Unit 2

Question 1

Indicate who is most likely to recognize and report physical symptoms of stress.

Answer 1

• People who score high on hypochondriasis are preoccupied that normal bodily symptoms are indicators of illness.
• Individuals with conversion disorders, who convert psychological stress into physical symptoms such as headaches, back and joint pain, abdominal symptoms such as bloating, allergies to particular foods, and cardiovascular symptoms such as palpitations.
• People high in neuroticism, who tend to have negative emotions, self-consciousness, and a concern with bodily processes.
• People who are focused on or preoccupied with themselves, perhaps because they are socially isolated or insufficiently stimulated in their personal and professional lives.
• People who are chronically stressed.
• People who are high in negative affectivity, and are consistently pessimistic, anxious, depressed, and hostile.

Question 2

Distinguish among four types of advanced-practice nurses.

Answer 2

• Nurse practitioners are affiliated with physicians in private practice; they see their own patients, provide all routine medial care, prescribe for treatment, monitor the progress of chronically ill patients, and seek walk-in patients with a variety of disorders.
• Certified nurse midwives are responsible for some obstetrical care and child births.
• Clinical nurse specialists have a specialty such as cardiac or cancer care, surgery, or ICUs.
• Certified registered nurse anesthetists can administer anesthesia.

Question 3

Name five problems associated with the use of SLE scales.

Answer 3

1. Some of the items on the list are vague; for example, “personal injury or illness” could mean anything from the flu to a heart attack.
2. Because events have pre-assigned point values, individual differences in the way events are experienced are not taken into account. For example, a divorce may mean welcome freedom to one partner but a collapse in living standard or self-esteem to the other.
3. SLE scales usually include both positive and negative events, treating them the same. They fail to distinguish between events that individuals choose, such as getting married, and events that simply happen, such as the death of a close friend.
4. These inventories do not assess whether those events have been successfully resolved or not, even though stressful events that have been successfully resolved do not produce adverse effects for most individuals.
5. SLE scales do not have a way of assessing how long the effects of a stressor last.

Question 4

Identify two cost-containment strategies that affect hospital care.

Answer 4

• Diagnostic-related groups (DRGs) are part of a patient classification scheme that determines the typical nature and length of treatment for particular disorders; this scheme is sued by some third-party reimbursement systems to determine the amount of reimbursement based on the diagnosis.
• Preferred provider organizations (PPOs) are networks of affiliated practitioners that have agreed to charge pre-established rates for particular medical services.

Question 5

nosocomial infection

Answer 5

Infection that results from exposure to disease in the hospital setting.

Question 6

diagnostic related group (DRG)

Answer 6

A patient classification scheme that specifies the nature and length of treatment for particular disorders; used by some third-party reimbursement systems to determine the amount of reimbursement.

Question 7

preferred provider organization (PPO)

Answer 7

A network of affiliated practitioners that has agreed to charge pre-established rates for particular medical services.

Question 8

Distinguish among the two major never fibers involved in nociception.

Answer 8

• A-delta fibers are small, myelinated fibers that transmit sharp pain. They respond especially to mechanical or thermal pain, transmitting sharp brief pains rapidly.
• C-fibers are unmyelinated nerve fibers, involved in polymodal pain, that transmit dull or aching pain.

Question 9

acute stress paradigm

Answer 9

A laboratory procedure whereby an individual goes through moderately stressful procedures (such as counting backwards rapidly by 7s), so that stress-related changes in emotions and physiological and/or neuroendocrine processes may be assigned.

Question 10

stressful life events (SLE)

Answer 10

Events that force an individual to make changes in his or her life.

Question 11

daily hassles

Answer 11

Minor daily stressful events; believed to have a cumulative effect in increasing the likelihood of illness.

Question 12

Discuss the relationship between chronic pain and Minnesota Multiphasic Personality Inventory (MMPI) scores.

Answer 12

Chronic pain patients typically show elevated scores on three MMPI subscales: hypochondriasis, hysteria, and depression. This constellation of three factors is commonly referred to as the “neurotic triad” because it frequently shows up in the personality profiles of patients with neurotic disorders.

Question 13

Explain why surgical control of pain is not a practical form of treatment.

Answer 13

1. Surgical control of pain is not a practical form of treatment because
2. The effects of surgery are temporary.
3. The risks are great.
4. It has significant side effects.
5. The cost is prohibitive.
6. It can worsen the problem by damaging pain fibers.

Question 14

pain control

Answer 14

The ability to reduce the experience of pain, report of pain, emotional concern over pain, inability to tolerate pain, or presence of pain-related behaviors.

