Transcript
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1.
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 that decreases the 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)
Positive feedback
B)
Adaptation
C)
Negative feedback
D)
Homeostasis
Ans:
C
Feedback:
his regulation and attempt to normalize blood pressure are 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.
2.
A 61-year-old woman with a 40-pack-a year history of cigarette smoking and a diagnosis of chronic obstructive pulmonary disease (COPD) is experiencing an increase in arterial levels of CO2. This change has been detected in the client's medulla, aortic bodies, and carotid bodies, stimulating the inspiratory center in the medulla oblongata, which has in turn caused the diaphragm to contract more forcefully and increase the respiratory rate. Which of the following terms best describes the role of the inspiratory center?
A)
Integrator/comparator
B)
Sensor
C)
Effector
D)
Feedback system
Ans:
A
Feedback:
An integrator/comparator sums and compares incoming data with a set point. In this case, the inspiratory center has determined the need for increased respiration and stimulated the effector (diaphragm) to respond. The sensor role is in the client's medulla, aortic bodies, and carotid bodies. This overall process is an example of a feedback system, but this does not characterize the particular role of the inspiratory center.
3.
Which of the following physiological processes would be considered a positive feedback mechanism?
A)
The release of antidiuretic hormone (ADH) from the posterior pituitary gland
B)
Shivering in response to low environmental temperature
C)
The platelet aggregation mechanism for closing minute ruptures in very small blood vessels during accidental injury
D)
Increased production of white blood cells (WBCs) in response to a microorganism
Ans:
C
Feedback:
The release of hormones during labor increases rather than mitigates a physiological system. Specifically, uterine contraction stimulates the production of other relevant hormones that cause temporary instability that culminates in childbirth. ADH counters the potential instability of insufficient hydration and/or blood pressure, much as shivering is an attempt to counter low temperature. Increased production of WBCs is a response to the potential homeostatic instability of an infectious process.
4.
An occupational health officer who works in the context of a large police force is attempting to understand the role that stress may play in the health of his clients. According to Selye, which of the following statements best captures an aspect of the phenomenon of stress?
A)
The alarm stage involves the release of cortisol and catecholamines.
B)
The nature of a stress response is determined by the objective severity of the stressor.
C)
Systemic illnesses can sometimes result from the resistance stage of stress response.
D)
Periods of stress can be developmentally positive or negative.
Ans:
D
Feedback:
Selye noted that stress can result in positive growth and development, and that stress is not unanimously detrimental to health and development. The alarm stage is associated with the release of cortisol and catecholamines, and a stress response is dependent on properties of the stressor and the individual's conditioning; the severity is not objectively determined. Illness is often a consequence of the exhaustion stage.
5.
An 80-year-old woman is slated for total hip replacement the following day and is experiencing a large amount of stress around her potential surgical outcomes. Which of the following is most likely to be uninvolved in the physiological response to her stress?
A)
Hypothalamus
B)
Parathyroid
C)
Adrenal cortex
D)
Pituitary gland
Ans:
B
Feedback:
The physiology of stress is associated with the hypothalamic?pituitary?adrenal axis. The parathyroid is not noted to be centrally involved in stress response.
6.
A 45-year-old woman with a diagnosis of shingles is experiencing an acute onset of severe neuropathic pain. Which stage of Selye's characterization of stress response is the woman most likely experiencing at the moment?
A)
General adaptation syndrome (GAS)
B)
Exhaustion
C)
Alarm
D)
Resistance
Ans:
C
Feedback:
The stimulation of the sympathetic nervous system, such as that during an episode of pain, characterizes the alarm stage. Resistance and exhaustion would likely follow, and GAS encompasses the whole continuum, not just this particular stage.
7.
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)
The primary role of the parasympathetic nervous system is to stimulate the vagus nerve.
B)
The corticotropin-releasing factor stimulates the release of norepinephrine, which is responsible for ?fight-or-flight? reaction to stress.
C)
Endorphins are released from the brain every time we experience stress.
D)
The pituitary gland is ultimately responsible for growth, metabolism, and maturation, all of which are important when the body is stressed.
