NSG-316 QUIZ 3
Which question would the nurse ask the patient with rheumatoid arthritis to evaluate the effectiveness of corticosteroid therapy? "When did your pain start?" "What does this pain mean to you?" "Why do you think you are having pain?" "What makes your pain better or worse?"
"What makes your pain better or worse?" To identify the effectiveness of the treatment, the nurse would ask the patient what makes the pain better or worse. It helps the nurse determine whether the treatment provided to the patient is effective in alleviating pain. The nurse asks the patient when the pain started to identify the onset and duration of the pain, but this does not help evaluate the effectiveness of the treatment. Asking questions like what pain means to the patient and what the patient thinks to be the cause of pain helps the nurse identify the pain myths and misconceptions the patient may believe.
Which statement made by the student nurse indicates effective learning when differentiating between A and C peripheral fibers? A fibers are myelinated, and C fibers are unmyelinated A fibers are smaller in diameter, and C fibers are larger diameter A fibers transmit signal slowly, and C fibers transmit signals rapidly A fibers cause diffuse sensation, and C fibers cause localized sensations
A fibers are myelinated, and C fibers are unmyelinated A fibers are myelinated, whereas C fibers are unmyelinated. A fibers are larger, whereas C fibers are smaller in diameter. Because A fibers are larger in diameter, they transmit signals more rapidly to the CNS compared with the smaller C fibers. The sensation caused by the stimulation of A fibers are localized, whereas the sensations caused by the stimulating of C fibers are diffuse
Patients with which conditions are at risk for chronic nonmalignant pain? SATA A patient with arthritis A patient with fibromyalgia A patient with low back pain A patient with thyroid disorder Skin infection
A patient with arthritis A patient with fibromyalgia A patient with low back pain Arthritis, low back pain, and fibromyalgia are all musculoskeletal disorders that are associated with severe nerve and tissue damage, and which result in chronic nonmalignant pain. Skin infection and thyroid disorder are not associated with nerve damage and may not cause chronic nonmalignant pain. Skin infection may result in acute pain due to inflammation and tissue damage. Thyroid disorder is associated with low serum thyroxine levels resulting in impaired metabolism
Which pathologic disorders are associated with nociceptive pain? Arthritis Mechanical back pain Central poststroke pain Carpal tunnel syndrome Complex regional pain syndrome
Arthritis Mechanical back pain Arthritis and mechanical back pain are the physiologic disorders associated with nociceptive pain. Central poststroke pain, carpal tunnel syndrome, and complex regional pain syndrome are physiologic disorders associated with neuropathic pain.
The nurse is caring for a diabetic patient with peripheral neuropathy. Which finding will the nurse expect to observe in this patient? Burning pain in feet bilaterally Brittle nails with pale, shiny, dry skin Severe stabbing or piercing pain in face Burning, shooting pain in glove-and-stocking manner
Burning pain in feet bilaterally The diabetic patient with peripheral neuropathy shows symptoms of burning pain in the feet bilaterally, which worsens during the night. The patient with reflexive sympathetic dystrophy has brittle nails, and the skin appears pale, dry, and shiny. Patients with trigeminal neuralgia have severe stabbing or piercing pain in the facial area. Cancer patients who undergo chemotherapy may develop chemotherapy-induced peripheral neuropathy. This symptoms manifests as burning, shooting pain in glove-and-stocking manner
Which conditions are associated with visceral pain? SATA Arthritis Appendicitis Fibromyalgia Cholecystitis Kidney stones
Cholecystitis Appendicitis Visceral pain results from the activation of nociceptors of visceral organs. Pain associated with appendicitis and cholecystitis is visceral pain. Chronic nonmalignant pain is often associated with musculoskeletal conditions such as arthritis and fibromyalgia. Pain caused by kidney stones is an example of acute pain.
