

(375)

38

MULTIPLE CHOICE a (358)

d (358)

a (358)

d (358)

b (358)

d (359)

1. According to Shontz, the first stage in the sequence following the diagnosis of disabling illness is a. shock. b. encounter reaction. c. reaction formation. d. retreat.

2. Which is not a characteristic of shock? a. It is most pronounced when the crisis comes without warning. b. Feelings of being stunned or bewildered. c. Feeling a sense of detachment from the situation. d. Feelings of loss, grief, despair.

3. Which of the following statements regarding avoidance strategies is true? a. They are used especially when people feel there is nothing they can do to change the situation. b. They are used only by acute pain patients. c. They are always maladaptive. d. They are never maladaptive.

4. The use of avoidance strategies in coping with chronic illness a. often causes patients to gain less information about their illness. b. may be psychologically beneficial early in the coping process. c. may prevent the patient from making important lifestyle changes in fighting their illness. d. all of the above 5. One key difference in chronic health problems vs. short‑term difficulties is a. chronic problems are always more painful. b. chronic problems require behavioral, social, and emotional adjustments. c. short‑term problems are more painful. d. chronic problems cause less reliance on the medical field.

6. Moos’ theory on adjustment to crises focuses on a. illness factors. b. background and personal factors. c. physical and social environmental factors d. all of the above

39

a (359)

b (359)

7. Wayne is having trouble coping with the embarrassing joint deformities that have resulted from his rheumatoid arthritis. According to Moos, this is a(n) ____ factor. a. illness b. personal c. physical d. background 8. According to Moos, which of the following types of disfigurement is likely to affect coping the most? a. Loss of a limb. b. Severe facial scarring. c. Loss of a breast. d. Loss of the ability to walk.

a 9. Which of the following people are likely to have the most significant problems (359) coping with their treatment regimen? a. Paul, whose treatment is extremely painful. b. Mark, whose medications have minor side effects. c. Frank, whose treatment regimen requires him to take his meds once a day. d. George, whose treatment program is held on nights and weekends. d (359)

d (360)

c (360)

10. People who cope well with chronic illness have __________ personalities. a. passive b. pessimistic c. dependent d. hardy 11. Which of the following are characteristic of people who cope well? a. They have resources to resolve the chronic nature of the situation. b. They find purpose and quality in life. c. They are able to find hope in life. d. all of the above 12. Males differ from females in coping with chronic illness in that a. their greater self‑esteem causes them to cope with chronic illness better. b. they are more adherent to treatment regimen. c. they tend to be more threatened by the dependent, passive role they might have to take. d. men suffer fewer chronic illnesses.

40

c (360)

c (360)

d (360)

a (360)

b (360)

b (361)

13. Adolescents are most likely to avoid their treatment regimens for chronic illness because of a. the painful nature of treatment regimen. b. fear of parental separation. c. their desire to avoid appearing different from their friends. d. pre‑conceived ideas about illness.

14. For middle-aged patients with chronic illness, which of the following reflects a likely coping difficulty? a. Resentment that they aren’t able to enjoy their leisure time. b. Concern with being viewed as different from their peers. c. Not being able to complete tasks they have begun. d. The frightening nature of medical procedures.

15. Which of the following statements reflects the relationship between selfblame and coping with chronic illness? a. Self-blame may affect coping at first but tends to fade away quickly. b. Self-blame has little impact on coping with a chronic illness. c. Self-blame is linked to more aggressive coping attempts. d. Self-blame is associated with higher levels of depression and poor coping.

16. When adjusting to a chronic illness which of the following represents a physical environmental factor that may occur? a. The lack of assistive devices to increase self-sufficiency. b. The feelings involved in role threat. c. The lack of support networks in the community. d. The complexity of the treatment regimen.

17. The primary source of social support for children and most adults who are ill comes from a. their friends. b. their families. c. their support groups. d. their physicians.

18. Learning and adhering to a medical regimen would be classified by Moos as a. an environmental task. b. an adaptive task. c. a cognitive appraisal. d. a personal factor.

41

d (359)

d (361)

a (362)

b (362)

b (363)

a (364)

d (364)

19. In crisis theory, which of the following is not a task related to general psychosocial functioning? a. Controlling negative feelings. b. Maintaining a satisfactory self‑image. c. Preserving good relationships with family and friends. d. Adjusting to the pain.

20. Which is a coping strategy for chronic health problems? a. Learning to provide one’s own medical care. b. Recruiting support from family and friends. c. Denying the seriousness of the illness. d. all of the above 21. The process of making changes in order to adjust constructively to life’s circumstances is called a. adaptation. b. quality of life. c. instrumental support. d. emotional coping.

