Penn State University
LANIF • 152 SRUN
PSU Ross and Carol Nese College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Health Assessment & Health Systems
F I N A L E X A M I N AT I O N • ST R E SS , M E N TA L H E A LT H , U. S . H E A LT H C A R E SYST E M & S D O H
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (B.S.N.) ACADEMIC YEAR
EXAM TITLE Health Assessment — Final Examination TOTAL QUESTIONS 35 Questions
FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover stress physiology (allostatic load), mental health epidemiology, the Socio-Ecological Model, epigenetics, the
U.S. healthcare system (history, financing, insurance), health disparities, and social determinants of health.
▸ Pay close attention to the differences between market-justice and social-justice perspectives, Medicare vs. Medicaid, and
upstream vs. downstream approaches.
▸ Correct answers and detailed rationales appear below each question for final exam preparation.
SECTION I — STRESS, MENTAL HEALTH, HEALTHCARE SYSTEMS & Questions 1 –
HEALTH EQUITY 35
1. How does chronic stress physiologically lead to an increased risk of type 2 diabetes?
A. Chronic stress decreases cortisol and epinephrine, leading to hypoglycemia
B. High cortisol increases appetite; high epinephrine causes insulin resistance; resulting hyperglycemia leads to high
insulin production, eventually contributing to type 2 diabetes
C. Stress directly destroys pancreatic beta cells
D. Stress has no physiological connection to diabetes
CORRECT ANSWER B — High cortisol increases appetite; high epinephrine causes insulin resistance; resulting
hyperglycemia leads to high insulin production, eventually contributing to type 2 diabetes
RATIONALE Chronic stress triggers a cascade of physiological responses that increase the risk of type 2 diabetes. Stress
activates the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system: (1) High cortisol
levels increase appetite, particularly for calorie-dense foods, contributing to weight gain and central obesity.
(2) High epinephrine (adrenaline) causes insulin resistance — cells become less responsive to insulin's signal
to uptake glucose. (3) The combination of increased calorie intake and insulin resistance leads to
hyperglycemia (elevated blood glucose). (4) The pancreas compensates by producing more insulin
(hyperinsulinemia). (5) Over time, the pancreatic beta cells become exhausted, insulin production declines,
and type 2 diabetes develops. This pathway illustrates how psychological stress translates into physical
disease through neuroendocrine mechanisms.
,2. What is allostatic load?
A. The process of adapting to environmental and psychological stressors to maintain stability
B. The "wear and tear" on the body resulting from chronic stress, with cortisol and blood pressure constantly elevated
C. A measure of physical fitness and exercise capacity
D. The body's immediate fight-or-flight response to an acute stressor
CORRECT ANSWER B — The "wear and tear" on the body resulting from chronic stress, with cortisol and blood pressure
constantly elevated
RATIONALE Allostatic load refers to the cumulative physiological "wear and tear" that results from chronic exposure to
stress. The concept distinguishes between allostasis (the normal, adaptive process of responding to
environmental and psychological stressors to maintain homeostasis — the body's healthy stress response)
and allostatic LOAD (the damage that occurs when stress responses are activated too frequently or fail to turn
off). Elevated allostatic load is characterized by chronically high cortisol levels, elevated blood pressure,
dysregulated immune function, and metabolic disturbances. Over time, this cumulative strain contributes to
cardiovascular disease, diabetes, immune dysfunction, and accelerated aging. Health disparities are partly
explained by differential allostatic load — marginalized populations experiencing chronic stressors
(discrimination, poverty, housing instability) develop higher allostatic loads earlier in life.
3. What is the prevalence of Any Mental Illness (AMI) among U.S. adults according to 2022 data?
A. Approximately 6% (~15 million adults)
B. Approximately 23% (~59 million adults)
C. Approximately 50% (~130 million adults)
D. Less than 5% (~12 million adults)
CORRECT ANSWER B — Approximately 23% (~59 million adults)
RATIONALE In 2022, Any Mental Illness (AMI) — defined as a mental, behavioral, or emotional disorder — affected
approximately 23.1% of U.S. adults, representing about 59 million people. Serious Mental Illness (SMI), which
results in serious functional impairment substantially interfering with or limiting one or more major life
activities, affects more than 15 million adults (about 6% of U.S. adults). The highest prevalence of AMI is found
among young adults aged 18–25. Females experience higher rates of mental illness than males. Vulnerable
groups include: young adults, students, females, individuals identifying as two or more races, American
Indian and Alaska Native populations (rooted in multi-generational trauma and historical oppression), elders,
those living in poverty, and those experiencing housing instability. Understanding mental health
epidemiology is essential for population health assessment and resource allocation.
, 4. What are the six layers of the Socio-Ecological Model from innermost to outermost?
