Ch 4 EDGE
A patient is speaking to a nurse about the patient's stressful life. Which of the following recommendations may the nurse make? Up your caffeine intake so you have more energy. Stop all activity and exercise, and rest as much as possible. If you sleep less, you can get more done. Eat a balanced, nutritious diet.
Eat a balanced, nutritious diet. Rationale: Stress can disrupt eating patterns. Eating a balanced diet can help restore the body during times of stress.
A patient presents with the following characteristics: reduced white blood cell (WBC) levels, immunosuppression, a sense of being rundown and unable to cope, and suppressed hormone levels. Which stage of the stress response may the patient be experiencing? Alarm Rationale: The alarm stage of the stress response is characterized by elevated hormone levels and a strong immune response. Resistance Rationale: In the resistance stage of the stress response, stress hormones remain high. Exhaustion Rationale: In the exhaustion stage of the stress response, hormone levels decline, immunosuppression develops, and sense of being overwhelmed may develop. Indeterminate Rationale: "Indeterminate" is not a stage of the stress response.
Exhaustion Rationale: In the exhaustion stage of the stress response, hormone levels decline, immunosuppression develops, and sense of being overwhelmed may develop. The alarm stage of the stress response is characterized by elevated hormone levels and a strong immune response. In the resistance stage of the stress response, stress hormones remain high.
A group of nursing students has created a flowchart to learn the hormones of the stress response. Which of the following show a mistake has been made on the flowchart? Hypothalamus—post pituitary—adrenal gland Posterior pituitary—antidiuretic hormone (ADH)—fluid retention Chronic renal failure (CRF)—Adrenocorticotropic hormone(ACTH)—cortisol Anterior pituitary—adrenal cortex-cortisol
Hypothalamus—post pituitary—adrenal gland Rationale: The hypothalamus stimulates the anterior pituitary, which then stimulates the adrenal gland.The posterior pituitary releases ADH, which targets the kidney to retain fluid. CRF is released from the hypothalamus, which stimulates ACTH from the anterior pituitary, which stimulates cortisol release from the adrenal cortex. The anterior pituitary stimulates the adrenal cortex, which releases cortisol.
A patient arrives at the emergency department having come from the scene of a motor vehicle accident. Initial blood laboratory values indicate elevated blood glucose levels. Which of the following are likely explanations? Select all that apply. Patient must have diabetes mellitus Increased epinephrine Inaccurate specimen as blood glucose tests require fasting Adrenal gland suppression Increased cortisol release Increased antidiuretic hormone
Increased Epinephrine and Increased cortisol release Rationale: Cortisol raises blood glucose levels. Epinephrine increases blood glucose levels during the stress response. Although diabetes mellitus is associated with high blood glucose levels, blood glucose levels can also elevate in response to stress.Blood glucose levels can be evaluated at any time. In testing for diabetes mellitus, levels are usually measured following fasting. The adrenal gland is activated, not suppressed, during stress. Adrenal gland hormones elevate blood glucose. Antidiuretic hormone retains water and does not directly affect blood glucose levels.
A nurse rushes up to a trauma victim. Which of the following signs and symptoms is the nurse expecting to encounter? Select all that apply. Decreased heart rate (HR) Increased blood pressure (BP) Pupil dilation Slow, deep breathing Cool, clammy extremities
Increased blood pressure (BP) Cool, clammy extremities Rationale: BP and HR increase during the stress response. Peripheral vasoconstriction, which occurs during the stress response, causing coolness of the extremities. Pupils dilate during the stress response. Respiratory rate is increased.
Which of the following are conditions not associated with chronic stress? Select all that apply. Migraines Hypertension Acute, traumatic fractures Myocardial infarctions Peptic ulcer disease
Migranes Hypertention Myocardial Infarctions Peptic Ulcer Disease Rationale:Chronic stress can increase the risk of migraines. Hypertension may develop in response to chronic stress. Acute events such as a traumatic fracture are not directly related to chronic stress. Chronic stress is a risk factor for myocardial infarctions. Peptic ulcers have been associated with chronic stress.
A nurse is educating a patient about the stress response because the patient wants to know why the stress response is so strong. The nurse responds that several systems are the initial primary responders to stress. Which systems was the nurse speaking about? Select all that apply. Gastrointestinal tract Cardiac Nervous Endocrine Immune Respiratory
Nervous Endocrine Immune Rationale: The nervous system, particularly the sympathetic nervous system, endocrin system, and immune system are primary responders to a stress event.
