Pathophysiology Ch 9
A patient with an underlying heart condition is being admitted to the hospital with an upper respiratory infection. The nurse anticipates that this patient will be admitted to which unit?
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. Page 215
A counseling psychologist is working with a 30 year old female client who is experiencing the symptoms of post-traumatic stress disorder (PTSD) following a house fire several months prior. Which of the client's following diagnostic results could most likely be interpreted as a manifestation of PTSD?
The client has decreased levels of cortisol. Explanation: Decreased cortisol levels are a marker of PTSD and a differentiation from other subtypes of stress. Low levels of norepinephrine and angiotensin II would not accompany any common variant of stress response, and growth hormones are suppressed in response to stress.
A client experiencing an acute stress response has increased urination. What does the nurse determine is the cause of this clinical manifestation?
The client has hyperglycemia. Explanation: The patient has an increase in blood glucose levels during acute stress, which causes increased urination, as seen in diabetes. The other explanations are incorrect. Page 215
Based on assessment results, which hospitalized client is most likely to be experiencing the effects of chronic stress?
A 45 year old paraplegic who is experiencing delayed wound healing of an ischial ulcer. Explanation: Delayed wound healing has been associated with chronic stress. Endocarditis, renal failure, COPD and CHF are not noted as common effects of chronic stress. Page 216
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:
work harder to maintain employment. Explanation: Eustress is a beneficial type of stress that can motivate. Eustress is consequently not linked to PTSD or hopelessness. Page 208
Which client is experiencing the effects of a positive feedback mechanism?
A pregnant client whose oxytocin levels are rising during the second stage of labour. Explanation: The release of hormones during labour increases rather than mitigates a physiologic system. Specifically, uterine contraction stimulates the production of other relevant hormones that cause temporary instability that 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. Page 208
Which of the following organs are involved in the general adaptation syndrome (GAS)? Select all that apply.
Adrenal gland Pituitary gland Hypothalamus Explanation: The hypothalamic-pituitary-adrenal axis plays a pivotal role in the development of the general adaptation syndrome. Page 215
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 most likely experiencing at the moment?
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. Page 215
The elderly 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?
Arrhythmias Explanation: For people with limited coping abilities, either because of physical or mental health, the acute stress response may be detrimental. For people with preexisting heart disease the overwhelming sympathetic behaviors associated with stress can lead to arrhythmias. The other options are not stimulated by the sympathetic response. Page 215
The nurse is caring for an ex-soldier who has been diagnosed with posttraumatic stress disorder (PTSD). The nurse should prioritize which action?
Assessing the client for depression and risk for suicide. Explanation: 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. Page 216
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 Explanation: 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. Page 216
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?
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. Page 207
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 Explanation: 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 pharmacological treatments, and never advise a client to "get over" an event. Page 216-217
A previously healthy 42-year-old client was recently diagnosed with hypertension. Select the response that best describes a positive reaction to the acute stress.
Decreasing dietary sodium and fat intake Explanation: In an acute stress, a healthy or positive response to a diagnosis such as hypertension would be to redirect attention to promoting health (i.e., decreased sodium and fat intake). The other options are not positive responses. Page 215-216
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 which of the following?
Eustress Explanation: 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. Page 208
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 of the following medications?
Glucocorticoid Explanation: 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. Page 211-212
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?
Glucocorticoid hormones Explanation: The glucocorticoid hormones have functions that are meant to protect the organism against the effects of a stressor and to focus energy on regaining balance in the face of an acute challenge to homeostasis. The other hormones do not have these functions. Page 210-211
During a period of stress, the nurse asks the patient to close their eyes and think of a calm, relaxing place where they can feel the wind blowing on their cheek and smell the salty air from the ocean. This is an example of utilizing which type treatment for stress reduction?
Guided imagery. Explanation: Guided imagery is another technique that is used to achieve relaxation. One method is scene visualization, in which the person is asked to sit back, close the eyes, and concentrate on a scene narrated by the therapist. Whenever possible, all five senses are involved. Page 218
The nurse is reviewing a client's history and recognizes that she has remained healthy despite being challenged by a high level of stressors. This is known as which of the following?
