PAIN

How is pain transferred into the CNS? A. Dorsal root ganglion B. Hypothalamus C. Pulses

A- Dorsal root ganglion

A post-operative client is observed breathing 24 breaths/minute while complaining of 10/10 abdominal pain. The client's oxygen saturation is 90% on 2 liters nasal cannula. What is the nurse's priority action? A.Administer prescribed analgesia as ordered. B.Teach and encourage incentive spirometry use. C.Explain why deep breathing and coughing is important. D.Manually ventilate client with ambu bag at bedside.

A- The client is complaining of a the highest level of pain at 10/10. Therefore, the increased respirations and low oxygen saturation are likely a result of hypoventilation due to pain. Acute pain that is is not adequatley treated can impair pulmonary function. When the client is suffering from an intense amount of time, the client may not be very receptive to teaching and explanations. The client may have the desire to cough and deep breathe but is unable to due to the intensity of pain. The client can still breathe on his/her own, so an ambu bag is not needed.

Activation of pain receptors A. Transduction B.Transmission C.Perception D.Modulation

A- transduction

During a lecture on pain management, the nursing instructor informs the group of nursing students that the primary treatment measure for pain is which of the following? A.Analgesics B.Surgery C.Relaxation techniques D Cutaneous stimulation

A-Analgesics are most often the primary treatment measure for pain, although a growing trend involves the integration of complementary, nonpharmacologic measures with conventional medicine.

The U.S. government has created guidelines for health care providers caring for clients in pain. Which of the following reflect these guidelines? A.Joint Commission Standards for Pain Management. B. National Institutes of Health Standards for Pain Treatment. C. American Cancer Society Guidelines for Pain Management. D.American Pain Society Guidelines for Pain Management.

A-Joint Commission Standards for Pain Management were revised and published in 2000-2001. The standards require health care providers and organizations to improve pain assessment and management for all patients.

As a nurse is adjusting a client's hospital bed, the nurse accidently pinches a finger between the bed and the wall. Which of the following components is involved in the transduction of the pain the nurse feels? A.A-delta fibers B.C-fibers C.K-fibers D.L-beta fibers

A-Nociceptors are located at the peripheral ends of both myelinated nerve endings of type A fibers and unmyelinated type C fibers, and there are three types that are stimulated by different stimuli: mechanosensitive nociceptors (of A-delta fibers), sensitive to intense mechanical stimulation (e.g., pliers pinching skin); temperature-sensitive (thermosensitive) nociceptors (of A-delta fibers), sensitive to intense heat and cold; and polymodal nociceptors (of C fibers), sensitive to noxious stimuli of a mechanical, thermal, or chemical nature. There are no "K-fibers" or "L-beta fibers."

The nurse administers pain medication to a client at 1600. At what time should the nurse return to reassess the client's pain level? A.1630 B.1730 C.2000 D.2030

A-Pain should be assessed every 4 hours; reassessments after interventions should be done in 30 minutes after intervention.

A nurse is caring for a client with dull ache in her abdomen. On the way to the health care facility, the client vomits and shows symptoms of pallor. What kind of pain is the client experiencing? A.Visceral pain B.Cutaneous pain C.Somatic pain D.Neuropathic pain

A-The client is experiencing visceral pain, which is associated with disease or injury. It is sometimes referred or poorly localized as it is not experienced in the exact site where an organ is located. In cutaneous pain, the discomfort originates at the skin level, and is a commonly experienced sensation resulting from some form of trauma. Somatic pain develops from injury to structures such as muscles, tendons, and joints. Neuropathic pain is experienced days, weeks, or even months after the source of the pain has been treated and resolved.

Mark is a 20-year-old college student who has been experiencing increasingly sharp pain in the right, lower quadrant of his abdomen over the last 12 hours. A visit to the emergency department and subsequent diagnostic testing have resulted in a diagnosis of appendicitis. What category of pain is Mark most likely experiencing? A.Visceral pain B.Referred pain C.Cutaneous pain D.Somatic pain

A-Visceral pain occurs when organs stretch abnormally and become distended, ischemic, or inflamed. Appendicitis is characterized by inflammation of the vermiform appendix. Cutaneous pain is superficial and somatic pain is more commonly associated with tendons, ligaments, and bones. Referred pain is perceived distant from its point of origin, but this patient's pain is sensed near the location of his appendix.

