Patho CH 14
About 30 minutes following the morning medication pass, the nurse's aide informs the nurse that one of the clients on their team is complaining of "hot sweats." The aide also states that the client's temperature is now 101.5°F (38.6°F). Knowing that some medications can cause hyperthermia, the nurse reviews the medications. Which client is at high risk for developing an elevated temperature? Postoperative client receiving oxycodone for pain Client with Clostridioides difficile receiving vancomycin IV every 6 hours Client with hypertension being treated with lisinopril Suicidal client who overdosed on a monoamine oxidase (MOA) inhibitor
Suicidal client who overdosed on a monoamine oxidase (MOA) inhibitor
Which conditions or events commonly trigger nociceptive pain? Select all that apply. Shingles Surgery Diabetes mellitus Osteoarthritis Chemical burn
Surgery Osteoarthritis Chemical burn
A nurse conducting a community education program on hyperthermia determines that the participants understand the information when they identify that the heat index is which of the following? Temperature sensed when temperature and humidity are combined Measure of humidity Temperature sensed by the body in hot, dry climates Measure of core body temperature
Temperature sensed when temperature and humidity are combined
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? Migraine headache Temporomandibular joint syndrome Sinus headache Cluster headache
Temporomandibular joint syndrome
The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy? Sinus Cluster Migraine Tension
Tension
Which pain disorder is a manifestation of a disruption of cranial nerve function? Trigeminal neuralgia Postherpetic neuralgia Temporomandibular joint (TMJ) syndrome Phantom limb pain
Trigeminal neuralgia
A client is being taught how to use a TENS unit. The nurse determines that teaching was effective when the client states: "I should take my medication and apply the TENS unit to the painful area as soon as I feel the pain." "The TENS unit is the easiest and most cost-effective way to manage my pain at home." "Anytime that the setting on my TENS unit needs to be changed I will have to return it to the company and wait for them to deliver a new one." "I will need to return to the doctor's office to have this TENS unit surgically implanted under my skin for the best pain relief."
"I should take my medication and apply the TENS unit to the painful area as soon as I feel the pain."
The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate? "Migraine headaches usually respond poorly to medication, so I can help you explore nonpharmacologic options." "Migraines are poorly understood and are generally considered unavoidable, so always have your medication with you." "It's likely in your best interest to move to a rural setting and explore getting a less stressful job." "Many people find that maintaining regular eating and sleeping habits is beneficial."
"Many people find that maintaining regular eating and sleeping habits is beneficial."
A 30-year-old female has suffered a third-degree burn to her hand after spilling hot oil in a kitchen accident. Which teaching point by a member of her care team is most appropriate? "It's imperative that we prevent you from developing a tolerance for opioids while you're getting treatment for your burn." "Tell us as soon as you sense the beginnings of a round of pain and we will start with analgesics." "Opioids aren't without side effects, but we will take action to manage these side effects so you can continue getting these drugs." "Opioids like morphine often cause constipation, but if this happens to you we will discontinue opioids and change to another family of medications."
"Opioids aren't without side effects, but we will take action to manage these side effects so you can continue getting these drugs."
A nurse is working at the medical booth at a marathon on a hot summer day. Which individual is at greatest risk for hyperthermia? 83-year-old spectator with congestive heart failure 56-year-old with a history of a myocardial infarction walking the marathon 25-year-old running in the marathon 13-year-old running the marathon
83-year-old spectator with congestive heart failure
The nurse evaluates which core body temperature as outside the normal range? Select all that apply. 96.8°F (36°C) 99.6°F (37.5°C) 36.2°C (97.1°F) 37.4°C (99.3°F)
99.6 *F and 96.8*F
A nurse is providing care for several clients on a neurological unit of a hospital. With which of the following clients would the nurse be justified in predicting a problem with thermoregulation? A 45 year old female with a T8 fracture secondary to a diving accident. A 68 year old male with end stage neurosyphilis. A 22 year old male with damage to his cerebellum secondary to a motorcycle accident. A 66 year old male with damage to his thalamus secondary to a cerebral vascular accident.
A 66 year old male with damage to his thalamus secondary to a cerebral vascular accident.