Hardiness Explanation: Hardiness is a personality characteristic that helps some people remain healthy despite being challenged by a high level of stressors. A negative feedback mechanism is a control mechanism that monitors a value or function and increases it if it falls below the set value. The general adaptation syndrome is a response to stressors that allows the person to use functions of the system best able to respond to it. The fight-or-flight response is the sympathetic nervous system manifestation of the stress reaction. Page 214
A client who has experienced posttraumatic stress disorder (PTSD) tells the nurse he now has "flashbacks" during waking hours or nightmares in which the past traumatic event is relived, often in vivid and frightening detail. The nurse recognizes this as:
Intrusion Explanation: Intrusion involves the 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 includes inability to experience positive emotions such as love, joy, pleasure, or satisfaction. Page 216-217
The treatment of stress disorders should engage them in alternative strategies that reduce stress. Which are nonpharmacologic treatments for stress disorders? (Select all that apply.)
Massage therapy Music therapy Explanation: The treatment of stress should be directed toward helping people avoid coping behaviors that impose a risk to their health and providing them with alternative stress-reducing strategies. Nonpharmacologic methods used for stress reduction are relaxation techniques, guided imagery, music therapy, massage, and biofeedback. Page 218-219
An occupational health officer who works in the context of a large police force is attempting to understand the role that stress may play in the health of his clients. According to Selye, which of the following statements best captures an aspect of the phenomenon of stress?
Periods of stress can be developmentally positive or negative. Explanation: Selye noted that stress can result in positive growth and development, and that stress is not unanimously detrimental to health and development. The alarms stage is associated with the release of cortisol and catecholamines, and a stress response is dependent on properties of the stressor and the individual's conditioning; the severity is not objectively determined. Illness is often a consequence of the exhaustion stage. Page 208
The health care provider is teaching a client about the ability of the body to function and maintain homeostasis under conditions of change in the internal and external environment. The most important regulation is controlled by which system?
Physiologic Explanation: The ability of the body to function and maintain homeostasis under conditions of change in the internal and external environment depends upon thousands of physiologic control systems that regulate body function. 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. The other options do not control homeostasis. Page 207
Some clients experience chronic activation of the stress response as a result of experiencing a severe trauma. Which of the following is the disorder that can occur when the stress response is chronically activated?
Posttraumatic stress disorder Explanation: Posttraumatic stress disorder is an example of chronic activation of the stress response as a result of experiencing a severe trauma. In this disorder, memory of the traumatic event seems to be enhanced. Flashbacks of the event are accompanied by intense activation of the neuroendocrine system. Chronic renal insufficiency, schizophrenia, and postdelivery depression in a new mother are not the result of chronic activation of the stress response following a severe trauma. Page 216-217
Select the stage of general adaptation when the body implements the most effective channels of defense.
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. Page 208
What mechanism may be a contributor to symptoms in a child who has "failure to thrive"?
Stress response on growth hormone Explanation: 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. Page 211
Chronic and excessive activation of the stress response has been shown to play a part in the development of long-term health problems. The stress response can also result from chronic illness. Which health problems have been linked to a stress response that is chronic and excessive?
Suicide and immune disorders Explanation: Diseases of the cardiovascular, gastrointestinal, immune, and neurologic systems, as well as depression, chronic alcoholism and drug abuse, eating disorders, accidents, and suicide, have all been linked to the chronic and excessive activation of the stress response. Page 216
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 Explanation: 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. Page 218
Which component of the stress response functions as the relay center and is important in receiving, sorting out and distributing sensory input?
Thalamus Explanation: The thalamus functions as the relay center and is important in receiving, sorting out, and distributing sensory input. The hypothalamus coordinates the responses of the endocrine and autonomic nervous system (ANS). The cerebral cortex is involved with vigilance, cognitive and focused attention. The reticular activating system modulates mental alertness, autonomic nervous system activity, and skeletal tone, using input from the neural structures. Page 209
When explaining to a patient admitted for stress-induced supraventricular tachycardia, the nurse will incorporate which of the following statements about what happens in the body as a result of excess stress?
The corticotrophin-releasing factor stimulates the release of norepinephrine, which is responsible for "fight-flight" reaction to stress. Explanation: Norepinephrine stimulates the secretion of CRF, and CRF stimulates the release of norepinephrine. Page 209-211
A female patient 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 which migrate to the brain where they secrete cytokines, which trigger inflammation. Explanation: Immune cells such as monocytes and lymphocytes can penetrate the blood-brain barrier and take up residence in the brain, where they secrete chemical messengers called cytokines that influence the stress response. This triggers inflammation. Page 212
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?
