Chapter 11: Stress and Disease

MULTIPLE CHOICE
1. Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is

not successful?
a. Flight or fight
b. Alarm

c. Adaptation
d. Arousal

ANS: C

Exhaustion occurs if stress continues and adaptation is not successful, ultimately causing
impairment of the immune response, heart failure, and kidney failure, leading to death. The
other stages occur before the adaptation stage.
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2. Which organ is stimulated during the alarm phase of the general adaptation syndrome (GAS)?
a. Adrenal cortex
c. Anterior pituitary
b. Hypothalamus
d. Limbic system
ANS: B

The alarm phase of the GAS begins when a stressor triggers the actions of the hypothalamus
and the sympathetic nervous system (SNS) (see Figure 11-1). The other organs are not
stimulated by the alarm phase of GAS.
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3. During an anticipatory response to stress, the reaction from the limbic system is stimulated by

the:
Retronucleus of the anterior pituitary
Anterior nucleus of the hippocampus
Paraventricular nucleus of the hypothalamus
Prefrontal nucleus of the amygdala

a.
b.
c.
d.

ANS: C

The paraventricular nucleus (PVN) of the hypothalamus must be stimulated to cause the
limbic system to be stimulated. The other options are not involved in the stimulation of the
limbic system.
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4. Which hormone prompts increased anxiety, vigilance, and arousal during a stress response?
a. Norepinephrine
b. Epinephrine
c. Cortisol
d. Adrenocorticotropic hormone (ACTH)
ANS: A

Only the release of norepinephrine promotes arousal, increased vigilance, increased anxiety,
and other protective emotional responses.

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5. Perceived stress elicits an emotional, anticipatory response that begins where?

a. Prefrontal cortex
c. Limbic system
b. Anterior pituitary
d. Hypothalamus
ANS: C

Perceived stressors elicit an anticipatory response that begins in the limbic system of the
brain, the only option responsible for emotions and cognition.
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6. During a stress response, the helper T (Th) 1 response is suppress by which hormone?
a. ACTH
c. Prolactin
b. Cortisol
d. Growth hormone
ANS: B

Stress can activate an excessive immune response and, through cortisol and catecholamines,
suppress the Th1 response, causing a Th2 shift. This response is not active by any of the other
options.
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7. What is the effect that low-serum albumin has on the central stress response?
a. Impaired circulation of epinephrine and norepinephrine
b. Impaired wound healing
c. Lessened circulation of cortisol
d. Diminished oncotic pressure
ANS: A

Low-serum albumin impairs circulation of both epinephrine and norepinephrine since both
bind to plasma protein albumin. The other options do not accurately describe the effect of
low-serum albumin.
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8. Stress-age syndrome directly results in depressed function of which system?

a. Respiratory
c. Digestive
b. Endocrine
d. Immune
ANS: D

Of the available options, immunodepression is the only characteristic change observed in

stress-age syndrome.
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9. Stress-induced sympathetic stimulation of the adrenal medulla causes the secretion of:
a. Epinephrine and aldosterone
c. Epinephrine and norepinephrine
b. Norepinephrine and cortisol
d. Acetylcholine and cortisol
ANS: C

The sympathetic nervous system is aroused during the stress response and causes the medulla
of the adrenal gland to release catecholamines (80% epinephrine and 20% norepinephrine)
into the bloodstream. The stress-induced efforts on the adrenal medulla do not include any of
the other options.
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10. Stress-induced norepinephrine results in:

a. Pupil constriction
b. Peripheral vasoconstriction

c. Increased sweat gland secretions

d. Decreased blood pressure

ANS: B

During stress, norepinephrine raises blood pressure by constricting peripheral vessels; it

dilates the pupils of the eye, causes piloerection, and increases sweat gland action in the
armpits and palms.
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11. Released stress-induced cortisol results in the stimulation of gluconeogenesis by affecting

which structure?
a. Adrenal cortex
b. Pancreas

c. Liver
d. Anterior pituitary

ANS: A

One of the primary effects of cortisol is the stimulation of gluconeogenesis through

stimulation of the adrenal cortex. The other options do not produce a stimulation of
gluconeogenesis when exposed to cortisol.
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12. What is the effect of increased secretions of epinephrine, glucagon, and growth hormone?
a. Hyperglycemia
c. Bronchodilation
b. Hypertension
d. Pupil dilation
ANS: A

Cortisol enhances the elevation of blood glucose promoted by other hormones, such as
epinephrine, glucagon, and growth hormone. This effect is not true of the other options.
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13. Which hormone increases the formation of glucose from amino acids and free fatty acids?
a. Epinephrine
c. Cortisol
b. Norepinephrine
d. Growth hormone
ANS: C

One of the primary effects of cortisol is the stimulation of gluconeogenesis or the formation of
glucose from noncarbohydrate sources, such as amino or free fatty acids in the liver. Neither
reaction is a result of the effects of any of the other options.
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14. What effect do androgens have on lymphocytes?

a.
b.
c.
d.

