Chapter 5: Stress and Inflammatory Responses

1. A nurse is counseling a client with an opioid addiction who is now ready for
discharge. What factors would the nurse emphasize to build resilience and prevent
relapse?
A. Finding a fulfilling job that they enjoy and setting new goals
B. Having a supportive relationship with family members and role model
exposure
C. Taking an inexpensive, short vacation to unwind and reevaluate problems
D. Promoting a strenuous exercise program that emphasizes weight loss

ANS: B

Rationale: Factors that play a role in building a client’s resilience are having strong,
supportive relationships with family members and other individuals as well as being
exposed to positive role models. Finding a job, taking a vacation, and starting an
exercise program are steps that are individualized goals and don’t, in themselves, build
resilience. Resilience is defined as the ability of a person to function well in a stressful
situation.

PTS: 1 REF: p. 100 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

2. The nurse is caring for an adult client who has just received a diagnosis of prostate
cancer. The client states, “I will never be able to cope with this situation.” How should
the nurse best understand the concept of stress when attempting to meet this client's
needs?
A. It is a physiologic measurement used to deal with change, and the client will
physically adapt.
B. It is a physiologic or psychological process that the client implements to adapt
to change.
 C. It is an external event or situation that produces change that does not
contribute to growth.
D. It is a disruptive condition produced by a change that influences the
client’s dynamic balance.

ANS: D

Rationale: Stress is a disruptive condition produced by a change in the environment

that is perceived as challenging, threatening, or damaging to a person’s dynamic
balance or equilibrium. Stressors can be described as psychological, physiologic, or
psychosocial. Stress can be an internal or external event and contributes to growth.

PTS: 1 REF: p. 98 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice

3. The nurse is with a client who has learned that they have glioblastoma multiforme,
a brain tumor associated with an exceptionally poor prognosis. The client’s heart rate
increases, eyes dilate, and blood pressure increases. The nurse recognizes these
changes as being attributable to what response?
A. Part of the limbic system response
B. Sympathetic nervous response
C. Hypothalamic–pituitary response
D. Local adaptation syndrome

ANS: B
Rationale: The sympathetic nervous system responds rapidly to stress; norepinephrine
is released at nerve endings, causing the organs to respond (i.e., heart rate increases,
eyes dilate, and blood pressure increases). The limbic system is a mediator of
emotions and behavior that are critical to survival during times of stress. The
hypothalamic–pituitary response regulates the cortisol-induced metabolic effect that
results in elevated blood sugars during stressful situations. Local adaptation syndrome
is a tissue-specific inflammatory reaction.

PTS: 1 REF: p. 101

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

4. A hospitalized client tells the nurse about feeling anxious about "being in this place.”
The client's blood pressure and heart rate are elevated but return to normal after 10
minutes. The client asks the nurse whether there is a concern for hypertension. What
statement will guide the nurse's response?
A. The client should not worry because the increased blood pressure was stress-
related and the client's regular blood pressure is good.
B. The first blood pressure reading was part of a stress response; the
long-term blood pressure is controlled by negative feedback systems.
C. Blood pressure is the only measure of hypertension; the client needs to
recheck it regularly.
D. A respiratory infection is probably the cause of the elevated blood pressure
and will return to normal after treatment.

ANS: B
Rationale: A stress response will temporarily elevate blood pressure and heart rate.
Long-term blood pressure response is controlled by negative feedback systems. The
nurse would be incorrect in assuming the client's 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 client that the blood pressure will return to
normal with treatment may not be true.

PTS: 1 REF: p. 103 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

5. A client presents to the health center and is diagnosed with an enlarged thyroid. The
health care provider believes the thyroid cells may be undergoing hyperplasia. How
should the nurse explain this condition to the client?
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.

ANS: 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.

PTS: 1 REF: p. 106

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
NOT: Multiple Choice

6. A parent has brought a 6-year-old child to the emergency department. The parent
tells the triage nurse that the child was stung by a bee about an hour ago. The parent
explains to the nurse that the site of the sting hurts badly and looks swollen, red, and
infected. What can the triage nurse teach the parent?
A. The pain, redness, and swelling are part of the inflammatory process,
but it is probably too early for an infection.
B. Bee stings frequently cause infection, pain, and swelling; with treatment, the
infection should begin to subside late today.
C. The infection was probably caused by the stinger, which may still be in the
wound.
D. The parent’s assessment is accurate and the child will probably be prescribed
antibiotics to fix the problem.