The prolonged presence of cortisol leads to suppression of growth hormone. Explanation: Although growth hormone is initially elevated at the onset of stress, the prolonged presence of cortisol leads to suppression of growth hormone. Although the connection is speculative, the effects of stress on growth hormone may provide one of the vital links to understanding failure to thrive in children. The other options are not associated with failure to thrive in children. Page 212
The client has been admitted to the emergency department following a traumatic motor vehicle accident. The client is hypotensive due to blood loss. Which of the following stress response hormones will aid in fluid replacement?
Vasopressin Explanation: 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. Page 212
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:
physiologic reserve. Explanation: 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. Page 216
The emergency department nurse evaluates the orientee's understanding of the acute stress response in a trauma patient. The nurse knows the orientee understands it when he states which of the following?
"There is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention." Explanation: The reactions to acute stress are those associated with the autonomic nervous system. Centrally, there is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention. In situations of life-threatening trauma, these acute responses may be lifesaving in that they divert blood from less essential to more essential body functions. Increased alertness and cognitive functioning enable rapid processing of information and arrival at the most appropriate solution to the threatening situation. Page 215
A daughter of an elderly 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:
"This is an expected response." Explanation: The capacity to adapt to stress is influenced by age. Changes in the elderly's adaptation to stress result from age-related changes in renal function. There is a reported decline in ANS and cardiovascular responsiveness to stress associated with advancing age. Aging is also associated with impaired activation and proliferation of T and B lymphocytes, as well as poorer natural killer cell response to stimulatory cytokines. Page 213
Which of the following clients will have the most efficient adaptation?
A client who has been noticing small amounts of blood in his stool over the past week Explanation: Adaptation is most efficient when changes occur gradually rather than suddenly. The client with a slow gastrointestinal bleed will adapt better than the other options with rapid blood loss. Page 212-214
The client is hospitalized for four 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 Explanation: 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. Page 215
As a nurse prepares to change a patient's dressing,the patient states that she is afraid that it will be painful. Noting that the patient's heart rate and respiratory rate has increased, the nurse adjusts the plan of care to reflect care for a patient in which phase of Selye's general adaptation syndrome?
Alarm Explanation: The nurse plans care for a patient in the alarm stage of Selye's general adaptation syndrome. During this stage, the sympathetic nervous system is stimulated, which can result in increases in heart and respiratory rate. Page 215
The physician places his client with liver failure on spironolactone to decrease sodium absorption by the kidney. Which hormone is this medication affecting?
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. Page 211
Adaptation implies that an individual has successfully created a new balance between the stressor and the ability to deal with it. The method of adaptation that allows the body to live with only one of a pair of organs (i.e., one lung or one kidney) is known by which term?
Anatomic reserve The ability of body systems to increase their function given the need to adapt is known as the physiologic reserve. Many of the body organs, such as the lungs, kidneys, and adrenals, are paired to provide anatomic reserve as well. Both organs are not needed to ensure the continued existence and maintenance of the internal environment. Genetic endowment, physiologic reserve, and health status are all coping mechanisms, but they do not impact the body's need to survive when one organ of a pair is missing.
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 Explanation: The configuration of significant others that constitutes the social network functions to mobilize the resources of the person; these friends, colleagues, and family members share the person's tasks and provide monetary support, materials and tools, and guidance in improving problem-solving capabilities. Social networks cannot protect the person from other internal stressors. Page 213
Which of the following patients, when faced with acute stressful situations, would be considered highest risk for becoming noncompliant with their medication regimen?
End stage renal failure patient experiencing electrolyte imbalances related to having trouble sticking to their prescribed diet. Explanation: For people with health problems [like ESRD patients], acute stress can interrupt compliance with medication regimens and exercise programs. Page 214
It has long been known that our bodies need a stable internal environment to function optimally. What serves to fulfill this need?
Control systems Explanation: 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. Page 207
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?
Coping mechanisms Explanation: Adaptation implies that an individual has successfully created a new balance between stressor and the ability to deal with it. The means used to attain this balance (e.g., nutrition, sleep) are called coping strategies or coping mechanisms. The term allostasis is used to describe the physiologic changes in the neuroendocrine, autonomic and immune systems that occur in response to either real or perceived challenges to homeostasis. Avoidance is a stage of posttraumatic stress disorder that refers to the emotional numbing and disrupts important personal relationships. Page 213
A client asks the nurse why some people adapt to physiological and psychological threats differently. The best response would be:
Coping mechanisms Explanation: Coping mechanisms are the emotional and behavioral responses used to manage threats to our physiological and psychological homeostasis. The ability to ignore symptoms is not the best way to deal with stress, and previous experience with an event will help the person know how to deal with it by having developed coping skills. Page 213
Which is an endocrine regulator of pituitary and adrenal activity and neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior?