The nursing student asks the nurse what would be an example of visceral pain. What would be the correct response by the nurse? A.Gallbladder pain B.Burn pain C.Cardiac pain DArthritic pain

A-Visceral pain originates from abdominal organs, such as the gallbladder. Burns cause cutaneous pain, which is derived from the dermis, epidermis, and subcutaneous tissues. Referred pain originates from a specific site, but is experienced in another site along the innervating spinal nerve, such as occurs with cardiac pain. Somatic pain originates from skin, muscles, bones, and joints, such as arthritic pain.

The nurse is assessing the pain of an older adult client who is recovering from a right hip open reduction procedure. What element would the nurse know it is important to review to best understand the patient's pain? A.Sleep patterns B.Family history C.Genetic history D.Elimination pattern

A-When assessing pain in older adults, the nurse should be sure to also review the effects of pain on diet, sleep, and mood. Unrelieved pain may lead to insomnia or depression and seriously affect the client's quality of life. It would not be necessary to assess the family history, genetic history, or elimination pattern to gain insight into the client's pain level.

Patient describe this type of pain impulse as sharp or stabbing. A. A-delta B. C fibers

A. A- delta

This nerve fiber is large and covered with myelin; they conduct pain impulses rapidly. A. A-delta B. C fibers

A. A-delta

Two main type of nerve fibers are located where? A. Peripheral nervous system B. Central nervous system

A. Peripheral Nervous system

A patient reports after a back massage that his lower back pain has decreased from 8 to 3 on the pain scale. What opioid neuromodulator may be responsible for this increased level of comfort? A.The release of endorphins B.The release of insulin CThe release of melatonin D.The release of dopamine

A.Endorphins and enkephalins are opioid neuromodulators that are powerful pain-blocking chemicals that have prolonged analgesic effects and produce euphoria. It is thought that certain measures such as skin stimulation and relaxation techniques release endorphins.

A cyclist reports to the nurse that he is experiencing pain in the tendons and ligaments of his left leg, and the pain is worse with ambulation. The nurse will document this type of pain as which of the following? A.Somatic pain B.Cutaneous pain C.Visceral pain D.Phantom pain

A.Somatic pain is diffuse or scattered pain, and it originates in tendons, ligaments, bones, blood vessels, and nerves. Cutaneous pain usually involves the skin or subcutaneous tissues. Visceral pain is poorly localized and originates in body organs. Phantom pain occurs in an amputated leg for which receptors and nerves are clearly absent, but the pain is a real experience for the patient.

In addition to pain intensity, what is another basic element of a pain assessment? A. Quality B.Focused goal C.History D Preferred assessment tool

A.Some prefer to use mnemonics to remember the elements of pain assessment. One of these is PQRST: O: Onset; P: Provocative or palliative; Q: Quality; R: Region and radiation; S: Severity; T: Timing.

Which would the nurse recognize as an example of visceral pain? Select all that apply. A. Liver pain B.Gallbladder pain C.Pancreatic pain D.Burn pain E.Muscular pain

A/B/C- Examples of visceral pain include pain associated with the liver, gallbladder, and pancreas. Pain associated with a burn is an example of cutaneous pain. Muscular pain is a type of somatic pain.

A nursing instructor is teaching the class about different theories of pain. The instructor informs the students that the most common clinical interpretation of pain transmission is called "nociception." The instructor includes the following components in nociception: (Check all that apply.) A.Transduction B.Initiation C.Modulation D. Perception E.Transmission

A/B/D/E-The most common clinical interpretation of pain is a concept called nociception, which means the perception of pain by sensory receptors located throughout the body and nociceptors. The following are the four steps in nociception: transduction, transmission, perception, and modulation. Initiation is not associated with this process.

