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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.
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What would be the most complete statement by the students about the concept of steady state?
- A. The concept of steady state preserves life.
- B. The mechanisms of steady state work to maintain balance in the body.
- C. This concept compensates for biologic and environmental attacks on the body.
- D. Steady state is the same as adaptation.
Correct Answer: B
Rationale: Mechanisms for adjusting internal conditions promote the normal steady state of the organism and its survival. These mechanisms are compensatory in nature and work to restore balance in the body. Adaptation is a part of the concept of steady state; it is not the concept itself.
What should you encourage the patient to consider?
- A. Improve his nutritional intake.
- B. Make an appointment at a wellness clinic.
- C. Walk on a daily basis.
- D. Increase his interaction with his social network.
Correct Answer: D
Rationale: Social networks can reduce stress by providing the individual with a positive social identity, emotional support, material aide, information, and new social contacts. Changes to diet and activity may be beneficial, but social interaction is known to be of particular benefit. Attendance at a wellness clinic may or may not be beneficial, and does not involve social interaction.
What do you know is occurring with this young woman?
- A. The mediating process is occurring.
- B. The patient is experiencing an expected level of denial.
- C. The patients awareness of her stress makes it more acute.
- D. The patient is emotionally overwhelmed.
Correct Answer: A
Rationale: After recognizing a stressor, a person consciously or unconsciously reacts to manage the situation. This is termed the mediating process. Nothing in the scenario indicates the patient is either in denial or feeling overwhelmed. Awareness of stress does not necessarily exacerbate it.
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.
What would be your best response?
- A. This is a local inflammatory response to the insect bite; it is not an infection so antibiotics will not help.
- B. In children who are previously healthy, inflammation and infections usually resolve without the need for drugs.
- C. Ill make sure the doctor is made aware that youd like your son to have a course of antibiotics.
- D. Infection is not the same as inflammation. What your son has is inflammation.
Correct Answer: A
Rationale: Regardless of the cause, a general sequence of events occurs in the local inflammatory response. This sequence involves changes in the microcirculation, including vasodilation, increased vascular permeability, and leukocytic cellular infiltration. As these changes take place, five cardinal signs of inflammation are produced: redness, heat, swelling, pain, and loss of function. Infections do not always resolve spontaneously. The nurse should teach the patients father about the reasons that antibiotics are unnecessary rather than simply deferring to the physician.