Nokea
What pathophysiological process has occurred as a result of the submersion?
- A. Atrophy of brain cells
- B. Cellular lysis
- C. Hypoxia to the brain
- D. Necrosis to the brain
Correct Answer: C
Rationale: The length of time different tissues can survive without oxygen varies. The brain will become hypoxic in 3 to 6 minutes. The other options are incorrect because submersion injuries do not cause atrophy to brain cells right away; submersion injuries also do not cause cellular lysis or necrosis to the brain.
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What statement should guide the nurses response?
- A. She should not worry; it was stress related and her regular blood pressure is good.
- B. The first blood pressure was part of a simple stress response; our long-term blood pressure is controlled by negative feedback systems.
- C. Blood pressure is only one measure of hypertension; she should review this with the doctor and plan to recheck it on a regular basis.
- D. The respiratory infection is the probably the cause of the elevated blood pressure, and, with treatment, her blood pressure should remain normal.
Correct Answer: B
Rationale: A simple stress response will temporarily elevate a blood pressure and heart rate. Long-term blood pressure response is controlled by negative feedback systems. For a science teacher, this would be an appropriate level of teaching/learning and would serve to promote health. The nurse would be incorrect in assuming the patients blood pressure is good based on only two blood pressure readings. The stress of a respiratory infection could account for the elevated blood pressure, but assuring the patient that, with treatment, her blood pressure will return to normal may not be true.
To what do you attribute this elevation in blood sugars?
- A. It is a temporary result of increased secretion of antidiuretic hormone.
- B. She must have had diabetes prior to surgery that was undiagnosed.
- C. She has suffered pancreatic trauma during her abdominal surgery.
- D. The blood sugars are probably a result of the fight-or-flight reaction.
Correct Answer: D
Rationale: During stressful situations, ACTH stimulates the release of cortisol from the adrenal gland, which creates protein catabolism releasing amino acids and stimulating the liver to convert amino acids to glucose; the result is elevated blood sugars. Antidiuretic hormone is released during stressful situations and stimulates reabsorption of water in the distal and collecting tubules of the kidney. Assuming the patient had diabetes prior to surgery demonstrates a lack of understanding of stress-induced hyperglycemia. No evidence presented in the question other than elevated blood sugars would support a diagnosis of diabetes.
How would the nurse practitioner explain this condition to the patient?
- A. Hyperplasia is the abnormal decrease in cell and organ size and is a precursor to cancer.
- B. Hyperplasia is an abnormal increase in new cells and is reversible with the stimulus for cell growth removed.
- C. Hyperplasia is the change in appearance of the thyroid due to a chronic irritation and will reverse with the stimulus removed.
- D. Hyperplasia is a cancerous growth and will be removed surgically.
Correct Answer: B
Rationale: Hyperplasia is an increase in the number of new cells in an organ or tissue. This is due to increased mitotic stimulation from the additional cell division, and this, in turn, enlarges the tissue. Hyperplasia is reversible when the stimulus for cell growth is removed. Hyperplasia is the increase in the number of new cells, not a change in size or appearance. Hyperplasia is the increase in the number of new cells, which may or may not be cancerous growth.
Which of the following statements should underlie the nurses care planning for this patient?
- A. The patient and spouse should seek counseling to ease their transition.
- B. The patient will have better coping skills being in a stable relationship.
- C. Happy events do not normally cause stress.
- D. Marriage causes transition, which has the potential to cause stress.
Correct Answer: D
Rationale: Transition can contribute to stress, even if the transition is a positive change. The third group of stressors has been studied most extensively and concerns relatively infrequent situations that directly affect people. This category includes the influence of life events such as death, birth, marriage, divorce, and retirement. Counseling is not necessarily indicated.
What principle of stress and adaptation should be integrated into the nurses plan of care for this patient?
- A. Adaptation often fails during stressful events and results in homeostasis.
- B. Stress is a part of all lives, and, eventually, this young woman will adapt.
- C. Acute anxiety and depression can be adaptations that alleviate stress in some individuals.
- D. An accumulation of stressors can disrupt homeostasis and result in disease.
Correct Answer: D
Rationale: Four conceptsâ??constancy, homeostasis, stress, and adaptationâ??are key to the understanding of steady state. Homeostasis is maintained through emotional, neurologic, and hormonal measures; stressors create pressure for adaptation. Sometimes too many stressors disrupt homeostasis, and, if adaptation fails, the result is disease. If a person is overwhelmed by stress, he or she may never adapt. Acute anxiety and depression are frequently associated with stress.