A. Policy, Community, Organization, Interpersonal, Individual
B. Individual, Interpersonal, Organizations, Communities, Policy/Structure/Systems, Societal
C. Societal, Community, Family, Individual, Biological
D. Individual, Family, School, Workplace, Government, Global
CORRECT ANSWER B — Individual, Interpersonal, Organizations, Communities, Policy/Structure/Systems, Societal
RATIONALE The Socio-Ecological Model (SEM) provides a framework for understanding how multiple levels of influence
affect health, moving from the innermost (individual) to the outermost (societal). The six levels are: (1)
Individual — self-concept, biological and personal characteristics, epigenetics, knowledge, attitudes,
behaviors. (2) Interpersonal — networks of family, friends, and social support; social isolation at this level
increases health risks. (3) Organizations — social institutions such as schools, workplaces, and healthcare
facilities that can support or harm health (e.g., discriminatory vs. supportive environments). (4) Communities
— informal networks within defined boundaries; disadvantaged neighborhoods marked by discrimination,
violence, or housing instability increase mental health risks. (5) Policy/Structure/Systems — local, state,
national, and global policies; the Affordable Care Act interacted with the individual level by expanding access
to preventive care. (6) Societal — broad, overarching factors: poverty, cultural norms, social and economic
conditions that shape opportunities available to individuals. The levels interact dynamically.
5. What is epigenetics and how does it affect health?
A. The study of DNA mutations that alter the genetic code
B. The study of how changes in gene expression occur without altering the actual DNA sequence — external factors
"turn genes on or off," influencing health outcomes throughout life
C. The study of infectious disease transmission
D. A branch of pharmacology studying drug-gene interactions
CORRECT ANSWER B — The study of how changes in gene expression occur without altering the actual DNA sequence —
external factors turn genes on or off, influencing health outcomes throughout life
RATIONALE Epigenetics is the study of heritable changes in gene expression that occur without alterations to the
underlying DNA sequence. Epigenetic mechanisms (DNA methylation, histone modification, non-coding RNA)
regulate whether genes are "turned on" (expressed) or "turned off" (silenced). These changes are heavily
influenced by an individual's interaction with their environment — nutrition, stress, toxins, social experiences,
and trauma can all produce epigenetic modifications. This differs fundamentally from genetic mutations,
which involve a physical change in the DNA sequence. Epigenetics explains how environmental exposures
"get under the skin" — for example, chronic stress can cause epigenetic changes that alter stress hormone
receptor expression, affecting future stress responses. Importantly, some epigenetic changes can be passed
to future generations, meaning trauma experienced by one generation can biologically affect subsequent
generations. This has profound implications for understanding health disparities rooted in historical trauma.
LANIF • 152 SRUN
PSU Ross and Carol Nese College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Health Assessment & Health Systems
F I N A L E X A M I N AT I O N • ST R E SS , M E N TA L H E A LT H , U. S . H E A LT H C A R E SYST E M & S D O H
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (B.S.N.) ACADEMIC YEAR
EXAM TITLE Health Assessment — Final Examination TOTAL QUESTIONS 35 Questions
FORMAT Multiple Choice — Select the Single Best
Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover stress physiology (allostatic load), mental health epidemiology, the Socio-Ecological Model, epigenetics, the
U.S. healthcare system (history, financing, insurance), health disparities, and social determinants of health.
▸ Pay close attention to the differences between market-justice and social-justice perspectives, Medicare vs. Medicaid, and
upstream vs. downstream approaches.
▸ Correct answers and detailed rationales appear below each question for final exam preparation.
SECTION I — STRESS, MENTAL HEALTH, HEALTHCARE SYSTEMS & Questions 1 –
HEALTH EQUITY 35
1. How does chronic stress physiologically lead to an increased risk of type 2 diabetes?
A. Chronic stress decreases cortisol and epinephrine, leading to hypoglycemia
B. High cortisol increases appetite; high epinephrine causes insulin resistance; resulting hyperglycemia leads to high
insulin production, eventually contributing to type 2 diabetes
C. Stress directly destroys pancreatic beta cells
D. Stress has no physiological connection to diabetes
CORRECT ANSWER B — High cortisol increases appetite; high epinephrine causes insulin resistance; resulting
hyperglycemia leads to high insulin production, eventually contributing to type 2 diabetes
RATIONALE Chronic stress triggers a cascade of physiological responses that increase the risk of type 2 diabetes. Stress
activates the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system: (1) High cortisol
levels increase appetite, particularly for calorie-dense foods, contributing to weight gain and central obesity.
(2) High epinephrine (adrenaline) causes insulin resistance — cells become less responsive to insulin's signal
to uptake glucose. (3) The combination of increased calorie intake and insulin resistance leads to
hyperglycemia (elevated blood glucose). (4) The pancreas compensates by producing more insulin
(hyperinsulinemia). (5) Over time, the pancreatic beta cells become exhausted, insulin production declines,
and type 2 diabetes develops. This pathway illustrates how psychological stress translates into physical
disease through neuroendocrine mechanisms.
,2. What is allostatic load?
