Chapter 9: Stress and Adaptation Prep U
The pathophysiology student is studying the general adaptation syndrome (GAS). Which statement by the student demonstrates understanding? "Epinephrine is released in the alarm stage." "Increased levels of cortisol, which are no longer needed, drop during the exhaustion stage." "Signs of 'wear and tear' or systemic damage appear during the resistance stage." "The parasympathetic nervous system is stimulated in the alarm stage."
"Epinephrine is released in the alarm stage."
The student explains her understanding of how the stress response affects the immune response. The faculty member knows that the student understands when she states: "Another possible route for neuroendocrine regulation of immune functions is through the parasympathetic nervous system." "The hallmark of the stress response is the endocrine-immune interactions that are known to increase the immune response." "The exact mechanism by which stress produces its effect on the immune system is thought to be the same from person to person." "Immune cells can penetrate the blood-brain barrier, where they secrete chemical messengers called cytokines that influence the stress response."
"Immune cells can penetrate the blood-brain barrier, where they secrete chemical messengers called cytokines that influence the stress response." Immune cells can penetrate the blood brain barrier and secrete cytokines that influence the stress response. The hallmark of the stress response is the endocrine-immune interactions that suppress the immune response. The exact mechanism by which stress produces its effects on the immune response probably varies from person to person. Another possible route for neuroendocrine regulation of immune function is through the sympathetic nervous system.
A female client with a new diagnosis of systemic lupus erythematosus (SLE) has been told that this is an autoimmune disease whereby the immune system is attacking the body's cells and tissue. She knows that she has inflammation and tissue damage. She asks her nurse to explain "What cells in the body are triggering this inflammation?" The nurse responds: "The lymphocytes that migrate to the brain where they secrete cytokines, which trigger inflammation." "Mainly the adrenocorticoids like cortisone are responsible for all your inflammation." "Mineralocorticoids like aldosterone usually begin the process of inflammation." "Primarily, this acute stress reaction is associated with stimulation of the autonomic nervous system, which causes stiffness in the joints."
"The lymphocytes that migrate to the brain where they secrete cytokines, which trigger inflammation."
The emergency department nurse evaluates the orientee's understanding of the acute stress response in a trauma client. The nurse knows the orientee understands it when he states: "Reactions to acute stress are those associated with the central nervous system." "Acute responses may be lifesaving in that they divert blood from more essential to less essential body functions." "There is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention." "Decreased alertness and cognitive functioning enable rapid processing of information and arrival at the most appropriate solution to a threatening situation."
"There is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention."
A daughter of an older adult client tells the nurse that her mother is not able to handle stress like she used to. The best response by the nurse would be: "Age has no influence in response." "This is an expected response." "This results from an increase in ANS stimulation." "This results from increased renal function."
"This is an expected response."
A daughter of an older adult client tells the nurse that her mother is not able to handle stress like she used to. The best response by the nurse would be: "Age has no influence in response." "This results from increased renal function." "This results from an increase in ANS stimulation." "This is an expected response."
"This is an expected response."
Select the most appropriate statements that describe the "stress response." Select all that apply. Brings the body to a stable state Decreases a person's chance of survival A normal response Chronic response Short-term it will damage organs
A normal response Brings the body to a stable state
Which client is experiencing the effects of a positive feedback mechanism? 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 postoperative client who is shivering in response to low environmental temperature. A client whose fluid volume is increasing because of the release of antidiuretic hormone (ADH) from the posterior pituitary gland
A pregnant client whose oxytocin levels are rising during the second stage of labor.
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 Posttraumatic stress disorder (PTSD) Chronic intermittent Chronic sustained
Acute time limited
As a nurse prepares to change a client's dressing, the client states that she is afraid that it will be painful. Noting that the client's heart rate and respiratory rate have increased, the nurse adjusts the plan of care to reflect care for a client in which phase of Selye's general adaptation syndrome? Resistance Exacerbation Exhaustion Alarm
Alarm
A 45-year-old woman with a diagnosis of shingles is experiencing an acute onset of severe neuropathic pain. Which stage of Selye's characterization of stress response is the woman mostlikely experiencing at the moment? Exhaustion Alarm General Adaptation Syndrome (GAS) Resistance
Alarm Explanation: The stimulation of the sympathetic nervous system, such as that during an episode of pain, characterizes the alarm stage. Resistance and exhaustion would likely follow, and GAS encompasses the whole continuum, not just this particular stage.
The physician places his client with liver failure on spironolactone to decrease sodium absorption by the kidney. Which hormone is this medication affecting? Cortisol Vasopressin Adrenocorticotropic hormone (ACTH) Aldosterone
Aldosterone Explanation: Aldosterone, produced in the adrenal cortex, increases sodium absorption by the kidney. Vasopressin increases water absorption by the kidney. ACTH stimulates the synthesis and release of cortisol. Cortisol does not effect sodium absorption.
