NUR 256 Mental Health Exam 2 Review: Stress &
Anxiety Management | Actual verified study complete
Solutions | A+ Graded | 2026 Updates | 100% correct
CHAPTER 10: STRESS RESPONSES & MANAGEMENT (pg. 154)
*REVIEW:
Sympathetic Nervous System: Fight or flight system (activates the stress response: increased
HR, elevated BP, rapid breathing, dilated pupils, sweating, muscle tension, glucose surge for
added energy, decreased digestive system).
• Perceived dangerous stimuli sent to the brain’s Amygdala (processes emotional data) and
sounds alarm to the hypothalamus to signal the adrenal glands to pump out adrenaline
(catecholamine epinephrine).
• (HPA) hypothalamus, pituitary, and adrenal gland are activated as a surge of epinephrine
subsides. The hypothalamus secretes a corticotropin-releasing hormone that stimulates
the pituitary to release (ACTH) adrenocorticotropic hormone. ACTH travels through the
bloodstream to the adrenal cortex, which then produces extra cortisol to increase blood
glucose levels & muscle endurance.
Parasympathetic Nervous System: Rest and digest (dampens the stress response: HR slows,
pupils constrict, lungs constrict for slowed breathing, BP lowers, increased digestive system )
***PHYSIOLOGICAL RESPONSES TO STRESS & STRESS MANAGEMENT***
*General Adaptation Syndrome (GAS) Theory: Hans Selye “nonspecific responses of the
body to any demand for change”. Other researchers believe diff stressors bring diff patterns of
responses, and the degree of stressor is important. Body’s response to pressure/stress.
Alarm>>>Resistance>>>Exhaustion
• Alarm= initial, brief and adaptive response (fight or flight) to the stressor, blood vessels
constrict, norepinephrine and epinephrine are released, BP increases.
, lOMoAR cPSD| 61371432
• Resistance= “adaptation stage”, sustained and optimal resistance, stressors are
overcome. (Recovery, repair, and renewal may occur), hormone levels adjust, body
functions return to homeostasis.
• Exhaustion = attempts to resist the stressor are futile, resources are depleted, and the
stress may become chronic. Immune system becomes challenged, lymph nodes increase
in size, potential for cardiac/renal failure, death may occur. (disorders develop,
anxiety/somatic s/s develop) clinical manifestation of disorder vs. s/s of disorder.
Females differ from males in stress response: estrogen exposure may regulate stress response.
Not always fighting/fleeing but, “tend and befriend” (protection and social network support),
increased limbic (emotional) activity. Men = experience altered prefrontal blood flow.
Adaptations to Stress: People with w/serious mental illnesses may have an impaired ability to
adapt to stress, individuals' sense of self-control may be affected, their perception of the
environment may be distorted, and coping mechanisms may not exist or may be ineffective.
*Stress: is the brain’s response to any demand (challenge or threat to mental/physical health) and
is natural. Exposure to high levels of stress in childhood may result in greater incidences of
mental illness as adults.
Distress: negative, draining energy resulting in anxiety, depression, confusion,
helplessness, hopelessness, and fatigue (examples: death in family, financial overload,
school/work demands).
Eustress: normal, positive energy motivating people and results in feelings of happiness,
hopefulness, and purposeful movement.
Physical stressors): illness (infection, pain), poor diet (hunger), lack of sleep,
environmental toxins (weather, pollution, crowded spaces, natural disasters), physical
exertion, prolonged sitting
Psychological stressors: personal (work/school demands), social (conflicts w/family or
friends), life events (deaths, divorce, moving, loss of job, retirement), financial (debt,
unexpected expenses), personal (chronic health issues, body image, personal trauma).
***The nurse’s role is to intervene to reduce stress by promoting a healing environment:
(take care of patient needs, offer meds if prescribed, remove environmental stimuli, self),
facilitating successful coping (provide basic needs, role model effective coping, self
affirmation), and developing future coping strategies (once stable, inquire coping utilized,
teach adaptive ways to cope).
TABLE 10.2 REACTIONS TO ACUTE VS. CHRONIC STRESS
Acute Stress can cause: Chronic Stress can cause:
Uneasiness/concern Anxiety/panic attacks
Sadness Major depressive disorder
,*Immune System Stress Responses:
Loss of Appetite Anorexia/overeating
Suppression of the immune system Lowered resistance to infections/risk of
bacterial infections
HTN Insulin-resistant DM
Decreased memory/learning Increased fatigue/irritability
Infertility Amenorrhea or loss of sex drive
Impotence Increased risk for cardiac events (MI, angina,
sudden heart-related death)
Increased energy mobilization and use Increased respiratory problems
Increased cardiovascular tone
Increased risk of blood clots/stroke
Increased cardiopulmonary tone
link between stress (biopsychosocial), immune system and
disease.
