Chapter 7
A daughter of an older adult client tells the nurse that her mother is not able to handle stress like she used to. The best response by the nurse would be: "This results from an increase in ANS stimulation." "This results from increased renal function." "Age has no influence in response." "This is an expected response."
"This is an expected response." Explanation: The capacity to adapt to stress is influenced by age. Changes in an older adult'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 4 days with an acute myocardial infarction. After a coronary artery stent is placed, the client is discharged to home in stable condition. This would be an example of which pattern of stress? Chronic sustained Posttraumatic stress disorder (PTSD) Acute time limited Chronic intermittent
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.
As a nurse prepares to change a client's dressing, the client states that she is afraid that it will be painful. Noting that the client's heart rate and respiratory rate have increased, the nurse adjusts the plan of care to reflect care for a client in which phase of Selye's general adaptation syndrome? Exhaustion Alarm Resistance Exacerbation
Alarm Explanation: The nurse plans care for a client 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 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's neurologic status frequently Assessing the client for depression and risk for suicide Teaching the client to modify his stress response Encouraging the client to talk about his trauma
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.
The client has expressed a desire to explore stress-reducing strategies for chronic migraines. The provider explains one technique that involves electronic monitoring of physiologic responses to stress with immediate feedback. This is known as which of the following? Progressive muscle relaxation Music therapy Imagery Biofeedback
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.
A health care provider suspects a client has developed posttraumatic stress disorder (PTSD). Select the necessary criterion to validate the diagnosis. An impaired deficit of memory and concentration for greater than a 6-month period after a traumatic event has occurred At least 1 month of clinically significant distress affecting a person after witnessing or experiencing a traumatic event that affects other parts of his or her life A functional magnetic resonance imaging (MRI) scan that demonstrates that a client has decreased reactivity of the amygdala and hippocampus after a traumatic event A positron emission tomography (PET) scan that demonstrates that a client has decreased reactivity of the anterior cingulate and orbitofrontal areas after a traumatic event
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 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 Shut down the body at death Act on invading organisms Feed cells under stress
Control life processes Explanation: The body's control systems regulate cellular function, control life processes, and integrate functions of the different organ systems. Homeostatic control systems do not feed cells when they are under stress, they do not act on invading organisms, and they do not shut down the body at death.
The nursing student implemented a plan of getting adequate sleep and nutrition to adapt to the new demands. These strategies are known as which of the following? Avoidance Stressors Coping mechanisms Allostasis
Coping mechanisms Explanation: Adaptation implies that an individual has successfully created a new balance between a 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.
Which of these is an endocrine regulator of pituitary and adrenal activity and a neurotransmitter involved in autonomic nervous system activity, metabolism, and behavior? Corticotropin-releasing factor Fight-or-flight hormone Immune factor Allostatic factor
Corticotropin-releasing factor 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 interaction.
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 Exhibiting a carefree attitude about life Ceasing to exercise Spending more time at work
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 (e.g., decreased sodium and fat intake). The other options are not positive responses.
The parents of a newborn are irritable and extremely tired due to their lack of sleep, yet are very happy. Selye described this type of stress as:
Eustress 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 client who is in the intensive care unit after experiencing a massive heart attack begins to go into renal failure. The nurse plans the client's care knowing that the client is in which phase of Selye's general adaptation syndrome? Alarm Exacerbation Resistance Exhaustionad
Exhaustion Explanation: The nurse plans care knowing that this client is in Selye's exhaustion stage. In this stage, the body's ability to defend itself is overwhelmed and resources are depleted; signs of systemic damage, such as renal failure, begin to appear.
Most physiologic control systems function under positive feedback mechanisms. True False
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.
After exposure to poison ivy, the client has hives on his trunk and extremities. In an effort to decrease his immune response the practitioner places him on which medication? Insulin Aldosterone Glucocorticoid Antidiuretic hormone
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.
A client in treatment for posttraumatic stress disorder is instructed to close the eyes and imagine being in a relaxing beach setting, smell a favorite food, and touch a handful of sand. Select the option that best describes the intervention. Music therapy Massage therapy Guided imagery Relaxation
Guided imagery Explanation: Guided imagery involves scene visualization in which a person is asked to sit back, close the eyes, and concentrate on a scene narrated by the therapist. When possible it includes techniques to involve all five senses. In this given situation, music and massage therapy are not used. Relaxation would involve the tensing and releasing of muscles.