ANS: A

Rationale: Cells or tissues of the body may be injured or killed by any agent—physical,
chemical, or infectious. When this happens, an inflammatory response naturally occurs
in the healthy tissues adjacent to the injury site. Inflammation is not the same as
infection. An infectious agent is only one of several agents that may trigger an
inflammatory response. Although bee stings may cause infection, the signs and
symptoms (very painful, looks swollen and red) result from the acute inflammatory
response. If the stinger were still in the wound, it would only be creating inflammation,
not infection. Antibiotics are not indicated.

PTS: 1 REF: p. 108

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
NOT: Multiple Choice
7. The nurse is caring for an older adult client who is being treated for acute anxiety.
The client has a nursing diagnosis of Ineffective Coping related to a feeling of
helplessness. What would be the most appropriate nursing intervention?
A. Put the primary onus for planning care on the client.
B. Assess and provide constructive outlets for anger and hostility.
C. Assess the client's sources of social support.
D. Encourage an attitude of realistic hope to help the client deal with
helpless feelings.

ANS: D
Rationale: By encouraging an attitude of realistic hope, the client will be empowered.
This allows the client to explore feelings and bring about more effective coping
patterns. The onus for care planning should not lie with the client. The nursing
diagnosis is related to a feeling of helplessness, not anger and hostility. Social support
is necessary but does not directly address the feeling of helplessness.

PTS: 1 REF: p. 111 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

8. A female client has presented to the local health center with a large mass in the
right breast. The client has felt the lump for about a year but was afraid to come to the
clinic because the client was sure it was cancer. What is the most appropriate nursing
diagnosis for this client?
A. Self-esteem disturbance related to late diagnosis
B. Ineffective individual coping related to reluctance to seek care
C. Altered family process related to inability to obtain treatment
D. Ineffective denial related to reluctance to seek care

ANS: B
Rationale: Ineffective individual coping is the inability to assess our own stressors and
then make choices to access appropriate resources. In this case, the client was unable
to access health care even when they were was aware the disorder could be life-
threatening. Self-esteem disturbance, altered family process, and ineffective denial are
nursing diagnoses that are often associated with breast cancer, but the client's
ineffective individual coping has created a significant safety risk and is, therefore, the
most appropriate nursing diagnosis. The client did not deny the severity of the finding,
but rather feared it and was unable to cope.

PTS: 1 REF: p. 99 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

9. The nurse at the student health center is seeing a group of students who are
interested in reducing their stress levels. The nurse identifies guided imagery as an
appropriate intervention. What should the nurse include in this intervention?
A. Progressive tensing and relaxing of muscles to release tension in each muscle
group
B. Encouraging a positive self-image to increase and intensify physical exercise,
which decreases stress
C. The mindful use of a word, phrase, or visual, which allows oneself to
be distracted and temporarily escape from stressful situations
D. The use of music and humor to create a calm and relaxed demeanor, which
allows escape from stressful situations

ANS: C

Rationale: Guided imagery is the mindful use of a word, phrase, or visual image to
distract oneself from distressing situations or consciously taking time to relax or
reenergize. Guided imagery does not involve muscle relaxation, positive self-image, or
humor.

PTS: 1 REF: p. 112 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
NOT: Multiple Choice

10. The nurse is assessing a client and palpates two enlarged supraclavicular lymph
nodes. The nurse asks the client how long these nodes have noticeably enlarged. The
client states, "I can't remember. A long time I think. Do I have cancer?" Which of the
following is an immediate physiologic response to stress the nurse would expect this
client to experience?
A. Vasodilation of peripheral blood vessels
B. Increased blood pressure
C. Decrease in blood glucose levels
D. Pupil constriction

ANS: B

Rationale: An initial response to stress, as seen by the fight-or-flight response, is an

increase in the client's heart rate and blood pressure. Vasoconstriction leads to the
increase in blood pressure. Blood glucose levels increase, supplying more readily
available energy, and pupils dilate.

PTS: 1 REF: p. 101

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice

11. A client reports just having been told that the computed tomography results were
abnormal and looks worried. What hormone will the nurse expect the client’s adrenal
gland to release in response to this news?
A. Endorphins
B. Dopamine
C. Epinephrine
D. Erythropoietin
ANS: C

Rationale: In the sympathetic–adrenal–medullary response to stress, the sympathetic

nervous system stimulates the adrenal gland to release epinephrine and
norepinephrine, not endorphins, dopamine, or erythropoietin.

