Chapter 9: Stress and Adaptation
The faculty member is explaining homeostasis to her student. The faculty member knows the student understands the concept when he states which of the following about homeostasis? a) "It is a system of carefully coordinated physiologic processes that oppose change." b) "It is characterized by a severe stress response secondary to experiencing previous trauma." c) "It is a control system that monitors a function or value. When the function or value decreases below the set point of the system, the mechanism causes the function or value to increase." d) "An organism is able to survive as long as the composition of the external environment is compatible with the survival needs of the individual cells."
a) "It is a system of carefully coordinated physiologic processes that oppose change." Explanation: The kind of stability called homeostasis, or a stable internal environment, is achieved through a system of carefully coordinated physiologic processes that oppose change. Post-traumatic stress disorder is characterized by a severe stress response secondary to experiencing previous trauma. An organism is able to survive as long as the internal environment is compatible with the survival needs of the individual cells. A negative feedback mechanism monitors a function or value and causes the value to increase if it falls below the set point of the systems. Feedback mechanisms regulate functions to maintain homeostasis.
A child has been experiencing hypoglycemic episodes. "How does the body know when to secrete insulin and when to stop secreting it?" The best response by the nurse, explaining the physiologic background, would be: a) "The body knows that if the blood glucose level falls, it will inhibit insulin secretion and release glycogen to release glucose from the liver." b) "Your pituitary gland in the brain is the 'master gland,' and it controls and regulates all the hormones." c) "It's just a big guessing game; first we give sugar like orange juice, and then we withhold the carbohydrates if the blood glucose level is too high." d) "Once the child starts getting confused, the brain will send a message to the pancreas to stop producing insulin."
a) "The body knows that if the blood glucose level falls, it will inhibit insulin secretion and release glycogen to release glucose from the liver." Explanation: In the negative feedback mechanism that controls blood glucose levels, an increase in blood glucose stimulates an increase in insulin, which enhances removal of glucose from the blood. When glucose has been taken up by cells and blood glucose levels fall, insulin secretion is inhibited and glucagon and other counterregulatory mechanisms stimulate release of glucose from the liver, which causes blood glucose levels to return to normal.
The psychologist is leading a group session with clients who have recently undergone a variety of stressful events. Which of the following clients will have the best adaptation? a) 50-year-old female who sees her new life as a widow as a challenge rather than a threat b) 89-year-old man with congestive heart failure c) 40-year-old man who is unable to make appropriate choices related to his new life as a single parent d) 40-year-old female with insomnia
a) 50-year-old female who sees her new life as a widow as a challenge rather than a threat Explanation: 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 psychologic reserves and is a strong determinant of the ability to adapt.
Which of the following clients will be more able to adapt to a stressor based on an individual's ability to adapt? Select all that apply. a) An infant with decreased water intake due to diarrhea b) A Muslim male experiencing abnormal GI bleeding c) A client with known CAD, expressing problems affording all his prescribed medication d) A child living in a crowded apartment with his financially poor, immediate family e) A male client producing increased corticotropin-releasing factor (CRF)
a) An infant with decreased water intake due to diarrhea c) A client with known CAD, expressing problems affording all his prescribed medication e) A male client producing increased corticotropin-releasing factor (CRF) Explanation: An individual's ability to adapt to a stressor is determined by the interplay of numerous variables, including age, gender, and preexisting health status. Ethnicity and socioeconomic status have not been noted to directly influence the adaptation process.
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? a) Biofeedback b) Imagery c) Music therapy d) Progressive muscle relaxation
a) Biofeedback Explanation: 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
Select the factor that may influence a client's relative risk for development of a stress-related pathologic process. a) Conditioning b) Adaptation c) Stress d) Psychological
a) Conditioning Explanation: Stressors tend to produce different responses in different persons or in the same person at different times, indicating the influence of the adaptive capacity of the person or what Selye called conditioning factors. These conditioning factors may be internal (e.g., genetic predisposition, age, sex) or external (e.g., exposure to environmental agents, life experiences, dietary factors, level of social support).
