A nurse is assessing a client who is experiencing anxiety. Which of the following findings should the nurse expect?

Choice A reason: Dehydration reduces plasma volume, lowering blood pressure and causing hypotension. Increasing fluid intake restores intravascular volume, improving cardiac output and blood pressure. Oral or intravenous fluids (e.g., isotonic saline) correct electrolyte imbalances, supporting renal perfusion and hemodynamic stability in dehydrated patients.

Choice B reason: Elevating the head of the bed may worsen hypotension in dehydrated patients by reducing venous return to the heart, further decreasing cardiac output. In hypovolemic states, a flat or Trendelenburg position is preferred to enhance blood flow to vital organs, counteracting the effects of low plasma volume.

Choice C reason: Guided imagery promotes relaxation by reducing sympathetic activity and stress hormones like cortisol. While beneficial for anxiety, it does not address the physiological cause of hypotension in dehydration—low plasma volume. Fluid replacement is required to restore hemodynamic stability, making imagery a secondary, non-urgent intervention.

Choice D reason: The Valsalva maneuver increases intrathoracic pressure, reducing venous return and cardiac output, potentially worsening hypotension in dehydrated patients. It is used in specific contexts (e.g., assessing autonomic function) but is contraindicated in hypovolemic states, as it can exacerbate cardiovascular instability and reduce cerebral perfusion.

Choice A reason: Financial difficulties are a significant psychosocial stressor, activating the hypothalamic-pituitary-adrenal axis, increasing cortisol, and contributing to chronic stress responses. Economic instability can lead to anxiety, sleep disturbances, and cardiovascular strain, as individuals worry about meeting basic needs, making this a primary source of stress in the psychological and physiological context.

Choice B reason: A wrist fracture causes physical pain and temporary disability but is not a primary source of stress unless it leads to prolonged financial or functional issues. Acute injuries trigger short-term stress responses, but their impact is less chronic compared to ongoing psychosocial stressors like financial difficulties, making this incorrect.

Choice C reason: Hypothermia is a physiological condition, not a direct source of stress. It triggers compensatory responses like shivering to maintain body temperature but is not a psychosocial or chronic stressor. Stress is more associated with psychological or environmental factors, making hypothermia an incorrect choice for a primary stress source.

Choice D reason: Burn injuries cause acute physical stress and pain, activating the body’s stress response temporarily. However, they are not a chronic psychosocial stressor like financial difficulties. Their impact is more immediate and physical, with stress subsiding post-recovery, making this a less relevant source compared to ongoing financial concerns.