patho exam 7

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

• Surgery • Osteoarthritis • Chemical burn

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 which of the following interventions? Select all that apply.

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

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.

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.

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 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

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

Carbamazepine is a first-line treatment.

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."

A nurse is assessing the pain level of an adult with the use of a visual analog scale. Select the response that best indicates the client's rating using this tool.

"My pain level falls above the 5-cm mark."

A 30 year-old female has suffered a third-degree burn to her hand after spilling hot oil on it in a kitchen accident. Which of the following teaching points by a member of her care team is most appropriate?

"Opioids aren't without side effects, but we will take action to manage these side effects so you can continue getting these drugs."

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 client arrives in the clinic and informs the nurse that he is having pain in the left knee that has lasted for several weeks. The physician orders an x-ray of the left hip and knee. The client tells the nurse that the pain is in the knee, not the hip. What is the best response by the nurse?

"The pain you are having may be referred pain, which can cause the pain in the knee resulting from a hip problem."

A 60 year-old male client with a long history of back pain has had little success with a variety of analgesic regimens that his family physician has prescribed. He has recently been diagnosed with a chronic pain disorder. Which of the following teaching points about chronic pain would his physician most likely emphasize to the client?

"These pain signals your body is sending likely serve no real, useful, or protective function."

Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)?

A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident.

A nurse who is testing a patient's response to passive movement of the fingers with the patient's eyes closed, notes that the patient cannot accurately identify on which side the movement occurred or in what position the finger was placed. Which of the following is an appropriate interpretation of this result?

Abnormal discrimination pathway function

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

A client fell from a ladder and broke his ankle and is being seen in the emergency department for severe ankle pain with swelling and limited range of motion. What type of pain does the nurse recognize the client experiencing?

Acute pain

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

Using surgery to relieve severe, intractable pain has been successful to a degree. What can surgery be used for when a person is in pain?

Block transmission of phantom limb pain

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)

A patient with multiple sclerosis complains of chronic burning and aching pain. Which of the following explains the cause of this type of pain?

Damage causing central mechanisms to respond to pain abnormally

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

Intractable pain

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

• Inexpensive • Have minimal adverse effects • Effective

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.

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 tactile receptors will signal continuous touch on the skin?

Merkel discs

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

NSAIDs block the enzyme that synthesizes prostaglandins.

Migraine headaches affect millions of people worldwide. What are first-line agents for the treatment of migraine headaches?

Naproxen sodium and metoclopramide

Which of the following types of pain is characterized by severe, brief, often repetitive pain?

Neuralgia

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 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

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

Referred

A female client with bone metastases secondary to lung cancer is admitted for palliative radiation treatment and pain control. The client is presently experiencing pain that she rates at 9 out of 10. Which of the following non-pharmacological treatments is most likely to be a useful and appropriate supplement to pharmacological analgesia at this point?

Relaxation and distraction

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

Ruffini's end organs

Which tactile receptors will signal when an athlete experiences a joint injury?

Ruffini's end organs

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

Severe pain behind the eye

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

Tension

Which of the following is an accurate method of assessing pain in children ages 3 to 8 years?

Using a faces scale

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 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

Nonopioids, such as acetaminophen (Tylenol), are the first line of therapy for managing mild to moderate pain in the elderly because they are safe.

True

The nurse is testing her patient's tactile sensation. She knows that the pacinian corpusles are functioning when the patient reports which of the following sensations?

Vibration

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

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

Which of the following patients is an example of referred pain? Select all that apply.

• One with a myocardial infarction who states, "an elephant is sitting on my chest." • One with gallstones who states, someone is stabbing between my shoulder blades." • One with renal calculi who describes a cramping colicky pain in the scrotum.

While talking about their migraine headaches, two women have found that they have some common triggers for their migraines, which may include: Select all that apply.

• At the time of their menstrual cycle • Consuming chocolate

Which of the following chemical mediators directly stimulate nociceptors to produce a pain response? Select all that apply.

