Chapter 14: Somatosensory Function, Pain, Headache, and Temperature Regulation

A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which statement is most accurate?

"Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus."

In describing the ideal analgesic, what factors would be included? Select all that apply

Inexpensive Have minimal adverse effects Effective

In which client with a transecting spinal cord injury should the nurse anticipate an impaired ability for temperature regulation?

Injury at T2

Which statement explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?

NSAIDs block the enzyme that synthesizes prostaglandins.

What will conduct injurious stimuli to alert the body to potential damage?

Nociceptors

The nurse is teaching a client about various methods of pain control. Which information will the nurse include when teaching the client about applying heat for pain control?

"Heat promotes more blood flow to the area to improve oxygen supply."

The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate?

"Many people find that maintaining regular eating and sleeping habits is beneficial."

A nurse assessing an older adult 3 hours postoperative notes guarding, grimacing, and stiff body movement when changing positions. The client denies feeling pain. Which response will help the nurse best manage this client's pain?

"You seem to be uncomfortable. Pain is common with surgery. I can bring you pain medication."

Which temperature readings indicate to the nurse that the clients have fever? Select all that apply.

3-day-old with rectal reading of 38ºC (100.4ºF) 35-year-old with pulmonary artery reading of 37.9ºC (100.2ºF) 19-year-old with oral reading of 38.4ºC (101.1ºF)

A nurse is teaching a parent how to take an axillary temperature on the child. The nurse indicates that the glass thermometer should be held in the axillary fossa for which amount of time?

5-10 minutes

A client reports general malaise and has a temperature is 103.8°F (39.9°C). What is the rationale for administering a prescribed aspirin, an antipyretic, to this client?

Antipyretics protect vulnerable organs, such as the brain, from extreme temperature elevation.

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. The nurse anticipates educating this client about which medication?

Carbamazepine

What will the nurse teach a client with trigeminal neuralgia about the condition?

Carbamazepine is a first-line treatment.

The provider is testing the client's ability to identify the specific location of skin touch in two different areas. This ability is communicated through which pathway?

Discriminative

Which intervention would be considered a nonpharmacologic method of pain control? Select all that apply.

Distraction by knitting Guided imagery Biofeedback

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

Sometimes recurrent fevers occur but do not follow a strictly periodic pattern. Causes of these recurrent fevers include genetic disorders such as familial Mediterranean fever. What are the characteristics of familial Mediterranean fever?

Early age of onset (<20 years) and high fever

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.

Keep the environment cool. Remove client's heavy clothing. Provide fluid resuscitation.

A normal response to fever is an elevated heart rate. A client with a fever who is not exhibiting an elevated heart rate would indicate to the nurse that the cause of the fever might be:

Legionnaires' disease

Which statement is true of migraine headaches?

Migraines may have a hormonal etiology in some clients.

An older adult client with a history of chronic obstructive pulmonary disease (COPD) develops a fever of 38.3ºC (101ºF). What is the primary reason for the nurse to implement temperature-lowering measures?

Reduce oxygen demand

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

Paresthesia from temporary nerve compression

A nurse assesses a client with a cerebral infarct for sensation. Which result indicates that second-order neurons are intact?

Patellar reflex +2

Place the four successive stages of fever in correct order.

Prodromal Chill Flush Defervescence

When assessing a newborn (7 days old), which finding indicates the infant may have a bacterial infection?

Rectal temperature of 100.4°F (38°C).

A nurse reading a client's history and physical notes that the client has had a remitting fever. The nurse interprets this to mean that the client's temperature has done what?

Remained elevated but varied a few degrees

The renal excretion of drugs in children is dependent on which factors? Select all that apply.

Renal blood flow Glomerular filtration rate Tubular secretion

The nurse is caring for a client with acute pain from broken humerus. Which direction will the nurse provide the client related to pain management?

Requesting pain medication before the pain is severe can reduce how much medication is needed.

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?

Salt depletion from heavy sweating

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

Second-order neurons

The nurse is conducting a community education course on hyperthermia and heatstroke. The nurse determines that the participants understand the information when they state that which bodily function increases core temperature?

Shivering

Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by which region of the brain?

Somatosensory cortex

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.

TENS of the large myelinated afferents innervating the area Hypnosis Relaxation techniques

Which client manifestation indicates signs of drug fever?

Temperature reaches 40°C (104°F) every afternoon, pulse 76 beats/minute, pruritis

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

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy?

Tension

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 is reacting normally.

The medical team is assessing a newly admitted client who is hypothermic following a night spent lost on a ski slope. The health care professionals would recognize that which phenomenon most likely contributed to minimizing the client's heat loss in a cold environment?

The tissue thickness of the outer shell increased and preserved heat.

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.

A nurse is assessing a client for manifestations of chronic pain. Which finding is characteristic of chronic pain? Select all that apply.

Withdrawal from activities Mental depression Loss of appetite

A client with trigeminal neuralgia usually complains of excruciating pain. Which activities may trigger an acute pain attack? Select all that may apply.

Working in the office that has an air duct located directly overhead Spouse other lightly stroking his or her face Walking outside on a windy day

Which symptom indicates the next stage of a fever after a prodrome?

a chill

A client diagnosed with moderate hypothermia would likely experience the instillation of warmed fluids into the gastrointestinal tract and extracorporeal blood warming. This type of rewarming is referred to as:

active core

The loss of heat from the body through the circulation of air currents is known as:

convection

A nurse assess an older adult client for signs and symptoms of infection. In the absence of a fever, for which will the nurse assess? Select all that apply.

decreased mental status change in functional capacity fatigue

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

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.

Which assessment finding correlates to the prodromal stage of a fever?

fatigue

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

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?

intermittent fever

In the hospital setting, one of the best ways to lower the fever in a client with hyperthermia would be to facilitate conduction of heat from the body by:

placing the client on a cooling mattress that circulates a coolant solution through the mattress.

Which stimulus would be used to elicit the withdrawal reflex when testing response to nociceptive stimuli?

pressure from a sharp object

A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:

referred

A hospital client who is being treated for acute kidney injury has developed an oral temperature of 39.1°C (102.4°F) despite the absence of other signs and symptoms of infection. When attempting to determine the etiology of the client's fever, the nurse should:

review the client's recent medication history.

Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, are often used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. The use of aspirin is limited in children, however, because it can sometimes cause which disease?

reye symptoms

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

severe pain behind the eyes

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:

stop sponging the client and retake a set of vital signs.

When lecturing about heart attacks (myocardial infarctions), the instructor will emphasize the client may present with: Select all that apply.

substernal chest pain. neck pain. pain that radiates to the left arm.

A client has an increase in core temperature. What does the nurse expect to assess with this finding? Select all that apply.

sweating Dilation of superficial blood vessels

A client is experiencing anorexia, myalgia, arthralgia, headache, and fatigue. The nurse should assess for:

temperature

Which client(s) is showing manifestations of infection? Select all that apply.

75-year-old client with temperature 37.3°C (99.2°F), declining mental status, weakness and fatigue 25-year-old client with temperature 40°C (104°F), sweating, shivering, states generalized pain 2-month-old client with temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis

A recovery room nurse monitoring a client for adverse effects of cold cardioplegia assesses for:

Ventricular dysrhythmia