Which criteria are assessed using the PAINAD pain assessment scale? SATA Visual acuity Consolability Facial expression Hearing ability Body language
Consolability Facial expressions Body language While using the PAINAD assessment tool, the nurse would monitor fiver parameters: breathing, vocalization, consolability, facial expression, and body language. Because of the pain, the pt may suffer from hypoxia and hyperventilation. The nurse would check the patient's breathing rate. The pt may make a whimpering sound in response to pain, so the nurse would monitor vocalization. The patient may be confused because of the dementia and may not be open to suggestions. Therefore, the nurse would check if the patient is consolable. The patient may exhibit a facial grimace in response to pain and may change the body posture to promote comfort so the nurse would monitor facial expressions and body language. Pain does not impair visual acuity and does not cause hearing impairment. Therefore, the nurse need not the pt's vision and hearing
Which statement is correct regarding the care of these patients? Pt.1 Patient has mechanical back pain and complains of deep squeezing pressure on the back Pt. 2 Patient has neuropathic back pain and complains of constant burning and stabbing sensation Pt. 3 Patient has bone metastasis neuropathy Pt. 4 Patient has arthritis and complains of a localized dull ache in the knees A. Pt 1 requires antidepressant drug for pain relief B. Pt 2 requires muscle relaxant drugs for pain relief C. Pt 3 requires corticosteroids for pain relief D. Pt 4 requires non steroidal anti-inflammatory drugs for pain relief
D. Pt 4 requires non steroidal anti-inflammatory drugs for pain relief Patient 4 has arthritis, which is associated with nociceptive somatic pain. Therefore the nurse anticipates that inflammation and pain association with arthritis. Therefore, the nurse anticipates that patient 4 should be prescribed NSAIDs. Patient 1 has mechanical back pain, which is associated with nociceptive pain. Muscle relaxants relieve muscle spasm and alleviate pain. Antidepressant drugs do not provide muscle relaxation and alleviate back pain. Therefore the nurse does not anticipate antidepressants to be prescribed to PT1. Pt 2 has neuropathic pain, which can be alleviated with local anesthetics but not muscle relaxants. Pt 3 has cancer pain. Opioid drugs, not corticosteroids, alleviate cancer pain
The nurse asks the patient with lower back pain, "How does the pain limit your daily activities?" to determine which aspect of the patient's pain experience? Quality of pain Degree of impairment Onset and duration of the pain Preconceived notions of pain and meds
Degree of impairment Questions on how pain limits the patient's function or activities help the nurse identify its effect on the quality of life.
Which pain assessment tool is appropriate for a 2 yrs old pt? FLACC CRIES PAINAD Faces pain scale-revised
FLACC The FLACC is a nonverbal pain assessment tool that is used to assess the intensity of pain in infants and children under 3 years of age by observing facial expression, leg movement, activity level, cry, and consolability in the child; the scale gives a score from 0 to 10. The CRIES scale is a 3-point scale that helps assess postoperative pain in preterm infants and neonates. The PAINAD scale is a pain assessment tool that helps measure pain in patients with dementia. It uses breathing, vocalization, and facial expression as assessment tools. Faces Pain Scale-Revised (FPS-R) is a pain assessment tool that helps assess the intensity of pain through drawings of different facial expressions
Which pain scale would the nurse use to assess the pain level in a 6-year-old child? Faces pain scale Visual analog scale Numeric rating scale Verbal descriptor scale
Faces pain scale Children over the age of 5 yrs old can use the faces pain rating scale. The visual analog scale lets the pt make a mark on a 10-cm horizontal line.
Which examination visualizes neurochemical changes in the brain caused by nociception? X-ray examination (x-ray film) Computerized axial tomography (CAT) scan Functional magnetic resonance imaging (fMRI) Traditional magnetic resonance imaging (MRI)
Functional magnetic resonance imaging (fMRI) Functional magnetic resonance imaging (fMRI) determines the structural, functional, and neurochemical changes caused in the brain by nociception. The x-ray examination, computerized axial tomography (CAT) scan, or traditional magnetic resonance imaging (MRI) cannot help in determining the neurochemical changes in the brain that lead to pain perception.
Which associated disorders may be found in a patient with neuropathic pain? SATA Herpes zoster Liver metastasis Postoperative pain Trigeminal neuralgia Distal polyneuropathy
Herpes Zoster Trigeminal neuralgia Distal polyneuropathy Those three disorders cause neuropathic pain because they cause primary lesion, called neuroma, and damage the nervous system. Liver metastasis is visceral damage that results in nociceptive pain. Postoperative pain is somatic damage that causes nociceptive pain
Which neurotransmitters are released at the site of injury? Select all that apply. Glutamate Histamine Bradykinin Prostaglandin Gamma-aminobutyric acid
Histamine Bradykinin Prostaglandin Histamine, bradykinin, and prostaglandin are the neurotransmitters that are released at the site of injury. These neurotransmitters send the signal of pain to the spinal cord. Glutamate and gamma-aminobutyric acid are released from the brain and block the transmission of pain impulses.