What are the steps for pain transmission in the gate control theory? (Mark all that apply.) A.Unrelieved painful stimulus on a peripheral neuron causes the "gate" to open B.The gate opens through repolarization of the nerve fiber C.The brain stem recognizes the stimulus as pain D.The pain stimulus passes down the afferent pathway E.The pain stimulus crosses the dorsal horn of the spine to the limbic system

A/E-The steps for pain transmission in the gate control theory are as follows: (1) Continued painful stimulus on a peripheral neuron causes the "gate" to open through depolarization of the nerve fiber. This is accomplished by ion influx and outflow. (2) The pain stimulus then passes from the peripheral nervous system at a synaptic junction to the central nervous system up the afferent nerve pathways. (3) The pain stimulus passes up through and across the dorsal horn of the spine to the structures of the limbic system and the cerebral cortex. (4) In the cerebral cortex, the stimulus is identified as pain and a response is created. The response, once generated, passes down the efferent pathways where reaction to the pain is created. The distractors listed all have an incorrect component in the option which was noted above in the explanation.

A patient recovering from a stroke complains of pain. The nurse suspects this patient is most likely experiencing which type of pain? A.Nociceptive B.Neuropathic C.Somatic D.Idiopathic

B- Neuropathic pain can occur from central nervous system brain injury caused by a stroke. Nociceptive pain is caused by tissue damage. Somatic pain is another term used for nociceptive pain. Idiopathic pain does not have an identified cause.

Why is it important for a nurse to gather information about a client's past experiences with pain? A.Identify factors that increase or decrease the pain B.Provides insight into positive or negative expectations for relief C.Assess how much the pain impacts the client's lifestyle D.Understand the course of the pain for clues to patterns

B-Past experiences with pain may shed light on the previous history of the client in addition to possible positive or negative expectations of pain therapies. Identifying factors that increase or decrease pain, assessing how much it impacts the client's lifestyle, and understanding the course of the pain are questions that assist the nurse to elicit important information about the pain itself.

The patient comes to the emergency department reporting indigestion and left arm pain. The physician orders an EKG along with drawing of cardiac enzymes. When the results are back, the patient is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following? A.Visceral pain B.Referred pain C.Cutaneous pain D.Somatic pain

B-Referred pain originates from a specific site, but the person feels the pain at another site site along the innervated spinal nerve. An example is cardiac pain that the person experiences as arm pain and indigestion. Visceral pain originates from abdominal organs. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. Somatic pain originates from skin, muscles, bones, and joints.

A patient is reporting pain and rates it as 7 on a scale of 1 to 10. When the nurse asks him to decribe the pain, he states, "It feels like a knife is stabbing or cutting me." The nurse knows that this type of pain is conducted by which fibers? A.C fibers B.A-delta fibers C. AC fibers D.P fibers

B. A-delta fibers are myelinated and conduct impulses rapidly, resulting in pain being described as sharp or stabbing. C fibers are unmyelinated and cause pain that is achy and ongoing. There are no known AC or P fibers related to pain.

Patients describe this type of nerve pain as achy and ongoing even after the pain stimulus has gone away. A. A-delta B. C fibers

B. C fibers

This type of nerve fiber is smaller and unmyelinate. They conduct pain impulses more slowly. A. A-delta B. C fibers

B. C fibers

C fibers release a pain- facilitating substance from nerve ending called? A. substance A B. Substance P C. A-delta

B. Substance P- which quicken the transmission of the pain stimulus up the pain pathway.

conduction along pathways (A-delta and C- fibers) A.Transduction B.Transmission C.Perception D.Modulation

B. Transmission

What can explain why heat and pressure can provide pain relief. A. amount of activity in large and small afferent fibers and nerve impulses B. stimulate large nerve fiber to close the gate and block impulses from that area C. Pain meds

B. only a limited amount of sensory information can be processed by the nervous system, when too much information is sent through certain cells in the spinal column interrupt the signal by "closing the gate"

A patient recovering from a stroke complains of pain. The nurse suspects this patient is most likely experiencing which type of pain? A.Nociceptive B.Neuropathic C.Somatic D.Idiopathic

B.Neuropathic pain can occur from central nervous system brain injury caused by a stroke. Nociceptive pain is caused by tissue damage. Somatic pain is another term used for nociceptive pain. Idiopathic pain does not have an identified cause.

