A nurse is discussing therapeutic milieu with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of therapeutic milieu?

The correct answer is: A, D, E, and F.

Choice A reason:

Muscular tension, blood pressure, and triglycerides increase. Long-term stress can lead to chronic muscle tension, elevated blood pressure, and increased triglyceride levels. Chronic muscle tension is a common response to prolonged stress, often resulting in pain and discomfort. Elevated blood pressure is a well-documented effect of chronic stress, which can increase the risk of cardiovascular diseases. Increased triglycerides are also associated with prolonged stress, contributing to metabolic syndrome and cardiovascular risk.

Choice B reason:

Epinephrine is released, increasing heart and respiratory rates. This response is more characteristic of acute stress rather than long-term stress. Epinephrine (adrenaline) is released during the “fight-or-flight” response, causing immediate increases in heart rate and respiratory rate. However, this is a short-term physiological response and not typically sustained over long periods.

Choice C reason:

Corticosteroid release increases stamina and impedes digestion. While corticosteroids like cortisol are released during stress, their primary long-term effect is not to increase stamina but to manage energy by increasing blood glucose levels through gluconeogenesis. Chronic cortisol release can indeed impede digestion by diverting energy away from non-essential functions like the digestive system.

Choice D reason:

Cortisol is released, increasing gluconeogenesis and reducing fluid loss. Cortisol, a key stress hormone, is released during long-term stress and increases gluconeogenesis, which is the production of glucose from non-carbohydrate sources. This helps maintain energy levels during prolonged stress. Cortisol also helps in reducing fluid loss by promoting sodium retention in the kidneys.

Choice E reason:

Immune system functioning decreases, and risk of cancer increases. Chronic stress can suppress the immune system, making the body more susceptible to infections and diseases. Prolonged immune suppression can also increase the risk of cancer as the body’s ability to detect and destroy abnormal cells is compromised.

Choice F reason:

Risk of depression, autoimmune disorders, and heart disease increases. Long-term stress is linked to an increased risk of depression and other mental health disorders due to the continuous release of stress hormones affecting brain function. It can also trigger autoimmune disorders by causing chronic inflammation and dysregulation of the immune system. Additionally, the persistent high levels of stress hormonees can lead to heart disease by promoting hypertension and other cardiovascular issues.

Choice A Reason:
This statement is an example of assertive communication because it acknowledges the client's feelings while also standing firm on the nurse's actions. Assertive communication is characterized by being direct, clear, concise, honest, confident, and respectful¹. It involves expressing thoughts and feelings in a considerate way that respects others, aiming to foster and maintain healthy relationships, rectify conflicts, and prevent resentment due to unexpressed needs.

Choice B Reason:
Telling a client to calm down can be perceived as dismissive and may not be considered assertive communication. It does not acknowledge the client's feelings and can come across as commanding or condescending, which may escalate the situation rather than resolve it.

Choice C Reason:
While this statement does convey the consequences of the client's actions, it lacks the empathy component that is crucial in assertive communication. It is important to balance directness with understanding when addressing sensitive issues.

Choice D Reason:
Asking why the client chose to behave negatively could be seen as confrontational and may put the client on the defensive. Assertive communication aims to avoid power games and foster clear outcomes, which is best achieved through statements that do not provoke or blame.