Question 15

counter irritation

Answer 15

A pain control technique that involves inhibiting pain in one part of the body by stimulating or mildly irritating another area, sometimes adjacent to the area in which the pain is experienced.

Question 16

biofeedback

Answer 16

A method whereby an individual is provided with ongoing, specific information or feedback about how a particular physiological process operates, so that he or she can learn how to modify that process.

Question 17

hypnosis

Answer 17

A pain management technique involving relaxation, suggestion, distraction, and the focusing of attention.

Question 18

acupuncture

Answer 18

A technique of healing and pain control, developed in China, in which long, thin needles are inserted into designated areas of the body to reduce discomfort in a target area of the body.

Question 19

guided imagery

Answer 19

A techniques of relaxation and pain control in which a person conjures up a picture that is held in mind during a painful or stressful experience.

Question 20

pain management programs

Answer 20

Coordinated, interdisciplinary efforts to modify chronic pain by bringing together neurological, cognitive, behavioral, psychodynamic expertise concerning pain; such programs aim not only to make pain more manageable but also to modify the lifestyle that has evolved because of the pain.

Question 21

Discuss the findings of Beckman & Frankel (1984).

Answer 21

In a study of physicians’ initial responses to patient-initiated visits, Beckman and Frankel studied 74 office visits. In only 23% of the cases did patients have the opportunity to finish their explanation of concerns before the provider began the process of diagnosis. In 69% of the visits, the physician interrupted, directing the patient toward a particular disorder. On average, physicians interrupted after their patients had spoken for only 18 to 22 seconds.

Question 22

List three ways that acute and chronic pain differ.

Answer 22

1. Chronic pain is more often linked to psychological distress, such as depression, anxiety and anger.
2. Chronic pain is much harder to treat.
3. Chronic pain involves the complex interaction of physical, psychological and social components.

Question 23

Discuss the prevalence of medication use among hospitalized and non-hospitalized patients.

Answer 23

Hospitalized patients receive, on average, 14 drugs at the same time. 55% of non-hospitalized adults have taken at least one medication in the past day, and 40% use some medication on a regular basis. Over 750,000 people a year report adverse side effects from a medication they are taking.

Question 24

Discuss the effects of disclosure on stress and illness.

Answer 24

Discussing and disclosing one’s emotional response to a stressor can have dramatic health benefits, including long-term beneficial effects on immune functioning. For instance, individuals who write about traumatic events in their lives have fewer health issues six months later. Also, talking about the death one’s spouse reduces the likelihood of illness for as long as two years following the loss.

Question 25

Distinguish among the four types of delays in the use of health services.

Answer 25

• Appraisal delay: The time it takes an individual to decide that a symptom is serious.
• Illness delay: The time between the recognition that symptom implies an illness and the decision to seek treatment.
• Behavioral delay: The time between actually deciding to seek treatment and actually doing so.
• Medical delay: The time that elapses between the person’s calling for an appointment and receiving appropriate medical care.

Question 26

Cite evidence that endogenous opioid peptides are involved in stress-induced analgesia (SIA).

Answer 26

Endogenous opioid peptides are found in the adrenal glands, pituitary gland, and hypothalamus, which are are linked to stress response.

Question 27

Describe the qualities of the provider, the patient and the setting that are most conducive to placebo effects.

Answer 27

• Provider characteristics: Providers who exude warmth, confidence, and empathy get stronger placebo effects than do more remote and formal providers. Placebo effects are also strengthened when the provider radiates competence and provides reassurance to the patient that the condition will improve. The provider’s faith in the treatment increases the effectiveness of placebos.
• Patient characteristics: People who have a high need for approval or low self-esteem, who are externally oriented toward their environment, and who can be persuaded easily in other contexts show stronger placebo effects. Anxious people experience stronger placebo effects. So do patients who are high in hypnotizability, imaginative involvement, and effortless experiencing.
• Setting characteristics: A setting that has the trappings of medical formality (medications, machines, uniformed personnel) will induce stronger placebo effects than will a less formal setting. If all the staff radiates as much faith in the treatment as the physician, placebo effects will be heightened.

Question 28

List three criticisms of the general adaptation syndrome.

Answer 28

1. It assigns a very limited role to psychological factors, and researchers now believe that the psychological appraisal of events is important in the determination of stress.
2. The theory assumes that responses to stress are uniform, but not all stressors produce the same endocrinological responses. How people respond to stress is substantially influenced by their personalities, perceptions and biological constitutes.
3. It treats stress as an outcome, which is evident only when the general adaptation syndrome has run its course, rather than as a process.