22. Which of the following is TRUE regarding quality of life? a. Factors that influence quality of life vary a great deal in different countries. b. Around the world, people judge quality of life using similar criteria. c. Quality of life is difficult to measure cross-culturally. d. Making adaptive changes has very little effect on quality of life assessments.

23. Which of the following is NOT true about asthma? a. Most childhood cases of asthma become less severe over time. b. Death from asthma attacks no longer occurs. c. Asthma is not associated with disability or loss of work days in the US. d. Prevalence rates are higher for children than adults.

24. The primary site of irritation in the first phase of an asthma attack is a. the bronchial tubes. b. the nostrils. c. the peritoneum. d. the alveoli.

25. Which of the following is a likely trigger of asthma attacks? a. exercise b. weather changes c. psychosocial factors d. all of the above 42

a (364)

b (365)

b (365)

d (365)

b (365)

d (366)

26. Which of the following is a common treatment for asthma? a. Use of anti-inflammatories. b. Refraining from exercise. c. Gradual exposure to triggers. d. all of the above.

27. Which of the following statements reflects the relationship between maladjustment and asthma? a. Maladjustment has not been linked to asthma conditions. b. The relationship appears to be reciprocal. c. Asthma may lead to maladjustment but not the other way around. d. Maladjustment affects asthma but only if the level of maladjustment is severe.

28. During a recent epileptic attack, Kim lost consciousness and had muscle spasms. She most likely had a. petit mal attack b. grand mal seizure c. absence attack d. psychomotor seizure 29. Which of the following is NOT a risk factor for developing epilepsy? a. Family history. b. Severe head injury. c. Central nervous system infections. d. Low socioeconomic status.

30. Which is the BEST thing to do for an individual suffering an epileptic seizure? a. Call an ambulance immediately. b. Remain calm and protect the epileptic from injury due to falls. c. Lay the person on his or her back. d. Put a spoon in his or her mouth to prevent tongue swallowing.

31. Joshua has been diagnosed with grand mal seizure disorder. He might experience which of the following while trying to adjust to this condition? a. Stigmatized treatment by others. b. Possible cognitive impairments that could limit his memory capabilities. c. Increased seizure activity when emotionally aroused. d. all of the above

43

b (367)

d (367)

b (368)

d (369)

c (370)

b (370)

d (370)

32. Quadriplegia is to _____ spinal cord damage as paraplegia is to _____ spinal cord damage. a. lower; upper b. upper; lower c. minor; severe d. severe; minor 33. Which of the following best described the demographics of spinal cord injuries? a. They are more prevalent in males. b. They are more common under age 30. c. Most result from traffic accidents. d. all of the above 34. The most common cause of death related to spinal cord injury after the spinal shock period is a. heart disease. b. renal failure due to repeated infections. c. stroke. d. suicide.

35. Which of the following statements regarding sexual function and spinal injury below the waist is correct? a. All sexual function is lost. b. Males usually retain fertility. c. Females usually lose fertility due to the injury. d. The greatest barriers to sexual function are psychosocial.

36. Which of the following is TRUE regarding the prevalence of diabetes? a. It is a fairly rare disease worldwide. b. It occurs more frequently in children than in adults. c. It is among the most common chronic conditions in the United States. d. Women of color are very unlikely to develop the disease.

37. For Type I diabetes, the main acute complication that occurs is a. heart disease. b. ketoacidosis. c. hypertension. d. hypoglycemia.

38. Which of the following has been implicated in the development of of diabetes? a. Genetic factors. b. Viral infections. c. Dietary factors. d. all of the above 44

d (370)

c (371)

c (371)

a (372)

b (372)

d (374)

39. Which of the following ailments is correlated with diabetes? a. Neuropathy. b. Blindness. c. Gangrene. d. all of the above 40. The primary approach to treating diabetes involves a. medicine use only. b. dietary changes only. c. a combination of medicine, dietary changes, and exercise. d. psychosocial intervention only.

41. Research on adherence to diabetes regimen indicates that a. most diabetics carefully administer recommended insulin doses. b. self-report information regarding adherence tends to be fairly accurate. c. adherence to the medical aspects of regimen is higher than that associated with dietary changes. d. people with diabetes often don’t even try to adhere to their regimen.

42. Epinephrine may worsen the effects of diabetes by a. causing the pancreas to decrease insulin production. b. causing the liver to increase glucose production. c. causing the liver to secrete insulin. d. contributing directly to weight gain.

