Chapter 14 - Somatosensory Function, Pain and Headache

A client in an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is complaining of intense, diffuse pain in her abdomen. Which of the following physiological phenomena is most likely contributing to her complaint? A) Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS. B) First-order neurons are inappropriately signaling pain to the dorsal root ganglion. C) The client is experiencing neuropathic pain. D) The client's C fibers are conducting pain in the absence of damaged Aδ fibers.

A

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the bag other than the phone. The nurse knows that which of the following terms best describes one's ability to sense of shape and size of an object in the absence of visualization? A) Stereognosis B) Astereognosis C) Modalities D) Somesthesia

A

Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)? A) A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident B) A woman who requires analgesia more than 3 months after an episode of shingles C) A male client with diabetes mellitus who requires analgesia prior to each dressing change on his chronic foot wound D) A female who has seemingly unprovoked attacks of pain that are accompanied by facial tics and spasms

A

Match the pain theory to the correct physiologic basis for the pain. A. Specificity theory B. Pattern theory C. Gate control theory D. Neuromatrix theory 1. Light touch applied to the skin would produce the sensation of touch through low-frequency firing of the receptor. 2. Repeated sweeping of a soft-bristled brush on the skin over or near a painful area may result in pain reduction for several minutes. 3. Proposes that the brain contains a widely distributed neural network that contains somatosensory, limbic, and thalamocortical components. 4. Describes how an acute injury is predicted to be but does not take into account the person's feelings of how the pain feels to him or her.

A - 4 B- 1 C - 2 D - 3

A 7-year-old child had an emergency appendectomy during the night. When trying to assess his pain, the nurse should A) ask him to rate his pain on a scale of 0 to 10, with 0 = no pain and 10 = worse pain ever. B) show him a scale with faces of actual children and have him point to the picture that best describes how he is feeling. C) consider his pulse and BP readings to be the most specific indicators of the amount of pain he is experiencing. D) try to distract him by blowing bubbles to minimize the use of opioids so that he does not become addicted to the narcotic.

B

A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating his feet are "burning." The nurse in the emergency department knows that the child's response is based on which of the following pathophysiological principles listed below? A) Children react much quicker to contact with hot water than adults. B) The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first. C) It takes a long time for thermal signals to be processed before the brain can send a signal through the spinal cord and tell the foot to withdraw. D) The thermal processing center is located on the rapid conducting anterolateral system on the same side of the brain as the injury.

B

A patient with diabetes mellitus has just undergone a right, below-the-knee amputation following gangrene infection. A few days post-op, the patient confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can A) administer a psychotropic medication to help the patient cope with the loss of his leg. B) explain that many amputees have this sensation and that one theory surmises that the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site. C) call the physician and ask him for an order for a psychological consult. D) educate the patient that this area has an usually abnormal increase in sensitivity to sensation but that it will go away with time.

B

Following a knee injury, a football player is taking ibuprofen, a nonsteroidal anti-inflammatory drug, for the control of pain. Which of the following drug actions is most likely to result in diminished sensation of pain for the player? A) The drug inhibits communication by third-order neurons between the thalamus and cerebral cortex. B) The drug inhibits the enzyme needed for prostaglandin synthesis. C) The drug changes the postexcitatory potential in C fibers, leading to pain sensitization. D) The drug slows the conduction velocity of myelinated Aδ fibers in the pain pathway.

B

If the patient's dorsal columns are not functioning, the nurse will observe which of the following responses during neurotesting, where the nurse asks the patient to close his eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points? A) Grimacing when body touched with sharp points B) No response to two-point discrimination C) Heightened proprioceptive response D) Inability to identify which way his finger was moved during the test

B

Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many comorbids that require several prescription medications. The nurse knows that which of the following factors is likely to complicate the clinician's assessment and treatment of the client's pain? A) Neural pain pathways in the elderly differ from those in younger adults and are less responsive to treatment. B) Assessment and treatment are possibly complicated by the large number of drugs that the client receives. C) Accurate pain assessment is not possible in clients with significant cognitive deficits. D) Frequent complaints of pain in older adults with dementia normally indicate hyperalgesia rather than an underlying physical problem.

B

Which of the following would be an example of a child born with congenital insensitivity to pain? A child who A) develops pins-and-needles sensation after jumping out of a tree. B) fell off a skate board and fractured ankle but did not feel any pain and just noted swelling in foot. C) skinned knee from a bike accident but only told parents when it started burning. D) cries every time the wind blows because it hurts his face and ears.

B

A 25-year-old woman who works as an air-traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis? A) Migraine headache B) Cluster headache C) Temporomandibular joint syndrome D) Sinus headache

C

A 30-year-old female has suffered a third-degree burn to her hand after spilling hot oil on it in a kitchen accident. Which of the following teaching points by a member of her care team is most appropriate? A) "Tell us as soon as you sense the beginnings of a round of pain, and we will start with analgesics." B) "Opioids like morphine often cause constipation, but if this happens to you, we will discontinue opioids and change to another family of medications." C) "Opioids aren't without side effects, but we will take action to manage these side effects, so you can continue getting these drugs." D) "It's imperative that we prevent you from developing a tolerance for opioids while you're getting treatment for your burn."

C

A nurse on a postsurgical unit is providing care for a 76-year-old female client who is 2 days posthemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which of the following guidelines should the nurse use for short-term and long-term treatment of the client's pain? A) Reconciling the client's need for opioid analgesics with the risk of addiction to these drugs B) Recognizing the client's pain is not likely self-limiting C) Knowing that the client's self-report of pain is the most reliable indicator of pain D) Realizing that chronic pain is likely to require innovative and complex treatment

C

A nurse practitioner is assessing a 7-year-old boy who has been brought to the clinic by his mother, who is concerned about her son's increasingly frequent, severe headaches. Which of the nurse's following questions is least likely to yield data that will allow for a confirmation or ruling out of migraines as the cause of his problem? A) "Does your son have a family history of migraines?" B) "When your son has a headache, does he ever have nausea and vomiting as well?" C) "Does your son have any food allergies that have been identified?" D) "Is your son generally pain free during the intervals between headaches?"

C

A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's unique ability? A) Pacinian corpuscles B) Ruffini end organs C) Meissner corpuscles D) Free nerve endings

C

While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options. A) Thalamus B) Dorsal root ganglion body C) Dorsal root ganglion periphery D) Axon E) Cerebral cortex

C B D A E

A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain? A) Postherpetic neuralgia B) Migraine headache C) Complex regional pain syndrome D) Trigeminal neuralgia

D

A 60-year-old male client with a long history of back pain has had little success with a variety of analgesic regimens that his family physician has prescribed. He has recently been diagnosed with a chronic pain disorder. Which of the following teaching points about chronic pain would his physician most likely emphasize to the client? A) "If your pain comes and goes, then we won't characterize it as chronic, and it will require different treatment." B) "You need to remind yourself that this is a purely physical phenomenon that requires physical treatment." C) "Our challenge is to bring you relief but still treat the underlying back problem that your body is telling you about." D) "These pain signals your body is sending likely serve no real, useful, or protective function."

D

A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is presently experiencing pain that she rates at 9 out of 10. Which of the following nonpharmacological treatments is most likely to be a useful and appropriate supplement to pharmacological analgesia at this point? A) Teaching the client guided imagery and meditation B) Initiating neurostimulation C) Heat therapy D) Relaxation and distraction

D