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The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 10-3, 4 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

Multiple Response

1. Which changes reflect short-term physiological responses to stress? (Select all that apply.)

a. Muscular tension, blood pressure, and triglycerides increase.

b. Epinephrine is released, increasing heart and respiratory rates.

c. Corticosteroid release increases stamina and impedes digestion.

d. Cortisol is released, increasing glucogenesis and reducing fluid loss.

e. Immune system functioning decreases, and risk of cancer increases.

f. Risk of depression, autoimmune disorders, and heart disease increases.

ANS: A, B, C, D

The correct answers are all short-term physiological responses to stress. Increased risk of immune system dysfunction, cancer, cardiovascular disease, depression, and autoimmune disease are all long-term (chronic) effects of stress.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 10-3 to 5, 8 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. “A divorce, while stressful, can be the beginning of a new, better phase of life.” b. “You mentioned your spirituality. Are there aspects of your faith that could be helpful to you at this time?” c. “Journaling often promotes awareness of how experiences have affected people.” d. “It seems to me you are overreacting to this change in your life.” e. “There is a support group for newly divorced persons in your neighborhood.”

2. Which comments by a nurse are likely to help a patient cope by addressing the mediators of the stress response? (Select all that apply.)

ANS: A, B, C, E

Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how we perceive and respond to stress (or how our personality affects how we respond to stressors). A loan could help the patient by reducing the financial pressures. Participation in support groups is an excellent way to expand one’s support network relative to specific issues. Many persons derive comfort and support from participation in faith-based interventions. The incorrect response demonstrates judging, which is non-therapeutic communication by the nurse and would not facilitate coping.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 10-9 to 11, 13, 14, 19, 37 (Box 10-1)