A. The process of adapting to environmental and psychological stressors to maintain stability
B. The "wear and tear" on the body resulting from chronic stress, with cortisol and blood pressure constantly elevated
C. A measure of physical fitness and exercise capacity
D. The body's immediate fight-or-flight response to an acute stressor
CORRECT ANSWER B — The "wear and tear" on the body resulting from chronic stress, with cortisol and blood pressure
constantly elevated
RATIONALE Allostatic load refers to the cumulative physiological "wear and tear" that results from chronic exposure to
stress. The concept distinguishes between allostasis (the normal, adaptive process of responding to
environmental and psychological stressors to maintain homeostasis — the body's healthy stress response)
and allostatic LOAD (the damage that occurs when stress responses are activated too frequently or fail to turn
off). Elevated allostatic load is characterized by chronically high cortisol levels, elevated blood pressure,
dysregulated immune function, and metabolic disturbances. Over time, this cumulative strain contributes to
cardiovascular disease, diabetes, immune dysfunction, and accelerated aging. Health disparities are partly
explained by differential allostatic load — marginalized populations experiencing chronic stressors
(discrimination, poverty, housing instability) develop higher allostatic loads earlier in life.
3. What is the prevalence of Any Mental Illness (AMI) among U.S. adults according to 2022 data?
A. Approximately 6% (~15 million adults)
B. Approximately 23% (~59 million adults)
C. Approximately 50% (~130 million adults)
D. Less than 5% (~12 million adults)
CORRECT ANSWER B — Approximately 23% (~59 million adults)
RATIONALE In 2022, Any Mental Illness (AMI) — defined as a mental, behavioral, or emotional disorder — affected
approximately 23.1% of U.S. adults, representing about 59 million people. Serious Mental Illness (SMI), which
results in serious functional impairment substantially interfering with or limiting one or more major life
activities, affects more than 15 million adults (about 6% of U.S. adults). The highest prevalence of AMI is found
among young adults aged 18–25. Females experience higher rates of mental illness than males. Vulnerable
groups include: young adults, students, females, individuals identifying as two or more races, American
Indian and Alaska Native populations (rooted in multi-generational trauma and historical oppression), elders,
those living in poverty, and those experiencing housing instability. Understanding mental health
epidemiology is essential for population health assessment and resource allocation.
, 4. What are the six layers of the Socio-Ecological Model from innermost to outermost?
A. Policy, Community, Organization, Interpersonal, Individual
B. Individual, Interpersonal, Organizations, Communities, Policy/Structure/Systems, Societal
C. Societal, Community, Family, Individual, Biological
D. Individual, Family, School, Workplace, Government, Global
CORRECT ANSWER B — Individual, Interpersonal, Organizations, Communities, Policy/Structure/Systems, Societal
RATIONALE The Socio-Ecological Model (SEM) provides a framework for understanding how multiple levels of influence
affect health, moving from the innermost (individual) to the outermost (societal). The six levels are: (1)
Individual — self-concept, biological and personal characteristics, epigenetics, knowledge, attitudes,
behaviors. (2) Interpersonal — networks of family, friends, and social support; social isolation at this level
increases health risks. (3) Organizations — social institutions such as schools, workplaces, and healthcare
facilities that can support or harm health (e.g., discriminatory vs. supportive environments). (4) Communities
— informal networks within defined boundaries; disadvantaged neighborhoods marked by discrimination,
violence, or housing instability increase mental health risks. (5) Policy/Structure/Systems — local, state,
national, and global policies; the Affordable Care Act interacted with the individual level by expanding access
to preventive care. (6) Societal — broad, overarching factors: poverty, cultural norms, social and economic
conditions that shape opportunities available to individuals. The levels interact dynamically.
5. What is epigenetics and how does it affect health?
A. The study of DNA mutations that alter the genetic code
B. The study of how changes in gene expression occur without altering the actual DNA sequence — external factors
"turn genes on or off," influencing health outcomes throughout life
C. The study of infectious disease transmission
D. A branch of pharmacology studying drug-gene interactions
CORRECT ANSWER B — The study of how changes in gene expression occur without altering the actual DNA sequence —
external factors turn genes on or off, influencing health outcomes throughout life
RATIONALE Epigenetics is the study of heritable changes in gene expression that occur without alterations to the
underlying DNA sequence. Epigenetic mechanisms (DNA methylation, histone modification, non-coding RNA)
regulate whether genes are "turned on" (expressed) or "turned off" (silenced). These changes are heavily
influenced by an individual's interaction with their environment — nutrition, stress, toxins, social experiences,
and trauma can all produce epigenetic modifications. This differs fundamentally from genetic mutations,
which involve a physical change in the DNA sequence. Epigenetics explains how environmental exposures
"get under the skin" — for example, chronic stress can cause epigenetic changes that alter stress hormone
receptor expression, affecting future stress responses. Importantly, some epigenetic changes can be passed
to future generations, meaning trauma experienced by one generation can biologically affect subsequent
generations. This has profound implications for understanding health disparities rooted in historical trauma.
