Chapter 7
The term used to describe oscillations with a frequency similar to that of the 24-hour light-dark solar day is: Milieu interieur Hardiness angiotensin-aldosterone Control systems
Circadian - The term circadian is used to describe 24-hour diurnal rhythms. Hardiness refers to characteristics of individuals who remain healthy despite being challenged by high levels of stressors. Homeostatic control systems consist of a collection of interconnected components that function to keep a physical or chemical parameter of the body relatively constant. Claude Bernard described the importance of a stable internal environment, which he termed the milieu interieur.
It has long been known that our bodies need a stable internal environment to function optimally. What serves to fulfill this need? Organ systems Control systems Biochemical messenger systems Neurovascular systems
Control systems - A homeostatic control system consists of a collection of interconnected components that function to keep a physical or chemical parameter of the body relatively constant. Organ systems are a group of organs that function together to accomplish necessary functions in the body; for example, the cardiovascular system provides blood to all the body's components. Biochemical messengers are in the brain; they are not control systems. Neuroendocrine systems are control systems that help to regulate our response to stress. Neurovascular systems do not aid in the control of homeostasis in the body.
Which client is experiencing the effects of a positive feedback mechanism? A client whose fluid volume is increasing because of the release of antidiuretic hormone (ADH) from the posterior pituitary gland A postoperative client who is shivering in response to low environmental temperature. A client who is producing white blood cells (WBC) in response to sepsis. A pregnant client whose oxytocin levels are rising during the second stage of labor.
A pregnant client whose oxytocin levels are rising during the second stage of labor. - The release of hormones during labor increases rather than mitigates a physiologic system. Specifically, uterine contraction stimulates the production of other relevant hormones that cause temporary instability, which culminates in birth. ADH counters the potential instability of insufficient hydration or blood pressure, much as shivering is an attempt to counter low temperature. WBCs are a response to the potential homeostatic instability of an infectious process.
The client is hospitalized for 4 days with an acute myocardial infarction. After a coronary artery stent is placed, the client is discharged to home in stable condition. This would be an example of which pattern of stress? Acute time limited Chronic sustained Posttraumatic stress disorder (PTSD) Chronic intermittent
Acute time limited - Stressors can assume a number of patterns in relation to time. They may be classified as acute time-limited, chronic intermittent, or chronic sustained. An acute time-limited stressor is one that occurs over a short time and does not recur. A chronic intermittent stressor is one to which a person is chronically exposed intermittently; chronic sustained is continuous. PTSD is characterized by a severe stress response secondary to experiencing previous trauma.
The nurse is caring for an ex-soldier who has been diagnosed with posttraumatic stress disorder (PTSD). The nurse should prioritize which action? Encouraging the client to talk about his trauma Teaching the client to modify his stress response Assessing the client for depression and risk for suicide Assessing the client's neurologic status frequently
Assessing the client for depression and risk for suicide - PTSD creates a significant risk of depression and suicide; the nurse's assessments should prioritize these threats to safety. Having the client talk about his trauma may or may not be appropriate, and may be beyond the nurse's scope of practice. Education may be beneficial, but safety is a priority.
A health care provider suspects a client has developed posttraumatic stress disorder (PTSD). Select the necessary criterion to validate the diagnosis. At least 1 month of clinically significant distress affecting a person after witnessing or experiencing a traumatic event that affects other parts of his or her life An impaired deficit of memory and concentration for greater than a 6-month period after a traumatic event has occurred A positron emission tomography (PET) scan that demonstrates that a client has decreased reactivity of the anterior cingulate and orbitofrontal areas after a traumatic event A functional magnetic resonance imaging (MRI) scan that demonstrates that a client has decreased reactivity of the amygdala and hippocampus after a traumatic event
At least 1 month of clinically significant distress affecting a person after witnessing or experiencing a traumatic event that affects other parts of his or her life - The triad of symptoms of intrusion, avoidance, and hyperarousal that characterize PTSD must be present together for at least 1 month, and the disorder must have caused clinically significant distress or impairment in social, occupational, and other areas of functioning.