Question 29

Discuss the role of the SAM system and the HPA axis in stress response.

Answer 29

The sympathetic-adrenomedullary (SAM) system produces epinephrine and norepinephrine in response to stress. When events are encountered that are perceived as harmful or threatening, they are labeled as such by the cerebral cortex, which, in turn sets off a chain of reactions mediated by these appraisals. Information from the cortex is transmitted to the hypothalamus, which initiates one of the earliest responses to stress – namely, sympathetic nervous system arousal, or the fight-or-flight response. Sympathetic arousal stimulates the medulla of the adrenal glands, which, in turn, secret the catecholamines epinephrine, and norepinephrine. These effects result in the cranked-up feeling we usually experience in response to stress.

In addition to the activation of the sympathetic nervous system, the hypothalamic-adrenal pituitary (HPA) axis is activated in response to stress. The hypothalamus releases corticotrophin-releasing factor (CRF), which stimulates the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which, in turn, stimulates the adrenal cortex to release glucocorticoids. Of these, cortisol is especially significant. It acts to conserve stores of carbohydrates and helps reduce inflammation in the case of an injury. It also helps the body return to its steady state following stress. HPA activation also produces elevations in growth hormone and prolactin, secreted by the pituitary gland.

Question 30

Distinguish among harm, threat and challenge.

Answer 30

• Harm is the assessment of the damage that has already been done by an event. Thus, for example, a man who has just been fired from his job may perceive present harm in terms of his own loss of self-esteem and his embarrassment as his coworkers silently watch him pack up his desk.
• Threat is the assessment of possible future damage that may be brought about by the event. Thus, the man who has just lost his job may anticipate problems that the loss of income will create for him and his family in the future. Primary appraisals of events as threats have important effects on physiological responses to stress. For example, blood pressure is higher when threat is higher or when threat is high and challenge is low.
• Challenge is the potential to overcome and even profit from an event. For example, the man who has lost his job may perceive that a certain amount of harm and threat exists, but he may also see his unemployment as an opportunity to try something new. Challenge appraisals are associated with more confident expectations of the ability to cope with the stressful event, more favorable emotional reactions to the event, and lower blood pressure.

Question 31

Identify the two neurotransmitters that are implicated in pain transmission.

Answer 31

Substance P is a neuropeptide that transmits information about tissue damage to the central nervous system. Glutamate is an excitatory neurotransmitter that acts as an agent in transmitting pain signals.

Question 32

List the three families of endogenous opioid peptides.

Answer 32

1. Beta-endorphins, which produce peptides that project to the limbic system and brain stem, among other places.
2. Proenkaphalins, which are distributed throughout the nervous and endocrine systems.
3. Prodynorphins, found in the gut and the posterior pituitary.

Question 33

Summarize the findings of Janis (1958) and of Egbert et al (1964).

Answer 33

• Janis (1958): This classic study compared the post-operative experiences of patients with low, medium, and high levels of anxiety. Patients who were moderately anxious prior to surgery coped most effectively with post-operative stress. High-anxiety patients remained anxious after surgery and were more likely to experience negative side effects such as pain, loss of appetite, and nausea. Low-anxiety patients also showed unfavorable reactions to post-operative stress, becoming angry and upset over symptoms that they were not prepared to face. The medium-anxiety patients had the right level of vigilance; they were prepared to expect post-operative stress but did not compound that stress with their own worries and fears.
• Egbert et al (1964): In this study, half the patients were alerted to the likelihood of post-operative pain and were given information about its normality, duration, and severity. They were also taught breathing exercises that would help them control the pain. The other half of the patients received no such information or instructions. When examined post-operatively, patients in the instruction group showed better post-operative adjustment. They required fewer narcotics and were able to leave the hospital sooner than were the patients who had not received the preparatory instructions.

Question 34

Describe the preparation interventions that are most effective for children.

Answer 34

Children respond most positively to preparation interventions that lets them know what to expect of the hospitalization experience, that offers relaxation and coping skills, that teaches them positive self-talk, and that provides age-appropriate information related to their illness and treatment.

Question 35

Identify two cost-containment strategies that affect hospital care.

Answer 35

• Diagnostic-related groups (DRGs) are part of a patient classification scheme that determines the typical nature and length of treatment for particular disorders; this scheme is sued by some third-party reimbursement systems to determine the amount of reimbursement based on the diagnosis.
• Preferred provider organizations (PPOs) are networks of affiliated practitioners that have agreed to charge pre-established rates for particular medical services.

