# Situation: The nurse teaches a stress-management class for adults attending the outpatient mental health clinic. A participant asks why her heart pounded, her palms sweated, and her blood sugar rose during a sudden family crisis. Which explanation is accurate?

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> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630171  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse teaches a stress-management class for adults attending the outpatient mental health clinic.

A participant asks why her heart pounded, her palms sweated, and her blood sugar rose during a sudden family crisis. Which explanation is accurate?

## 보기

1. The alarm stage triggered sympathetic activity and cortisol **✔ 정답**
2. The resistance stage lowered stress hormones to normal
3. The parasympathetic system prepared her body to fight
4. The exhaustion stage released stored glucose into the blood

**정답: 1**

## 해설

The alarm stage of the general adaptation syndrome is the fight-or-flight response: sympathetic activation raises heart rate and sweating, and cortisol release raises blood glucose. Resistance and exhaustion follow only if the stressor continues.

## 심화 해설

The alarm stage is the first phase of the general adaptation syndrome described by Selye, and it corresponds directly to the fight-or-flight reaction that Cannon linked to catecholamine release [1]. When a sudden family crisis occurs, the brain perceives a threat and immediately activates two coordinated pathways: the sympathetic-adrenomedullary system and the hypothalamic-pituitary-adrenal axis.

Sympathetic activation releases epinephrine and norepinephrine, which rapidly increase heart rate, contractility, and sweat gland activity, producing the pounding heart and sweaty palms the participant experienced. At the same time, the hypothalamus triggers corticotropin-releasing hormone, which leads to adrenocorticotropic hormone release and subsequent cortisol secretion from the adrenal cortex [1][2]. Cortisol raises blood glucose by promoting gluconeogenesis and reducing peripheral glucose uptake, ensuring that fuel is available for muscles and the brain during the perceived emergency [2].

The acute activation of the HPA axis is adaptive and protective in this context [2]. The body is mobilizing energy and cardiovascular reserve to respond to an immediate threat. This is not a sign of pathology; it is the expected physiological response to an acute stressor.

| Stage | Physiological response | Clinical correlate |
| --- | --- | --- |
| Alarm stage | Sympathetic surge, catecholamine release, cortisol elevation, hyperglycemia, diaphoresis, tachycardia | Fight-or-flight response; the symptoms described by the participant |
| Resistance stage | Hormone levels remain elevated but the body attempts adaptation; glucose and cortisol may stay above baseline | Occurs only if the stressor persists beyond the initial alarm |
| Exhaustion stage | Depletion of adaptive energy, possible HPA dysregulation, increased vulnerability to illness | Develops after prolonged or repetitive stress, not during a sudden acute crisis |

Watch out! The resistance and exhaustion stages do not explain the immediate symptoms. They follow only when the stressor continues over time [1]. The parasympathetic system would produce the opposite effects—slowing the heart and reducing arousal—so it cannot be the source of a fight-or-flight presentation.

Key point! The alarm stage is the acute, adaptive stress response driven by sympathetic activation and cortisol release, and it accounts for the tachycardia, diaphoresis, and elevated blood glucose seen during a sudden crisis. Chronic or repeated HPA activation, by contrast, contributes to allostatic load and maladaptive metabolic changes, which is a separate concern from the acute alarm reaction [2].References (research sources)

- [1][The endocrine stress reaction in anesthesia and surgery--origin and significance].Research articleAdams HA, Hempelmann G (1991) · DOI: 10.1055/s-2007-1000588

- [2]Adaptive changes in adrenal steroid metabolism under extreme physical and psychological stress: a narrative review.Research articleBorakowska D, Podgórski R, Łuszczki E. (2026) · DOI: 10.3389/fendo.2026.1860059

## 임상 시나리오

Acute Stress Response: Alarm Stage RecognitionIdentifying the fight-or-flight reaction in clinical practice
The alarm stage of the general adaptation syndrome is the immediate fight-or-flight response. Sympathetic activation causes tachycardia, diaphoresis, and elevated blood glucose via cortisol release.

Two pathways activate simultaneously: the sympathetic-adrenomedullary system releases epinephrine and norepinephrine, while the hypothalamic-pituitary-adrenal axis triggers cortisol secretion from the adrenal cortex.

CautionThese acute physiological changes are adaptive and expected, not pathological. Do not misinterpret normal stress responses as disease. Resistance and exhaustion stages occur only if the stressor persists.

## 핵심 개념

- **General Adaptation Syndrome** — Selye's three-stage model of stress response: alarm, resistance, and exhaustion.
- **Alarm Stage** — The initial fight-or-flight phase characterized by sympathetic activation and cortisol release.
- **Cortisol** — A glucocorticoid released from the adrenal cortex that raises blood glucose during stress.
- **Sympathetic Nervous System** — The division of the autonomic nervous system responsible for the fight-or-flight response.
- **Fight-or-Flight Response** — An acute physiological reaction to threat involving increased heart rate, sweating, and energy mobilization.

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