Suppression of B-cell responses and enhancement of T-cell responses

Suppression of T-cell responses and enhancement of B-cell responses
Suppression of B- and T-cell responses
Enhancement of B- and T-cell responses

ANS: C

Androgens suppress T- and B-cell responses. The other options do not occur in response to
androgens.
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15. Which gland regulates the immune response and mediates the apparent effects of circadian

rhythms on immunity?
a. Anterior pituitary
b. Adrenal

c. Basal ganglia
d. Pineal

ANS: D

Of the options available, only the pineal gland regulates the immune response and mediates
the apparent effects of circadian rhythm on immunity.
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16. Which cytokines initiate the production of corticotropin-releasing hormone (CRH)?

a. IL1 and IL-6
c. IFN and IL-12
b. IL-2 and TNF-
d. TNF- and IL-4
ANS: A

Although a number of stress factors initiate the production of CRH, of the options available,
only high levels of IL-1 and IL-6 initiate such a response.
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REF: Pages 348-349

17. The release of which cytokines is triggered by bacterial or viral infections, cancer, and tissue

injury that, in turn, initiate a stress response?

IL-1 and IL-2
IL-12, TNF-, and colony-stimulating factor
IFN, TNF-, and IL-6
IL-4 and IL-24

a.
b.
c.
d.

ANS: C

Of the options offered, only the release of immune inflammatory mediators IL-6, TNF-, and
IFN is triggered by bacterial or viral infections, cancer, and tissue injury that, in turn, initiates
a stress response through the hypothalamic-pituitary-adrenal (HPA) pathway.
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18. The action of which hormone helps explain increases in affective anxiety and eating disorders,

mood cycles, and vulnerability to autoimmune and inflammatory diseases in women as a

result of stimulation of the CRH gene promoter and central norepinephrine system?
a. Progesterone
c. Estrogen
b. Cortisol
d. Prolactin

ANS: C

Of the options provided, only estrogen directly stimulates the CRH gene promoter and the
central noradrenergic (norepinephrine) system, which may help explain adult womens slight
hypercortisolism, increases in affective anxiety and eating disorders, mood cycles, and
vulnerability to autoimmune and inflammatory disease, all of which follow estradiol
fluctuations.
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19. What effect does estrogen have on lymphocytes?

a. Depression of B-cell functions and enhancement of T-cell functions
b. Depression of T-cell functions and enhancement of B-cell functions
c. Depression of B- and T-cell functions
d. Enhancement of B- and T-cell functions
ANS: B

Estrogens generally are associated with only a depression of T-celldependent immune

functions and an enhancement of B-cell functions.
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20. Which statement is true concerning the differences between stress-induced hormonal

alterations of men and women?

a. After injury, women produce more proinflammatory cytokines than men, a profile

that is associated with poor outcomes.

b. Androgens appear to induce a greater degree of immune cell apoptosis after injury,
creating greater immunosuppression in injured men than in injured women.
c. Psychologic stress associated with some types of competition decreases both
testosterone and cortisol, especially in athletes older than 45 years of age.
d. After stressful stimuli, estrogen is increased in women, but testosterone is
decreased in men.
ANS: B

Androgens appear to induce a greater degree of immune cell apoptosis after injury, a
mechanism that may elicit a greater immunosuppression in injured men versus injured
women. The other options are not true statements concerning the differences between how the
genders are affected by stress-induced hormones.
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21. Diagnostic blood work on individuals who perceive themselves to be in a chronic stress state

will likely demonstrate:

a. Decreased Th lymphocytes
b. Increased erythrocytes

c. Decreased Tc cells
d. Increased platelets

ANS: C

Illustrating the influence of chronic stress appraisal on the physiologic processes, a metaanalysis of the relationships between stressors and immunity found that a higher perception of
stress was associated with reduced T cytotoxic (Tc)-cell cytotoxicity, although not with levels
of circulating Th or Tc lymphocytes. Research has substantiates the other options.
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22. What are the signs that a patient is in the adaptive stage of the general adaptation syndrome?
a. He or she begins to experience elevated heart and respiratory rates.
b. He or she finds it difficult to concentrate on a solution for the stress.
c. The patient perceives his or her only options are to run away or fight back.
d. The patient has exceeded his or her ability to cope with the current situation.
ANS: C

