Chapter 6 Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

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Chapter 6  Brunner & Suddarth’s Textbook of Medical-Surgical Nursing 13Th Edition

 

 

Complete Chapter Questions And Answers
 

Sample Questions

 

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?

  1. A)  Adaptation often fails during stressful events and results in homeostasis.
  2. B)  Stress is a part of all lives, and, eventually, this young woman will adapt.
  3. C)  Acute anxiety and depression can be adaptations that alleviate stress in some individuals.
  4. D)  An accumulation of stressors can disrupt homeostasis and result in disease.

Ans: D

Feedback:

Four concepts—constancy, homeostasis, stress, and adaptation—are 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?

  1. A)  Coping is a physiologic measure used to deal with change, and he will physically adapt.
  2. B)  Coping is composed of the physiologic and psychological processes that people use to

    adapt to change.

  3. C)  Coping is the human need for faith and hope, both of which create change.
  4. D)  Coping is a social strategy that is used to deal with change and loss.

Ans: B

Feedback:

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.

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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?

  1. A)  Part of the limbic system response
  2. B)  Sympathetic nervous response
  3. C)  Hypothalamic-pituitary response
  4. D)  Local adaptation syndrome

Ans: B

Feedback:

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?

  1. A)  It is a temporary result of increased secretion of antidiuretic hormone.
  2. B)  She must have had diabetes prior to surgery that was undiagnosed.
  3. C)  She has suffered pancreatic trauma during her abdominal surgery.
  4. D)  The blood sugars are probably a result of the “fight-or-flight” reaction.

Ans: D

Feedback:

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.

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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?

  1. A)  She should not worry; it was stress related and her regular blood pressure is good.
  2. B)  The first blood pressure was part of a simple stress response; our long-term blood

    pressure is controlled by negative feedback systems.

  3. C)  Blood pressure is only one measure of hypertension; she should review this with the

    doctor and plan to recheck it on a regular basis.

  4. D)  The respiratory infection is the probably the cause of the elevated blood pressure, and,

    with treatment, her blood pressure should remain normal.

Ans: B

Feedback:

A simple stress response will temporarily elevate a blood pressure and heart rate. Long- term blood pressure response is controlled by negative feedback systems.
For a science teacher, this would be an appropriate level of teaching/learning and would serve to promote health. The nurse would be incorrect in assuming the patient’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 patient that, with treatment, her blood pressure will return to normal may not be true.

6. A patient presents to the health center and the nurse practitioner’s assessment reveals an enlarged thyroid. The nurse practitioner believes the thyroid cells may be undergoing hyperplasia. How would the nurse practitioner explain this condition to the patient?

  1. A)  Hyperplasia is the abnormal decrease in cell and organ size and is a precursor to cancer.
  2. B)  Hyperplasia is an abnormal increase in new cells and is reversible with the stimulus for

    cell growth removed.

  3. C)  Hyperplasia is the change in appearance of the thyroid due to a chronic irritation and will

    reverse with the stimulus removed.

  4. D)  Hyperplasia is a cancerous growth and will be removed surgically.

Ans: B

Feedback:

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.

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