Some individuals appear to suffer from stress to a greater degree than others. Which of the following may account for a more pronounced stress response? Select all that apply. Poorer ability to adapt Infrequent stressors Shorter duration stressors Longer duration stress response Strong adaptations and copings
Poorer ability to adapt Rationale: Some individuals have a reduced capacity to adapt to stressful events. Longer duration stress response Rationale: Individuals with a prolonged stress response are more likely to have a pronounced response to stress.
In order to make studying easier, some nursing students have decided to group together items that increase during the stress response. Which of the following should be included on the students' list? Select all that apply. Urine output Gastrointestinal (GI) motility Epinephrine Blood glucose Acute immune response Rationale: Immune system is initially stimulated with stress. Blood flow to skin
Acute immune response Epinephrine Blood glucose Epinephrine and Blood glucose levels increase during the stress response. Immune system is initially stimulated with stress.
Which of the following choices shows the correct sequence for Hans Selye's stress response? Exhaustion, alarm, resistance Resistance, alarm, exhaustion Alarm, resistance, exhaustion R Alarm, exhaustion, resistance
Alarm, resistance, exhaustion Rationale: This shows the correct order for the stress response.
While taking a patient's history, the nursing student learns that the patient has been under extreme stress at school and has suffered repeated infections of the common cold. The nursing student knows that prolonged stress may produce wear and tear on the body's systems. What term describes the nursing student's understanding? Alarm stage of stress Eustress Allostasis Allostatic load
Allostatic load Rationale: Allostatic load is the wear and tear on the body due to repeated stressors. Allostasis is a dynamic state of balance. The patient's constant colds indicate that this state of balance is lacking. Eustress stimulates a person positively. The alarm stage of stress is an acute response to a stressor.
A nurse has received a series of laboratory values and vital signs for a patient who recently experienced a traumatic accident. The laboratory values were taken when the patient was in the alarm stage of the stress response. Which of the following laboratory values and vital signs does the nurse expect to see? Select all that apply. Decreased respiratory rate Decreased antidiuretic hormone (ADH) Increased blood pressure (BP) Increased heart rate (HR) Elevated white blood cells (WBCs)
Increased blood pressure (BP) Increased heart rate (HR) Elevated white blood cells (WBCs) Rationale: WBCs initially increase in acute stress response. HR increases during the stress response. BP levels increase during the stress response. Respiratory rate is increased in the alarm stage of the stress response. ADH levels increase during the stress response.
A patient with rheumatoid arthritis, an autoimmune condition, is upset because she has been prescribed corticosteroids to suppress the immune system. The patient feels this is wrong, as she has learned that cortisol activates the immune response. Which of the following would be an appropriate response by the nurse? Support the patient's views, as patients seems resistant to correction. Inform the patient of the different effects of cortisol on the immune system, whether the cortisol is present for a short duration or long term. Offer to change the prescription. Tell the patient she is misinformed. Corticosteroids do not work on immune system. They were prescribed to help her bones grow.
Inform the patient of the different effects of cortisol on the immune system, whether the cortisol is present for a short duration or long term. Rationale: This response provides the patient with correct information.
A patient has developed a tumor of the hypothalamus disrupting hypothalamic hormone production. As the nurse scans the laboratory report, which finding most directly supports this conclusion? Elevated cortisol Reduced aldosterone Elevated antidiuretic hormone (ADH) Reduced corticotropin releasing factor(CRF)
Reduced corticotropin releasing factor(CRF) Rationale: CRF is produced by the hypothalamus. If the hypothalamus is damaged, CRF production will be reduced. Problems with the hypothalamus may affect aldosterone levels, but this is not the result that most directly indicates a hypothalamic problem. If the hypothalamus is damaged, ADH production will be lower than normal. Cortisol levels may be affected by hypothalamic dysfunction, but this is not the result that most directly indicates a hypothalamic problem.
A nursing educator overhears some students speaking about how amazing the adrenal glands are for the stress response. Which of the following comments indicate the students need help? The adrenal cortex produces epinephrine and norepinephrine. Adrenal cortex hormones help maintain blood volume and blood sugar. The hypothalamus and the anterior pituitary regulate adrenal cortex hormone production. Several hormones—cortisol, aldosterone, epinephrine—are produced by the adrenal gland.
The adrenal cortex produces epinephrine and norepinephrine. Rationale: The adrenal medulla produces epinephrine and norepinephrine, not the adrenal cortex.