Corticotropin-releasing factor Explanation: 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 interactions. Page 210
Which of the following hormones is central to the endocrine component of the neuroendocrine response to stress?
Corticotropin-releasing factor (CRF) Explanation: Corticotropin-releasing factor is central to the endocrine component of the neuroendocrine response to stress. Corticotropin-releasing factor, from the hypothalamus, induces secretion of adrenocorticotropic hormone from the anterior pituitary gland. Adrenocorticotropic hormone, in turn, stimulates the adrenal gland to synthesize and secrete glucocorticoid hormones. Page 214
Selye suggested that stress could have positive influences on the body, and these periods of positive stress are called:
Eustress Explanation: Selye suggested that mild, brief, and controllable periods of stress could be perceived as positive stimuli to emotional and intellectual growth and development. These periods of stress are called eustress. Severe, protracted, and uncontrolled situations of psychological and physical distress are disruptive to health. Emotional stress and exercise stress are subtypes of stress that are not related. Page 208
A client being evaluated in the emergency room is unable to speak logically or follow directions. The client's family states the client has been under a great deal of stress for about 6 months. The client is most likely experiencing:
Exhaustion Explanation: If the stressor is prolonged or overwhelms the ability of the body to defend itself, the exhaustion stage ensues, during which resources are depleted and signs of "wear and tear" or systemic damage appear. Deliberation is not a stage of the Selye general adaptation syndrome. The alarm stage is characterized by a generalized stimulation of the sympathetic nervous system. During the resistance stage, the body selects the most effective and economic channels of defense. Page 206
A patient who is in the intensive care unit after experiencing a massive heart attack begins to go into renal failure. The nurse plans the patient's care knowing that the patientis in which phase of Selye's general adpatation syndrome?
Exhaustion Explanation: The nurse plans care knowing that this patient 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. Page 208
The nurse knows that everyone who experiences stressful life events develops a disease.
False Explanation: The evidence for a link between the stress response system and the development of disease in susceptible people is compelling but not conclusive.
For the most part, the stress response is meant to be acute and ongoing.
False Explanation: The stress response is meant to be acute and time limited. Page 207-208
The physician suspects that a patient under a lot of stress (stimulation of the sympathetic nervous system) is experiencing stress-induced release of vasopressin. Knowing the effects of an activated rennin-angiotensin-aldosterone system (RAAS), the nurse should be assessing the patient for which primary nursing diagnosis?
Fluid volume excess related to retention water in the body. Explanation: Activation of the RAAS results in an increase in vascular tone (elevation of BP) and renal retention of sodium and water. These changes contribute to the physiologic changes that occur with the stress response. Page 211
Which therapy guides the client to focus on creating a specific mental image designed to bring about positive physical and/or emotional effects to combat stress?
Guided imagery Explanation: Guided imagery is a mind-body technique intended to relieve stress and promote a sense of peace and tranquility during periods of stress or difficulty. Progressive muscle relaxation techniques, music therapy, massage therapy, and biofeedback are all different types of relaxation techniques. Page 218
A patient with Parkinson's disease has challenged themselves to maintain mobility for longer than the physician predicts. They strive every day to walk 5-10 steps further than the day before. This phenomenon, being researched by social psychologists, is known as:
Hardiness. Explanation: Hardiness describes a personality characteristic that includes a sense of having control over the environment, a sense of having a purpose in life, and an ability to conceptualize stressors as a challenge rather than a threat. Page 214
In response to hearing about her poor prognosis, a client is experiencing stress. Which neural structures will participate in the client's autonomic stress response? Select all that apply.
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. The cerebellum does not participate in the stress response. Page 209
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:
Inappropriate and sustained Explanation: The response to physiologic disturbances that threaten the integrity of the internal environment is specific to the threat; the body usually does not raise the body temperature when an increase in heart rate is needed. In contrast, the response to psychological disturbances is not regulated with the same degree of specificity and feedback control; instead, the effect may be inappropriate and sustained. No systems in the body are regulated by a positive feedback system. In cardiovascular physiology, the baroreflex or baroreceptor reflex is one of the body's homeostatic mechanisms for maintaining blood pressure. It has nothing to do with the body's response to a psychological threat Page 213
The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). Which of the following lab results would the provider expect to see?
Increased blood glucose Explanation: 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). Page 211
A client is experiencing an increase in cortisol secretion. It would be most important for the nurse to assess the client for:
Increased blood glucose Explanation: 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. Page 215
A patient who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which of the following results?