The client has expressed a desire to explore stress-reducing strategies for chronic migraines. The provider explains one technique that involves electronic monitoring of physiologic responses to stress with immediate feedback. This is known as which of the following? Imagery Music therapy Biofeedback Progressive muscle relaxation
Biofeedback - Biofeedback is a technique in which a person learns to control physiologic functioning. It involves electronic monitoring of one or more physiologic responses to stress with immediate feedback of the specific response.
A client is experiencing an increase in cortisol secretion. It would be most important for the nurse to assess the client for: increased levels of epinephrine in the blood. decreased vascular tone. increased blood glucose. increased immune reactions.
increased blood glucose. - Cortisol, the primary glucocorticoid secreted by the adrenal cortex in response to activation of the HPA axis, has an important role in many of the physiologic functions during trauma and critical illness. The actions of cortisol include its anti-inflammatory effects, as well as its effect on blood glucose, vascular tone, endothelial integrity, and modulation of angiotensinogen synthesis.
A client who is a performer expends a tremendous amount of energy while on stage, but his body is not harmed by the added stress. Protection against the harmful effects of stress is primarily a result of: cultural factors. anatomic characteristics. immune system compensation. physiologic reserve.
physiologic reserve - The ability of body systems to increase their function in response to the need to adapt is the physiologic reserve. Anatomic reserve is attributed to organ structure; immune system compensation may be a component of physiologic reserve.
A 29-year-old mother of three is suffering from chronic stress. The causes of her stress are her young children, the need for and lack of money, and the potential loss of her job. Assessment reveals that she is experiencing eustress. This will likely cause her to: develop chronic stress. ignore her life circumstances. develop posttraumatic stress disorder. work harder to maintain employment.
work harder to maintain employment. - Eustress is a beneficial type of stress that can motivate. Eustress is consequently not linked to PTSD or hopelessness.
A client diagnosed with posttraumatic stress disorder (PTSD) tells the nurse about having "flashbacks" during waking hours or nightmares in which the past traumatic event is relived, often in vivid and frightening detail. What term for this experience will the nurse document in the client's record? Intrusion Avoidance Arousal Hyperarousal
Intrusion - Intrusion involves recurrent, involuntary distressing memories or "flashbacks" during waking hours or nightmares in which the past traumatic event is relived, often in vivid and frightening detail. The client did not report avoidance, which refers to the attempt to avoid situations, including people, places, activities, and objects that arouse distressing memories; nor did the client report marked alterations in arousal and reactivity, which include inability to experience positive emotions such as love, joy, pleasure, or satisfaction.
A client with a history of posttraumatic stress syndrome reports frequently reliving the traumatic event. The nurse documents that the client is experiencing: Depression Anxiety Intrusion Battle fatigue
Intrusion - The nurse documents that the client is experiencing intrusion, defined as the occurrence of flashbacks or nightmares in which the traumatic event is relived in vivid detail.
When thyroxine (T4) in the thyroid is low, it triggers the pituitary to increase thyroid stimulating hormone (TSH), which then increases T4 secretion. This is an example of which of the following? Negative feedback mechanism General adaptation syndrome Stress response Positive feedback mechanism
Negative feedback mechanism - In a negative feedback mechanism, when the monitored function or value decreases below the set point of the system, the feedback mechanism causes the function or value to increase. In a positive feedback mechanism, the initiating stimulus produces more of the same. Neuroendocrine control systems that influence behavior are called the stress response. The general adaptation syndrome is a manifestation of the body's attempt to adapt to stimuli.
Although stress exposure initiates integrated responses by multiple systems, the functional changes are first manifested in which body system? Gastrointestinal Pulmonary Neuroendocrine Cardiovascular
Neuroendocrine - Exposure to stress activates an immediate response by the neuroendocrine system that plays a role in most of the responses to stress and attempts to adapt. The coordinated physiologic system response to stress is meant to increase the probability of survival, but also designed to be an acute response. Therefore, the hormones that are released during the response do not persist long enough to cause damage to vital tissues. Subsequently, all other body systems become part of the response.