A child has been experiencing hypoglycemic episodes. "How does the body know when to secrete insulin and when to stop secreting it?" The best response by the nurse, explaining the physiologic background, would be: a) "Once the child starts getting confused, the brain will send a message to the pancreas to stop producing insulin." b) "The body knows that if the blood glucose level falls, it will inhibit insulin secretion and release glycogen to release glucose from the liver." c) "It's just a big guessing game; first we give sugar like orange juice, and then we withhold the carbohydrates if the blood glucose level is too high." d) "Your pituitary gland in the brain is the 'master gland,' and it controls and regulates all the hormones."
b) "The body knows that if the blood glucose level falls, it will inhibit insulin secretion and release glycogen to release glucose from the liver." Explanation: In the negative feedback mechanism that controls blood glucose levels, an increase in blood glucose stimulates an increase in insulin, which enhances removal of glucose from the blood. When glucose has been taken up by cells and blood glucose levels fall, insulin secretion is inhibited and glucagon and other counterregulatory mechanisms stimulate release of glucose from the liver, which causes blood glucose levels to return to normal.
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: a) "This results from an increased in ANS stimulation." b) "This is an expected response." c) "This results from increased renal function." d) "Age has no influence in response."
b) "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.
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? a) Chronic sustained b) Acute time limited c) Post-traumatic stress disorder (PTSD) d) Chronic intermittent
b) 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.
Which of the following organs are involved in the general adaptation syndrome (GAS)? Select all that apply. a) Thyroid gland b) Adrenal gland c) Pancreas d) Hypothalamus e) Pituitary gland
b) Adrenal gland d) Hypothalamus e) Pituitary gland Explanation: The hypothalamic-pituitary-adrenal axis plays a pivotal role in the development of the general adaptation syndrome.
Most physiologic control systems function under positive feedback mechanisms. a) True b) False
False Explanation: The reason most physiologic control systems function under negative rather than positive feedback mechanisms is that a postive feedback mechanism interjects instability rather than stability into a system.
Following a school shooting, many of the children want to talk about the traumatic event. The school nurse knows this is very therapeutic and would be called: a) Debriefing b) Guided imagery c) Non-adaptive functioning d) Fatalism
a) Debriefing Explanation: Debriefing, or talking about the traumatic event at the time it happens, often is an effective therapeutic tool. Crisis teams are often among the first people to attend to the emotional needs of those caught in catastrophic events. Some people may need continued individual or group therapy.
Which of the following patients, when faced with acute stressful situations, would be considered highest risk for becoming non-compliant with their medication regimen? a) End stage renal failure patient experiencing electrolyte imbalances related to having trouble sticking to their prescribed diet. b) Paraplegic patient who forgot their pressure control device and has a small decubitus on their coccyx. c) New mother who is breastfeeding every 2-3 hours throughout the day and night. d) Teenager whose period is late by 2 weeks and afraid to tell their parents.
a) 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
What will the nurse assess as the end result of activation of the renin angiotensin aldosterone system? a) Increased blood pressure b) Increased heart rate c) Increased respiratory rate d) Increased urination
a) Increased blood pressure Explanation: 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 number of responses occur in the body to the release of neurohormones when the body encounters stress, including which of the following? a) Inhibition of reproductive function b) Decreased cerebral blood flow c) Decrease in awareness d) Increase in appetite
a) 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 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? a) Monitored/telemetry b) Surgical c) Intensive care d) Medical
a) 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.
The first goal of treatment of stress disorders is to aid clients in avoiding those coping mechanisms that cause their health to be at risk. Secondly, the treatment of stress disorders should engage them in alternative strategies that reduce stress. Which are nonpharmacologic treatments of stress disorders? (Select all that apply.) a) Music therapy b) Massage therapy c) Lithium therapy d) Education therapy
a) Music therapy b) Massage 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.
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? a) Norepinephrine b) Cytokines c) Aldosterone d) Thyroid stimulating hormone (TSH)
a) Norepinephrine Explanation: People with chronic post-traumatic 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 nursing student is studying failure to thrive in children. She explains that one possible cause is which of the following? a) The prolonged presence of cortisol leads to suppression of growth hormone. b) Antidiuretic hormone, also involved in the stress response, increases water retention by the kidneys. c) Stress-induced cortisol secretion is associated with decreased levels of thyroid stimulating hormone and inhibits conversion of thyroxine (T4) to triiodothyronine (T3). d) Severe stress can induce anovulation in women
a) 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.