The patient reports severe lower back pain while standing for the past 2 days. The nurse documents which type of pain?Chronic Incident Malignant Breakthrough
Incident Incident pain is a type of acute pain caused by certain body movements. Lower back pain while standing indicates that the patient is having incident pain. If a patient experiences lower back pain for more than 6 months, which is not the case here, then it indicates chronic pain. Breakthrough pain occurs in patients who undergo opioid therapy; the patient experiences sudden pain because of the reduced half-life of the medication. Malignant pain is a type of chronic pain; it is induced by tissue necrosis or by the stretching of an organ by a growing tumor.
After assessing pain in a 2-year-old child, the nurse documents the score as 5, using the FLACC scale. Which pain level is this patient experiencing? None Mild Moderate Severe
Moderate The FLACC scale is an objective assessment of pain in children under 3 years of age. The tool assesses five behaviors of pain: facial expression, leg movement, activity level, cry, and consolability. A score range of 4 to 6 indicates that the child has moderate pain. As the documented score falls within this range, the nurse interprets that the patient may have moderate pain. The score of 0 indicates that the child is relaxed and comfortable and is not experiencing any pain. The score range of 1 to 3 indicates that the child has mild pain. The score range of 7 to 10 indicates that the child has severe pain.
Opioids inhibit which part of nociception? Secretion of glutamate and adenosine triphosphate at the synaptic cleft Secretion of histamine, bradykinin, and prostaglandins at the site of injury Movement of the pain impulse across the synaptic cleft to the dorsal horn Movement of the pain impulses from the spinal cord to the thalamus via the ascending fibers
Movement of the pain impulses from the spinal cord to the thalamus via the ascending fibers Opioid analgesics activate the opioid receptors located in the spinal cord and block the transmission of the pain impulses from the spinal cord to the thalamus; this occurs in the second phase of nociception. The secretion of histamine, bradykinin, prostaglandin, glutamate, and ATP takes place during the first phase. The opioid analgesic do not inhibit the events of the first phase, because they do not block the receptors that secrete histamine, bradykinin, prostaglandin, and glutamate. The transmission of the pain impulses across the synaptic cleft to the dorsal horn neurons takes place because of the secretion glutamate and ATP. Because the opioid analgesics do not inhibit the secretion of glutamate, they do not hinder the transmission of the impulses across the synaptic cleft to the dorsal horn neurons.
A patient with carpal tunnel syndrome reports having a tingling and burning sensation in the thumb, middle, and index fingers. Which type of pain would the nurse report to the provider? Referred Cutaneous Nociceptive Neuropathic
Neuropathic The presence of a tingling burning sensation in the thumb, middle, and index fingers indicates that the pt has neuropathic pain. It is caused by impaired processing of the pain impulses from the site of injury to the nerve fibers. The pt with referred pain has an injury at a particular site, but experiences pain at other sites of the body. Referred pain is caused by damage to spinal nerve, which sends signals to two different parts of the body. If the patient has pain resulting from skin surface damage, it indicates that the pt has cutaneous pain. Nociceptive pain is associated with aching, throbbing, and cramping sensation. Because the pt does not report having any aching or throbbing sensation, the nurse would not interpret that the patient has nociceptive pain.
The aging patient with dementia appears agitated and is pacing and yelling. Which would the nurse infer as the cause of the agitation? Pain Worsening Med overdose Decreased prostaglandins levels
Pain When a patient with dementia experiences pain, he or she may exhibit agitation, pacing, and repetitive yelling. These findings do not indicate an exaggeration of dementia in the patient. Medication overdose may not cause agitation, pacing, and repetitive yelling, but causes other systemic symptoms. The pain worsens because of increased prostaglandin levels, not decreased prostaglandin levels.
Which pt has referred pain? Patient 1: Deep, aching, and throbbing pain due to skin burns Patient 2: Menstrual pain and complains of severe vomiting Patient 3: Acute appendicitis and complains of severe pain in the umbilical area Patient 4: Shoulder fracture and complain of deep prickling sensation.
