Chapter 06: Individual and Family Homeostasis, Stress, and Adaptation
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition
MULTIPLE CHOICE
1. A nurse is meeting with a young woman who has recently lost her job after
moving with her husband to a new city. She describes herself as being anxious
and pretty depressed. What principle of stress and adaptation should be
integrated into the nurse's 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.
ANS: D
Four conceptsóconstancy, homeostasis, stress, and adaptationóare 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.
2. You are the nurse caring for an adult patient who has just received a diagnosis
of prostate cancer. The patient states that he will never be able to cope with this
situation. How should you best understand the concept of coping when
attempting to meet this patient's needs?
A) Coping is a physiologic measure used to deal with change, and he will physically
adapt.
B) Coping is composed of the physiologic and psychological
processes that people use to adapt to change.
C) Coping is the human need for faith and hope, both of which create change.
D) Coping is a social strategy that is used to deal with change and loss.
, ANS: B
Indicators of stress and the stress response include both subjective and objective
measures. They are psychological, physiologic, or behavioral and reflect social
behaviors and thought processes. The physiologic and psychological processes
that people use to adapt to stress are the essence of the coping process. Coping
is both a physiologic and psychological process used to adapt to change. Coping
is a personal process used to adapt to change.
3. The nurse is with a patient who has learned that he has glioblastoma
multiforme, a brain tumor associated with an exceptionally poor prognosis. His
heart rate increases, his eyes dilate, and his 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
The sympathetic nervous system responds rapidly to stress; norepinephrine is
released at nerve ending 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.
, 4. You are the nurse caring for a 72-year-old woman who is recovering from a
hemicolectomy on the postsurgical unit. The surgery was very stressful and
prolonged, and you note on the chart that her blood sugars are elevated, yet
diabetes does not appear in her previous medical history. 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.
ANS: D
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.
5. A patient tells the nurse that she does not like to go to the doctor and is feeling
anxious about being in this place. When the nurse checks her blood pressure, it
is elevated along with her heart rate. The nurse rechecks her blood pressure
about 10 minutes later and it is normal. The patient asks the nurse if she should
be concerned that she may have hypertension. What statement should guide the
nurse's 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
Hinkle: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition
MULTIPLE CHOICE
1. A nurse is meeting with a young woman who has recently lost her job after
moving with her husband to a new city. She describes herself as being anxious
and pretty depressed. What principle of stress and adaptation should be
integrated into the nurse's 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.
ANS: D
Four conceptsóconstancy, homeostasis, stress, and adaptationóare 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.
2. You are the nurse caring for an adult patient who has just received a diagnosis
of prostate cancer. The patient states that he will never be able to cope with this
situation. How should you best understand the concept of coping when
attempting to meet this patient's needs?
A) Coping is a physiologic measure used to deal with change, and he will physically
adapt.
B) Coping is composed of the physiologic and psychological
processes that people use to adapt to change.
C) Coping is the human need for faith and hope, both of which create change.
D) Coping is a social strategy that is used to deal with change and loss.
, ANS: B
Indicators of stress and the stress response include both subjective and objective
measures. They are psychological, physiologic, or behavioral and reflect social
behaviors and thought processes. The physiologic and psychological processes
that people use to adapt to stress are the essence of the coping process. Coping
is both a physiologic and psychological process used to adapt to change. Coping
is a personal process used to adapt to change.
3. The nurse is with a patient who has learned that he has glioblastoma
multiforme, a brain tumor associated with an exceptionally poor prognosis. His
heart rate increases, his eyes dilate, and his 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
The sympathetic nervous system responds rapidly to stress; norepinephrine is
released at nerve ending 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.
, 4. You are the nurse caring for a 72-year-old woman who is recovering from a
hemicolectomy on the postsurgical unit. The surgery was very stressful and
prolonged, and you note on the chart that her blood sugars are elevated, yet
diabetes does not appear in her previous medical history. 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.
ANS: D
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.
5. A patient tells the nurse that she does not like to go to the doctor and is feeling
anxious about being in this place. When the nurse checks her blood pressure, it
is elevated along with her heart rate. The nurse rechecks her blood pressure
about 10 minutes later and it is normal. The patient asks the nurse if she should
be concerned that she may have hypertension. What statement should guide the
nurse's 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