43. Stress has which of the following effects on diabetics? a. It results in increases in insulin release. b. It contributes to increases in blood glucose levels. c. It has only an indirect effect on blood glucose levels. d. It is associated with enhanced vigilance to the medical regimen.

44. Research on parent and physician goals in diabetic treatment suggest a. both parents and physicians are focused on preventing long-term complications. b. parents are concerned with preventing hypoglycemic episodes in their children. c. physicians are primarily concerned with promoting the day-to-day wellbeing and activities of these children. d. physicians and parents have different goals for treatment.

45

c (374)

b (375)

c (375)

d (375)

c (375)

d (376)

45. When treatment responsibility for diabetes regimen shifts to adolescents a. adherence increases. b. parents continue to assume primary responsibility. c. adherence is highest in adolescents with high self-esteem and social competence. d. hormonal changes are of little concern in diabetic regimen.

46. Musculoskeletal disorders affecting the joints and connective tissues are called a. gout. b. rheumatic disease. c. congenital disease. d. renal disease.

47. The condition called gout is characterized by an excess of a. peritoneum. b. insulin c. uric acid d. histamine 48. The primary mechanism resulting in the development of osteoarthritis is a. cancer. b. excess uric acid. c. an immune response. d. physical wear and tear.

49. The musculoskeletal disorder most likely to be associated with one’s occupation is a. gout. b. rheumatoid arthritis. c. osteoarthritis. d. fibromyalgia.

50. Common treatment approaches to arthritis include a. use of pain relief medication. b. use of physical therapy. c. use of appropriate assistive devices. d. all of the above.

46

c (376)

a (378)

c (378)

d (378)

a (379)

b (378)

a

51. Research on the relationship between mood and coping with rheumatoid arthritis indicates a. most patients believed they had control over the course of their disease. b. patients who believed they had control over their disease showed high levels of distress. c. patients who saw themselves as active partners in treatment were better adjusted. d. mood did not correlate with adjustment.

52. The progressive loss of cognitive functions, usually in old age, is called a. dementia. b. epilepsy. c. fibromyalgia. d. neuropathy.

53. A common early symptom of Alzheimer’s disease is loss of a. sexual function. b. energy. c. memory. d. motor control.

54. Which of the following statements regarding current treatment approaches for Alzheimer’s disease is accurate? a. Genetic therapy has been shown to be highly effective. b. Administration of beta‑amyloid delays progression of the disease. c. Physical therapy reduces the likelihood of muscular deterioration. d. There currently is no effective treatment.

55. Anna is in the early stage of Alzheimer’s disease. Like most victims, she receives her care a. at home from her spouse and children. b. in a nursing home. c. in a hospital. d. in a day‑care facility.

56. Research on caregivers of patients with Alzheimer’s disease has found a. emotional and physical effects of caregiving varies widely across different cultures. b. negative health effects are associated with levels of social support and distress. c. emotional distress tends to be short-lived since the disease progresses so quickly. d. negative health effects occur only for those caregivers who had poor health to begin with.

57. According to research, when a parent’s child has a serious disease, 47

(380)

d (380)

c (382)

d (382)

a. they tend to have less negative views of those diseases. b. their views of disease seriousness are exaggerated. c. their views on disease seriousness are no different than those of parents whose children don’t have serious disease. d. their adjustment levels uniformly tend to be poor.

58. Which of the following is included in the type of adjustment problems associated with chronic illness? a. Learning to adjust to changes in one’s self-image. b. Coping with disability or pain. c. Coping with the loss of enjoyable activities or relationships. d. all of the above 59. Regarding the use of biofeedback interventions with patients with epilepsy, research has found a. it works well with most patients. b. it does not work effectively in most cases. c. it is difficult to determine with whom these interventions will be effective. d. it is an inexpensive intervention and thus should be used more frequently.

60. A primary reason to use insight or family therapy in the treatment of chronic illness includes a. changing distorted thoughts about the illness. b. the discussion of reinforcement techniques in intervention. c. the explicit need to increase compliance with treatment regimen. d. addressing anxieties and changes in self-concept and relationships.

Short Answer Questions 1. Discuss 3 of the 7 coping strategies for dealing with chronic illness. How will each affect adjustment?

2. Your cousin is just about to enter rehabilitation for a spinal cord injury due to a motorcycle accident. Outline for him what he should expect during treatment.

3. Compare and contrast the various forms of rheumatic diseases.

48

Essay Questions 1. Elliot has just been diagnosed with asthma. Using Moos' crisis theory and the factors of that theory, describe how Elliot is likely to adjust to his disease.

2. Your 8-year-old nephew has just been diagnosed with Type I diabetes. Based on what you've learned from the text, help him understand the disease and what he needs to do in his treatment regimen.

