A nurse is teaching a class about the general adaptation syndrome. The nurse should include that which of the following manifestations occurs during the exhaustion stage?

Choice A reason: Anemia results from factors like iron deficiency or chronic disease, not directly from prolonged stress. Stress may elevate cortisol, affecting hematopoiesis indirectly, but anemia is not a primary manifestation. Chronic stress primarily impacts neuroendocrine and immune systems, not red blood cell production or hemoglobin levels.

Choice B reason: Prolonged stress typically increases blood pressure via sympathetic activation, releasing catecholamines (e.g., epinephrine), which cause vasoconstriction and elevated heart rate. Decreased blood pressure is not a common stress response, as the hypothalamic-pituitary-adrenal axis drives hypertension, not hypotension, in chronic stress scenarios.

Choice C reason: Prolonged stress elevates cortisol and catecholamines, suppressing immune function by inhibiting T-cell proliferation and cytokine production. This reduces the body’s ability to fight infections, increasing susceptibility to illness. Chronic activation of the hypothalamic-pituitary-adrenal axis downregulates immune responses, a well-documented effect of sustained stress.

Choice D reason: Hypoglycemia is not a typical manifestation of prolonged stress. Stress hormones (cortisol, glucagon) increase blood glucose by promoting glycogenolysis and gluconeogenesis to provide energy. While acute stress may cause transient glucose fluctuations, chronic stress typically leads to hyperglycemia, not low blood sugar, in most individuals.

Choice A reason: Change in marital status is a psychological stressor, activating the hypothalamic-pituitary-adrenal axis, increasing cortisol, and causing emotional distress. It affects mental health through social and emotional pathways but does not directly disrupt physiological homeostasis, unlike physical injuries that trigger systemic stress responses.

Choice B reason: A burn injury is a physiological stressor, causing tissue damage, pain, and systemic inflammation. It activates the sympathetic nervous system and releases stress hormones (e.g., catecholamines, cortisol), increasing metabolic demand, heart rate, and immune response to repair tissue and combat potential infections, disrupting bodily homeostasis.

Choice C reason: Academic pressure is a psychological stressor, engaging cognitive and emotional pathways, elevating cortisol via the hypothalamic-pituitary-adrenal axis. It impacts mental health but lacks direct physical disruption to bodily systems, unlike physiological stressors that cause immediate tissue or metabolic changes, such as infections or injuries.

Choice D reason: Financial difficulties are psychological stressors, triggering anxiety and cortisol release through emotional distress. They affect mental health but do not directly cause physiological disruption like tissue damage or metabolic imbalance, which are characteristic of physiological stressors impacting the body’s physical homeostasis and organ function.