The client experienced a traumatic event in the past that has caused chronic nightmares in which the event is relived. The client may have increased levels of which of the following? Aldosterone Thyroid stimulating hormone (TSH) Norepinephrine Cytokines
Norepinephrine - People with chronic posttraumatic stress disorder (PTSD) have been shown to have increased levels of norepinephrine and increased activity of alpha-adrenergic receptors. The other options are not increased in PTSD.
The client experienced a traumatic event in the past that has caused chronic nightmares in which the event is relived. The client may have increased levels of which of the following? Cytokines Norepinephrine Thyroid stimulating hormone (TSH) Aldosterone
Norepinephrine - People with chronic posttraumatic stress disorder (PTSD) have been shown to have increased levels of norepinephrine and increased activity of alpha-adrenergic receptors. The other options are not increased in PTSD.
The locus caeruleus (LC) is an area in the brain stem that produces which hormone? Antidiuretic hormone (ADH) Norepinephrine (NE) Cortisol Aldosterone
Norepinephrine (NE) - Central to the neural component of the neuroendocrine response to stress is an area of the brain stem called the locus caeruleus (LC). The LC is densely populated with neurons that produce norepinephrine. Cortisol, a glucocorticoid, is produced in the adrenal cortex. Aldosterone, a mineralocorticoid, is produced in the adrenal cortex. Antidiuretic hormone is produced in the hypothalamus and posterior pituitary.
A client is experiencing stress as a nurse prepares to insert a peripheral intravenous catheter into his forearm. The client's locus caeruleus (LC) is consequently producing which hormone? Adrenocorticotropic hormone (ACTH) Antidiuretic hormone (ADH) Norepinephrine (NE) Corticotropin-releasing factor (CRF)
Norepinephrine (NE) - The LC is densely populated with neurons that produce norepinephrine (NE); it does not produce CRF, ADH, or ACTH.
Which mechanism may be a contributor to symptoms in a child who has "failure to thrive"? Stress response on growth hormone Starvation response Renin-angiotensin-aldosterone system Fear of failure
Stress response on growth hormone - The stress response causes a suppression of growth hormone. This may contribute to symptoms seen in "failure to thrive" syndromes. The other listed mechanisms are not speculated to cause the symptoms in failure to thrive.
A client's primary care provider has recommended biofeedback in an effort to address chronic stress and reduce the potential for complications. What will be the goal of this intervention? Teaching the client to consciously control their own physiologic (body) functioning Using exercise to control the client's endocrine function Helping the client to accommodate continued nervous stimulation Relieving tension using tactile stimulation
Teaching the client to consciously control their own physiologic (body) functioning - Biofeedback is a technique in which an individual learns to control physiologic functioning. It does not use exercise alone, and it aims to resolve, not simply accommodate, stress. Various types of stimulation are used, but not all are tactile.
The psychologist is counseling a client who is overwhelmed by losing his job and the recent death of a parent. Which strategy would be effective for stress reduction? Teaching the client to systematically contract and relax major muscle groups Encouraging the client to decrease interaction with others Encouraging the client to listen to music on the radio Encouraging the client to eat and drink whatever he wants
Teaching the client to systematically contract and relax major muscle groups - Progressive muscle relaxation is one method of relieving musculoskeletal tension and decreasing sympathetic system activity (part of the stress response). It consists of systematic contraction and relaxation of the major muscle groups. Radio and television music is inappropriate for music therapy because of the inability to control selection of pieces that are played. Deficiencies or excesses of any nutrients can alter a person's health status and impair his ability to adapt. Social isolation also increases stress.
The client has been admitted to the emergency department following a traumatic motor vehicle accident. The client is hypotensive due to blood loss. Which stress response hormone will aid in fluid replacement? Epinephrine Vasopressin Cortisol Norepinephrine
Vasopressin - Antidiuretic hormone (ADH), released from the posterior pituitary, is also involved in the stress response, particularly in hypotensive stress or stress due to fluid volume loss. ADH, also know as vasopressin, increases water retention by the kidneys and produces vasoconstriction of blood vessels. Epinephrine and norepinephrine increase vascular smooth muscle contractility but not fluid retention. Cortisol does not cause fluid replacement or vasoconstriction.