3. Develop and discuss a comprehensive treatment program for patients with chronic illness.

49

Chapter 14 TEST QUESTIONS True or False T

1.

Cognitive adjustments patients make to high‑mortality illnesses include developing positive reappraisals of their life situations, gaining a sense of control, and restoring their self-esteem.

2.

Women are more likely to have heart attacks, but less likely to die from them than men.

3.

50% of patients who begin an exercise program as part of their cardiac rehabilitation discontinue within the first six months.

4.

The vast majority of those smokers who suffer a myocardial infarction quit smoking.

5.

Ischemic strokes are caused when blood supply to the brain is cut off by a blood clot or a plaque.

6.

Aphasias are language disorders that can be caused by stroke in the. left hemisphere of the brain.

7.

Cancer is the most frequent cause of death in the U.S.

8.

The most common site for cancer is the lung

9.

The criteria for diagnosis of AIDS has been changed to include low T-cell counts.

(388)

F (389)

T (393)

F (393)

T (396)

T (398)

F (400)

F (400)

T (409)

F

10.

The vast majority of cancer patients experience severe depression throughout their treatment.

37

Matching Match the following disorders with their descriptions in one through five. a. angina pectoris b. myocardial infarction c. carcinoma d. stroke e. AIDS b

1. The destruction of heart muscle due to lack of blood.

(389)

e (410)

2. May be associated with Pneumocystis carinii pneumonia and eventual encephalopathy.

a

3. Caused by a brief or incomplete blockage of oxygenated blood to the heart.

(389)

d

4. Results in motor or cognitive deficits and possible emotional lability.

(396)

c

5. Characterized by an unrestrained proliferation of cell growth.

(400)

Match the following treatments with their description in six through ten. a. balloon angioplasty b. external beam therapy c. chemotherapy d. lumpectomy e. AZT e

6. May prolong survival, but is not a cure for AIDS

(410)

a

7. Is used to treat blockages in coronary arteries.

(392)

d

8. A treatment for a limited breast cancer

(404)

c

9. Results in anticipatory nausea in 25-50% of those treated.

(404)

b

10. A radiation treatment for cancer.

(404)

38

Multiple Choice d (387)

c (387)

c (387)

b (388)

a (388)

c (388)

1. Which of the following is NOT considered a high-mortality chronic illness? a. cancer b. heart disease c. stroke d. asthma 2. When a person has been diagnosed with a high-mortality disease such as cancer, they a. probably have only a matter of months to live. b. seldom make it to the 5-year survival window. c. may be totally cured. d. are no more likely of dying than a healthy person.

3. During the first few months after diagnosis of a life‑threatening illness, a. patients usually plan for the future with assurance. b. patients are usually pessimistic. c. more active approaches in coping begin to be utilized. d. the use of avoidance coping grows stronger.

4. The helplessness that a person with a high-mortality illness experiences, coupled with nurturance from his or her family, can lead to ____ on the part of the patient. a. high self esteem b. dependence c. self-efficacy d. hardiness 5. May has dealt with her breast cancer by focusing on the good things in life and living each day to the fullest. This approach best fits what Taylor would categorize as a. finding meaning. b. avoidance. c. restoring self‑esteem. d. gaining control.

6. Which of the following statements best captures the experience of relapse in high-mortality diseases? a. Relapse is a low occurrence event. b. Patients respond better to relapses than they did to the original diagnosis. c. Relapse is often viewed as a bad sign and that the prognosis is worse. d. Patients use the same coping strategies and continue to experience just as much hope as at the time of the original diagnosis.

39

b (389)

a (389)

d (389)

c (389)

c (389)

b (389)

7. The painful cramp associated with a brief blockage of oxygenated blood to the heart is called a. myocardial infarction. b. angina pectoris. c. transient ischemic attacks. d. atherosclerosis.

8. Another term for "heart attack" is a. myocardial infarction. b. angina pectoris. c. transient ischemic attacks. d. cerebral infarction.

9. Dan's cardiologist discovers he has an enlarged heart with poor pumping capability which contributes to his shortness of breath when he walks up his apartment stairs. Dan is likely to be diagnosed with a. myocardial infarction. b. angina pectoris. c. transient ischemic attacks. d. congestive heart failure.

10. Which of the following contributes to greater likely of heart damage following a heart attack? a. Getting to the hospital as quickly as possible following onset of symptoms. b. Getting to the hospital within an hour of symptom onset. c. Getting to the hospital within 3 hours of symptom onset. d. The greatest amount of damage occurs immediately – delay seldom affects levels of heart damage.