Infants are at greater risk of hypothermia than children because of which of the following? A high ratio of surface area to body mass An increased thickness of subcutaneous fat at birth The inability of infants to state that they are cold Their inability to remove clothing
A high ratio of surface area to body mass
Which hospital client is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)? A male client with diabetes mellitus who requires analgesia prior to each dressing change on his chronic foot wound A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident A female who has seemingly unprovoked attacks of pain that are accompanied by facial tics and spasms A woman who requires analgesia more than 3 months after an episode of shingles
A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident
Which client may be experiencing the effects of neuropathic pain? A man whose pain is caused by gastric cancer A man with pain secondary to his poorly controlled diabetes An older adult woman with a stage III pressure injury A girl whose playground accident resulted in an arm fracture
A man with pain secondary to his poorly controlled diabetes
Chronic pain is difficult to treat. Cancer, a common cause of chronic pain, has been especially addressed by the World Health Organization (WHO). What has WHO created to assist clinicians in choosing appropriate analgesics? Stepping stones for pain control A list of nonpharmacologic ways to control pain An analgesic ladder for pain control An opioid ladder for pain control
An analgesic ladder for pain control
When conducting a health assessment that focuses on the pain experienced by an older client diagnosed with early dementia, the nurse will pay particular attention to which of the following? The client's comfort level regarding the discussion of pain Behavioral signs of pain demonstrated by the client Cultural beliefs held by the client regarding the cause of pain The client's verbal perception of pain
Behavioral signs of pain demonstrated by the client
A nurse caring for a client with hypothermia anticipates that the client's temperature will be: Above 40°C (104°F) Below 100°F (37.7°C) Below 97°F (36.1°C) Below 35°C (95°F)
Below 35°C (95°F)
Nonshivering thermogenesis occurs in which of the following to help the newborn infant fight hypothermia? Epidermis Brown fat Adipose tissue Subcutaneous tissue
Brown fat
What will the nurse teach a client with trigeminal neuralgia about the condition? Surgery will relieve the condition. It is good to spend time alone every day. Carbamazepine is a first-line treatment. Avoid eating if it triggers the pain.
Carbamazepine is a first-line treatment.
What can the nurse assume about a child's behavior when faced with the need to repeat a painful procedure? Children act to avoid pain based on their memory of past painful events. Pain causes similar responses in people regardless of their age. A child will resist any intervention that involves contact with his or her body. A child will benefit from a matter-of-fact approach on the part of the nurse.
Children act to avoid pain based on their memory of past painful events.
In which client should the nurse anticipate the necessity of regulating body temperature through a heat-gain response? Select all that apply. Client with hyperthyroidism Client in a huddle position Client with diabetes Client experiencing diaphoresis
Client with hyperthyroidism Client in a huddle position
A severe type of headache that occurs more frequently in men than women and is described as having unrelenting, unilateral pain located most frequently in the orbit is called: Migraine headache Chronic daily headache Cluster headache Tension headache
Cluster headache
The loss of heat from the body through the circulation of air currents is known as: Evaporation Radiation Conduction Convection
Convection
An older adult's blood cultures have come back positive, despite the fact that the client's oral temperature remains within normal range. Which phenomena underlies the alterations in fever response that occur in older adults? Disturbance in the functioning of the thermoregulatory center Persistent closure of arteriovenous shunts Increased heat loss by evaporation Presence of comorbidities that are associated with lowered core temperature
Disturbance in the functioning of the thermoregulatory center
Drug fever is a fever that can occur with the administration of a specific drug and then disappear when the drug is discontinued. Which method indicates a way that drugs can induce fever? Select all that apply. Drugs can act as direct pyrogens. Drugs can injure tissues directly. Drugs can induce an autoimmune response. Drugs can cause heat dissipation.
Drugs can act as direct pyrogens. Drugs can induce an autoimmune response. Drugs can injure tissues directly.
In describing the ideal analgesic, what factors would be included? Select all that apply. Decrease the level of consciousness Have minimal adverse effects Addictive Effective Inexpensive
Have minimal adverse effects Effective Inexpensive
A hiker presents to the emergency department with reports of flu-like symptoms—thirst, nausea, and inability to urinate. Upon assessment, it is determined that the client has a rectal temperature of 102.2°F (39°C) and is tachycardic. These symptoms support a diagnosis of: Heatstroke Heat exhaustion Malignant hyperthermia Heat cramps
Heat exhaustion
What is the most common cause of drug fever? Impaired peripheral heat dissipation by atropine Hypersensitivity reaction to medication Serotonin syndrome Increased heat production from PTU
Hypersensitivity reaction to medication
A febrile, 3-week-old infant is currently undergoing a diagnostic workup to determine the cause of the fever. Which statement conveys the rationale for this careful examination? Commonly used antipyretics often have no effect on the core temperature of infants. Fever in infants is often evidence of a congenital disorder rather than an infection. The immature hypothalamus is unable to perform normal thermoregulation. Infants are susceptible to serious infections, because of their decreased immune function.
Infants are susceptible to serious infections, because of their decreased immune function.
