The nurse identifies that a client is experiencing the resistance stage of the general adaption syndrome. What did the nurse assess to make this clinical decision?
1. The client is unable to focus on activities and events.
2. The client is exhausted, and spends time sleeping.
3. There is localized swelling and inflammation of the client's leg wound.
4. The client's capillary blood glucose level is 180 mg/dL.
Correct Answer: 3
Rationale 1: The client's inability to focus on activities and events is not a characteristic of the resistance stage of the general adaption syndrome.
Rationale 2: The client's being exhausted and sleeping are characteristics of the stage of exhaustion within the general adaption syndrome.
Rationale 3: In the second stage in the general adaption syndrome, the stage of resistance is when the body's adaption takes place. The body attempts to cope with the stressor and to limit the stressor to the smallest area of the body that can deal with it, such as with localized swelling and inflammation of a leg wound.
Rationale 4: An elevated capillary blood glucose level is a finding associated with the alarm stage of the general adaption syndrome.
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