Patient 3 Refered pain is pain that is experienced at a site different from the origin of injury. The patient with appendicitis has an inflamed appendix in the lower right of the abdomen but has the sensation of pain in the umbilical area. Therefore, it indicates that the patient has referred pain. Patient 1 has deep, throbbing pain because of skin burns. Therefore, this finding indicates that the patient has cutaneous pain. Pt 2 has menstrual pain along with severe vomiting, which indicates tat the pt has somatic pain. Pt 4 has pain because of a shoulder fracture, which indicates that
Which phase of the nociceptive pain signifies the conscious awareness of a painful sensation in the patient? Perception Modulation Transduction Transmission
Perception Perception is the third phase of nociceptive pain, and it signifies the conscious awareness of a painful sensation in the patient. During this phase, the limbic system interprets the noxious stimuli and elicits emotional responses to pain in the pt. During the modulation phase, the body slowly reduces the pain by stopping the processing of a painful stimulus. During the transduction phase, the pain signals are transmitted from the site of injury to the spinal cord. During the transmission phase, the pain signals move from the spinal cord to the brain; they do not elicit emotional responses to pain
A patient with joint pain has edema and skin discoloration at the knees. The patient feels severe knee pain when the nurse touches the affected area with a cotton swab. The nurse also observes the patient has pale, dry, shiny skin and brittle nails. Which medication would be helpful in treating this patient? Aspirin Pregabalin Prednisone Amitriptyline Acetaminophen
Pregabalin Prednisone Amitriptyline The presence of pale, dry skin, brittle nails, joint pain, edema, and discoloration of the affected extremity indicates that the patient has complex regional pain syndrome (CRPN). Damaged nerves result in impaired functioning of the sensory, motor, and autonomic nerves. Due to nerve damage, the patient feels severe pain even with the contact of a cotton swab. Pregabalin, prednisone, and amitriptyline block the pain impulses from the damaged nerves and help to alleviate pain and inflammation. Therefore, the primary health care provider would prescribe these medications to the patient. Aspirin and acetaminophen reduce prostaglandin levels and alleviate nociceptive pain. These drugs do not repair damaged nerve fibers and do not alleviate neuropathic pain.
Which is characteristic of C fibers? A large diameter Presence of a myelin sheath Rapid transmission of pain signals Presence of diffused sensation
Presence of diffused sensation C fibers are unmyelinated sensory fibers that cause pain signals to be more diffuse, The C primary sensory fibers produce a diffused and aching sensation. Because of the absence of Schwann cells, these fibers are not covered with a myelin sheath. Because the C primary sensory fiber is unmyeilinated, it has a smaller diameter and transmits signals slowly.
A patient with a severe muscle cramp tells the nurse, "The pain is a little better when I massage the muscle or apply a cold pack." Which criterion of the PQRST method of pain assessment is addressed in the patient's statement? Severity scale Quality/Quantity Region/Radiation Provocation/Palliation
Provocation/Palliation PQRST is an assessment scale; it stands for Provocation/Palliation, Quality/Quantity, Region/Radiation, Severity Scale, and Timing. Because the pt is describing methods that provide comfort and relieve the pain, it indicates that the patient Is addressing Provocation/Palliation. If the pt reports about severity of pain on a sale of 0-10, then it indicates that the pt is addressing Severity. When addressing the quality/quantity of the pain, the patient describes the pain felt. If the pt reports about the site of pain, then the pt is addressing Region/radiation
After assessing a patient, the nurse concludes that the patient has deep somatic pain. Which patient finding would support the nurse's conclusion? Tendinitis Stomach and intestinal pain Back pain upon changing positions Coronary syndrome with pain in the next
Tendinitis Tendinitis is the inflammation of tendons, which causes deep somatic pain. Intestinal pain and severe stomach cramps indicates visceral pain. Pain felt by the pt while chasing position is an indicator of indecent pain. If the pt has coronary disease experiences pain in the next, then it indicates that the patient has referred pain
While assessing pain in a patient the nurse asks about the effects of pain on the patient's mood, walking, functional ability, and sleep in the past 24 hours. Which pain assessment scale is the nurse using in the examination? Initial Pain Assessment Verbal Descriptor Scale The Brief Pain Inventory The McGill Pain Questionnaire
The Brief Pain Inventory The nurse is using a Brief Pain inventory scale. The patient can rate the pain using these graduations based on the effect of pain in mood, walking, ability, and sleep in the past 24 hrs. In the initial pain assessment, the nurse asks questions concerning location, intensity, and duration of pain. The nurse would ask the pt to describe the feelings about the intensity of pain when using the verbal descriptor scale. In the McGill Pain Questionnaire, the nurse asks the pt to rank a list of descriptors in terms of their intensity and to give an overall intensity rating of pain
Which phase of nociceptive pain involves the release of bradykinin and prostaglandins? Perception Modulation Transmission Transduction
Transduction During the transduction phase, bradykinin and prostaglandins are released from the injured tissues. These chemicals transmit pain signals from the injury site to the spinal cord. Perception is the third phase of nociception and is associated with conscious awareness of a painful sensation. The modulation phase is associated with alleviation of the pain stimulus, because there is no release of bradykinin and prostaglandins from injured tissues. During the transmission phase, endogenous opioids are released which activate opioid receptors and block the transmission of pain impulses.