Question 36

worried well

Answer 36

Individuals free from illness who are nonetheless concerned about their physical state and frequently and inappropriately use medical services.

Question 37

somaticizer

Answer 37

Someone who expresses distress and conflict through bodily symptoms.

Question 38

secondary gains

Answer 38

Benefits of being treated for illness, including the ability to rest, to be freed from unpleasant tasks, and to be taken care of by others.

Question 39

delay behavior

Answer 39

The act of delaying seeking treatment for recognized symptoms

Question 40

List the three elements of a pessimistic explanatory style.

Answer 40

Pessimistic explanatory style interprets and explains negative events in terms of factors that are internal (“It is my fault”), global (“I can’t do anything right”), and stable (“This is going to screw up everything”).

Question 41

Distinguish between the direct effects hypothesis and the buffering hypothesis.

Answer 41

• The direct effects hypothesis maintains that social support is generally beneficial during non-stressful times as well as during stressful times. Generally, when researchers have looked at social support in social integration terms, such as the number of people one identifies as friends or the number of organizations one belongs to, direct effects of social support on health have been found.
• The buffering hypothesis claims that the health benefits of social support are chiefly evident during periods of high stress. When there is little stress, social support has few physical or mental health benefits. According to this hypothesis, social support acts as a reserve and resource that blunts the effects of stress improves coping.

Question 42

social support

Answer 42

Information from other people that one is loved and cared for, esteemed and valued, and part of a network of communication and mutual obligation.

Question 43

direct effects hypothesis

Answer 43

The theory that coping resources, such as social support, have beneficial psychological and health effects under conditions of both high stress and low stress.

Question 44

buffering hypothesis

Answer 44

The hypothesis that coping resources are useful primarily under conditions of high stress and not necessarily under conditions of low stress.

Question 45

matching hypothesis

Answer 45

The hypothesis that social support is helpful to an individual to the extent that the kind of support offered satisfies that individual’s specific needs.

Question 46

Identify the illnesses that stress management programs have been effective in treating.

Answer 46

Stress management programs teach individuals to deal with stress by appraising stressful events, developing coping skills, and putting those skills into practice. These programs have been useful in treating and managing tension and migraine headaches, coronary heart disease, multiple sclerosis symptoms, and high blood pressure.

Question 47

Describe three phases of a stress management program.

Answer 47

1. Participants learn what stress is and how to identify the stressors in their own lives.
2. They acquire and practice skills for coping with stress.
3. They practice these stress management techniques in targeted stressful situations and monitor their effectiveness.

Question 48

coping outcomes

Answer 48

The beneficial effects that are thought to result from successful coping; these include reducing stress, adjusting more successful to it, maintaining emotional equilibrium, having satisfying relationships with others, and maintaining a positive self-image.

Question 49

stress management

Answer 49

A program for dealing with stress in which people learn how they appraise stressful events, develop skills for coping with stress, and practice putting these skills into effect.

Question 50

stress inoculation

Answer 50

The process of identifying stressful events in one’s life and learning skills for coping with them, so that when the events com up, one can put those coping skills into effect.

Question 51

time management

Answer 51

Skills for learning how to use one’s time more effectively to accomplish one’s goals.

Question 52

stress carriers

Answer 52

Individuals who create stress for others without necessarily increasing their own level of stress.

Question 53

Describe the effectiveness of the health belief model in predicting the use of health services.

Answer 53

The health belief model maintains that whether a person seeks treatment for a symptom can be predicted from two factors: (1) the extent to which the person perceives a threat to health and (2) the degree to which he or she believes that a particular health measure will be effective in reducing that threat. The model does a better job of explaining the treatment-seeking behavior of people who have money and access to health care services than of people who do not.

Question 54

Indicate who is most likely to delay seeking treatment.

Answer 54

• Middle-aged individuals appear to delay more than the elderly, particularly if they experience symptoms judged to be potentially serious.
• Poorer people seem to delay treatment, because the perceived expense of treatment is a major factor in delay.
• People with no regular contact with a physician may be discouraged by the extra burden of finding someone from whom to seek it.
• People who do not believe in the medical model.

Question 55

Identify the types of treatment regimens that are most likely to produce adherence.

Answer 55

Adherence is high (90%) when the advice is perceived as “medical” (taking medication) but lower (76%) if the advice is vocational (for example, taking time off from work) and lower still (66%) if the advice is social or psychological (for example, avoiding stressful social situations).