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? a) Exacerbation b) Alarm c) Resistance d) Exhaustion
b) 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.
The physician places his client with liver failure on spironolactone to decrease sodium absorption by the kidney. Which hormone is this medication affecting? a) Vasopressin b) Aldosterone c) Cortisol d) Adrenocorticotropic hormone (ACTH)
b) 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.
A client reports fatigue and an inability to concentrate. The client has been unemployed for the second time in a year and is concerned about supporting the family. Select the type of stressor the client most likely experiencing. a) Associated b) Chronic sustained c) Acute reflexive d) Acute time-limited
b) Chronic sustained Explanation: Chronic intermittent or chronic sustained stress occurs when a person is repeatedly exposed to a stressor. An acute time-limited stressor is one that occurs over a short time and does not reoccur.
It has long been known that our bodies need a stable internal environment to function optimally. What serves to fulfill this need? a) Neurovascular systems b) Control systems c) Organ systems d) Biochemical messenger systems
b) 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.
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: a) Assessing family relations and strengthening them as needed b) Debriefing with a crisis team about the event as soon as possible c) Immediate treatment with antianxiety medications d) Advising those held hostage to "get over" the event and pretend it did not happen
b) 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
A hostage situation has occurred at a high school campus. The school superintendent and faculty are concerned about the students experiencing post-traumatic stress disorder (PTSD). The most important intervention would be: a) Advising those held hostage to "get over" the event and pretend it did not happen b) Debriefing with a crisis team about the event as soon as possible c) Immediate treatment with antianxiety medications d) Assessing family relations and strengthening them as needed
b) 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.
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. a) Ceasing to exercise b) Decreasing dietary sodium and fat intake c) Spending more time at work d) Exhibiting a carefree attitude about life
b) 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.
Which of the following patients, when faced with acute stressful situations, would be considered highest risk for becoming noncompliant with their medication regimen? a) Teenager whose period is late by 2 weeks and afraid to tell their parents. b) End stage renal failure patient experiencing electrolyte imbalances related to having trouble sticking to their prescribed diet. c) New mother who is breastfeeding every 2-3 hours throughout the day and night. d) Paraplegic patient who forgot their pressure control device and has a small decubitus on their coccyx.
b) 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
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? a) Resistance b) Exhaustion c) Exacerbation d) Alarm
b) 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.
Most physiologic control systems function under positive feedback mechanisms. a) True b) False
b) False Explanation: The reason most physiologic control systems function under negative rather than positive feedback mechanisms is that a positive feedback mechanism interjects instability rather than stability into a system.
For the most part, the stress response is meant to be acute and ongoing. a) True b) False
b) False Explanation: The stress response is meant to be acute and time limited
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? a) Nutritional imbalance related to vomiting and diarrhea. b) Fluid volume excess related to retention water in the body. c) Electrolyte imbalance related to retention of potassium. d) Decreased cardiac output related to positional low blood pressure.
b) 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.
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? a) Antidiuretic hormone b) Glucocorticoid c) Insulin d) Aldosterone
b) 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.
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? a) Growth hormone b) Glucocorticoid hormones c) Angiotensin II d) Thyroid-stimulating hormone
b) 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.
A nurse is caring for an adolescent with post-traumatic stress syndrome. The patient reports having difficulty concentrating and has an increased startle reflex. The nurse's documentation includes the presence of which of the following? a) Resistance b) Hyperarousal c) Intrusion d) Shell shock
b) Hyperarousal Explanation: 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 patient with post-traumatic stress syndrome.
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? a) Increased white blood count (WBC) b) Increased blood glucose c) Increased hemaglobin d) Increased albumin
b) 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).
What will the nurse assess as the end result of activation of the renin angiotensin aldosterone system? a) Increased respiratory rate b) Increased blood pressure c) Increased urination d) Increased heart rate
b) Increased blood pressure Explanation: 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.
What will the nurse assess as the end result of activation of the renin-angiotensin-aldosterone system? a) Increased respiratory rate b) Increased blood pressure c) Increased urination d) Increased heart rate
b) Increased blood pressure Explanation: 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.
