NRS 232 Final Exam Questions and Answers
Graded A+ Assured Success New Update
2026
What Does Stress SNS Activation Do?
-Increased epinephrine and norepinephrine
-Increased heart rate and blood pressure
-Increased cortisol release and blood sugar
-Pupils dilate
-Decreased gut motility
-Vasoconstriction to shunt blood to muscles, brain, and heart
-Increased muscle contractility
-Increased stomach acid
-Increased breathing rate
-Bronchodilation (increased airflow)
-Increased blood coagulability
-Dry mouth
-Water retention (edema)
-Decreased reproduction and growth
Epinephrine and Norepinephrine
-Released from adrenal medulla (inner part of adrenal gland)
-Release is stimulated by SNS activation
-Limbic system (portions of the brain that regulate emotions) detects fear
and signals the hypothalamus to release corticotropin-releasing factor
(CRF). CRF triggers the locus coeruleus (located in brainstem) to activate
SNS.
-SNS signals the release of epinephrine and norepinephrine
-Approximately 80% epinephrine and 20% norepinephrine released from
adrenal medulla
-Increases heart rate and blood pressure, vasoconstriction, respiratory rate,
,bronchodilation (increased airflow), and other symptoms related to SNS
activation
Cortisol
-Limbic system activates hypothalamus to release corticotropin-releasing
factor (CRF), which signals the anterior pituitary gland to release
adrenocorticotropic hormone (ACTH). ACTH acts on the adrenal cortex to
release cortisol. This is regulated by a negative feedback loop (more
cortisol disrupts CRF release).
-Cortisol increases blood sugar, fat, and protein for body use
-Cortisol suppresses the immune system and increases the risk of infection
if levels are high
-Glucocorticoid excess (Cushing's syndrome) can lead to hypokalemia
(decreased blood potassium levels) by causing increased potassium output
in urine
-Chronically high cortisol can also lead to ECV excess and edema (cortisol
promotes sodium/water retention), diabetes, muscle wasting, and
osteoporosis (cortisol promotes calcium release from bones)
-While taking corticosteroids, the adrenal gland stops natural production. If
a patient stops taking corticosteroids suddenly, natural synthesis will not be
at normal levels for healthy functioning
Reticular Activating System (RAS)
-Sensory input recognized by thalamus and cerebral cortex, which
activates RAS
-RAS communicates to the skeletal muscles via gamma neurons to cause
increased muscle tension (explains why chronic stress may lead to muscle
soreness)
-RAS also increases alertness and arousal
Anterior Pituitary Gland Vs. Posterior Pituitary Gland
Anterior Pituitary: Releases Adrenocorticotropic hormone (ACTH), which
acts on the adrenal cortex to release cortisol
,Posterior Pituitary: Releases ADH in response to high blood sodium (main
stimulus) and decreased perfusion to kidneys (lesser stimulus). ADH acts
on the kidneys to retain water only.
Consequences of Chronic Stress
-Chronic stress inhibits the negative feedback loop and causes constant
release of cortisol. Constant release of cortisol suppresses the immune
system and increases blood sugar. This increases the risk of diabetes,
infection, and poor wound healing. Increased cortisol also increases
stomach acid production, fat redistribution, sodium and water retention
(ECV excess, edema, and hypokalemia), and increased calcium release
from bones (increased risk of osteoporosis among post-menopausal
women)
-Muscle wasting
-Difficulty regulating emotions (labile emotions)
-Increased epinephrine and norepinephrine leads to hypertension,
endothelial cell dysfunction, vasoconstriction, and tachycardia. All of this
increases the risk of coronary artery disease, myocardial infarction, kidney
disease. and stroke.
-Constant activation of the reticular activating system (RAS) causes
prolonged muscle tension and soreness. Muscle soreness is a stressor as
well, so it amplifies the body's stress response
How to Treat Patient Stress After Experiencing a Traumatic Event
-Provide insulin to lower blood sugar and risk of infection
-Address increased stomach acid by providing a proton pump inhibitor,
which will help lower the risk of stomach ulcers
-Monitor and intervene for constipation, increased blood pressure, and
increased heart rate
Stretch Reflex
-Also called myotatic reflex
, -Muscle spindles detect stretch of a muscle, and afferent sensory neurons
conduct action potentials to the spinal cord. Afferent neurons synapse with
alpha motor neurons at the spinal cord. Alpha motor neurons carry action
potentials back to the muscle to cause contraction and to prevent further
stretching.
-The reticular activating system (RAS) also prevents stretch by sending
signals to gamma motor neurons. Gamma motor neurons conduct signals
from the spinal cord to the muscle fibers and help regulate muscle tension
involuntarily. This causes increased contractility of the muscle.
What causes you to suddenly become wide awake and oriented when
being woken up from an alarm?
The reticular activating system (RAS), which is aroused by the limbic
system in response to the alarm
What are some additional responses to stress?
-Increased ADH and aldosterone, which can lead to ECV excess and
edema
-Growth and reproduction impairment
Can the effects of stress be passed on to offspring?
Yes! Chronic stress alters the expression of multiple genes in the HPA axis,
and can lead to epigenetic changes (changing how genes are expressed)
that are passed onto offspring.
What happens if there is an obstructed artery?
-Arteries carry blood away from the heart
-Ischemia and reversible cell swelling
-Irreversible cell swelling may occur if ischemia is not treated
What happens if there is an obstructed vein?
-Veins carry blood to the heart
-Venous congestion and fluid buildup can cause increased hydrostatic
pressure and edema
-Less blood flow to the heart
Virchow's Triad
Graded A+ Assured Success New Update
2026
What Does Stress SNS Activation Do?