The client has been admitted to the emergency department following a traumatic motor vehicle accident. The client is hypotensive due to blood loss. Which stress response hormone will aid in fluid replacement? Vasopressin Cortisol Norepinephrine Epinephrine
Vasopressin - Antidiuretic hormone (ADH), released from the posterior pituitary, is also involved in the stress response, particularly in hypotensive stress or stress due to fluid volume loss. ADH, also know as vasopressin, increases water retention by the kidneys and produces vasoconstriction of blood vessels. Epinephrine and norepinephrine increase vascular smooth muscle contractility but not fluid retention. Cortisol does not cause fluid replacement or vasoconstriction.
Which emergency department client is most likely demonstrating clinical manifestations of acute stress? A client with: an acute heightened sense of alertness to surroundings and personnel muscle impairment and fatigue negative feedback overactivity resulting in mental instability inattention to details of the accident with memory issues
an acute heightened sense of alertness to surroundings and personnel - Acute stress is time limited, and reactions are those of the autonomic nervous system—the fight-or-flight response. Acute stress is short term and does not recur. Centrally, there is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition, and focused attention, as well as appropriate aggression. Acute stress situations are controlled by a negative feedback system. When chronic stress continues, components of the system become abnormally active or fatigued and fail. The other distractors may relate to a physical problem and not "acute stress."
Which emergency department client is most likely demonstrating clinical manifestations of acute stress? A client with: muscle impairment and fatigue an acute heightened sense of alertness to surroundings and personnel negative feedback overactivity resulting in mental instability inattention to details of the accident with memory issues
an acute heightened sense of alertness to surroundings and personnel - Acute stress is time limited, and reactions are those of the autonomic nervous system—the fight-or-flight response. Acute stress is short term and does not recur. Centrally, there is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition, and focused attention, as well as appropriate aggression. Acute stress situations are controlled by a negative feedback system. When chronic stress continues, components of the system become abnormally active or fatigued and fail. The other distractors may relate to a physical problem and not "acute stress."
A hostage situation has occurred at a high school campus. The school superintendent and faculty are concerned about the students experiencing posttraumatic stress disorder (PTSD). The most important intervention would be: debriefing with a crisis team about the event as soon as possible. immediate treatment with antianxiety medications. advising those held hostage to "get over" the event and pretend it did not happen. assessing family relations and strengthening them as needed.
debriefing with a crisis team about the event as soon as possible. - Debriefing or talking about the traumatic event with a crisis team at the time it happened is an effective therapeutic tool. Strong family relations are important, but this would not be the time to work on strengthening them. Not all people involved in a traumatic event should use pharmacologic treatments, and never advise a client to "get over" an event.
A client who is in the intensive care unit after experiencing a massive heart attack begins to go into renal failure. The nurse plans the client's care knowing that the client is in which phase of Selye's general adaptation syndrome? exhaustion resistance alarm exacerbation
exhaustion - The nurse plans care knowing that this client is in Selye's exhaustion stage. In this stage, the body's ability to defend itself is overwhelmed and resources are depleted; signs of systemic damage, such as renal failure, begin to appear. The alarm stage is characterized by a generalized stimulation of the sympathetic nervous system and during the resistance stage, the body selects the most effective and economic channels of defense. Exacerbation refers to the worsening of an underlying condition and does not apply to general adaptation syndrome.
The parents of a newborn are irritable and extremely tired due to their lack of sleep, yet are very happy. Selye described this type of stress as: Exhaustion stage Distress Resistance stage Eustress
Eustress - Selye indicated that not all stress was detrimental; hence, he coined the terms eustress and distress. Eustress is mild, brief, and controllable periods of stress that can be perceived as positive stimuli to emotional and intellectual growth and development, such as the birth of a newborn. Distress is the severe, protracted, and uncontrolled situations of psychological and physical distress that are disruptive to health. The exhaustion stage and resistance stage are stages of the general adaptation syndrome.