The patient comes to the emergency department reporting indigestion and left arm pain. The physician orders an EKG along with drawing of cardiac enzymes. When the results are back, the patient is informed of the diagnosis of heart attack. The indigestion and arm pain are examples of which of the following? A.Visceral pain B.Referred pain C.Cutaneous pain D.Somatic pain

B.Referred pain originates from a specific site, but the person feels the pain at another site site along the innervated spinal nerve. An example is cardiac pain that the person experiences as arm pain and indigeston. Visceral pain originates from abdominal organs. Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. Somatic pain originates from skin, muscles, bones, and joints.

When patients report pain, it is important to find the source. When patients describe pain as "burning, painful numbness, or tingling," the source is more than likely: A.Visceral B.Neuropathic C.Somatic D.Referred

B.Visceral pain originates from abdominal organs and is often described as crampy or gnawing. Somatic pain originates from the skin, muscles, bones, and joints. Referred pain originates from a specific site, but the patient experiencing the pain feels it at another site along the innervating spinal nerve. Neuropathic pain is described as burning, painful numbness, or tingling.

A client enters the emergency department moaning and complaining of severe pain in his lower back. Which of the following clinical manifestations should the nurse expect to see in this client as a physiologic response to pain? Select all that apply. A.Hypoglycemia B.Perspiration C.Increased heart rate D. Increased intestinal motility E.Sleeplessness

B/C/E- Sleeplessness, perspiration, and increased heart rate are physiologic responses to pain. Pain elicits a stress response in the human body that triggers the sympathetic nervous system. Hyperglycemia, not hypoglycemia, and decreased, not increased, intestinal motility are physiologic responses to pain.

A nurse begins to assess pain in a client admitted to the hospital for new onset of severe nausea and vomiting. What question should the nurse ask the client to assess the pattern of pain? A. "When did your pain start?" B."What therapies have you tried to control the pain?" C."How often do you experience the pain?" D."Where is the pain located?"

C

Which of the following is not released during the stress response? A.Epinephrine B.Norepinephrine C.Dopamine D.Cortisol

C

A client injures his thumb by accidently slamming the car door shut on it. He arrives at the emergency department in intense pain. Which of the following processes is associated with the transduction process of this pain? A.Inflammation leading to conduction of an impulse to the spinal cord B.Emotional response and rational interpretation and response C.Tissue injury leading to inflammation D.Changes or inhibitions to the pain message relay in the spinal cord

C- Transduction of pain begins when a mechanical, thermal, or chemical stimulus results in tissue injury or damage, resulting in an inflammatory process. The transmission process is initiated by this inflammatory process, resulting in the conduction of an impulse in the primary afferent neurons to the dorsal horn of the spinal cord. The process of pain perception involves the hypothalamus and limbic system, which are responsible for the emotional aspect of the pain perception, and the frontal cortex, which is responsible for the rational interpretation and response to pain. Modulation changes or inhibits the pain message relay in the spinal cord.

When is sensation of pain recognized? A. when it reaches thalamus B. when its passes through lateral spinothalamic tracts C. cerebral cortex

C- cerebral cortex

Awareness of the characteristics of pain A. Transduction B.Transmission C.Perception D.Modulation

C- perception of pain

A middle aged female client presents to the emergency department complaining of indigestion and left arm pain. What is the nurse's best action? A.Alert the healthcare provider to the client's somatic pain complaints. B.Administer an antacid and apply a topical anesthetic for the arm pain. C.Check the client's vital signs and connect her to a cardiac monitor. D.Request a strong narcotic analgesic for the client's visceral pain complaints.

C-Pain nociception has various locations. Visceral pain originates from abdominal organs; patients often describe this pain as crampy or gnawing. Somatic pain originates from skin, muscles, bones, and joints; patients usually describe somatic pain as sharp (D'Arcy, 2014). Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues. It is often burning or sharp, such as with a partial-thickness burn. Referred pain originates from a specific site, but the person experiencing it feels the pain at another site along the innervating spinal nerve (Fig. 6.3). An example is cardiac pain that a person experiences as indigestion, neck pain, or arm pain. Phantom pain is pain in an extremity or body part that is no longer there (e.g., a patient who experiences pain in a leg with an amputation). The client is presenting with atypical chest pain and should be assessed for pain of a cardiac origin.