Ans:
B
Feedback:
Norepinephrine stimulates the secretion of CRF, and CRF stimulates the release of norepinephrine.
8.
A student is attempting to trace the feedback cycle involved in the stress response. Which of the following neural structures is thought to be the central integrating site for the stress response?
A)
Hypothalamus
B)
Cerebral cortex
C)
Locus ceruleus
D)
Reticular formation
Ans:
C
Feedback:
The locus ceruleus (LC) produces norepinephrine (NE), which initiates the autonomic syndrome known as ?fight-or-flight.? The LC?NE system is connected to the hypothalamus, the limbic system, the hippocampus, and the cerebral cortex, which carry out the specific functions of the stress response.
9.
A medical student is scheduled to undergo a clinical exam of his assessment skills under the supervision of the attending physician. As a result of this stressor, the student has high serum levels of glucocorticoid hormones such as cortisol. Which of the following statements best captures an aspect of the role of glucocorticoid hormones such as cortisol in the physiological response to stress?
A)
Blood glucose levels are increased in anticipation of energy expenditure.
B)
The immune system is bolstered in response to an impending threat.
C)
Osteoblast activity and protein synthesis are suppressed in order to refocus energy.
D)
Attention, arousal, and respiratory rate are increased in order to prepare for a response.
Ans:
C
Feedback:
Cortisol suppresses osteoblast activity, hematopoiesis, protein and collagen synthesis, and immune responses with the goal of preserving energy for a fight-or-flight response. Blood glucose levels are stabilized, not increased, and the immune system is not prioritized in the stress response. Increased attention, arousal, and respiratory rate are the domain of the locus ceruleus?norepinephrine system.
10.
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 renin?angiotensin?aldosterone system (RAAS), the nurse should be assessing the patient for which primary nursing diagnosis?
A)
Fluid volume excess related to retention of water in the body
B)
Decreased cardiac output related to positional low blood pressure
C)
Electrolyte imbalance related to retention of potassium
D)
Nutritional imbalance related to vomiting and diarrhea
Ans:
A
Feedback:
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.
11.
A patient who has been awaiting the results of a bone marrow biopsy for several days is experiencing stress as a result of uncertainty and the possibility that abnormal cell growth may be detected. A physical examination and blood work would most likely yield which of the following results?
A)
Increased respiratory rate; increased levels of testosterone
B)
Increased blood pressure and heart rate; increased antidiuretic hormone (ADH)
C)
Pupil dilation; increased somatomedin C
D)
Increased gastrointestinal motility; decreased thyroid-stimulating hormone
Ans:
B
Feedback:
Increases in ADH, blood pressure, and heart rate are all associated with the stress response. Testosterone and somatomedin C are decreased in prolonged stress exposure. Gastrointestinal motility is decreased, not increased, during stress.
12.
A female patient with a recent 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 tissues. 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 that
A)
mainly the adrenocorticoids like cortisone are responsible for all your inflammation.
B)
mineralocorticoids like aldosterone usually begin the process of inflammation.
C)
the lymphocytes that 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 that causes stiffness in the joints.
Ans:
C
Feedback:
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.
13.
An electrician who has been working 14 to 16 hour/day for several weeks in order to ensure the financial survival of his business presents to his family physician with complaints of persistent headaches and insomnia. His family physician attributes the physical complaints to the ongoing stress that the man has been undergoing. Which of the following factors has most likely contributed the most to the man's response to this stressful period of his life?
A)
The fact that he has previously had difficulty coping with stress
B)
The fact that he is not physically active on a regular basis
C)
The fact that his company is heavily in debt
D)
The fact that he takes diuretic medication for his hypertension
Ans:
A
Feedback:
An individual's subjective response to stress is closely linked to previous experiences in dealing with stress and the presence or absence of coping mechanisms. Physical activity, subjective financial status, and diuretic medications would be less likely to have as great an effect.
14.
