Author Question: Rank the order in which a nurse, when teaching clients about the initial alarm reaction to stress, ... (Read 70 times)

MirandaLo · **on:** Jul 19, 2018

Rank the order in which a nurse, when teaching clients about the initial alarm reaction to stress,
should present the following facts:

A. The heart rate and blood pressure increase, airways dilate, and the liver releases glucose for
fuel.
B. The threat message goes to the hypothalamus, which communicates chemically with the
pituitary gland.
C. Adrenaline, noradrenaline, and other catecholamines enter the bloodstream.
D. The initial alarm reaction, known as the fight or flight response, occurs when the individual
perceives a threat to survival.
E. Acetylcholine is released and activates hormones for the adrenal medulla.

Question 2

A client, aged 82 years, has Alzheimer's disease. She lives with her daughter's family and goes to a
day care facility on weekdays. The family cares for her during the evening and at night.

Noting the
client had several bruises, the nurse discussed her observations with the daughter, who became
defensive and said that her mother was very difficult to manage because she is confused and
wanders all night. The bruises resulted from a fall down stairs. The daughter states I have lost my
mother.. The nursing intervention that should take priority is
a. teaching the daughter more about the effects of Alzheimer's disease.
b. identifying two resources that can be used for the mother's evening and night
care.
c. supporting the daughter to grieve the loss of her mother's ability to function.
d. teaching the family how to give physical care more effectively and efficiently.

meltdown117 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS:
D, B, E, C, A
Rationale: The initial alarm reaction is known as the fight or flight response. It occurs when the
individual perceives a threat to survival. The sympathetic nervous system is the pathway of stress
responses. The threat message goes to the hypothalamus, triggering chemical communication with
the pituitary gland. Acetylcholine is subsequently released and activates hormones for the adrenal
medulla. Adrenaline, noradrenaline, and other catecholamines then enter the bloodstream, causing
the heart rate and blood pressure to increase, airways to dilate, the liver to release glucose for fuel,
blood flow to shift from smooth muscles to the digestive tract to skeletal muscles, and platelet
aggregation to increase to aid blood clotting.

Answer to Question 2

B
The client's daughter and her family were coping with care until the client began to wander more at
night. The family needs assistance with evening and night care to resume their precrisis state of
functioning. Secondary prevention calls for the nurse to mobilize community resources to relieve
overwhelming stress. The other interventions may then be accomplished.