Patho Final - 35

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?

"Does your son have any food allergies that have been identified?"

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" Which of the following is an appropriate response from the nurse?

"Get a Zostavax vaccination."

A beta-adrenergic blocker has been prescribed for a client diagnosed with migraines. The most important information for the nurse to teach the client would be:

"Take the medication daily as you have been directed."

A nurse is assessing the pain level of a client who has just had surgery. The client tells the nurse he does not think he should take any medication until the pain becomes extreme. The best response would be:

"The use of pain medication before the pain becomes extreme will help prevent hyperexcitability of the CNS."

A diabetic client has developed diabetic neuropathy and is prescribed pharmacologic intervention. The medication most likely to be prescribed would be a:

Antiseizure

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 co-morbids 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?

Assessment and treatment are possibly complicated by the large number of drugs that the client receives.

A client has been seen in the clinic with severe recurring sharp, stabbing pain in the face that begins after brushing teeth or being exposed to cold air. The client states that he feels no numbness. What medication does the nurse anticipate educating this client regarding?

Carbamazepine (Tegretol)

The client asks the health care provider to explain what the purpose is for the application of cold to a sprained ankle. The best response would be:

Cold provides pain relief and suppresses the release of products from tissue damage.

A client is being taught how to use a TENS unit .The nurse determines that teaching was effective when the client states:

Correct response: "I should take my medication and apply the TENS unit to the painful area as soon as I feel the pain."

The nurse instructs the certified nursing assistant (CNA) to be sure to turn the client every 2 hours in order to avoid pressure on the skin and avoid a pressure ulcer. What type of stimuli is the nurse encouraging the CNA to avoid?

Correct response: Mechanical stimuli

Stretch-sensitive receptors in the skin (Ruffini end organs, Pacinian corpuscles, and Merkel cells) help signal postural information and are processed through the:

Dorsal column-medial lemniscus pathway

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:

Explain that many amputees have this sensation and that one theory surmises the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site.

When giving pain medicine for acute pain, health care workers are reluctant to provide much needed opioid pain medicine. What is the major concern of health care workers when providing opioid pain relief?

Fear of addiction

Which of the following would be an example of a child born with congenital insensitivity to pain? A child that:

Fell off a skate board and fractured ankle but did not feel any pain, just noted swelling in foot.

n assessing a patient with a cerebral infarct for sensation, which of the following results would a nurse find that would indicate that third-order neurons are intact?

Identifying a scent

The nurse knows that chronic pain lacks which of the characteristic pain-related reactions?

Increased heart rate

A patient reports a sudden intense headache. Which of the following factors would indicate the presence of a possible subarachnoid hemorrhage?

Intractable pain

A nurse on a post-surgical unit is providing care for a 76 year-old female client who is two days post-hemiarthroplasty (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?

Knowing that the client's self-report of pain is the most reliable indicator of pain.

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?

Meissner corpuscles

Select the tactile receptors that are sensitive to the movement of very light objects over the surface of the skin.

Meissner corpuscles

Which of the following explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?

NSAIDs block the enzyme that synthesizes prostaglandins.

A patient experiencing phantom limb pain after a traumatic amputation finds that opioids, biofeedback, a transcutaneous electrical nerve stimulation unit, and relaxation therapy are all needed to reduce the pain to a tolerable level. Which of the following pain theories is best supported by this event?

Neuromatrix

A client on 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?

Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS.

Which of the following will conduct injurious stimuli to alert the body of potential damage?

Nociceptors

When a peripheral nerve is irritated enough, it becomes hypersensitive to the noxious stimuli, which results in increased painfulness or hyperalgesia. Health care professionals recognize both primary and secondary forms of hyperalgesia. What is primary hyperalgesia?

Pain sensitivity that occurs directly in damaged tissues

Which tract in the spinal cord conducts the diffuse, dull, aching sensations that are associated with chronic and visceral pain?

Paleospinothalamic tract

A patient reports feeling a tingling sensation in the last two fingers of one hand after hitting the inner surface of the elbow on a desk. Which of the following is the cause of this symptom?

Paresthesia from temporary nerve compression

A nurse assesses a patient with a cerebral infarct for sensation. Which of the following results indicates that second-order neurons are intact?

Patellar reflex +2

The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by which of the following?

Second-order neurons

A client is experiencing a cluster headache. The client would most likely manifest:

Severe pain behind the eye

The nurse is providing nonpharmacologic pain relief for a client who has a pain level of 2 in the leg. What intervention provided by the nurse would be considered distraction?

Sitting with the client and having a conversation

Following a knee injury, a football player is taking ibuprofen, a non-steroidal 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?

The drug inhibits the enzyme needed for prostaglandin synthesis.

A mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating their 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?

The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first.

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:

The withdrawal reflex is activated.

Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population?

Treat on individual basis and match analgesic agent with cause and level of pain.

A client with a history of migraine headaches tells the physician that he or she usually experiences an aura before the onset of the headache. The client is most likely experiencing:

Visual disturbances

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?

an analgesic ladder for pain control

Which of the following conditions or events commonly trigger neuropathic pain? Select all that apply.

• Diabetes mellitus • Shingles

A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be:

"Pain threshold is the point at which a stimulus is perceived as painful."