Chapter 11

A reduction is an individual's number of natural killer (NK) cells appears to correlate with an increased risk for the development of: a. Depression b. Type 1 diabetes c. Obsessive compulsive disorder (OCD) d. Gastroesophageal reflux disorder (GERD)

ANS: A A meta-analysis of studies shows a relationship between depression and the reduction in lymphocyte proliferation and natural killer cell activity. Currently, no research supports the other options. PTS: 1 REF: Page 355

Which cytokines initiate the production of corticotropin-releasing hormone (CRH)? a. IL-1 and IL-6 b. IL-2 and TNF- c. IFN and IL-12 d. TNF-ß and IL-4

ANS: A Although a number of stress factors initiate the production of CRH, of the options available, only high levels of IL-1 and IL-6 initiate such a response. PTS: 1 REF: Pages 348-349

What is the effect of increased secretions of epinephrine, glucagon, and growth hormone? a. Hyperglycemia b. Hypertension c. Bronchodilation d. Pupil dilation

ANS: A Cortisol enhances the elevation of blood glucose promoted by other hormones, such as epinephrine, glucagon, and growth hormone. This effect is not true of the other options. PTS: 1 REF: Page 346

What is the effect that low-serum albumin has on the central stress response? a. Impaired circulation of epinephrine and norepinephrine b. Impaired wound healing c. Lessened circulation of cortisol d. Diminished oncotic pressure

ANS: A Low-serum albumin impairs circulation of both epinephrine and norepinephrine since both bind to plasma protein albumin. The other options do not accurately describe the effect of low-serum albumin. PTS: 1 REF: Page 345

Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting which structure? a. Adrenal cortex b. Pancreas c. Liver d. Anterior pituitary

ANS: A One of the primary effects of cortisol is the stimulation of gluconeogenesis through stimulation of the adrenal cortex. The other options do not produce a stimulation of gluconeogenesis when exposed to cortisol. PTS: 1 REF: Page 346

Which hormone prompts increased anxiety, vigilance, and arousal during a stress response? a. Norepinephrine b. Epinephrine c. Cortisol d. Adrenocorticotropic hormone (ACTH)

ANS: A Only the release of norepinephrine promotes arousal, increased vigilance, increased anxiety, and other protective emotional responses. PTS: 1 REF: Page 343

Which statements are true regarding lymphocytes? (Select all that apply.) a. Lymphocytes are involved in the production of the human growth hormone. b. Elevated catecholamine levels influence lymphocytes. c. Lymphocytes are synthesized in the anterior pituitary gland. d. Lymphocytes have receptors for the hormone prolactin. e. Lymphocytes produce endorphins in large amounts.

ANS: A, B, D GH is synthesized from the anterior pituitary gland and is produced by lymphocytes and mononuclear phagocytic cells. Several classes of lymphocytes have receptors for prolactin, suggesting a direct effect of prolactin on immune function. Although the effects of acute elevation of catecholamines on the alteration of lymphocyte function are real, they are short lived, lasting only approximately 2 hours. The other statements regarding lymphocytes are not true. PTS: 1 REF: Page 350 | Page 352

Which immune cells are suppressed by the corticotropin-releasing hormone (CRH)? (Select all that apply.) a. Monocyte-macrophage cells b. Cytokines c. Tc cells d. Th cells e. B cells

ANS: A, D Direct suppressive effects of CRH have been reported on two immune cell types possessing CRH receptors—the monocyte and macrophage and CD4 (T helper) lymphocytes. CRH does not suppress the remaining options. PTS: 1 REF: Pages 353-354

The effect epinephrine has on the immune system during the stress response is to increase which cells? (Select all that apply.) a. NK cells b. Immunoglobulins c. Cytokines d. T cells e. Th cells

ANS: A, D The injection of epinephrine into healthy human beings is associated with a transient increase of the number of lymphocytes (e.g., T cells, natural killer (NK) cells) in the peripheral blood. This association is not true of the other options. PTS: 1 REF: Page 346

Which statement is true concerning the differences between stress-induced hormonal alterations of men and women? a. After injury, women produce more proinflammatory cytokines than men, a profile that is associated with poor outcomes. b. Androgens appear to induce a greater degree of immune cell apoptosis after injury, creating greater immunosuppression in injured men than in injured women. c. Psychologic stress associated with some types of competition decreases both testosterone and cortisol, especially in athletes older than 45 years of age. d. After stressful stimuli, estrogen is increased in women, but testosterone is decreased in men.