PTS: 1 REF: p. 101

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

12. The nurse walks into a client's room and finds the client sobbing uncontrollably.
The client states, "I am so scared. I have never known anyone who goes into a
hospital and comes out alive." On the client's care plan, the nurse reads that there is a
preexisting nursing diagnosis of Ineffective Coping related to stress. What outcome is
most appropriate to this client's care?
A. Client will adopt coping mechanisms to reduce stress.
B. Client will be stress-free for the duration of treatment.
C. Client will avoid all stressful situations.
D. Client will be treated with an antianxiety agent.

ANS: A

Rationale: Stress management is directed toward reducing and controlling stress and
improving coping. The outcome for this diagnosis is that the client needs to adopt
coping mechanisms that are effective for dealing with stress, such as relaxation
techniques. The other options are incorrect because it is unrealistic to expect a client
to be stress-free; avoiding stressful situations and starting an antianxiety agent are
not the best answers as outcomes for ineffective coping.

PTS: 1 REF: p. 111 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

13. The nurse is assessing a client and learns that the client and new spouse were
married just 3 weeks earlier. What principle should underlie the nurse's care planning
for this client?
A. The client and spouse should seek counseling to ease their transition.
B. The client 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.

ANS: 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.

PTS: 1 REF: p. 99 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice

14. The nurse is assessing a client who is experiencing stress because of a recent fall
resulting in hip surgery. The client’s blood pressure is low with an increased heart rate
postoperatively. What is an expected example of a bodily function, in this instance,
that restores homeostasis?
A. Body temperature
B. Pupil dilation
C. Diuresis
D. Blood clotting

ANS: A
Rationale: Negative feedback mechanisms throughout the body monitor the internal
environment and restore homeostasis when conditions shift out of normal range. Body
temperature, blood pressure, and acid–base balances are examples of functions
regulated by these compensatory mechanisms. In this instance, a rise in body
temperature may be the direct result of damaged tissue and stress from surgery.
Blood clotting in the body involves positive feedback mechanisms. Pupil dilation and
diuresis are not modulated by negative feedback mechanisms.

PTS: 1 REF: p. 105

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice

15. A client who has a history of smoking 40 packs per-year may have dysplasia of the
epithelial cells in the bronchi. What should the nurse tell the client about this process?
A. It is a benign process that occurs as lung tissue regenerates.
B. It is a bizarre cell growth that carries an increased risk of malignancy.
C. It is a process that involves a rapid increase in the number of cells.
D. It may cause uncontrolled growth of scar tissue in other areas of the body.

ANS: B

Rationale: Dysplasia is bizarre cell growth that carries an increased risk for lung
carcinoma. It results in cells that differ in size, shape, or arrangement from other cells
of the same tissue type. Dysplastic cells have a tendency to become malignant;
dysplasia is seen commonly in epithelial cells in the bronchi of people who smoke. This
may not be a harmless condition, and dysplasia does not cause scar tissue.
Hyperplasia is an increase in the number of new cells.

PTS: 1 REF: p. 106

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

16. A 16-year-old client experienced a near-drowning and has been admitted to the
emergency department. The client was submerged for 5 minutes and remained
unconscious. What pathophysiologic 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

ANS: 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.

PTS: 1 REF: p. 106

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

17. A 55-year-old client has been diagnosed with urosepsis and has a temperature of
39.7°C (103.4°F). The nurse must anticipate that the client’s respiratory rate will
change in what direction and why?
A. Increase due to hypermetabolism
B. Decrease due to thermoregulatory dysfunction
C. Increase due to protein coagulation
D. Decrease due to vasoconstriction

ANS: A
Rationale: When a client's temperature is elevated, hypermetabolism occurs and the
respiratory, heart, and basal metabolic rates increase. Thermoregulatory dysfunction
makes the body unable to regulate temperature. This can cause either hyperthermia or
hypothermia. Vasoconstriction is a product of low temperatures, and protein
coagulation is a local response to a burn injury.

PTS: 1 REF: p. 107

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice

18. A client is admitted to the hospital with left leg deep vein thrombosis (DVT). The
client informs the nurse that the leg “must be infected because it is red, swollen, and
very painful.” Based on the nurse’s knowledge of inflammation, which response would
be best?
A. “Your leg is injured on a peripheral level, and inflammation is the typical
response to infection.”
B. “Your leg is probably infected and reacting by swelling. Antibiotics will be part
of your treatment plan.”
C. “Your leg is injured on a cellular level, and inflammation does not
always mean infection.”
D. “Your leg is not infected and the inflammation may be related more to your
sodium intake.”