11. Heart attacks are most common a. among men. b. in the morning. c. in Blacks. d. all of the above.

12. Which is not a biological risk factor for heart disease? a. Family history of the disease. b. Contact with an infected person. c. Hypertension. d. High LDL and total cholesterol levels.

40

d (390)

a (392)

d (392)

d (393)

b (393)

d (393)

13. Which sociocultural group has the lowest death rates from heart disease? a. African American. b. Hispanic. c. Native American. d. Asian American.

14. Following her recent heart attack Jamie's surgeon placed a balloon in one of her blocked blood vessels and inflated it. This procedure is called a. angioplasty. b. bypass surgery. c. cardiac resuscitation. d. angina pectoris.

15. Which of the following describes the course of anxiety that occurs following a heart attack? a. Anxiety remains high through hospitalization and continues to be higher than non-cardiac patients for years after the event. b. Anxiety is best eliminated through the use of denial. c. Anxiety is natural and rarely affects recovery from heart attack. d. Anxiety levels are high initially but then generally start to decline.

16. Recurrent chest pain following a heart attack a. is uncommon b. indicates a greater risk of heart attack in the near future. c. all of the above d. none of the above 17. Which of the following is least likely to be advised by a physician to a heart attack victim? a. Stop smoking. b. Increase alcohol consumption. c. Lose weight. d. Exercise.

18. Within the first six months of beginning an exercise program about 50% of heart attack victims a. have substantial weight gain. b. have another heart attack c. are re-hospitalized. d. discontinue the program.

41

d (394)

c (394)

c (394)

19. Which of the following describes the role of work following a heart attack? a. It is often viewed as a sign of recovery by patients. b. Most cardiac patients return to work but in a diminished job capacity. c. Returning to work has been linked to long-term well-being. d. all of the above.

20. Following a heart attack, prior family problems a. tend to be viewed as trivial. b. often are worked through more realistically. c. often become worse. d. have no impact on adherence to cardiac rehabilitation regimen.

21. Studies of wives' evaluations of the post‑heart attack physical abilities of their husbands indicate that wives develop more accurate evaluations by a. having heart attack patients tell them about their capabilities. b. simply observing the physical activity of patients. c. personally participating in patients' activities. d. having physicians tell them what their husbands were capable of doing.

b

22. Which of the following outcomes is NOT produced by cardiac rehabilitation (392) programs that include both psychosocial counseling and health/regimen education? a. Reduced mortality. b. Reduced anxiety and depression. c. Lower recurrence of heart problems. d. Reduced risk factors. a (396)

a (396)

a (397)

23. Wayne had a stroke that occurred very suddenly. His daughter found him unconscious on the living room floor. His stroke was probably caused by a. hemorrhage. b. blood clot. c. a piece of plaque lodged in a cerebral artery. d. shock.

24. Which of the following statements regarding strokes is TRUE? a. Strokes caused by hemorrhages produce the most extensive damage. b. Strokes caused by infarction tend to produce unconsciousness. c. Strokes due to infarctions are less common than strokes due to hemorrage. d. Infarctions cause more death than due hemorrhages.

25. Which sociocultural group has the highest death rates due to stroke? a. African American. b. Hispanic. c. European American. d. Native American.

42

d (396)

c (396)

b (397)

c (397)

c (397)

a (398)

26. Fred experienced a sudden, severe headache, followed by blindness in one eye and dizziness. These are symptoms of a. a myocardial infarction. b. diabetes. c. AIDS. d. a stroke.

27. Mini-strokes, which may occur one or more times before a full stroke, are called a. myocardial infarctions. b. angina pectoris. c. transient ischemic attacks. d. atherosclerosis.

28. The most common deficits experienced by stroke patients involve a. speech. b. motor action. c. cognitive dysfunction. d. memory loss.

29. Which of the following deficits would be most characteristic of right hemisphere damage from stroke? a. Receptive aphasia. b. Expressive aphasia. c. Visual and emotional disorders. d. Paralysis of the right side of the body.

30. The phenomenon of visual neglect occurs when there is damage in the _____ hemisphere and is characterized by the failure to process information from the _____ visual field. a. right; right b. left; left c. right; left d. left; right 31. The use of denial is most common in which of the following disorders? a. Stroke. b. Heart disease. c. Cancer. d. Diabetes.