Two people experience the same stressor, yet only one is able to cope and adapt adequately. Which term do physiologists use to describe this effect, which is correlated to positive health outcomes? Hardiness Psychological dysfunction Mobilization Circadian rhythm disruption
Hardiness Explanation: A person with "hardiness" has a sense of purpose in life and is better able to adapt to stress. Other factors that decrease physical stress and increase the ability to adapt include a regular circadian rhythm pattern and appropriate weight for body size. Psychological dysfunction is not associated with a positive sense of purpose in life.
A nurse is caring for an adolescent with posttraumatic stress syndrome. The client reports having difficulty concentrating and has an increased startle reflex. The nurse's documentation includes the presence of: Intrusion Shell shock Hyperarousal Resistance
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 client with posttraumatic stress syndrome.
The nurse is teaching a client who has been placed on an angiotensin receptor blocker. The nurse explains this medication will block the renin-angiotensin-aldosterone system (RAAS) which, when activated, causes which assessment findings? Select all that apply. Increase activity of the gastrointestinal tract Increase in peripheral vascular tone Pupil constriction Renal retention of sodium and water Heart rate decreases
Increase in peripheral vascular tone Renal retention of sodium and water Explanation: Stimulation of the sympathetic nervous system also activates the peripheral renin-angiotensin-aldosterone system, which mediates a peripheral increase in vascular tone and renal retention of sodium and water. The other options are caused by the parasympathetic nervous system.
The client is receiving chronic glucocorticoid therapy for chronic obstructive pulmonary disease (COPD). Which lab result would the provider expect to see? Increased blood glucose Increased hemoglobin Increased albumin Increased white blood count (WBC)
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? Increased heart rate Increased respiratory rate Increased urination Increased blood pressure
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.
Following a stressful event, which manifestation of stress would the nurse recognize as the nonspecific "fight-or-flight" response? Increased gastrointestinal motility Pupillary constriction Decreased short-term memory Increased cardiopulmonary rates
Increased cardiopulmonary rates Explanation: The fight-or-flight response is a manifestation of the sympathetic nervous system response to a situation. The resulting physiologic changes include increased heart rate and respiratory rates, to increase delivery of oxygen to the activated organs. The sympathetic response causes pupil dilation, decreased gastrointestinal motility, and increased alert/awareness and memory.
What assessment findings will the nurse attribute to the "fight or flight response"? Select all that apply. Pupil constriction Diarrhea Increased salivation Increased heart rate Increased respiratory rate
Increased heart rate Increased respiratory rate Explanation: During the "fight or flight" response, sympathetic stimulation causes increased heart rate, increased respiratory rate, pupil dilation, dry mouth, and decreased activity of the gastrointestinal tract. Increased salivation and diarrhea would not occur.
Allostasis incorporates which characteristics when applied to the human body? Future expectations as a catalyst for change Systems that detect psychologic function Interactive physiologic changes in numerous systems Organ-specific physiologic responses
Interactive physiologic changes in numerous systems Explanation: Allostasis describes the interactive physiologic changes in the neuroendocrine, autonomic, and immune systems that occur in response to either real or perceived challenges to homeostasis. This concept has been used to measure the cumulative effects of stress on humans. Organ-specific responses are a part of the general adaptation syndrome response to stress. Control systems detect changes in physiologic function and regulate the physical and chemical set points.
A client with a history of posttraumatic stress syndrome reports frequently reliving the traumatic event. The nurse documents that the client is experiencing: Anxiety Battle fatigue Intrusion Depression
Intrusion Explanation: The nurse documents that the client is experiencing intrusion, defined as the occurrence of flashbacks or nightmares in which the traumatic event is relived in vivid detail.
When thyroxine (T4) in the thyroid is low, it triggers the pituitary to increase thyroid stimulating hormone (TSH), which then increases T4 secretion. This is an example of which of the following? Negative feedback mechanism Positive feedback mechanism General adaptation syndrome Stress response
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 a manifestation of the body's attempt to adapt to stimuli.
The manifestations of the stress response are strongly influenced by which system? Respiratory Cardiac Renal Nervous
Nervous Explanation: The manifestations of the stress response are strongly influenced by both the nervous and endocrine systems.
Although stress exposure initiates integrated responses by multiple systems, the functional changes are first manifested in which body system? Neuroendocrine Pulmonary Gastrointestinal Cardiovascular
Neuroendocrine Explanation: Exposure to stress activates an immediate response by the neuroendocrine system that plays a role in most of the responses to stress and attempts to adapt. The coordinated physiologic system response to stress is meant to increase the probability of survival, but also designed to be an acute response. Therefore, the hormones that are released during the response do not persist long enough to cause damage to vital tissues. Subsequently, all other body systems become part of the response.