After exposure to poison ivy, the client has hives on his trunk and extremities. In an effort to decrease his immune response the practitioner places him on which medication? Aldosterone Antidiuretic hormone Glucocorticoid Insulin
Glucocorticoid - Glucocorticoids are know to suppress immune function, and pharmacologic doses of cortisol are used clinically to suppress the immune response. The other options do not decrease the immune response.
A client in treatment for posttraumatic stress disorder is instructed to close the eyes and imagine being in a relaxing beach setting, smell a favorite food, and touch a handful of sand. Select the option that best describes the intervention. Music therapy Guided imagery Massage therapy Relaxation
Guided imagery - Guided imagery involves scene visualization in which a person is asked to sit back, close the eyes, and concentrate on a scene narrated by the therapist. When possible it includes techniques to involve all five senses. In this given situation, music and massage therapy are not used. Relaxation would involve the tensing and releasing of muscles.
A nurse is caring for an adolescent with posttraumatic stress syndrome. The client reports having difficulty concentrating and has an increased startle reflex. The nurse's documentation includes the presence of: Hyperarousal Resistance Shell shock Intrusion
Hyperarousal - The nurse should document the presence of hyperarousal, defined as the presence of increased irritability, difficulty concentrating, exaggerated startle reflex, increased vigilance, and/or concern over safety in a client with posttraumatic stress syndrome.
The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). Which lab result would the provider expect to see? Increased white blood count (WBC) Increased blood glucose Increased hemoglobin Increased albumin
Increased blood glucose - Cortisol, a glucocorticoid, maintains blood glucose levels (increases them) by antagonizing the effects of insulin. It also suppresses hematopoiesis, protein and collagen synthesis, and immune responses (decreases white blood count).
What will the nurse assess as the end result of activation of the renin-angiotensin-aldosterone system? Increased heart rate Increased blood pressure Increased urination Increased respiratory rate
Increased blood pressure - Stimulation of the sympathetic nervous system activates the renin-angiotensin-aldosterone system, which mediates an increase in vascular tone and renal retention of sodium and water. This causes an increase in blood pressure. The other assessment findings would not be the end result of activation of this system.
A college student has just learned that her latest Papanicolaou test revealed atypical cells, a fact that has resulted in stress and an accompanying release of angiotensin II. How would the effects of this hormone be objectively manifested? Decreased oxygen saturation Decreased blood sugar Increased respiratory rate Increased blood pressure
Increased blood pressure - The central nervous system (CNS) effects of angiotensin II include the release of vasopressin and a consequent increase in blood pressure. Increased respiratory rate often accompanies stress, but this is not a direct effect of angiotensin II. Oxygen saturation and blood sugar are objective measures that are unlikely to decrease.
A client is experiencing significant stress while awaiting the results of her recent lymph node biopsy. Among the hormonal contributors to this response is a release of aldosterone, resulting in which physiologic effect? Decreased release of insulin Increased cardiac contractility Increased sodium absorption Potentiating effects of epinephrine
Increased sodium absorption - Mineralocorticoids such as aldosterone increase sodium absorption by the kidneys. Changes in insulin release and cardiac contractility are mediated by catecholamines, whereas cortisol potentiates the action of epinephrine.
A client with diabetes mellitus is experiencing an acute illness and has noted an increase in blood glucose levels. How will the nurse explain the reason for the elevated blood glucose levels to the client? "When you are sick your pancreas cannot work properly, increasing your blood glucose levels." "Due to the stress of illness, the body produces hormones that make insulin less effective." "Your body is letting more glucose into your cells to help them respond to the acute illness." "It is normal to have higher blood glucose when you are sick. The level will improve once you recover."
"Due to the stress of illness, the body produces hormones that make insulin less effective." - During the acute stress of illness, counterregulatory hormones lead to an increase in blood glucose levels. Cortisol specifically affects blood glucose levels by antagonizing the effects of insulin. Although this response is expected, the nurse should not dismiss the elevation in blood glucose, because this should be treated to prevent hyperglycemia. The elevation in blood glucose is not related to decreased pancreatic functioning. One effect of cortisol is to increase the amount of glucagon that is released from the pancreas and this also contributes to the elevation of blood glucose in acute illness. Although glucose utilization can be increased in acute stress, this relies on adequate insulin levels to prevent elevation in blood glucose. If glucose is entering the tissue cells effectively, it is not in the blood, so increased utilization of glucose by tissue cells will decrease, not increase, blood glucose levels.