Result in malfunctions in the immune system that lead to: autoimmune disorders,
immunodeficiency, and hypersensitivities.
Can enhance the immune system: fighting infections and healing wounds >> cytokines
are released which activate the immune system. (Activation is limited due to cytokines
stimulating the further release of corticosteroids, which inhibit the immune system).
*Stress Mediators:
, lOMoAR cPSD| 61371432
Perception: not always the stressor that determines a response but the person’s
emotional/psychological reaction to it. Perception is affected by age, gender, culture, life
experience, and lifestyle.
Temperament: our specific strengths and vulnerabilities determine response to stressors.
Good indicator of how one will react to stressors as adults.
Social Support: strong support from significant others can enhance mental/physical
health and act as a buffer against distress. (People/animals without social companionship
have higher rates of illness and early death.)
Culture: differences exist in the extent to which people perceive an event as stressful and
in behaviors they consider appropriate to deal with a stressful event.
Spirituality/Religion: enhance the immune system and sense of well-being. Often gain
a sense of comfort/support. Prayer is known to reduce stress physically/emotionally.
Recent Life Changes Questionnaire: measure positive/negative life events and stress levels
for the past 6 months to a year. Ask patient to gauge stress using scale 0-10. (0-low stress, 10high
stress).
• Not all events are perceived to have the same degree
• Culture may dictate if the event is stressful or how much Different
people may have different thresholds Questionnaire equates change
with stress.
*Stress Management:
Coping Strategies (Nurses can identify these areas to target for patient’s improvement to
stress response) involves any effort to decrease anxiety, can be constructive or
deconstructive, task or prob-oriented in relation to direct prob, cognitively oriented in an
attempt to neutralize the meaning of the prob, or defense or emotion-oriented to regulate the
response to protect oneself.
1.) Health-sustaining habits (medical adherence, proper diet, relaxation, pacing energy)
Life Satisfaction 2.)(work, family, hobbies, humor, spiritual solace, arts, nature)
3.) Social support
4.) Effective and healthy responses to stress
Relaxation Techniques (particularly beneficial for anxiety, depression, insomnia) internal
Biofeedback physiological processes detected by a recording device…. It
gives results of somatic activity increasing/ or decreasing. i.e
exercise trackers/smartwatches
Deep-breathing exercise
Anxiety Management | Actual verified study complete
Solutions | A+ Graded | 2026 Updates | 100% correct
CHAPTER 10: STRESS RESPONSES & MANAGEMENT (pg. 154)
*REVIEW:
Sympathetic Nervous System: Fight or flight system (activates the stress response: increased
HR, elevated BP, rapid breathing, dilated pupils, sweating, muscle tension, glucose surge for
added energy, decreased digestive system).
• Perceived dangerous stimuli sent to the brain’s Amygdala (processes emotional data) and
sounds alarm to the hypothalamus to signal the adrenal glands to pump out adrenaline
(catecholamine epinephrine).
• (HPA) hypothalamus, pituitary, and adrenal gland are activated as a surge of epinephrine
subsides. The hypothalamus secretes a corticotropin-releasing hormone that stimulates
the pituitary to release (ACTH) adrenocorticotropic hormone. ACTH travels through the
bloodstream to the adrenal cortex, which then produces extra cortisol to increase blood
glucose levels & muscle endurance.
Parasympathetic Nervous System: Rest and digest (dampens the stress response: HR slows,
pupils constrict, lungs constrict for slowed breathing, BP lowers, increased digestive system )
***PHYSIOLOGICAL RESPONSES TO STRESS & STRESS MANAGEMENT***
*General Adaptation Syndrome (GAS) Theory: Hans Selye “nonspecific responses of the
body to any demand for change”. Other researchers believe diff stressors bring diff patterns of
responses, and the degree of stressor is important. Body’s response to pressure/stress.
Alarm>>>Resistance>>>Exhaustion
• Alarm= initial, brief and adaptive response (fight or flight) to the stressor, blood vessels
constrict, norepinephrine and epinephrine are released, BP increases.
, lOMoAR cPSD| 61371432
• Resistance= “adaptation stage”, sustained and optimal resistance, stressors are
overcome. (Recovery, repair, and renewal may occur), hormone levels adjust, body
functions return to homeostasis.
• Exhaustion = attempts to resist the stressor are futile, resources are depleted, and the
stress may become chronic. Immune system becomes challenged, lymph nodes increase
in size, potential for cardiac/renal failure, death may occur. (disorders develop,
anxiety/somatic s/s develop) clinical manifestation of disorder vs. s/s of disorder.
