Patho: Chapter 35

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 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 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 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."

An elderly client is experiencing pain and is concerned about how the pain will be managed. The nurse is aware that the first line of therapy for managing pain in the elderly would be:

Acetaminophen

The nurse is caring for a client who has returned from surgery after having a colon resection. What is the best method for the nurse to use when administering an opioid for pain in order to optimize pain control?

Administer the opioid preemptively and before pain becomes extreme.

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.

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?

Behavioral signs of pain demonstrated by the client

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.

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 what?

Cluster headache

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.

The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. The best strategies for the nurse to implement would be: Select all that apply.

• Bubbles • Music • Television • Games

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.

Select the most appropriate pain assessment tool for a health care provider to use when caring for children between the ages of 3 to 7 years old.

Faces pain scale

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

With which of the following activities would a patient experiencing astereognosis need help?

Identifying an object by touch

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

Increased heart rate

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

Referred

If the patient's dorsal columns are not functioning, the nurse will observe which of the following responses during neuro testing, where the nurse asks the patient to close their eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points?

No response to two-point discrimination.

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?

Nociceptive afferents are conducting 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

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

Paleospinothalamic tract

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

Which of the following patients is exhibiting headache symptoms that indicate a need for further evaluation?

Pregnant mother with drowsiness and unrelenting headache

When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used?

Pressure from a sharp object

Which of the following skin receptors communicate the sensation of heavy and continuous touch and pressure?

Ruffini's end organs

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

Severe pain behind the eye

A 7 year old child had an emergency appendectomy during the night. When trying to assess their pain, the nurse should:

Show them a scale with faces of actual children and have them point to the picture that best describes how they are feeling.

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

• Diabetes mellitus • Shingles

A client who is being treated for chronic low back pain is using a TENS unit for relief of pain. The nurse is aware that the use of this device is considered what type of pain relief?

Stimulus-induced analgesia

A client is experiencing acute pain. The nurse would anticipate the client to manifest:

Tachycardia

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to non-medication centered therapy?

Tension

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items?

The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron

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.

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 patient 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.

A 58-year-old woman comes to the clinic for evaluation of a sharp, intermittent, severe, stabbing facial pain that she describes as, "like an electric shock." The pain occurs only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain?

Trigeminal neuralgia

A client is admitted to the acute care facility with severe pain in the abdomen related to inflammatory bowel disease. What type of pain will the nurse be administering medication to relieve?

Visceral pain

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

• Renal blood flow • Glomerular filtration rate • Tubular secretion

While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options.

• Thalamus • Dorsal root ganglion body • Dorsal root ganglion periphery • Axon • Cerebral cortex

The nurse is reviewing a food diary for a client who has migraine headaches. Which foods identified by the nurse may be triggers for the onset of a migraine headache? Select all that apply.

• Beef and broccoli from the Chinese restaurant • Hamburgers with bleu cheese crumbles • Chocolate candy bar