43

d

32. Common forms of effective rehabilitation treatments for victims of stroke (397) include: a. speech therapy. b. physical therapy. c. biofeedback. d. all of the above. b (400)

c (400)

a (400)

b (400)

c (400)

a (400)

33. Another common name for a tumor is a. protoplasm. b. neoplasm. c. cytoplasm. d. plasma.

34. Cancers of the blood‑forming organs are called a. sarcomas. b. lymphomas. c. leukemias. d. carcinomas.

35. The majority of human cancers are a. carcinomas. b. sarcomas. c. lymphomas. d. leukemias.

36. Cancers of the muscle, bone, or connective tissue are called a. carcinomas. b. sarcomas. c. lymphomas. d. leukemias.

37. The spread of cancers to other parts of the body from the primary site through the blood or lymphatic system is called a. osmosis b. leukocytosis c. metastasis d. metamorphosis 38. The increase in cancer death rate since 1950 is attributable to cancer of the a. lung b. liver c. breast d. pancreas

44

b (400)

d (402)

b (402)

c (403)

d (404)

b (405)

39. _____ is a direct cause of death due to cancer whereas _____ is an indirect cause of death due to cancer. a. Organ failure; painful pressure on organs. b. Organ failure; impaired appetite c. Impaired appetite; organ failure. d. Impaired appetite; reduced immune function.

40. Which of the following is true regarding the demographic characteristics of cancer? a. Incidence rates remain roughly the same across the life span. b. Women and men in the US now have equal incidence rates. c. Native Americans have relatively high levels of cancer compared to persons from other racial-ethnic groups. d. Cancer prevalence varies greatly between countries.

41. The organ most commonly afflicted with cancer in the United States is the a. lung. b. skin. c. prostate. d. breast.

42. The surgical removal and analysis of tissue to detect cancer is called a. radiology. b. anesthetic. c. biopsy. d. imaging.

43. Anticipatory nausea in chemotherapy patients a. is probably learned by classical conditioning. b. occurs in about 25-50% of long‑time recipients of the treatment. c. contributes to some people stopping treatment and, thus, shortening their lives. d. all of the above 44. What is one way to prevent the learned food aversions associated with chemotherapy? a. Use imaging therapy. b. Provide a scapegoat food prior to chemotherapy. c. Use progressive relaxation techniques. d. Use less powerful chemicals.

45

c (406)

c (407)

a (408)

d (410)

c (410)

d (410)

45. Which of the following statements about adapting to cancer is TRUE? a. Psychosocial functioning following cancer is often the same, if not better, than before the disease occurred. b. The amount of physical disability is only weakly linked to level of depression. c. Having cancer can significantly interfere with social relationships. d. Some cancers increase sexual functioning.

46. Carmela is experiencing a great deal of pain due to her advanced cancer.

According to research, she is likely to experience the greatest benefits from which of the following? a. Only narcotic drugs will provide her with relief. b. Using systematic desensitization procedures. c. Participation in a tailored cognitive-behavioral program. d. Using guided imagery.

47. During the treatment of childhood leukemia, the inpatient treatment phase is known as the _____ phase whereas the outpatient treatment phase is known as the _____ phase. a. induction; maintenance b. maintenance; induction c. chemotherapy; psychosocial therapy d. psychosocial therapy; chemotherapy 48. An AIDS diagnosis is made based on which of the following symptoms? a. Presence of an "opportunistic" disease. b. Low T-cell count. c. Behavioral history that confirms the person is at risk. d. both a and b.

48. The brain disorder often associated with AIDS is called a. Kaposi's sarcoma. b. nephritis. c. encephalopathy. d. stroke.

49. AIDS may be cured by a. psychotherapy. b. AZT. c. chemotherapy. d. no curative treatment is available at this time.

46

b (411)

a (411)

d (414)

50. According to the Sarafino text, the stigma associated with AIDS affects health in three ways. Which of the following is NOT one of the three ways mentioned in the text? a. Refusal of societies to acknowledge the disease, therefore allowing its spread. b. It causes some people to believe that if they aren't gay or use drugs, they can't get the disease. c. It causes some people to delay getting tested and, if HIV-positive, get treatment. d. Progression of HIV disease slows down once serostatus is disclosed to others.

51. Studies on the effects of psychosocial interventions with AIDS patients have found a. different intervention needs for those patients with access to antiretroviral regimen than for those without access to these medications. b. stress management is the most important aspect of treatment. c. immune functioning is not affected by psychosocial intervention. d. psychosocial interventions are not as effective as the strict use of antiretroviral regimen.

52. Which of the following is an accurate statement regarding the nature of bereavement? a. Family urging the bereaved to "get on with life" is critical to good adjustment. b. When children seem unconcerned following a death it is most likely due to denial. c. Most bereaved people appreciate the isolation they experience following the death of a loved one. d. Although most people make positive adjustments following a death, some people never adjust to the loss.