The psychologist is leading a group session with clients who have recently undergone a variety of stressful events. Which client will have the best adaptation? 40-year-old female with insomnia 50-year-old female who sees her new life as a widow as a challenge rather than a threat 89-year-old man with congestive heart failure 40-year-old man who is unable to make appropriate choices related to his new life as a single parent
50-year-old female who sees her new life as a widow as a challenge rather than a threat - Physiologic reserve, time, genetics, age, health status, nutrition, sleep-wake cycles, hardiness, and psychosocial factors influence a person's appraisal of a stressor and the coping mechanisms used to adapt to the new situation. The capacity to adapt is decreased at the extremes of age (89 years old). Gender-based differences in activation of the stress response may partially explain differences in susceptibility to diseases (females have lower activation of the sympathetic nervous system). Sleep disorders, especially insomnia and sleep deprivation, have been shown to alter immune function, and physical and psychological functioning. The ability to conceptualize stressors as a challenge rather than a threat is a characteristic of hardiness, which is correlated with positive health outcomes. Severe emotional stress (single parent) determines physiologic and psychological reserves and is a strong determinant of the ability to adapt.
Allostasis incorporates which characteristics when applied to the human body? Systems that detect psychologic function Interactive physiologic changes in numerous systems Organ-specific physiologic responses Future expectations as a catalyst for change
Interactive physiologic changes in numerous systems - Allostasis describes the interactive physiologic changes in the neuroendocrine, autonomic, and immune systems that occur in response to either real or perceived challenges to homeostasis. This concept has been used to measure the cumulative effects of stress on humans. Organ-specific responses are a part of the general adaptation syndrome response to stress. Control systems detect changes in physiologic function and regulate the physical and chemical set points.
Which of these is an endocrine regulator of pituitary and adrenal activity and a neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior? Corticotropin-releasing factor Allostatic factor Immune factor Fight-or-flight hormone
Corticotropin-releasing factor - Corticotropin-releasing factor is a small peptide hormone found in both the hypothalamus and in extrahypothalamic structures, such as the limbic system and the brain stem. It is both an important endocrine regulator of pituitary and adrenal activity and a neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior. The sympathetic nervous system manifestation of the stress reaction has been called the "fight or flight" response. This is the most rapid of the stress responses and represents the basic survival response of our primitive ancestors when confronted with the perils of the wilderness and its inhabitants. The term allostasis has been used by some investigators to describe the physiologic changes in the neuroendocrine, autonomic, and immune systems that occur in response to either real or perceived challenges to homeostasis. The hallmark of the stress response, as first described by Selye, is the endocrine-immune interaction.
A nursing student's current clinical placement has been a source of stress due to high client acuity. At the same time, the student has been fighting a cold for more than 2 weeks and has been unable to regain a normal feeling of health. How might these two phenomena be related? Stress and illness lack a statistical correlation, though they are often thought to coexist. The effects of stress on the cerebellum initiate a decrease in immunity. Epinephrine and norepinephrine inhibit the release and action of lymphocytes. Endocrine-immune interactions may suppress the student's immune response.
Endocrine-immune interactions may suppress the student's immune response. - Although the exact mechanisms of the effects of stress on immunity are not completely understood, it is generally thought that endocrine-immune interactions suppress immunity. The most significant arguments for interaction between the neuroendocrine and immune systems derive from evidence that the immune and neuroendocrine systems share common signal pathways (i.e., messenger molecules and receptors), that hormones and neuropeptides can alter the function of immune cells, and that the immune system and its mediators can modulate neuroendocrine function. Stress has the capacity to either enhance or suppress immune function. Epinephrine and norepinephrine do not directly inhibit lymphocytes; the cerebellum is not centrally involved in the stress response.