Increased blood pressure and heart rate; increased antidiuretic hormone (ADH). Explanation: Increases in ADH, blood pressure and heart rate are all associated with the stress response. Testosterone and somatomedin C are decreased in prolonged stress exposure. Gastrointestinal motility is decreased, not increased, during stress.
A number of responses occur in the body to the release of neurohormones when the body encounters stress, including which of the following?
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. Page 209
A patient with a history of posttraumatic stress syndrome reports frequently reliving the traumatic event. The nurse documents that the patient is experiencing which of the following?
Intrusion Explanation: The nurse documents that the patient is experiencing intrusion, defined as the occurrence of flashbacks or nightmares in which the traumatic event is relived in vivid detail. Page 217
A patient with an elevated temperature is beginning to sweat. The nurse interprets this as being an example of which of the following?
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. Page 207-208
The client tells the provider that she is afraid to sleep due to nightmares of a recent plane crash that seems real. Which state of posttraumatic stress disorder (PTSD) is the client experiencing?
Intrusion PTSD, formerly called battle fatigue, is characterized by a constellation of symptoms that are experienced as states of intrusion, avoidance, and hyperarousal. Intrusion refers to the occurrence of "flashbacks" during waking hours or nightmares in which the past traumatic event is relived, often in frightening detail. Avoidance refers to emotional numbing. Hyperarousal refers to the presence of increased irritability, difficulty concentrating, an exaggerated startle reflex, etc
A student is attempting to trace the feedback cycle involved in the stress response. Which of the following neural structures is thought to be the central integrating site for the stress response?
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. Page 210
An 81 year old male patient who has a diagnosis of orthostatic hypotension is experiencing an episode of particularly low blood pressure. The man's body has responded by increasing levels of angiotensin II in the bloodstream, a hormone which decreases glomerular filtration rate in the kidneys and contributes to an increase in blood pressure. Which of the following phenomena best describes what has occurred?
Negative feedback Explanation: This regulation and attempt to normalize blood pressure is an example of a negative feedback mechanism, in which physiological processes result in the maintenance of homeostasis. This process of normalization is not an example of positive feedback, and homeostasis is the goal rather than the process. This process involves adaptation, but negative feedback is a more precise characterization of the process. Page 207
What feedback system provides stability to the stress response?
Negative feedback mechanism Explanation: Most control systems in the body operate by negative feedback mechanism. This provides more stability than a positive feedback mechanism. The other two stated responses are not correct. Page 207
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 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 manifestations of the body's attempt to adapt to stimuli. Page 207-208
The manifestations of the stress response are strongly influenced by which of the following systems?
Nervous Explanation: The manifestations of the stress response are strongly influenced by both the nervous and endocrine systems. Page 208
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?
Norepinephrine Explanation: 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. Page 216
The locus caeruleus (LC) is an area in the brain stem that produces which of the following hormones?
Norepinephrine (NE) Explanation: 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 glucorticoid, 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. Page 210
A nurse assessing for factors that impact a patient's ability to adapt to stress includes assessing for which of the following? Select all that apply.
Nutrition Hardiness Sleep-wake cycle Explanation: Factors that impact a patient's ability to adapt to stress should include assessing the patient's hardiness, psychosocial factors, health status, sleep-wake cycle, nutrition, gender, age, genetics, time, and physiologic reserve. Page 214
For the diagnosis of post-traumatic stress disorder (PTSD) to be made, the triad of symptoms that characterize PTSD must be present for at least which time frame?
One month Explanation: The symptoms of intrusion, avoidance and hyperarousal that characterize PTSD must be present together for at least one month for a diagnosis to be made. Page 216-217
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?
Physiologic damage Explanation: 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. Page 208
The Olympic athlete is able to increase her cardiac output six to sevenfold during exercise. This is an example of which of the following?
Physiologic reserve Explanation: The ability of body systems to increase their functions, given the need to adapt, is known as physiologic reserve. The persistence or accumulation of physiologic changes, in response to either real or perceived challenges to homeostasis, has been called the allostatic load. The fight-or-flight response is the sympathetic nervous system's response to a stressful situation. Homeostasis is a system of carefully coordinated physiologic processes that oppose change. Page 213
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. Explanation: An individual's subjective response to stress is closely linked to previous experiences in dealing with stress and the presence or absence of coping mechanisms. Physical activity, subjective financial status and diuretic medications would be less likely to have as great an effect. Page 214
In the stress response, which of the following are functions of the cerebral cortex?
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.