Fight-or-flight behaviors are characteristic of the more advanced adaptive stage, whereas the
remaining options are noted in the initial alarm stage.
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23. The most influential factor in whether a person will experience a stress reaction is his or her:
a. General state of physical health
c. Intellectual abilities
b. Spiritual belief system
d. Ability to cope
ANS: D

A person does not have a stress reaction unless the stress exceeds his or her coping abilities.
The other options do not have the same degree of influence, as does a persons ability to cope.
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24. A reduction is an individuals number of natural killer (NK) cells appears to correlate with an

increased risk for the development of:

Depression
Type 1 diabetes
Obsessive compulsive disorder (OCD)
Gastroesophageal reflux disorder (GERD)

a.
b.
c.
d.

ANS: A

A meta-analysis of studies shows a relationship between depression and the reduction in

lymphocyte proliferation and natural killer cell activity. Currently, no research supports the
other options.
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25. A nurse is providing care to a terminally ill adult who has been with his life partner for over

56 years. Research supports the nurses assessment of the life partner for signs of:
a. Suicidal ideations
c. Severe stress reaction
b. Cardiac dysrhythmia
d. Anorexia induced weight loss
ANS: C

The results of a Harvard study showed evidence that a spouses illness or death can increase a
partners mortality by causing severe stress and removing a primary source of emotional,
psychologic, practical, and financial support. Although the other options may exist, research
does not currently support them as having the stated correlation.
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MULTIPLE RESPONSE

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26. The effect epinephrine has on the immune system during the stress response is to increase

which cells? (Select all that apply.)

NK cells
Immunoglobulins
Cytokines
T cells
Th cells

a.
b.
c.
d.
e.

ANS: A, D

The injection of epinephrine into healthy human beings is associated with a transient increase
of the number of lymphocytes (e.g., T cells, natural killer (NK) cells) in the peripheral blood.
This association is not true of the other options.
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27. Which immune cells are suppressed by the corticotropin-releasing hormone (CRH)? (Select

all that apply.)

Monocyte-macrophage cells
Cytokines
Tc cells
Th cells
B cells

a.
b.
c.
d.
e.

ANS: A, D

Direct suppressive effects of CRH have been reported on two immune cell types possessing
CRH receptorsthe monocyte and macrophage and CD4 (T helper) lymphocytes. CRH does
not suppress the remaining options.
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28. The increased production of proinflammatory cytokines is associated with which

considerations? (Select all that apply.)

Chronic respiratory dysfunction
Elevated anxiety levels
Immune disorders
Age and gender
Dementia

a.
b.
c.
d.
e.

ANS: B, C

Increased levels of proinflammatory cytokines has been shown to have a possible link
between stress and immune function. The other options are not as directly linked to cytokine
levels.
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29. Which statements are true regarding lymphocytes? (Select all that apply.)
a. Lymphocytes are involved in the production of the human growth hormone.
b. Elevated catecholamine levels influence lymphocytes.
c. Lymphocytes are synthesized in the anterior pituitary gland.
d. Lymphocytes have receptors for the hormone prolactin.
e. Lymphocytes produce endorphins in large amounts.

ANS: A, B, D

GH is synthesized from the anterior pituitary gland and is produced by lymphocytes and
mononuclear phagocytic cells. Several classes of lymphocytes have receptors for prolactin,
suggesting a direct effect of prolactin on immune function. Although the effects of acute
elevation of catecholamines on the alteration of lymphocyte function are real, they are short
lived, lasting only approximately 2 hours. The other statements regarding lymphocytes are not
true.
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MATCHING

Match the hormone with its effects during a stress response. Hormones may be used more
than once.
______ A. Epinephrine
______ B. Norepinephrine
______ C. Cortisol
30. Constricts peripheral vessels to increase blood pressure.
31. Increases cardiac output by increasing heart rate and myocardial contractility.
32. Increases gastric secretions.
30. ANS: B
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MSC: Norepinephrine regulates blood pressure by constricting smooth muscle in all blood vessels.
31. ANS: A
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MSC: Epinephrine enhances myocardial contractility (inotropic effect), increases the heart rate
(chronotropic effect), and increases venous return to the heart, all of which increase cardiac output and
blood pressure.
32. ANS: C
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MSC: Cortisol promotes gastric secretion in the gastrointestinal tract.