A widow, who lost her husband a few weeks ago, is having trouble with insomnia and maintaining her normal sleep pattern. When visiting with her health care provider, he suggests 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)
Hallucinations that may result in harm to the individual
B)
Alterations in the immune function that can result in an infection
C)
Excess of non?rapid eye movement (NREM) sleep that affects the creativity process
D)
An increased risk in accidents when sleep deprived similar to those under the influence of alcohol
E)
Restless leg syndrome due to inability to find a comfortable sleeping position
Ans:
B, D
Feedback:
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 decreases, affecting creativity and forming associations. Restless leg syndrome is not associated with insomnia.
15.
A patient with Parkinson disease has challenged himself to maintain mobility for longer than the physician predicts. He strives every day to walk 5 to 10 steps further than the day before. This phenomenon, being researched by social psychologists, is known as
A)
stubbornness.
B)
assertiveness.
C)
hardiness.
D)
positivism.
Ans:
C
Feedback:
Hardiness describes a personality characteristic that includes a sense of having control over the environment, a sense of having a purpose in life, and an ability to conceptualize stressors as a challenge rather than a threat.
16.
Which of the following patients, when faced with acute stressful situations, would be considered at highest risk for becoming noncompliant with their medication regimen?
A)
End-stage renal failure patient experiencing electrolyte imbalances related to having trouble sticking to his prescribed diet
B)
Teenager whose period is late by 2 weeks and afraid to tell her parents
C)
Paraplegic patient who forgot his pressure control device and has a small decubitus on his coccyx
D)
New mother who is breast-feeding every 2 to 3 hours throughout the day and night.
Ans:
A
Feedback:
For people with health problems (like ESRD patients), acute stress can interrupt compliance with medication regimens and exercise programs.
17.
Based on the assessment results, which of the following hospital patients is most likely to be experiencing the effects of chronic stress?
A)
A 32-year-old intravenous drug user with a diagnosis of endocarditis
B)
A 45-year-old paraplegic who is experiencing delayed wound healing of an ischial ulcer
C)
A 79-year-old woman who has a diagnosis of acute and chronic renal failure
D)
A 63-year-old man with a diagnosis of chronic obstructive pulmonary disease (COPD) and heart failure (HF)
Ans:
B
Feedback:
Delayed wound healing has been associated with chronic stress. Endocarditis, renal failure, COPD, and CHF are not noted as common effects of chronic stress.
18.
A counseling psychologist is working with a 30-year-old female client who is experiencing the symptoms of posttraumatic stress disorder (PTSD) following a house fire several months prior. Which of the client's following diagnostic results could most likely be interpreted as a manifestation of PTSD?
A)
The client has decreased levels of cortisol.
B)
The client has decreased levels of norepinephrine.
C)
The client has decreased levels of angiotensin II.
D)
The client has increased levels of growth hormones.
Ans:
A
Feedback:
Decreased cortisol levels are a marker of PTSD and a differentiation from other subtypes of stress. Low levels of norepinephrine and angiotensin II would not accompany any common variant of stress response, and growth hormones are suppressed in response to stress.
19.
During a period of stress, the nurse asks the patient to close his eyes and think of a calm, relaxing place where he can feel the wind blowing on his cheek and smell the salty air from the ocean. This is an example of utilizing which type of treatment for stress reduction?
A)
Hypnosis
B)
Guided imagery
C)
Yoga
D)
Biofeedback
Ans:
B
Feedback:
Guided imagery is another technique that is used to achieve relaxation. One method is scene visualization, in which the person is asked to sit back, close the eyes, and concentrate on a scene narrated by the therapist. Whenever possible, all five senses are involved.
20.
A health care professional has recommended biofeedback to a client as a method of dealing with the high levels of stress in her life. Which of the following explanations best characterizes an aspect of biofeedback treatment?
A)
?You might be asked to use an electrocardiogram as part of the therapy.?
B)
?The goal is to make you aware of your physiological processes.?
C)
?You'll hopefully be able to gain control over skeletal muscle contractions.?
D)
?You'll become aware of the increased skin temperature that accompanies anxiety.?
Ans:
C
Feedback:
The goal of biofeedback is to gain control over muscle contractions that accompany anxiety and tension. Electrocardiograms are not used in biofeedback, and control, rather than simply awareness, is the ultimate goal. Skin temperature decreases, not increases, with anxiety.
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