The client has just been told that he has a debilitating illness. The nurse recognizes it is very stressful for the client when which of the following signs and symptoms are observed? Select all that apply. a) Pupils constrict b) Increased respiratory rate c) Decreased heart rate d) Mouth becomes dry e) Increased activity of the gastrointestinal tract
b) Increased respiratory rate d) Mouth becomes dry Explanation: The sympathetic nervous system manifestation of the stress reaction has been called the fight-or-flight response. The increase in sympathetic activity causes the heart and respiratory rates to increase, the pupils dilate, the mouth becomes dry and the activity of the gastrointestinal tract decreases.
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? a) Intensive care b) Monitored/telemetry c) Surgical d) Medical
b) 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.
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? a) Homeostasis b) Negative feedback c) Adaptation d) Positive feedback
b) 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.
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? a) Positive feedback mechanism b) Negative feedback mechanism c) Stress response d) General adaptation syndrome
b) Negative feedback mechanism Explanation: 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.
After a client has survived a hurricane, she exhibits increased irritability, difficulty concentrating and an exaggerated startle reflex. Which of the following tests will the provider order to help identify this disorder? Select all that apply. a) Urinalysis b) Positron emission tomography (PET) c) Dexamethasone suppression test d) Complete blood count e) CAT scan of head
b) Positron emission tomography (PET) c) Dexamethasone suppression test Explanation: PET scans and functional magnetic resonance imaging have shown increased reactivity of the amygdala and hypocampus in clients with posttraumatic stress disorder(PTSD). People with PTSD demonstrate decreased cortisol levels, increased sensitivity of cortisol receptors, and an enhanced negative feedback inhibition of cortisol release with the dexamethasone suppression test. Because this hypersuppression has not been described in other psychiatric disorders, it may serve as a relatively specific marker for PTSD. The other options do not provide information specific to PTSD.
A client experiencing an acute stress response has increased urination. What does the nurse determine is the cause of this symptom? a) The client has been holding his urine. b) The client has hyperglycemia. c) The client has been taking diuretic medications. d) The client's kidneys are over stimulated.
b) 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.
In the stress response, which of the following are functions of the cerebral cortex? a) Skeletal muscle tone modulation b) Vigilance, cognition and focused attention c) Fear, excitement, rage and anger d) Coordination of the responses of the endocrine and autonomic nervous systems
b) Vigilance, cognition and focused attention Explanation: 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.
How does the nurse best define hardiness to a client? a) "Hardiness assists you in preventing nausea and vomiting." b) "Hardiness helps you respond to medications better." c) "Hardiness describes a personality characteristic that assists in the stress response." d) "Hardiness is how your muscles respond to stress."
c) "Hardiness describes a personality characteristic that assists in the stress response." Explanation: Hardiness describes how an individual responds to the stress responds through good coping mechanisms and having control over the environment. It does not explain muscle response, or influence medications, nausea, or vomiting.
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? a) "Acute responses may be lifesaving in that they divert blood from more essential to less essential body functions." b) "Reactions to acute stress are those associated with the central nervous system." c) "There is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention." d) "Decreased alertness and cognitive functioning enable rapid processing of information and arrival at the most appropriate solution to a threatening situation."
c) "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
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? a) Cerebrovascular accident b) Renal failure c) Arrhythmias d) Anemia
c) 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.
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? a) Distress b) Resistance stage c) Eustress d) Exhaustion stage
c) 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. (
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? a) Exacerbation b) Resistance c) Exhaustion d) Alarm
c) 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.
A client with suspected post-traumatic stress disorder (PTSD) undergoes a dexamethasone suppression test. The nurse anticipates the results to identify: a) Increased plasma levels of cortisol b) Decreased sensitivity of glucocorticoid receptors c) Increased sensitivity of cortisol receptors d) Decreased dexamethasone suppression
c) Increased sensitivity of cortisol receptors Explanation: Persons with PTSD demonstrate decreased cortisol levels, increased sensitivity of cortisol receptors, and an enhanced negative feedback inhibition of cortisol release with the dexamethasone suppression test. All the other options occur in clients with major depression.
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? a) Depression b) Battle fatigue c) Intrusion d) Anxiety
c) 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.