Short Answer Questions 1. Briefly discuss the significance of disease recurrence or relapse in patients’ experience with chronic and life-threatening health problems.

2. How is the rehabilitation of cardiac patients influenced by the psychosocial impact of the disease?

3. Discuss the importance of knowing the warning signs of disease in treatment for these diseases.

Essay Questions 1. Discuss differences in adapting to high-mortality illness before and after a relapse.

47

2. Compare and contrast the intervention needs for high-mortality illnesses discussed in this chapter with the chronic illnesses discussed in the previous chapter.

3. Compare and contrast the AIDS experience with the other high-mortality illnesses presented in this chapter.

48

Chapter 15 TEST QUESTIONS True or False F

1.

The cognitive and behavioral approaches psychologists use to change. health behaviors have been found to be relatively ineffective in producing initial change.

2.

In medical settings today, psychologists work mainly on the administration and interpretation of psychological tests.

3.

The "bottom line" issues in deciding whether to offer wellness programs or psychosocial interventions are efficacy and cost-benefit ratio.

4.

Calculating financial costs and benefits of interventions are standard practice for psychologists.

5.

From 1974 to 1985, the number of psychologists working in health care more than doubled.

6.

The quality-adjusted life years scale is useful in determining the value of different treatments.

7.

A patient's right to choose or withdraw treatment may be discussed in a hospital's bioethics committee.

8.

The APACHE III computer program can make the decision about whether a patient should be transferred into an intensive care unit.

9.

Extensive research has been done on how health beliefs and habits develop during childhood and adolescence.

10.

The study of health psychology has been quite active internationally and has influenced health care practice in most countries around the world.

(418)

F (420)

T (420)

F (420)

T (422)

T (424)

T (424)

F (424)

F (426)

F (428)

37

Matching Match the following terms with their descriptions in one through five. a. cost-benefit ratio b. ecological momentary assessment c. bioethics committees d. stages of change model e. quality-adjusted life years scale e

1. Predicts how long a person is likely to live after receiving treatment.

(424)

a (420)

2. Assesses extent to which providing an intervention saves more money than it costs.

d

3. The steps in people's readiness to change health-related behaviors.

(419)

(419)

4. Method which allows researchers to examine people’s behavior and feelings. in daily life.

c

5. Deals with questions regarding the patient’s right to choose treatments.

b

(424)

Match the following groups with the appropriate characteristics listed in six through ten. a. 18 to 60-year-old white American males b. the very young and very elderly c. children and adolescents d. adults and the elderly e. women b

6. Use health services more than other groups.

(426)

c

7. The formation of health beliefs and habits occurs in these groups.

(426)

a

8. Historically, the most frequently recruited subjects in research studies.

(425)

d

9. Possess ingrained and difficult-to-change health related values.

(426)

e

10. Neglected in health research until the 1980s.

(427)

38

Multiple Choice c (418)

d (418)

b (419)

c (420)

b (421)

d (420)

1. The set of actions which an individual undertakes when an illness is identified and treatment starts are called a. health behaviors b. illness behaviors c. sick-role behaviors d. efficacy behaviors 2. According to the text, which of the following two advances since the mid-1980s are likely to influence future efforts to prevent illness? a. The increase of chronic illness and improved physician-patient interactions. b. Improved community prevention programs and more effective cognitivebehavioral interventions. c. More effective medical interventions and improved cost containment efforts. d. New theories that explain health behaviors and the development of Internet sites that provide medical information.

3. Sarafino suggests the use of telemedicine will a. occur only via the Internet. b. be used for information delivery as well as diagnostic and treatment services. c. be difficult and costly to develop. d. not be useful in the practice of medicine.

4. According to the text, one of the difficulties with deciding whether to administer psychosocial interventions is that a. program efficacy tends not to be assessed. b. agencies tend to be more interested in costs than program efficacy. c. the full benefits of an intervention are often difficult to define and assess. d. the costs of interventions are almost always much higher than the benefits.

5. How is the function of health psychologists in medical settings likely to change in the future? a. They are likely to be restricted to administering and interpreting psychological tests of emotional and cognitive functioning only. b. The number of services and activities in which they engage is likely to expand. c. They will be asked to train medical students and interns to administer coping interventions but will not conduct these programs themselves. d. They are most likely to only be consultants to medical personnel.

6. A weight-loss program at a work-site was discontinued after all of the participants actually gained weight. The reason for its discontinuation would be problems with its 39

a. prevention model. b. stages of change model. c. cost-benefit analysis. d. efficacy. c (420)

b (420)

d (421)

a (421)

7. An expensive dental hygiene program at a work-site was discontinued after it was found to be cheaper to just pay for the dental insurance. The reason for its discontinuation was due to a. the prevention model. b. the stages of change model. c. cost-benefit analysis. d. efficacy analysis.