Pain-facilitating substance from C fibers is released and this is at the site of injury. Causes continued irritation at the site of injury. A. Substance P B. A-Delta C. Bradykinin

C. Bradykinin- which is a cellular chemical released from the damaged tissue

What is the neurotransmitter responsible for the communication of the peripheral and central nervous system? A. Substance P B. Lateral spinothalamic C. Glutamate

C. Glutamate

Which of the following cultural expressions of pain would be likely to be found in a person of Hispanic culture? A.Pain is honorable and should be endured. B.Pain is part of the preparation for the next life in the cycle of reincarnation. C.Pain must be endured to perform gender role duties, but response to it is very expressive. D.Pain may be caused by past transgressions and helps to atone and achieve higher spirituality.

C. In the Hispanic culture pain response is often very expressive, though pain must be endured to perform gender role duties.

The nurse should assess for which pain complaints from a client diagnosed with Type II Diabetes Mellitus? A.Sharp, stabbing B.Aching, gnawing C.Burning, tingling D.Pain only on movement

C. The nurse should assess for neuropathic pain associated with diabetic neuropath. Neuropathic pain: Pain that results from damage to nerves in the peripheral or central nervous system (Staats, et al., 2004). Examples of neuropathic pain include diabetic peripheral neuropathy, post herpetic neuralgia, and postmastectomy pain. You should also be alert for the common terms that patients use to report neuropathic pain, such as burning, painful tingling, pins and needles, and painful numbness.

The purpose of peripheral A&C fibers are referred to as? A. Pain fibers B. Impulses C. nociceptors

C. nociceptors- they carry pain signal to the CNS

Which of the following statements most accurately conveys an aspect of the gate-control theory? A.The transmission and sensation of pain exist completely within the spinal cord. B.Substances such as endorphins are noted to increase pain sensation. C.Specialized cells can decrease pain transmission by exciting inhibitory neurons. D. Pain transmission and emotional state exist independently of each other.

C.According to the gate-control theory, the excitation of inhibitory interneurons can inhibit pain. Peripheral receptors, the spinal cord, and the brain are all involved in the process, and endorphins can decrease pain. The gate-control theory identifies the way that pain and emotional state affect each other.

Recently, lung cancer has metastasized to the bones of a 68-year-old client, precipitating a sudden increase in his pain. The client's wife and daughter are concerned about the consequent increase in the amount of hydromorphone the client requires, citing the risk of addiction. How can the nurse best respond to the family's concern? A."Even when he becomes addicted, we can take comfort knowing that his pain is controlled." B. "It's actually a myth that clients can become addicted to hospital narcotics." C."If he ends up needing higher doses to resolve the pain, we will discontinue the drug." D. "There's a very minimal risk of addiction, and controlling his pain is our first concern."

D

Inhibition or modification of pain A. Transduction B.Transmission C.Perception D.Modulation

D- modulation

An adolescent client who suffered a crushing leg injury due to an all terrain vehicle (ATV) rollover, complains of painful tingling in the affected leg and inability to bend the knee. The client's leg is swollen. What is the nurse's priority action? A.Administer the prescribed non-steroid anti-inflammatory medication. B.Elevate the client's leg on several pillows and apply ice. C.Raise the head of the bed to High Fowler's position. D.Notify the healthcare provider immediately.

D-If acute pain is undertreated or completely untreated, patients are at risk for harder-to-treat neuropathic pain syndromes, such as complex regional pain syndrome (CRPS). Continued painful assault on the peripheral nerves results in neuronal plasticity and transfer of the pain stimulus to the central nervous system. These syndromes are very diffi cult to treat. Patients who have had surgery or a crush-type injury are at high risk for developing CRPS. You should be aware that when a patient with such an injury continues to complain of high levels of pain and begins to experience a subsequent loss of function, temperature sensitivity, swelling, or other skin changes (e.g., hair loss in the affected area), the patient may be developing CRPS. You should also be alert for the common terms that patients use to report neuropathic pain, such as burning, painful tingling, pins and needles, and painful numbness. The client may be developing CRPS or suffering other complications from the crush injury. The healthcare provider should be notified immediately. Elevating the leg, head of bed, or administering an NSAID are all interventions that will not help this client.