ANS: C

Rationale: An infectious agent is only one of several agents that may trigger an
inflammatory response. Inflammation occurs in cell injury events such as stroke, DVT,
and myocardial infarction. Antibiotics are not typically part of the treatment plan for
DVT. Inflammation due to sodium intake is typically edema that usually occurs, on
some level, in both legs.

PTS: 1 REF: p. 105 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice

19. An older adult client tells the nurse about a spouse who died 14 months ago and
reports continued grieving over the loss. What should the nurse encourage the client to
do?
A. Improve nutritional intake.
B. Make an appointment at a wellness clinic.
C. Walk on a daily basis.
D. Increase interactions within the client’s social network.

ANS: D

Rationale: Social networks can reduce stress by providing the individual with a positive
social identity, emotional support, material aid, 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.

PTS: 1 REF: p. 110 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

20. The nurse is caring for a client whose spouse died 4 months ago. The client states
feelings of "not doing well" and that friends and family seem hesitant to talk about the
loss of the spouse. What type of referral would be most helpful for the nurse to make
for the client?
A. A consciousness-raising group
B. A psychiatrist
C. A support group
D. A church or temple
ANS: C

Rationale: Being a member of a group with similar problems or goals has a freeing
effect on a person that promotes the expression and exchange of ideas. Psychiatry
may or may not be necessary. Spiritual assessment would necessarily precede any
referral to a specific religious setting. Consciousness-raising groups are not known to
be a common source of social support.

PTS: 1 REF: p. 113 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

21. A client will undergo a bilateral mastectomy later today and the nurse in surgical
admitting has begun the process of client education. What positive outcome of
providing the client with information should the nurse expect?
A. Increased concentration
B. Decreased depression levels
C. Sharing personal details
D. Building interdependent relationships

ANS: A

Rationale: Giving clients information also reduces the emotional response so that they
can concentrate and solve problems more effectively. Educating the client does not
decrease depression levels or build interpersonal relationships. Educating the client
does not mean sharing personal details.

PTS: 1 REF: p. 112

NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
NOT: Multiple Choice
22. The nurse is caring for a client who has just been informed of a diagnosis of colon
cancer. The client's vital signs are initially elevated but after the nurse speaks with the
client, the client's vital signs become closer to normal range. What biological action is
occurring that would explain this phenomenon?
A. Cortisol levels fluctuate and become unstable.
B. Endocrine activity has increased.
C. The client is adapting to noxious stressors.
D. The sympathetic response has been activated.

ANS: C

Rationale: Selye developed a theory of adaptation to biologic stress, known as general

adaptation syndrome, which has three phases: alarm, resistance, and exhaustion.
During the alarm phase, the sympathetic "fight-or-flight" response is activated with
release of catecholamines and the onset of the adrenocorticotropic hormone–adrenal
cortical response. The alarm reaction is defensive and anti-inflammatory but self-
limited. Because living in a continuous state of alarm would result in death, people
move into the second stage, resistance. During the resistance stage, adaptation to the
noxious stressor occurs, and cortisol activity is still increased. If exposure to the
stressor is prolonged, the third stage, exhaustion, occurs. During the exhaustion stage,
endocrine activity increases, and this has negative effects on the body systems
(especially the circulatory, digestive, and immune systems) that can lead to death.

PTS: 1 REF: p. 101

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

23. While talking with the parents of conjoined twins who are medically unstable, the
nurse observes one parent of the babies has an aggressive stance, is speaking in a
loud voice, and makes several hostile statements such as, "I'd sure like to have words
with that doctor who told us our babies would be okay." The nurse knows that this
parent’s cognitive appraisal has led to what feelings?
 A. Harm/loss feelings
B. Feelings of challenge
C. A positive adjustment to the possible loss of the children
D. The development of negative emotions

ANS: D

Rationale: The appraisal process contributes to the development of an emotion.

Negative emotions, such as fear and anger, accompany harm/loss appraisals, and
positive emotions accompany challenge. Harm and challenge are not feelings, so the
corresponding options are incorrect. There is nothing in the scenario that indicates that
the parent is making a positive adjustment to the possible loss of the children.