-Increased epinephrine and norepinephrine
-Increased heart rate and blood pressure
-Increased cortisol release and blood sugar
-Pupils dilate
-Decreased gut motility
-Vasoconstriction to shunt blood to muscles, brain, and heart
-Increased muscle contractility
-Increased stomach acid
-Increased breathing rate
-Bronchodilation (increased airflow)
-Increased blood coagulability
-Dry mouth
-Water retention (edema)
-Decreased reproduction and growth
Epinephrine and Norepinephrine
-Released from adrenal medulla (inner part of adrenal gland)
-Release is stimulated by SNS activation
-Limbic system (portions of the brain that regulate emotions) detects fear
and signals the hypothalamus to release corticotropin-releasing factor
(CRF). CRF triggers the locus coeruleus (located in brainstem) to activate
SNS.
-SNS signals the release of epinephrine and norepinephrine
-Approximately 80% epinephrine and 20% norepinephrine released from
adrenal medulla
-Increases heart rate and blood pressure, vasoconstriction, respiratory rate,
,bronchodilation (increased airflow), and other symptoms related to SNS
activation
Cortisol
-Limbic system activates hypothalamus to release corticotropin-releasing
factor (CRF), which signals the anterior pituitary gland to release
adrenocorticotropic hormone (ACTH). ACTH acts on the adrenal cortex to
release cortisol. This is regulated by a negative feedback loop (more
cortisol disrupts CRF release).
-Cortisol increases blood sugar, fat, and protein for body use
-Cortisol suppresses the immune system and increases the risk of infection
if levels are high
-Glucocorticoid excess (Cushing's syndrome) can lead to hypokalemia
(decreased blood potassium levels) by causing increased potassium output
in urine
-Chronically high cortisol can also lead to ECV excess and edema (cortisol
promotes sodium/water retention), diabetes, muscle wasting, and
osteoporosis (cortisol promotes calcium release from bones)
-While taking corticosteroids, the adrenal gland stops natural production. If
a patient stops taking corticosteroids suddenly, natural synthesis will not be
at normal levels for healthy functioning
Reticular Activating System (RAS)
-Sensory input recognized by thalamus and cerebral cortex, which
activates RAS
-RAS communicates to the skeletal muscles via gamma neurons to cause
increased muscle tension (explains why chronic stress may lead to muscle
soreness)
-RAS also increases alertness and arousal
Anterior Pituitary Gland Vs. Posterior Pituitary Gland
Anterior Pituitary: Releases Adrenocorticotropic hormone (ACTH), which
acts on the adrenal cortex to release cortisol
,Posterior Pituitary: Releases ADH in response to high blood sodium (main
stimulus) and decreased perfusion to kidneys (lesser stimulus). ADH acts
on the kidneys to retain water only.
Consequences of Chronic Stress
-Chronic stress inhibits the negative feedback loop and causes constant
release of cortisol. Constant release of cortisol suppresses the immune
system and increases blood sugar. This increases the risk of diabetes,
infection, and poor wound healing. Increased cortisol also increases
stomach acid production, fat redistribution, sodium and water retention
(ECV excess, edema, and hypokalemia), and increased calcium release
from bones (increased risk of osteoporosis among post-menopausal
women)
-Muscle wasting
-Difficulty regulating emotions (labile emotions)
-Increased epinephrine and norepinephrine leads to hypertension,
endothelial cell dysfunction, vasoconstriction, and tachycardia. All of this
increases the risk of coronary artery disease, myocardial infarction, kidney
disease. and stroke.
-Constant activation of the reticular activating system (RAS) causes
prolonged muscle tension and soreness. Muscle soreness is a stressor as
well, so it amplifies the body's stress response
How to Treat Patient Stress After Experiencing a Traumatic Event
-Provide insulin to lower blood sugar and risk of infection
-Address increased stomach acid by providing a proton pump inhibitor,
which will help lower the risk of stomach ulcers
-Monitor and intervene for constipation, increased blood pressure, and
increased heart rate
Stretch Reflex
-Also called myotatic reflex
, -Muscle spindles detect stretch of a muscle, and afferent sensory neurons
conduct action potentials to the spinal cord. Afferent neurons synapse with
alpha motor neurons at the spinal cord. Alpha motor neurons carry action
potentials back to the muscle to cause contraction and to prevent further
stretching.
-The reticular activating system (RAS) also prevents stretch by sending
signals to gamma motor neurons. Gamma motor neurons conduct signals
from the spinal cord to the muscle fibers and help regulate muscle tension
involuntarily. This causes increased contractility of the muscle.
What causes you to suddenly become wide awake and oriented when
being woken up from an alarm?
The reticular activating system (RAS), which is aroused by the limbic
system in response to the alarm
What are some additional responses to stress?
-Increased ADH and aldosterone, which can lead to ECV excess and
edema
-Growth and reproduction impairment
Can the effects of stress be passed on to offspring?
Yes! Chronic stress alters the expression of multiple genes in the HPA axis,
and can lead to epigenetic changes (changing how genes are expressed)
that are passed onto offspring.
What happens if there is an obstructed artery?
-Arteries carry blood away from the heart
-Ischemia and reversible cell swelling
-Irreversible cell swelling may occur if ischemia is not treated
What happens if there is an obstructed vein?
-Veins carry blood to the heart
-Venous congestion and fluid buildup can cause increased hydrostatic
pressure and edema
-Less blood flow to the heart
Virchow's Triad