A construction worker in his mid-40s suffered a severe laceration on his leg while on the job site. Soon after he arrives at the emergency room, a nurse assesses his pain. The client states that pain, although severe, has lessened since the accident first occurred. The nurse knows that the pain message likely has been inhibited by release of endorphins and other neurotransmitters. Which physiological process does this represent? A.Transduction B.Transmission C.Perception D. Modulation

D-Modulation is the physiological process whereby brain stem neurons release endogenous neurotransmitters (e.g., endorphins, enkephalins, and serotonin), which inhibit the transmission of pain. Transduction is the process whereby injured tissue releases chemicals that affect nociceptors, sending the pain message up the sensory neuron. Transmission is the process whereby the pain impulse from the nociceptors relays the pain from the spinal cord to the brain. Perception is the process whereby pain is perceived in the brain.

A client describes pain in the soles of both feet as constantly burning. Which type of pain should the nurse suspect this client is experiencing? A.somatic B.referred C.visceral D.neuropathic

D. Pain resulting from direct injury to the peripheral or central nervous system is termed neuropathic. Over time, neuropathic pain may become independent of the inciting injury and be described as burning. Somatic pain originates from skin, muscles, bones, and joints and is usually described as sharp. Referred pain is pain felt in a body area, away from the pain source. Visceral pain originates from abdominal organs and is usually described as cramping or gnawing.

A nurse is assessing the effect of a client's chronic back pain on his affective dimension. Which question should the nurse ask for this assessment? A.What medical conditions do you have? B.Where is the pain located? C.What is the highest level of education you've completed? D.How does the pain influence your overall mood?

D. The question regarding the influence of the pain on mood would address the client's affective dimension, which includes feelings and emotions that result from the pain. The question regarding medical conditions would help assess the client's physical dimension. The question regarding the location of the pain would address the client's sensory dimension. The question regarding the client's education would address his cognitive dimension.

A patient recovering from abdominal surgery is complaining of pain. The nurse realizes that the patient is most likely experiencing which type of pain? A.Psychogenic B.Idiopathic C.Neuropathic D.Somatic

D.Somatic pain is caused by tissue damage, which would occur after abdominal surgery. Psychogenic pain relates to factors that influence the patient's report of pain such as anxiety and depression. Idiopathic pain does not have an identified cause. Neuropathic pain results from direct injury to the peripheral or central nervous system.

A nurse is administering prescribed medicine to a client who experienced acute pain in the lower back after a motor vehicle accident. The client tells the nurse that compared to the previous week, his pain had reduced considerably. Which phase of pain is the client experiencing? A.Transduction B.Transmission C.Perception D.Modulation

D.The client is in the modulation phase of pain, during which the brain interacts with the spinal nerves in a downward fashion to subsequently alter the pain experience. The client is not in the transduction, transmission, or perception phase of pain. Transduction phase refers to the conversion of chemical information at the cellular level into electrical impulses that move toward the spinal cord. In transmission phase, the stimuli move from the peripheral nervous system toward the brain, and the perception phase occurs when the pain threshold is reached.

A patient recovering from abdominal surgery is complaining of pain. The nurse realizes that the patient is most likely experiencing which type of pain? A.Psychogenic B.Idiopathic C.Neuropathic D.Somatic

Somatic pain is caused by tissue damage, which would occur after abdominal surgery. Psychogenic pain relates to factors that influence the patient's report of pain such as anxiety and depression. Idiopathic pain does not have an identified cause. Neuropathic pain results from direct injury to the peripheral or central nervous system.

T/F- if pain impulses are predominate the pain stimulus is passed on which passes through spinal cord then to thalamus and pain limbic system.

True- if the pain is blocked then the pain stops