ANS: B Androgens appear to induce a greater degree of immune cell apoptosis after injury, a mechanism that may elicit a greater immunosuppression in injured men versus injured women. The other options are not true statements concerning the differences between how the genders are affected by stress-induced hormones. PTS: 1 REF: Page 353

Stress-induced norepinephrine results in: a. Pupil constriction b. Peripheral vasoconstriction c. Increased sweat gland secretions d. Decreased blood pressure

ANS: B During stress, norepinephrine raises blood pressure by constricting peripheral vessels; it dilates the pupils of the eye, causes piloerection, and increases sweat gland action in the armpits and palms. PTS: 1 REF: Page 345

What effect does estrogen have on lymphocytes? a. Depression of B-cell functions and enhancement of T-cell functions b. Depression of T-cell functions and enhancement of B-cell functions c. Depression of B- and T-cell functions d. Enhancement of B- and T-cell functions

ANS: B Estrogens generally are associated with only a depression of T-cell-dependent immune functions and an enhancement of B-cell functions. PTS: 1 REF: Page 353

During a stress response, the helper T (Th) 1 response is suppress by which hormone? a. ACTH b. Cortisol c. Prolactin d. Growth hormone

ANS: B Stress can activate an excessive immune response and, through cortisol and catecholamines, suppress the Th1 response, causing a Th2 shift. This response is not active by any of the other options. PTS: 1 REF: Page 349

Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)? a. Adrenal cortex b. Hypothalamus c. Anterior pituitary d. Limbic system

ANS: B The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus and the sympathetic nervous system (SNS) (see Figure 11-1). The other organs are not stimulated by the alarm phase of GAS. PTS: 1 REF: Page 339

The increased production of proinflammatory cytokines is associated with which considerations? (Select all that apply.) a. Chronic respiratory dysfunction b. Elevated anxiety levels c. Immune disorders d. Age and gender e. Dementia

ANS: B, C Increased levels of proinflammatory cytokines has been shown to have a possible link between stress and immune function. The other options are not as directly linked to cytokine levels. PTS: 1 REF: Page 353

What effect do androgens have on lymphocytes? a. Suppression of B-cell responses and enhancement of T-cell responses b. Suppression of T-cell responses and enhancement of B-cell responses c. Suppression of B- and T-cell responses d. Enhancement of B- and T-cell response

ANS: C Androgens suppress T- and B-cell responses. The other options do not occur in response to androgens. PTS: 1 REF: Page 353

Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful? a. Flight or fight b. Alarm c. Adaptation d. Arousal

ANS: C Exhaustion occurs if stress continues and adaptation is not successful, ultimately causing impairment of the immune response, heart failure, and kidney failure, leading to death. The other stages occur before the adaptation stage. PTS: 1 REF: Page 339

What are the signs that a patient is in the adaptive stage of the general adaptation syndrome? a. He or she begins to experience elevated heart and respiratory rates. b. He or she finds it difficult to concentrate on a solution for the stress. c. The patient perceives his or her only options are to run away or fight back. d. The patient has exceeded his or her ability to cope with the current situation.

ANS: C Fight-or-flight behaviors are characteristic of the more advanced adaptive stage, whereas the remaining options are noted in the initial alarm stage. PTS: 1 REF: Page 339

Diagnostic blood work on individuals who perceive themselves to be in a chronic stress state will likely demonstrate: a. Decreased Th lymphocytes b. Increased erythrocytes c. Decreased Tc cells d. Increased platelets

ANS: C Illustrating the influence of chronic stress appraisal on the physiologic processes, a meta-analysis of the relationships between stressors and immunity found that a higher perception of stress was associated with reduced T cytotoxic (Tc)-cell cytotoxicity, although not with levels of circulating Th or Tc lymphocytes. Research has substantiates the other options. PTS: 1 REF: Page 355