PTS: 1 REF: p. 100 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Choice

24. The nurse is caring for an older adult client who has been admitted 5 times for
hypertension since the death of a spouse 2 years ago. The client does not understand
why the blood pressure returns to normal after a day or two in the hospital when
taking the same outpatient prescribed medications. What should the nurse know about
the probable cause of this client's hypertension?
A. The emotional stress of losing a spouse and a perceived role in life
could contribute to physical illness.
B. Physical illness is caused by prolonged and unrelenting stress and anxiety.
C. Older adults are at increased risk for hypertension due to stress and
prolonged disability.
D. Stress exacerbates the physiologic processes of older adults.

ANS: A
Rationale: Sources of stress are related to alterations in a client’s physical and
emotional health status. Loss of a spouse or significant others, loss of perceived role in
life, and decreased social support can cause ineffective coping and increase stress.
When a person endures prolonged or unrelenting suffering, the outcome is frequently,
but not always, the development of a stress-related illness. Physical illness is not
always caused by prolonged stress. An older adult population is not the only population
at an increased risk for hypertension due to stress. Stress does not always exacerbate
the physiologic processes of older adults.

PTS: 1 REF: p. 100 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses KEY: Integrated Process: Caring
BLM: Cognitive Level: Analyze NOT: Multiple Choice
25. A psychiatric-mental health nurse is caring for a client whose sister and niece were
recently killed in a motor vehicle accident. The client is making arrangements for the
funerals, and the nurse knows that the client has insight into current stressors. What
process is occurring with this client?
A. The mediating process is occurring.
B. The client is experiencing an expected level of denial.
C. The client's awareness of stress makes it more acute.
D. The client is emotionally overwhelmed.

ANS: 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 client is either in denial or feeling overwhelmed. Awareness of stress does
not necessarily exacerbate it.

PTS: 1 REF: p. 99 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice
26. A client with diabetes is concerned because of a recent increase in blood glucose
readings requiring additional insulin. The client is busy starting a second business and
moving to a smaller home since the children are off to college. What internal stress
reduction methods would benefit this client?
A. Hire a moving company and accountant to manage personal requirements.
B. Develop a broad social network and encourage strong family ties.
C. Promote healthy eating habits and the development of relaxation
techniques.
D. Complete a health risk assessment and receive education on coping.

ANS: C

Rationale: Stress reduction methods and coping enhancements can derive from either
internal or external sources. Internal stress reduction methods are healthy eating
habits and using relaxation techniques. The client controls and manages internal stress
reduction methods. All the other stress reduction methods are external and utilize
outside sources.

PTS: 1 REF: p. 110 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

27. An area nurse is caring for a client in the urgent care center who presented with
reports of lethargy, malaise, aching, weakness, and loss of appetite. During the
assessment, the nurse identifies an area on the client's right posterior calf that is
edematous and warm and tender to touch. What is the most probable cause of this
client's symptoms?
A. Local inflammatory response
B. Systemic shock response
C. Local infectious response
D. Systemic inflammatory response

ANS: D
Rationale: The inflammatory response is often confined to the site, causing only local
signs and symptoms. However, systemic responses can also occur. During this
process, general, nonspecific symptoms develop, including malaise, loss of appetite,
aching, and weakness. The fact that the client is experiencing systemic effects such as
lethargy, malaise, aching, weakness, and loss of appetite suggests that inflammation is
not limited to one specific site.

PTS: 1 REF: p. 109

NAT: Client Needs: Physiological Integrity: Reduction of Risk Potential
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

28. The nurse is discharging a 4-year-old client from the emergency department. The
client was seen for an insect bite that became swollen, reddened, warm, and painful to
touch. The client's vital signs are all within normal range for age. While the nurse is
giving discharge instructions to the client's parent, the parent asks why the child is not
going to get antibiotics for the infected insect bite. What would be the nurse’s 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. "I'll make sure the doctor is made aware that you'd like your child to have a
course of antibiotics."
D. "Infection is not the same as inflammation. What your son has is
inflammation."

ANS: 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 client’s parent about the reasons
that antibiotics are unnecessary rather than simply deferring to the health care
provider.

PTS: 1 REF: p. 108

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Apply
NOT: Multiple Choice

29. A group of nursing students are applying the concept of steady state to the nursing
care plan of a client who is undergoing chemotherapy and radiotherapy for the
treatment of lung cancer. 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."