A client has been diagnosed with osteomyelitis and admitted to the hospital. The client's fever persists throughout most of the day but returns to normal at least twice a day. Which pattern of fever is this client displaying? Relapsing Remittent Intermittent Erratic
Intermittent
A client's temperature readings are as follows: 99.6°F (37.5°C) at 4 pm; 102°F (38.9°C) at 8 pm; and 97.9°F (36.6°C) at 12 am. The nurse's hand-off should include which note? Remittent fever Intermittent fever Defervescence Prodromal phase
Intermittent fever
Which statement is true of migraine headaches? Migraines may have a hormonal etiology in some clients. The majority of clients have a migraine with aura. Opioid analgesics achieve adequate pain control in most clients. Surgical treatments for migraines are indicated if pharmacologic treatments are unsuccessful.
Migraines may have a hormonal etiology in some clients.
Migraine headaches affect millions of people worldwide. What are first-line agents for the treatment of migraine headaches? Sumatriptan and tramadol Caffeine and syrup of ipecac Naproxen sodium and metoclopramide Ondansetron and morphine
Naproxen sodium and metoclopramide
A client on an acute medicine unit with a diagnosis of small bowel obstruction is reporting intense, diffuse abdominal pain. Which physiologic phenomenon is most likely contributing to the client's pain? The client is experiencing neuropathic pain. Nociceptive afferents are conducting along the cranial and spinal nerve pathways of the ANS. First-order neurons are inappropriately signaling pain to the dorsal root ganglion. An overlap of nerve fiber distribution between the dermatomes is causing the pain.
Nociceptive afferents are conducting along the cranial and spinal nerve pathways of the ANS.
What will conduct injurious stimuli to alert the body to potential damage? Nociceptors Thermoreceptors Proprioceptors Odorant
Nociceptors
A two-day postoperative client's temperature was 98.5°F (36.9°C) at 3:00 pm. At 6:00 pm, the unlicensed assistant (UAP) notifies the nurse that the client's temperature is 102°F (38.9°C). Which action should the nurse take? Document the temperature. Increase intravenous fluid rate. Notify the physician. Offer the client a cold drink.
Notify the physician.
A client has a mild headache and fatigue. He also states he has some aches and pains. Which stage of fever does the nurse determine the client is experiencing? Defervescence Flush Chill Prodrome
Prodrome
An emergency nurse working in a military hospital admits a new military recruit who collapsed during a heavy training exercise in the desert. The skin is moist, the pulse is 120 beats/minute, and the respirations are 28/minute. What interventions will the nurse implement? Select all that apply. Provide fluid resuscitation. Remove client's heavy clothing. Keep the environment cool. Immerse client in an ice bath. Administer dantrolene.
Provide fluid resuscitation. Remove client's heavy clothing. Keep the environment cool.
The nurse needs to assess a 1-year-old child for fever. Which approach will produce the most accurate reading? Rectal Axillary Forehead Oral
Rectal
Following an automobile accident that resulted in a traumatic amputation of the right lower leg, the client complains of feeling tingling, heaviness, and shooting pain in the amputated limb. The health care providers treat phantom limb pain by using which interventions? Select all that apply. Use of mirrors to visualize the limb is no longer there Relaxation techniques Warm, moist compresses Hypnosis TENS of the large myelinated afferents innervating the area
Relaxation techniques Hypnosis TENS of the large myelinated afferents innervating the area
Phantom limb pain is a little understood pain that is difficult to treat, even though the client is experiencing severe pain. Which treatments will most likely help the phantom limb pain? Opioid analgesics and relaxation training Relaxation training and transcutaneous electrical nerve stimulation on the afferents in the area Biofeedback and nonsteroidal anti-inflammatory drugs Sympathetic blocks and alternating heat and cold application.