The release of which cytokines is triggered by bacterial or viral infections, cancer, and tissue injury that, in turn, initiate a stress response? a. IL-1 and IL-2 b. IL-12, TNF-, and colony-stimulating factor c. IFN, TNF-ß, and IL-6 d. IL-4 and IL-24

ANS: C Of the options offered, only the release of immune inflammatory mediators IL-6, TNF-ß, and IFN is triggered by bacterial or viral infections, cancer, and tissue injury that, in turn, initiates a stress response through the hypothalamic-pituitary-adrenal (HPA) pathway. PTS: 1 REF: Page 349

The action of which hormone helps explain increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory diseases in women as a result of stimulation of the CRH gene promoter and central norepinephrine system? a. Progesterone b. Cortisol c. Estrogen d. Prolactin

ANS: C Of the options provided, only estrogen directly stimulates the CRH gene promoter and the central noradrenergic (norepinephrine) system, which may help explain adult women's slight hypercortisolism, increases in affective anxiety and eating disorders, mood cycles, and vulnerability to autoimmune and inflammatory disease, all of which follow estradiol fluctuations. PTS: 1 REF: Page 350

Which hormone increases the formation of glucose from amino acids and free fatty acids? a. Epinephrine b. Norepinephrine c. Cortisol d. Growth hormone

ANS: C One of the primary effects of cortisol is the stimulation of gluconeogenesis or the formation of glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver. Neither reaction is a result of the effects of any of the other options. PTS: 1 REF: Page 346

Perceived stress elicits an emotional, anticipatory response that begins where? a. Prefrontal cortex b. Anterior pituitary c. Limbic system d. Hypothalamus

ANS: C Perceived stressors elicit an anticipatory response that begins in the limbic system of the brain, the only option responsible for emotions and cognition. PTS: 1 REF: Page 343

During an anticipatory response to stress, the reaction from the limbic system is stimulated by the: a. Retronucleus of the anterior pituitary b. Anterior nucleus of the hippocampus c. Paraventricular nucleus of the hypothalamus d. Prefrontal nucleus of the amygdala

ANS: C The paraventricular nucleus (PVN) of the hypothalamus must be stimulated to cause the limbic system to be stimulated. The other options are not involved in the stimulation of the limbic system. PTS: 1 REF: Page 341

A nurse is providing care to a terminally ill adult who has been with his life partner for over 56 years. Research supports the nurse's assessment of the life partner for signs of: a. Suicidal ideations b. Cardiac dysrhythmia c. Severe stress reaction d. Anorexia induced weight loss

ANS: C The results of a Harvard study showed evidence that a spouse's illness or death can increase a partner's mortality by causing severe stress and removing a primary source of emotional, psychologic, practical, and financial support. Although the other options may exist, research does not currently support them as having the stated correlation. PTS: 1 REF: Page 357 | What's New box

Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of: a. Epinephrine and aldosterone b. Norepinephrine and cortisol c. Epinephrine and norepinephrine d. Acetylcholine and cortisol

ANS: C The sympathetic nervous system is aroused during the stress response and causes the medulla of the adrenal gland to release catecholamines (80% epinephrine and 20% norepinephrine) into the bloodstream. The stress-induced efforts on the adrenal medulla do not include any of the other options. PTS: 1 REF: Pages 344-345

The most influential factor in whether a person will experience a stress reaction is his or her: a. General state of physical health b. Spiritual belief system c. Intellectual abilities d. Ability to cope

ANS: D A person does not have a stress reaction unless the stress exceeds his or her coping abilities. The other options do not have the same degree of influence, as does a person's ability to cope. PTS: 1 REF: Page 339

Stress-age syndrome directly results in depressed function of which system? a. Respiratory b. Endocrine c. Digestive d. Immune

ANS: D Of the available options, immunodepression is the only characteristic change observed in stress-age syndrome. PTS: 1 REF: Page 358

Which gland regulates the immune response and mediates the apparent effects of circadian rhythms on immunity? a. Anterior pituitary b. Adrenal c. Basal ganglia d. Pineal

ANS: D Of the options available, only the pineal gland regulates the immune response and mediates the apparent effects of circadian rhythm on immunity. PTS: 1 REF: Page 354