8. Which of the following are recognized as problems encountered by health psychologists when conducting a cost-benefit analysis? a. They have never been trained on how to conduct them. b. Although costs might be more easily assessed, the full benefits of a program are difficult to determine. c. Most psychosocial interventions appear to produce more costs than benefits. d. Health psychologists are unlikely to view this type of analysis as important.

9. Which of the following are among the reasons that, prior to 1970, psychological services were viewed as tangential to the medical needs of patients? a. Psychologists tended to have little training in physiological systems, medical illnesses and treatment. b. The biopsychosocial approach was not recognized by the medical community yet. c. Psychologists had little background with the organization and protocol of hospital settings. d. all of the above 10. Physicians may be resistant to being taught "people skills", according to Christensen and Levinson (1991), because a. they tend to not see such skills as part of medicine. b. such skills are best taught by psychologists. c. "people skills" are considered too time-consuming. d. such efforts are not cost effective.

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b (421)

d (421)

d (423)

a (424)

d (425)

11. Psychologists may differ from physicians in style of communication in that psychologists a. prefer to communicate through notes in the hospital chart. b. prefer to talk directly to the physician in order to communicate issues regarding patient care. c. are more concerned with tests performed and the results of those tests. d. are more recommendation oriented.

12. Which of the following is not a prominent site of employment for psychologists? a. Colleges and universities. b. Medical schools. c. Health maintenance organizations. d. All of the above are places where psychologists commonly work.

13. Which of the following environmental issues would not be addressed by a psychologist? a. The effects of crowded and noisy environments. b. The reduction of harmful environmental conditions. c. The effects on health of pollutants. d. The development of less toxic industrial by-products.

14. The measurement known as quality-adjusted life years, or QALY's, allows health care planners and patients to a. make decisions regarding the value of different treatments. b. measure past quality of life. c. calculate the number of years a patient is expected to live. d. calculate the cost of treatment.

15. Shirley, who suffered from the final stages of a painful cancer, arranged for someone to purchase carbon monoxide for her, and put a mask attached to the canister over her face. She insisted on turning the dial which released the gas by herself. This situation is best described as a. murder. b. euthanasia. c. a cost-benefit analysis. d. assisted suicide.

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b (425)

b (426)

d (427)

c (427)

d (428)

16. Which of the following statements regarding euthanasia and physicianassisted suicide is NOT true? a. Euthanasia is legal in the Netherlands. b. In the United States, no laws currently allow for either euthanasia or physician-assisted suicide. c. In the future, psychologists will very likely to be asked to assess patients' emotional status and decision-making capabilities in such cases. d. Concerns over patients' level of depression have been a significant part of the debate in the medical community.

17. The best time to teach behaviors such as proper diets, exercise, dental care and seat belt use is a. prenatal period b. early childhood c. late childhood d. adolescence 18. Which of the following statements regarding sociocultural and crosscultural research is TRUE? a. The mechanisms underlying sociocultural differences in health habits are clearly understood. b. Explicit conclusions can be drawn regarding practices that promote health-protective behaviors. c. A comprehensive body of current research concerning cross-cultural research on health and illness exists. d. Many countries with people who could benefit from changing their behavioral risk factors have not recognized the principles of health psychology.

19. Which statement best describes the status of the study of gender differences in health psychology until the 1980's? a. Most health research focused entirely on women. b. Most health research studied men's and women's issues in equal proportion. c. Health issues relating to women and gender differences were neglected. d. The mechanisms for health behaviors were found to have no gender effect.

20. What factor is likely to have an impact on the future role of health psychology? a. Levels of government and private funding. b. Education and training in health psychology among students in nonpsychology fields. c. Developments in the field of medicine. d. all of the above

Short Answer Questions 42

1. This chapter starts with a section devoted to illness prevention. Summarize the ways that health psychologists contribute to prevention efforts.

2. What differences have or still need to be addressed to increase health psychologists' acceptance in medical settings?

3. Sarafino suggests a number of changes that need to occur in health psychology to increase our understanding of health and illness in different populations. Discuss 2 of his suggestions.

Essay Questions 1. You are an advisor in a psychology department and have an advisee that wants to know more about health psychology. What can you tell this student?

2. Pick one of the controversies described in this chapter and discuss its' relevance to health psychology.

3. As a student in a Health Psychology course, you may have been contemplating a career in this discipline. Using information from this chapter as support (i.e., areas of study, interesting challenges for the discipline), are you inclined to pursue such a career?

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