ANS: 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. Steady state does preserve life, but that is
not its only function. The concept of the steady state does not compensate for attacks
on the body. Antibodies have a closer connection to this concept. When an antigen or
foreign substance enters the body it triggers the production of antibodies that attack
and destroy the antigen. Adaptation is a part of the concept of steady state; it is not
the concept itself.

PTS: 1 REF: p. 98
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Understand
NOT: Multiple Choice

30. A nursing student has presented a concept map of a medical client's health that
demonstrates the maintenance of a steady state. The student has elaborated on the
relationship of individual cells to compensatory mechanisms. How often does the
compensatory mechanism direct bodily functions?
A. Each diurnal cycle
B. When needed
C. Continuously
D. Sporadically

ANS: C

Rationale: The concept of the cell as existing on a continuum of function and structure
includes the relationship of the cell to compensatory mechanisms, which occurs
continuously in the body to maintain the steady state. The diurnal cycle is any pattern
within a 24 hour period that reoccurs daily. Steady state, however, occurs much more
often than once daily. It also occurs more frequently than sporadically or when
needed.

PTS: 1 REF: p. 98
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Teaching/Learning BLM: Cognitive Level: Remember
NOT: Multiple Choice

31. A nurse is planning the care of a client who has been admitted to the medical unit
following an ischemic cerebrovascular accident. What should the nurse recognize as
the longest-acting phase of the client's physiologic response to stress and its cause?
A. Sympathetic nervous system discharge
B. Immunologic neuroendocrine discharge
C. Sympathetic–adrenal–medullary discharge
D. Hypothalamic–pituitary discharge

ANS: D

Rationale: The longest-acting phase of the physiologic response, which is more likely
to occur in persistent stress, involves the hypothalamic–pituitary pathway, not the
sympathetic–adrenal–medullary pathway. In the stress response impulses are carried
from sensory organs to nerve centers in the brain. Initially, there is a sympathetic
nervous system discharge, but this is not the longest acting phase of the stress
response. The immunologic system deals with the regulation of the inflammatory
response, not the stress response.

PTS: 1 REF: p. 101

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

32. Selye's general adaptation syndrome (GAS) is a theory of adaptation to biologic

stress. Selye compared the GAS with the life process: childhood, adulthood, and later
years. What would occur during "adulthood" in the GAS?
A. Stressful events occur and resistance or adaptation occurs.
B. Successful avoidance of stressful life events leaves the body vulnerable.
 C. The accumulation of life's stressors causes resistance to fall.
D. Vulnerability leads to eventual death.

ANS: A

Rationale: Selye compared the GAS with the life process. During childhood, too few
encounters with stress occur to promote the development of adaptive functioning, and
children are vulnerable. During adulthood, a number of stressful events occur, and
people develop resistance or adaptation. During the later years, the accumulation of
life's stressors and wear and tear on the organism again decrease people's ability to
adapt, so resistance falls and, eventually, death occurs.

PTS: 1 REF: p. 101 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice

33. The nurse is auditing the electronic health record of a young adult client who was
treated for a postpartum hemorrhage. When reviewing the client's records, the nurse
sees various demonstrations of negative feedback loops. Which of the following
constitute negative feedback loops? Select all that apply.
A. Serum glucose levels
B. Acid–base balance
C. Temperature
D. Blood clotting
E. Labor onset

ANS: A, B, C
Rationale: These mechanisms work by sensing deviations from a predetermined set
point or range of adaptability and triggering a response aimed at offsetting the
deviation. Blood pressure, acid–base balance, blood glucose level, body temperature,
and fluid and electrolyte balance are examples of functions regulated through such
compensatory mechanisms. Coagulation and labor onset are results of positive
feedback loops.
PTS: 1 REF: p. 105
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Analyze
NOT: Multiple Response

34. In a state of chronic arousal, what can happen within the body?
A. Blood pressure decreases.
B. Serum glucose levels drop.
C. Arteriosclerosis may develop.
D. Tissue necrosis may occur.

ANS: C

Rationale: If the sympathetic–adrenal–medullary response is prolonged or excessive, a

state of chronic arousal develops that may lead to high (not low) blood pressure,
arteriosclerotic changes, and cardiovascular disease. If the production of ACTH is
prolonged or excessive, behavior patterns of withdrawal and depression are seen. In
addition, the immune response is decreased, and infections and tumors may develop.
Serum glucose levels are more likely to rise, not drop, during chronic arousal. Tissue
necrosis is not likely to occur.