The nurse is caring for an ex-soldier who has been diagnosed with posttraumatic stress disorder (PTSD). The nurse should prioritize which action? Teaching the client to modify his stress response Encouraging the client to talk about his trauma Assessing the client's neurologic status frequently Assessing the client for depression and risk for suicide
Assessing the client for depression and risk for suicide
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 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 An impaired deficit of memory and concentration for greater than a 6-month period after a traumatic event has occurred 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 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? Progressive muscle relaxation Imagery Music therapy Biofeedback
Biofeedback
Psychosocial factors can impact the body's response to stress either positively or negatively. It has been shown that social networks play a part in the psychosocial and physical integrity of a person. How do social networks affect how a body deals with stress? By mobilizing the resources of the person By protecting the person from other internal stressors By stepping in and making decisions for the person By reapportioning the finances of the person
By mobilizing the resources of the person
Which client, when faced with acute stressful situations, would be considered highest risk for becoming noncompliant with his/her medication regimen? Client with end-stage renal failure experiencing electrolyte imbalances related to having trouble sticking to the prescribed diet Paraplegic client who forgot his pressure control device and has a small decubitus on the coccyx New mother who is breast-feeding every 2 to 3 hours throughout the day and night Teenager whose period is late by 2 weeks and afraid to tell her parents
Client with end-stage renal failure experiencing electrolyte imbalances related to having trouble sticking to the prescribed diet
The control systems of the body act in many ways to maintain homeostasis. These control systems regulate the functions of the cell and integrate the functions of different organ systems. What else do they do? Shut down the body at death Act on invading organisms Feed cells under stress Control life processes
Control life processes Explanation: The body's control systems regulate cellular function, control life processes, and integrate functions of the different organ systems. Homeostatic control systems do not feed cells when they are under stress, they do not act on invading organisms, and they do not shut down the body at death.
The nursing student was initially overwhelmed with the demands of nursing school. The student implemented a plan of getting adequate sleep and nutrition to adapt to the new demands. These strategies are known as which of the following? Allostasis Coping mechanisms Stressors Avoidance
Coping mechanisms
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 Fight-or-flight hormone Immune factor Allostatic factor
Corticotropin-releasing factor
The older adult client with a history of congestive heart failure is upset following the death of her husband yesterday. The practitioner observes the client for which of the following? Renal failure Dysrhythmias Cerebrovascular accident Anemia
Dysrhythmias
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: Eustress Exhaustion stage Distress Resistance stage
Eustress
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 adpatation syndrome? Alarm Resistance Exacerbation Exhaustion
Exhaustion
For the most part, the stress response is meant to be acute and ongoing. True False
False
Most physiologic control systems function under positive feedback mechanisms. False True
False
The nurse is caring for a client with left-sided heart failure causing chronic activation of the renin-angiotensin-aldosterone system (RAAS). What is the nurse's priority assessment? Hyperkalemia Increased urine output Decreased blood pressure when standing Fluid volume excess
Fluid volume excess
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? Insulin Glucocorticoid Aldosterone Antidiuretic hormone
Glucocorticoid
Which hormone has functions that are meant to protect the organism against the effects of a stressor and to focus energy or regain balance in the face of an acute challenge to homeostasis? Angiotensin II Growth hormone Glucocorticoid hormones Thyroid-stimulating hormone
Glucocorticoid hormones
During a period of stress, the nurse asks the client to close his eyes and think of a calm, relaxing place where he can feel the wind blowing on his cheek and smell the salty air from the ocean. This is an example of utilizing which type treatment for stress reduction? Yoga Hypnosis Biofeedback Guided imagery
Guided imagery
A nurse conducting a community education class on stress adaptation determines that the participants have understood the information when they state that a stable internal environment is called: Control Conditioning Homeostasis Adaptation
Homeostasis
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 Intrusion Shell shock
Hyperarousal
Which organs are involved in the general adaptation syndrome (GAS)? Select all that apply. Pancreas Pituitary gland Adrenal gland Hypothalamus Thyroid gland
Hypothalamus Pituitary gland Adrenal gland
The therapist is helping the client learn alternative stress-reducing strategies. The therapist has the client sit back, close his eyes, and envision being on the beach. Which type of relaxation technique is this? Biofeedback Music therapy Progressive muscle relaxation Imagery
Imagery
The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). Which lab result would the provider expect to see? Increased hemoglobin Increased blood glucose Increased albumin Increased white blood count (WBC)
Increased blood glucose
What will the nurse assess as the end result of activation of the renin-angiotensin-aldosterone system? Increased urination Increased heart rate Increased respiratory rate Increased blood pressure
Increased blood pressure The Renin-Angiotensin-Aldosterone System (RAAS) is a hormone system within the body that is essential for the regulation of blood pressure and fluid balance
The client has just been told that he has a debilitating illness. Which signs and symptoms would the nurse recognize as being related to stress? Select all that apply. Increased activity of the gastrointestinal tract Decreased heart rate Pupils constrict Increased respiratory rate Mouth becomes dry
Increased respiratory rate Mouth becomes dry
A number of responses occur in the body to the release of neurohormones when the body encounters stress, including: decrease in awareness. increase in appetite. inhibition of reproductive function. decreased cerebral blood flow.