The nurse is caring for a client who survived a severe motor vehicle accident that occurred 2 months ago. The accident killed her close friend. The client has been unable to express any positive emotions and has started driving at least 15 miles/hour slower than the posted speed limit. Which stage of post-traumatic stress disorder (PTSD) is she experiencing? a) Intrusion b) Negative alterations in cognition and mood c) Marked alterations in arousal and reactivity d) Avoidance
c) Marked alterations in arousal and reactivity Explanation: Marked alterations in arousal and reactivity include inability to experience positive emotions and have distorted beliefs regarding blame of self or others about the causes or consequences of the traumatic event may occur. In the intrusion stage, the client may experience "flashbacks" to the accident. Negative alterations in cognition and mood involve an inability to remember an important aspect of the event that is not the result of a head injury, alcohol, or drugs.
The client has just been told that he has a debilitating illness. The nurse recognizes it is very stressful for the client when which of the following signs and symptoms are observed? Select all that apply. a) Pupils constrict b) Decreased heart rate c) Mouth becomes dry d) Increased respiratory rate e) Increased activity of the gastrointestinal tract
c) Mouth becomes dry d) Increased respiratory rate Explanation: The sympathetic nervous system manifestation of the stress reaction has been called the fight-or-flight response. The increase in sympathetic activity causes the heart and respiratory rates to increase, the pupils dilate, the mouth becomes dry and the activity of the gastrointestinal tract decreases.
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? a) Aldosterone b) Thyroid stimulating hormone (TSH) c) Norepinephrine d) Cytokines
c) Norepinephrine Explanation: People with chronic post-traumatic 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 of the following hormones? a) Cortisol b) Antidiuretic hormone (ADH) c) Norepinephrine (NE) d) Aldosterone
c) 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.
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 of the following? a) One year b) One week c) One month d) Six months
c) 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.
A patient with an elevated temperature is beginning to sweat. The nurse interprets this as being an example of which of the following? a) Positive feedback mechanism b) Eustress c) Selye's stress response d) Negative feedback mechanism
c) Selye's stress response 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.
What mechanism may be a contributor to symptoms in a child who has "failure to thrive"? a) Fear of failure b) Starvation response c) Stress response on growth hormone d) Renin angiotensin aldosterone system
c) 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.
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: a) Mineralcorticoids like aldosterone usually begin the process of inflammation. b) Mainly the adrenocorticoids like cortisone is responsible for all your inflammation. c) The lymphocytes which migrate to the brain where they secrete cytokines, which trigger inflammation. d) Primarily, this acute stress reaction is associated with stimulation of the autonomic nervous system which causes stiffness in the joints.
c) 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.
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? a) Norepinephrine b) Cortisol c) Vasopressin d) Epinephrine
c) 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
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? a) "Reactions to acute stress are those associated with the central nervous system." b) "Decreased alertness and cognitive functioning enable rapid processing of information and arrival at the most appropriate solution to a threatening situation." c) "Acute responses may be lifesaving in that they divert blood from more essential to less essential body functions." d) "There is facilitation of neural pathways mediating arousal, alertness, vigilance, cognition and focused attention."
d) "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.
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: a) "This results from an increased in ANS stimulation." b) "Age has no influence in response." c) "This results from increased renal function." d) "This is an expected response."
d) "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.
Which of the following clients will have the most efficient adaptation? a) A client who has a ruptured abdominal aortic aneurysm b) A client in a motor vehicle accident who hemorrhages into his abdomen c) A client who is vomiting blood from ruptured esophageal varices d) A client who has been noticing small amounts of blood in his stool over the past week
d) 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
A widow, who lost her husband a few weeks ago, is having trouble with insomnia and maintaining their normal sleep pattern. When visiting with their healthcare provider, they suggest a prescription to help regain her normal circadian pattern. This is based on the fact that interruption of sleep-wake cycles can cause which of the following problems? Select all that apply. a) Excess of non-rapid eye movement (NREM) sleep which affects the creativity process. b) Hallucinations that may result in harm to the individual. c) Restless leg syndrome due to inability to find a comfortable sleeping position. d) Alterations in their immune function that can result in an infection. e) An increase risk in accidents when sleep deprived similar to those under the influence of alcohol.
d) Alterations in their immune function that can result in an infection. e) An increase risk in accidents when sleep deprived similar to those under the influence of alcohol. Explanation: Sleep disorders and alterations in the sleep-wake cycle have been shown to alter immune function, normal hormone secretion, and physical and psychological functioning. However, hallucinations are not associated with sleep deprivations. With sleep disorders, the REM sleep cycle with decrease affecting creativity and forming associations. Restless leg syndrome is not associated with insomnia.
