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: In the exhaustion stage of general adaptation syndrome, prolonged stress depletes the body’s resources, impairing the hypothalamic-pituitary-adrenal axis. Chronic cortisol elevation disrupts neurotransmitter balance, particularly serotonin and dopamine, leading to depression. This psychological manifestation reflects the body’s inability to cope with sustained stress, making it a hallmark of the exhaustion phase.

Choice B reason: Blood glucose levels returning to normal is characteristic of the resistance stage, not exhaustion. In exhaustion, metabolic dysregulation persists due to depleted energy reserves, potentially causing hypoglycemia or erratic glucose levels. The body’s failure to maintain homeostasis makes this an incorrect manifestation for the exhaustion stage.

Choice C reason: Pupil dilation occurs in the alarm stage of general adaptation syndrome, driven by sympathetic activation and catecholamine release to prepare for “fight-or-flight.” In the exhaustion stage, the body’s resources are depleted, and such acute responses diminish, making pupil dilation an incorrect manifestation for this chronic stress phase.

Choice D reason: Blood pressure increases during the alarm and resistance stages due to sympathetic activation and vasoconstriction. In the exhaustion stage, the body’s regulatory systems fail, potentially leading to hypotension or cardiovascular collapse due to depleted reserves, making increased blood pressure an incorrect manifestation for this stage.

Choice A reason: Acceptance in the Kubler-Ross model involves acknowledging terminal illness and preparing for death, such as updating a will. This reflects emotional processing in the prefrontal cortex, where the client comes to terms with mortality, focusing on practical steps, indicating resolution of grief and readiness for end-of-life planning.

Choice B reason: Denial involves rejecting the reality of a terminal diagnosis, often seen in avoidance behaviors or disbelief. Updating a will indicates the client acknowledges their condition, engaging in practical planning, which is inconsistent with denial’s cognitive and emotional resistance to accepting the prognosis.

Choice C reason: Bargaining involves seeking ways to delay or alter the outcome, often through negotiations (e.g., “If I live longer, I’ll do X”). Updating a will reflects acceptance, not bargaining, as it shows proactive preparation for death, not attempts to change the terminal prognosis.

Choice D reason: Anger in the Kubler-Ross model manifests as frustration or resentment toward the diagnosis or others. Updating a will is a calm, practical action, not an expression of anger, which involves heightened amygdala activity and emotional outbursts, inconsistent with the client’s composed behavior.