The client experienced a traumatic event in the past that has caused chronic nightmares in which the event is relived. The client may have increased levels of which of the following? Thyroid stimulating hormone (TSH) Aldosterone Norepinephrine Cytokines
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.
A client is experiencing stress as a nurse prepares to insert a peripheral intravenous catheter into his forearm. The client's locus caeruleus (LC) is consequently producing which hormone? Norepinephrine (NE) Corticotropin-releasing factor (CRF) Adrenocorticotropic hormone (ACTH) Antidiuretic hormone (ADH)
Norepinephrine (NE) Explanation: The LC is densely populated with neurons that produce norepinephrine (NE); it does not produce CRF, ADH, or ACTH.
The locus caeruleus (LC) is an area in the brain stem that produces which hormone? Antidiuretic hormone (ADH) Aldosterone Norepinephrine (NE) Cortisol
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 glucocorticoid, is produced in the adrenal cortex. Aldosterone, a mineralocorticoid, is produced in the adrenal cortex. Antidiuretic hormone is produced in the hypothalamus and posterior pituitary.
The client recently returned from a year of military battle duty and has posttraumatic stress disorder (PTSD). The client experiencing an "intrusion" state will likely exhibit which manifestation? Emotional numbing and feelings of depression Repeated relived memories as nightmares Loss of concentration and increased vigilance Excessive anxiety and safety concerns
Repeated relived memories as nightmares Explanation: Intrusion state is a repeated reliving of the traumatic events, as "flashbacks" while awake and as nightmares while asleep. PTSD is also characterized by avoidance, with emotional numbing and depression. Another characteristic of PTSD—hyperarousal—refers to increased vigilance, concerns about safety, concentration difficulties, and anxiety.
Which mechanism may be a contributor to symptoms in a child who has "failure to thrive"? Starvation response Renin-angiotensin-aldosterone system Fear of failure Stress response on growth hormone
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 client's primary care provider has recommended biofeedback in an effort to address chronic stress and reduce the potential for complications. What will be the goal of this intervention? Using exercise to control the client's endocrine function Teaching the client to consciously control their own physiologic (body) functioning Helping the client to accommodate continued nervous stimulation Relieving tension using tactile stimulation
Teaching the client to consciously control their own physiologic (body) functioning Explanation: Biofeedback is a technique in which an individual learns to control physiologic functioning. It does not use exercise alone, and it aims to resolve, not simply accommodate, stress. Various types of stimulation are used, but not all are tactile.
The psychologist is counseling a client who is overwhelmed by losing his job and the recent death of a parent. Which strategy would be effective for stress reduction? Encouraging the client to listen to music on the radio Teaching the client to systematically contract and relax major muscle groups Encouraging the client to eat and drink whatever he wants Encouraging the client to decrease interaction with others
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.
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? Antidiuretic hormone, also involved in the stress response, increases water retention by the kidneys. Severe stress can induce anovulation in women. The prolonged presence of cortisol leads to suppression of growth hormone. Stress-induced cortisol secretion is associated with decreased levels of thyroid stimulating hormone and inhibits conversion of thyroxine (T4) to triiodothyronine (T3).
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.
Which emergency department client is most likely demonstrating clinical manifestations of acute stress? A client with: an acute heightened sense of alertness to surroundings and personnel muscle impairment and fatigue negative feedback overactivity resulting in mental instability inattention to details of the accident with memory issues
an acute heightened sense of alertness to surroundings and personnel 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 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: assessing family relations and strengthening them as needed. debriefing with a crisis team about the event as soon as possible. advising those held hostage to "get over" the event and pretend it did not happen. immediate treatment with antianxiety medications.
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 pharmacologic treatments, and never advise a client to "get over" an event.
A client presents to the emergency department following a major traffic accident. Though outwardly there are no apparent physical injuries found, the client is experiencing chest pain and heightened alertness, which the health care worker attributes to the first stage of general adaptation syndrome (GAS). The health care worker concludes the client is experiencing manifestations related to the release of: too little cortisol. thyroid-stimulating hormone. epinephrine. aldosterone, which interferes with sodium absorption.
epinephrine. Explanation: The general adaptation syndromes has three stages—the first is alarm (fight or flight); second is resistance (fight); and the third is exhaustion. The alarm stage is characterized by a generalized stimulation of the sympathetic nervous system (SNS) and the HPA, resulting in release of catecholamines and cortisol. Increased insulin release or TSH release is not part of the GAS.
A number of responses occur in the body to the release of neurohormones when the body encounters stress, including: inhibition of reproductive function. decreased cerebral blood flow. decrease in awareness. increase in appetite.
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.