Inhibition of reproductive function Explanation: The results of the coordinated release of these neurohormones include the mobilization of energy, a sharpened focus and awareness, increased cerebral blood flow and glucose utilization, enhanced cardiovascular and respiratory functioning, redistribution of blood flow to the brain and muscles, modulation of the immune response, inhibition of reproductive function, and decrease in appetite.
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? Arousal Hyperarousal Avoidance Intrusion
Intrusion
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? Hyperarousal Intrusion Avoidance Arousal
Intrusion
A client with a history of posttraumatic stress syndrome reports frequently reliving the traumatic event. The nurse documents that the client is experiencing: Intrusion Battle fatigue Anxiety Depression
Intrusion
The client tells the provider that she is afraid to sleep due to nightmares of a recent plane crash that seem real. Which state of posttraumatic stress disorder (PTSD) is the client experiencing? Hyperarousal Intrusion Avoidance Battle fatigue
Intrusion
A student is attempting to trace the feedback cycle involved in the stress response. Which neural structure is thought to be the central integrating site for the stress response? Reticular formation Locus caeruleus Hypothalamus Cerebral cortex
Locus ceruleus Explanation: The locus ceruleus (LC) produces norepinephrine (NE), which initiates the autonomic syndrome known as "fight-or-flight." The LC-NE system is connected to the hypothalamus, the limbic system, the hippocampus, and the cerebral cortex, which carry out the specific functions of the stress response.
A client with an underlying heart condition is being admitted to the hospital with an upper respiratory infection. The nurse anticipates that this client will be admitted to which unit? Monitored/telemetry Surgical Medical Intensive care
Monitored/telemetry Explanation: This patient will most likely be admitted to a monitored/telemetry unit due to the risk for arrhythmia associated with the stress response to the upper respiratory system.
What feedback system provides stability to the stress response? Negative feedback mechanism Positive feedback mechanism Cardiac response Fear response
Negative feedback mechanism
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
A client with an elevated temperature is beginning to sweat. The nurse interprets this as being an example of: eustress. Selye's stress response. positive feedback mechanism. negative feedback mechanism.
Negative feedback mechanism Explanation: The example of an elevated temperature causing the patient to sweat is an example of the body's negative feedback mechanism. This mechanism regulates the body's endocrine system to maintain constancy or homeostasis.
The manifestations of the stress response are strongly influenced by which system? Renal Respiratory Cardiac Nervous
Nervous
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? Thyroid stimulating hormone (TSH) Norepinephrine Cytokines Aldosterone
Norepinephrine
The locus caeruleus (LC) is an area in the brain stem that produces which hormone? Antidiuretic hormone (ADH) Cortisol Aldosterone Norepinephrine (NE)
Norepinephrine (NE)
A client who lives with many psychosocial and physiologic stressors is experiencing the exhaustion stage of stress. The client is likely to develop what consequence of this stage? Emotional balance Death Heightened awareness Physiologic damage
Physiologic damage The exhaustion stage of stress causes physiologic damage. This can culminate in death, but this is not guaranteed. Emotional balance will not occur and heightened awareness accompanies the alarm stage.
The Olympic athlete is able to increase her cardiac output sevenfold during exercise. This is an example of: Allostatic load Homeostasis Physiologic reserve Fight-or-flight response
Physiologic reserve
Select the stage of general adaptation when the body implements the most effective channels of defense. Resistance Alarm Allostatic Exhaustion
Resistance Explanation: During the resistance stage, the body selects the most effective and economic channels of defense. During this stage, the increased cortisol levels present during the first stage drop because they are no longer needed.
