Author Question: The nurse is performing a physical assessment of patient who is undergoing a bone marrow biopsy. ... (Read 43 times)

sdfghj · **on:** Jul 23, 2018

The nurse is performing a physical assessment of patient who is undergoing a bone marrow biopsy. What finding by the nurse indicates the patient is experiencing stress?

a. Blood pressure of 120/84
b. Temperature of 37.5 C
c. Heart rate of 110 beats/min
d. Respiratory rate of 10 breaths/min

Question 2

The nurse is caring for a patient who is undergoing a major cardiac procedure. The patient tells you her heart is racing and she feels nauseated. You know this is part of hormone response known as:

a. sense of coherence.
b. stress appraisal.
c. fight or flight.
d. sympathoadrenal response.

mochi09 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

ANS: C
The release of hormones increase the heart rate, resulting in increased cardiac output and elevated blood pressure. A reading of 120/84 is a normal blood pressure, and temperature is elevated is indicative of an infection. The respiratory rate increases in stress not decreases.

Answer to Question 2

ANS: C
In the fight or flight response, the corticotropin-releasing hormone (CRH) released by the hypothalamus stimulates the pituitary to release adrenocorticotropic hormone (ACTH). These hormones increase the heart rate, resulting in increased cardiac output, and the motility of the digestive tract is decreased, slowing digestive processes that could result in abdominal distress. Sense of coherence (SOC) is a characteristic of personality that references one's perception of the world as comprehensible, meaningful, and manageable. Stress appraisal is the automatic, often unconscious, assessment of a demand or stressor. The sympathoadrenal response is a consequence of hypothalamic activation in sympathetic stimulation, which triggers epinephrine and norepinephrine release from the adrenal medulla.