Relaxation training and transcutaneous electrical nerve stimulation on the afferents in the area
The renal excretion of drugs in children is dependent on which factors? Select all that apply. Tubular secretion Renal blood flow Urinary output Oral fluid intake Glomerular filtration rate Child's weight SUBMIT ANSWER
Renal blood flow Glomerular filtration rate Tubular secretion
A nurse is conducting a health promotion education program on heat cramps that cause painful muscle cramps. What is the likely cause of these cramps? Kidneys are unable to conserve electrolytes Salt depletion from heavy sweating Metabolic alkalosis Poor absorption of nutrients from foods
Salt depletion from heavy sweating
Which intervention would be an appropriate action for a nurse to take in attempting to decrease a client's temperature through radiation heat loss? Set the room to a lower temperature Give client a warm blanket Use a cooling blanket Decrease client's activity level
Set the room to a lower temperature
A 54-year-old man presents with a temperature of 38.8°C (101.8°F), a racing heart, fatigue, and an upset stomach after spending an afternoon building a deck on a very hot, humid day. The physician assessing the man is performing a differential diagnosis as part of her assessment. Which finding would suggest fever rather than hyperthermia as a cause of the elevation in the man's temperature? Moist skin Dizziness Shivering Cognitive changes
Shivering
Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by which region of the brain? Thalamus Autonomic nervous system Somatosensory cortex Ruffini end-organ receptors
Somatosensory cortex
A client has recently been diagnosed with chronic back pain that requires the daily use of hydromorphone, an opioid analgesic. For the first few weeks, the client achieved relief with 4 mg every 6 hours. However, the client now requires 6 mg doses to achieve the same effect. How should the nurse best interpret this phenomenon? The opioid should likely be replaced with a nonsteroidal anti-inflammatory drug (NSAID) The client is exhibiting the early signs of opioid addiction The client is developing opioid tolerance, which is expected The client's medication should be replaced with nonpharmacologic intervention
The client is developing opioid tolerance, which is expected
A client who has been exercising for a few weeks begins to sweat as soon as he exercises. What will the nurse determine from this assessment? The client should rest before continuing. The client is not able to tolerate activity. The client is reacting normally. The client has a fever.
The client is reacting normally.
A nurse caring for an older adult who has been diagnosed with a urinary tract infection checks the client's temperature on admission and finds that it is 96.6°F (35.9°C). Which statement describes how the nurse should interpret the finding? The client may be exhibiting a blunted or absent febrile response. The client's temperature is normal so the client does not have an infection. The client is exhibiting a normal febrile response to a urinary tract infection. The client's absent febrile response indicates absence of an infection. SUBMIT ANSWER
The client may be exhibiting a blunted or absent febrile response.
The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as: Saying "Ouch" when the pin is pressed. The withdrawal reflex is activated. No response when the pin is pressed. Verifying the intensity of the pin's force of compression.
The withdrawal reflex is activated.
A 33-year-old client is brought into the emergency room with a core temperature of 39°C (102.2°F). The client is red in the face, chest, and back due to significant cutaneous vasodilation. The client is likely in which stage of fever? Second First Fourth Third
Third
Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population? Base treatment of pain on gender and age group. Treat pediatric pain the way the parents want it treated. Always use nonpharmacologic pain management before using pharmacologic pain management. Treat on individual basis and match analgesic agent with cause and level of pain.
Treat on individual basis and match analgesic agent with cause and level of pain.
A client reports chronic pain. Assessment indicates it is located at the T6 dermatome. How will this information assist the nurse to develop an effective plan of care? Treatment can be tailored to the specific location. Activities of daily living (ADLs) will be compromised. Biologic treatment is more effective than psychosocial. Management can prevent referred pain.
Treatment can be tailored to the specific location.
Which characteristic differentiates a migraine with aura from a migraine without aura? Lack of response to nonpharmacologic treatments Gastrointestinal involvement in the hours leading up to the headache Visual symptoms such as flickering lights precede the headache A decrease in mood and affect prior to the headache
Visual symptoms such as flickering lights precede the headache
Which risk factor presents the greatest risk for injury in an older adult client who is experiencing a dysfunction in temperature regulator function? delayed initiation of appropriate treatment acute dementia acute kidney injury misdiagnosis of pathology SUBMIT ANSWER
delayed initiation of appropriate treatment
Stretch-sensitive receptors in the skin (Ruffini end organs, Pacinian corpuscles, and Merkel cells) help signal postural information and are processed through the: posterior column of the spinal cord. anterolateral pathway. third-order neurons. dorsal column-medial lemniscus pathway.
dorsal column-medial lemniscus pathway.
A client has sought care because of recent malaise and fever. Upon assessment, the client states that for the past week there has been a cycle of high fever in the evening but normal temperature in the mornings. Which fever pattern will the nurse document? intermittent fever recurrent fever sustained fever remittent fever
intermittent fever
The nurse instructs the unlicensed assistive personnel (UAP) to be sure to turn the client every 2 hours to avoid pressure on the skin and avoid a pressure injury. What type of stimuli is the nurse encouraging the UAP to avoid? chemical stimuli mechanical stimuli thermal stimuli pain stimuli
mechanical stimuli
A client is said to be in the chill stage of the fever process when the nurse: determines the client will benefit from a cool sponge bath. observes the client is sweating. administers an antipyretic medication. observes piloerection on the skin.
observes piloerection on the skin.
While sponging a client who has a high temperature, the nurse observes the client begins to shiver. At this point, the priority nursing intervention would be to: increase the room temperature by turning off the air conditioner and continue sponging the client with warmer water. administer an extra dose of aspirin. place a heated electric blanket on the client's bed. stop sponging the client and retake a set of vital signs.
stop sponging the client and retake a set of vital signs.