A nurse assessing for factors that impact a client's ability to adapt to stress includes assessing for which of the following? Select all that apply. Elimination Hardiness Nutrition Physiologic reserve Sleep-wake cycle
Sleep-wake cycle Hardiness Nutrition Physiologic reserve
Which mechanism may be a contributor to symptoms in a child who has "failure to thrive"? Renin-angiotensin-aldosterone system Starvation response Stress response on growth hormone Fear of failure
Stress response on growth hormone
The fight-or-flight response is a manifestation of the stress reaction caused by which part of the nervous system? Sympathetic Peripheral Central Parasympathetic
Sympathetic
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? Encouraging the client to decrease interaction with others Encouraging the client to listen to music on the radio Teaching the client to systematically contract and relax major muscle groups Encouraging the client to eat and drink whatever he wants
Teaching the client to systematically contract and relax major muscle groups
A counseling psychologist is working with a 30-year-old female client who is experiencing the symptoms of posttraumatic stress disorder (PTSD) following a house fire several months prior. Which of the client's diagnostic results could most likely be interpreted as a manifestation of PTSD? The client has decreased levels of norepinephrine. The client has increased levels of growth hormones. The client has decreased levels of cortisol. The client has decreased levels of angiotensin II.
The client has decreased levels of cortisol.
When explaining to a client admitted for stress-induced supraventricular tachycardia, the nurse will incorporate which statement about what happens in the body as a result of excess stress? Endorphins are released from the brain every time we experience stress. The primary role of the parasympathetic nervous system is to stimulate the vagus nerve. The corticotrophin-releasing factor stimulates the release of norepinephrine, which is responsible for "fight-or-flight" reaction to stress. The pituitary gland is ultimately responsible for growth, metabolism, and maturation, all of which are important when the body is stressed.
The corticotrophin-releasing factor stimulates the release of norepinephrine, which is responsible for "fight-or-flight" reaction to stress.
An electrician who has been working 14- to 16-hour days for several weeks to ensure the financial survival of his business presents to his family physician with a report of persistent headaches and insomnia. His family physician attributes the physical symptoms to the ongoing stress likely caused by which component of the stress response? The fact that he has previously had difficulty coping with stress The fact that he is not physically active on a regular basis The fact that his company is heavily in debt The fact that he takes diuretic medication for his hypertension
The fact that he has previously had difficulty coping with stress
The nursing student is studying failure to thrive in children. She explains to her peers that which component is a possible cause for failure to thrive? Stress-induced cortisol secretion is associated with decreased levels of thyroid stimulating hormone and inhibits conversion of thyroxine (T4) to triiodothyronine (T3). Severe stress can induce anovulation in women. Antidiuretic hormone, also involved in the stress response, increases water retention by the kidneys. The prolonged presence of cortisol leads to suppression of growth hormone.
The prolonged presence of cortisol leads to suppression of growth hormone.
It is thought that there is an interaction between the neuroendocrine system and the immune system. It has been postulated that these interactions play a significant role in autoimmune diseases. What do these two systems have in common? Select all that apply. They are symbiotic systems and cannot work without each other. Hormones and neuropeptides can change what immune cells do. Mediators of the immune system can modify neuroendocrine function. They share common signal pathways.
They share common signal pathways. Hormones and neuropeptides can change what immune cells do. Mediators of the immune system can modify neuroendocrine function.
In the stress response, which are functions of the cerebral cortex? Vigilance, cognition, and focused attention Skeletal muscle tone modulation Fear, excitement, rage, and anger Coordination of the responses of the endocrine and autonomic nervous systems
Vigilance, cognition and focused attention In the stress response, the cerebral cortex is involved with vigilance, cognition and focused attention and the limbic system with the emotional components (e.g. fear, excitement, rage, anger). The hypothalamus coordinates the responses of the endocrine and autonomic nervous system. The reticular activating system modulates skeletal muscle tone.
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. advising those held hostage to "get over" the event and pretend it did not happen. immediate treatment with antianxiety medications. assessing family relations and strengthening them as needed.
debriefing with a crisis team about the event as soon as possible.
Our body's response to psychological perceived threats is not regulated to the same degree as our body's response to physiologic perceived threats. The psychological responses may be: appropriate and limited. regulated by a positive feedback system. the result of a baroreflex-mediated response. inappropriate and sustained.
inappropriate and sustained.
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. increased immune reactions. decreased vascular tone. increased blood glucose.
increased blood glucose.
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: immune system compensation. physiologic reserve. anatomic characteristics. cultural factors.
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: ignore her life circumstances. develop posttraumatic stress disorder. work harder to maintain employment. develop chronic stress.
work harder to maintain employment.
How does the nurse best define hardiness to a client? "Hardiness describes a personality characteristic that assists in the stress response." "Hardiness helps you respond to medications better." "Hardiness is how your muscles respond to stress." "Hardiness assists you in preventing nausea and vomiting."
"Hardiness describes a personality characteristic that assists in the stress response."
For the diagnosis of posttraumatic stress disorder (PTSD) to be made, the triad of symptoms that characterize PTSD must be present for at least which time frame? 1 month 6 months 1 year 1 week
1 month
For the diagnosis of posttraumatic stress disorder (PTSD) to be made, the triad of symptoms that characterize PTSD must be present for at least which time frame? 1 year 1 week 1 month 6 months
1 month