Which of the following emergency department clients is most likely demonstrating clinical manifestations of acute stress? A client with: a) Muscle impairment and fatigue b) Inattention to details of the accident with memory issues c) Negative feedback overactivity resulting in mental instability d) An acute heightened sense of alertness to surroundings and personnel
d) An acute heightened sense of alertness to surroundings and personnel Explanation: 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 health care provider suspects a client has developed post-raumatic stress disorder (PTSD). Select the necessary criterion to validate the diagnosis. a) A positron emission tomography (PET) scan that demonstrates that a client has decreased reactivity of the anterior cingulated and orbitofrontal areas after a traumatic event b) A functional magnetic resonance imaging (MRI) scan that demonstrates that a client has decreased reactivity of the amygdala and hippocampus after a traumatic event c) An impaired deficit of memory and concentration for greater than a 6-month period after a traumatic event has occurred d) 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
d) 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.
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? a) Encouraging the client to listen to music on the radio b) Encouraging the client to eat and drink whatever he wants c) Encouraging the client to decrease interaction with others d) Teaching the client to systematically contract and relax major muscle groups
d) 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.
A health care provider suspects a client has developed post-traumatic stress disorder (PTSD). Select the necessary criterion to validate the diagnosis. a) A functional magnetic resonance imaging (MRI) scan that demonstrates that a client has decreased reactivity of the amygdala and hippocampus after a traumatic event b) An impaired deficit of memory and concentration for greater than a 6-month period after a traumatic event has occurred c) A positron emission tomography (PET) scan that demonstrates that a client has decreased reactivity of the anterior cingulated and orbitofrontal areas after a traumatic event d) 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
d) 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.
Which is an endocrine regulator of pituitary and adrenal activity and neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior? a) Immune factor b) Fight-or-flight hormone c) Allostatic factor d) Corticotropin-releasing factor
d) 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.
Selye suggested that stress could have positive influences on the body, and these periods of positive stress are called: a) Exercise stress b) Emotional stress c) Distress d) Eustress
d) 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.
A client is experiencing an increase in cortisol secretion. It would be most important for the nurse to assess the client for: a) Increased immune reactions b) Decreased vascular tone c) Increased levels of epinephrine in the blood d) Increased blood glucose
d) 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.
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? a) Hyperarousal b) Avoidance c) Battle fatigue d) Intrusion
d) Intrusion Explanation: 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 patient with an elevated temperature is beginning to sweat. The nurse interprets this as being an example of which of the following? a) Positive feedback mechanism b) Eustress c) Selye's stress response d) Negative feedback mechanism
d) 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 of the following systems? a) Respiratory b) Cardiac c) Renal d) Nervous
d) Nervous Explanation: The manifestations of the stress response are strongly influenced by both the nervous and endocrine systems.
Select the stage of general adaptation when the body implements the most effective channels of defense. a) Alarm b) Exhaustion c) Allostatic d) Resistance
d) 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.
Select the stage of general adaptation when the body implements the most effective channels of defense. a) Exhaustion b) Alarm c) Allostatic d) Resistance
d) 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.
The fight-or-flight response is a manifestation of the stress reaction caused by which part of the nervous system? a) Peripheral b) Central c) Parasympathetic d) Sympathetic
d) Sympathetic Explanation: The sympathetic nervous system manifestation of the stress reaction has been called the fight-or-flight response.
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? a) Endorphins are released from the brain every time we experience stress. b) The pituitary gland is ultimately responsible for growth, metabolism and maturation, all of which are important when the body is stressed. c) The primary role of the parasympathetic nervous system is to stimulate the vagus nerve. d) The corticotrophin-releasing factor stimulates the release of norepinephrine, which is responsible for "fight-flight" reaction to stress.
d) 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