Females differ from males in stress response: estrogen exposure may regulate stress response.
Not always fighting/fleeing but, “tend and befriend” (protection and social network support),
increased limbic (emotional) activity. Men = experience altered prefrontal blood flow.
Adaptations to Stress: People with w/serious mental illnesses may have an impaired ability to
adapt to stress, individuals' sense of self-control may be affected, their perception of the
environment may be distorted, and coping mechanisms may not exist or may be ineffective.
*Stress: is the brain’s response to any demand (challenge or threat to mental/physical health) and
is natural. Exposure to high levels of stress in childhood may result in greater incidences of
mental illness as adults.
Distress: negative, draining energy resulting in anxiety, depression, confusion,
helplessness, hopelessness, and fatigue (examples: death in family, financial overload,
school/work demands).
Eustress: normal, positive energy motivating people and results in feelings of happiness,
hopefulness, and purposeful movement.
Physical stressors): illness (infection, pain), poor diet (hunger), lack of sleep,
environmental toxins (weather, pollution, crowded spaces, natural disasters), physical
exertion, prolonged sitting
Psychological stressors: personal (work/school demands), social (conflicts w/family or
friends), life events (deaths, divorce, moving, loss of job, retirement), financial (debt,
unexpected expenses), personal (chronic health issues, body image, personal trauma).
***The nurse’s role is to intervene to reduce stress by promoting a healing environment:
(take care of patient needs, offer meds if prescribed, remove environmental stimuli, self),
facilitating successful coping (provide basic needs, role model effective coping, self
affirmation), and developing future coping strategies (once stable, inquire coping utilized,
teach adaptive ways to cope).
TABLE 10.2 REACTIONS TO ACUTE VS. CHRONIC STRESS
Acute Stress can cause: Chronic Stress can cause:
Uneasiness/concern Anxiety/panic attacks
Sadness Major depressive disorder
,*Immune System Stress Responses:
Loss of Appetite Anorexia/overeating
Suppression of the immune system Lowered resistance to infections/risk of
bacterial infections
HTN Insulin-resistant DM
Decreased memory/learning Increased fatigue/irritability
Infertility Amenorrhea or loss of sex drive
Impotence Increased risk for cardiac events (MI, angina,
sudden heart-related death)
Increased energy mobilization and use Increased respiratory problems
Increased cardiovascular tone
Increased risk of blood clots/stroke
Increased cardiopulmonary tone
link between stress (biopsychosocial), immune system and
disease.
Result in malfunctions in the immune system that lead to: autoimmune disorders,
immunodeficiency, and hypersensitivities.
Can enhance the immune system: fighting infections and healing wounds >> cytokines
are released which activate the immune system. (Activation is limited due to cytokines
stimulating the further release of corticosteroids, which inhibit the immune system).
*Stress Mediators:
, lOMoAR cPSD| 61371432
Perception: not always the stressor that determines a response but the person’s
emotional/psychological reaction to it. Perception is affected by age, gender, culture, life
experience, and lifestyle.
Temperament: our specific strengths and vulnerabilities determine response to stressors.
Good indicator of how one will react to stressors as adults.
Social Support: strong support from significant others can enhance mental/physical
health and act as a buffer against distress. (People/animals without social companionship
have higher rates of illness and early death.)
Culture: differences exist in the extent to which people perceive an event as stressful and
in behaviors they consider appropriate to deal with a stressful event.
Spirituality/Religion: enhance the immune system and sense of well-being. Often gain
a sense of comfort/support. Prayer is known to reduce stress physically/emotionally.
Recent Life Changes Questionnaire: measure positive/negative life events and stress levels
for the past 6 months to a year. Ask patient to gauge stress using scale 0-10. (0-low stress, 10high
stress).
• Not all events are perceived to have the same degree
• Culture may dictate if the event is stressful or how much Different
people may have different thresholds Questionnaire equates change
with stress.
*Stress Management:
Coping Strategies (Nurses can identify these areas to target for patient’s improvement to
stress response) involves any effort to decrease anxiety, can be constructive or
deconstructive, task or prob-oriented in relation to direct prob, cognitively oriented in an
attempt to neutralize the meaning of the prob, or defense or emotion-oriented to regulate the
response to protect oneself.
1.) Health-sustaining habits (medical adherence, proper diet, relaxation, pacing energy)
Life Satisfaction 2.)(work, family, hobbies, humor, spiritual solace, arts, nature)
3.) Social support
4.) Effective and healthy responses to stress
Relaxation Techniques (particularly beneficial for anxiety, depression, insomnia) internal
Biofeedback physiological processes detected by a recording device…. It
gives results of somatic activity increasing/ or decreasing. i.e
exercise trackers/smartwatches
Deep-breathing exercise