PTS: 1 REF: p. 103

NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice

35. A client admits to using drugs and alcohol to reduce stress. What is most
important for the nurses to know about these coping behaviors?
A. They are effective, but alternative, coping behaviors.
B. They do not directly influence stress in the body.
C. They are adaptive behaviors.
 D. They increase the risk of illness.

ANS: D

Rationale: Coping processes that include the use of alcohol or drugs to reduce stress
increase the risk of illness. The use of drugs and alcohol as a means to reduce stress is
not an effective coping behavior. They are maladaptive behaviors, even though they
have a short-term effect on stress.

PTS: 1 REF: p. 103 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Understand
NOT: Multiple Choice

36. The nurse is assessing an older adult client’s post-myocardial infarction. The nurse
attempts to identify the client's health patterns and to assess if these health patterns
are achieving the client's goals. How should the nurse best respond if it is found that
the client's health patterns are not achieving their goals?
A. Seek ways to promote balance in the client.
B. Refer the client to social work.
C. Identify alternative models of health care.
D. Provide insight into the client's physiologic failings.

ANS: A

Rationale: The nurse has a significant role and responsibility in identifying the health
patterns of the client receiving care. If those patterns are not achieving physiologic,
psychological, and social balance, the nurse is obligated, with the assistance and
agreement of the client, to seek ways to promote balance. The nurse is not obligated
to refer to social work, identify alternative forms of care, or provide insight into the
physiologic failings of the system if the client's health patterns are not achieving their
goals.

PTS: 1 REF: p. 110

NAT: Client Needs: Safe, Effective Care Environment: Management of Care
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

37. A client is experiencing intense stress during a current hospital admission for the
exacerbation of chronic obstructive pulmonary disease. Which of the client's behaviors
best demonstrates adaptive coping?
A. Becoming controlling
B. Reprioritizing needs and roles
C. Using spouse’s benzodiazepines
D. Withdrawing

ANS: B

Rationale: Adaptive ways of coping included seeking information, reprioritizing needs

and roles, lowering expectations, making compromises, comparing oneself to others,
planning activities to conserve energy, taking things one step at a time, listening to
one's body, and using self-talk for encouragement. Becoming controlling or
withdrawing are not ways to cope adaptively. Benzodiazepines were not prescribed to
this client and may negatively interact with the client’s chronic condition or prescribed
medications.

PTS: 1 REF: p. 111 NAT: Client Needs: Psychosocial Integrity

TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

38. A 64-year-old client has returned from surgery after a right mastectomy and is
very anxious. The client doesn’t want any medications. What is the best intervention
the nurse could employ to manage the client’s anxiety at this time?
A. Encourage a brisk walk around the nurse’s station.
B. Review post-operational orders and procedural information.
C. Use guided imagery and deep breathing exercises.
 D. Turn off the television and lights and encourage rest.

ANS: C

Rationale: Guided imagery is the mindful use of a word, phrase, or visual image for the
purpose of distraction from distressing situations. Deep breathing exercises increase
the supply of oxygen to the brain and stimulate the parasympathetic nervous system.
These can be done easily at the bedside. The client returning from surgery is usually
too exhausted, sedated, or in too much pain to go for a brisk walk. While reviewing
procedural information before surgery reduces stress, postoperatively it is repeating
information that the client already has and may worsen the anxiety. A review of post-
operational orders is not the priority and may not be fully understood if anxiety levels
are high. Turning off the lights and television may increase anxiety.

PTS: 1 REF: p. 112 NAT: Client Needs: Health Promotion and Maintenance
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Choice

39. The nurse is admitting a client to the medical–surgical unit after a diagnosis of
cellulitis of the calf. What factor(s) does the nurse know impact the processes of
inflammation, repair, and replacement? Select all that apply.
A. Severity of the injury
B. Social relationships
C. Condition of the host
D. Familial support
E. Nature of the injury

ANS: A, C, E

Rationale: The condition of the host, the environment, and the nature and severity of
the injury affect the processes of inflammation, repair, and replacement. The client's
social relationships and familial support do not directly affect the processes of
inflammation, repair, and replacement.
PTS: 1 REF: p. 104
NAT: Client Needs: Physiological Integrity: Physiological Adaptation
TOP: Chapter 5: Stress and Inflammatory Responses
KEY: Integrated Process: Nursing Process BLM: Cognitive Level: Apply
NOT: Multiple Response