• Bradykinin • Serotonin • Histamine • Potassium

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?"

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."

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

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

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

Discriminative

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 of the following neurons transmits sensory information from the periphery to the CNS?

Dorsal root ganglion neurons

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

A patient experiencing acute pain finds relief for several hours after the light touch of a soft-bristled brush has been applied over the area. Which of the following pain theories is best supported by this event?

Gate control

One of the neurotransmitters between the nociceptive neurons and the dorsal horn neurons is a major excitatory neurotransmitter. What is this neurotransmitter?

Glutamate

Which of the following would be a nurse's most complete documentation about the results of a pain assessment?

Holding the wrist and sweating after a fall on ice and reporting sharp pain of 9 on a scale of 1-10

In 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

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

When assessing neurologic response times, the nurse expects the fastest rate of transmission to be from fibers that are deemed to be which of the following?

Large diameter, myelinated

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?

Mechanical stimuli

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

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

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 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

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

Opioid receptors are highly concentrated in which region of the CNS and produce pain relief through the release of endogenous opioids?

Periaqueductal gray (PAG) region

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.

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

Phantom limb pain is a little understood pain that is difficult to treat, even though the client is experiencing severe pain. What are the treatments for phantom limb pain?

Sympathetic blocks and hypnosis

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

Tachycardia

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?

Temporomandibular joint syndrome

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.

Which of the following is the most accurate method of assessing pain in children ages 8 years and older?

Using a numeric 1-10 scale

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

Which of following interventions are appropriate for a patient with chronic back pain from an old injury? Select all that apply.

• Biofeedback • Guided imagery • Amitriptyline (Elavil) • Ibuprofen (Motrin)

Which of the following factors influence pharmacologic choices for pain management in children? Select all that apply.

• Body size requires dosage adjustment. • Liver function is less efficient in an infant. • The goal is to minimize side effects. • Premature infants may have reduced renal function.

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 client who has had a spinal injury now has sensory changes on the distal forearm and fourth and fifth fingers. The nurse can predict that this client has experienced an injury to the: Select all that apply.

• Cervical (C) 8 • Thoracic (T) 1 dorsal root

Which of the following types of damage causes visceral pain? Select all that apply.

• Distention • Strong contractions • Ischemia

Which of the following factors influence pharmacologic choices for pain management in older adults? Select all that apply.

• Poor nutrition may lead to poor drug distribution. • Organ function may be less efficient. • Polypharmacy may cause drug interactions.

The nurse asks the client if she would like medication for pain after an appendectomy. The client states that she would like to wait and does not want to take anything at this time. What does the nurse understand may influence this client not to take pain medication? Select all that apply.

• Psychological factors • Cultural factors • Environmental factors • Familial factors

Which of the following responses to a sudden, unexpected stimulus indicate the presence of intact spinothalamic pathways? Select all that apply.

• Pupil dilation • Tachycardia • Pallor

A client is experiencing deep somatic pain. The client would manifest: Select all that apply.

• Radiation of pain • Pain reproduced by stimuli

A nurse is treating a patient who has chronic daily headache (CDH). In addition to possible administration of medication, Which of the following instructions should be included? Select all that apply.

• Consider acupuncture treatment. • Implement a guided imagery program. • Reduce or eliminate caffeine .

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

• Distraction by knitting • Guided imagery • Biofeedback

A patient reports experiencing seeing flickering lights for about 10 minutes before developing nausea and a pounding right-sided headache. Which of the following factors would correspond to a diagnosis of migraine headache? Select all that apply.

• Family history of migraine • Duration of 1-2 days • Occurring with menstruation

Which of the following sensations will be impaired in a patient who has an injury to the primary somatosensory cortex? Select all that apply.

• Fine touch in the thumb • Pressure sense in lips • Sense of hot and cold

A patient in pain uses analgesic medications and heat for pain control. Which of the following should the nurse teach the patient about the safe application of heat? Select all that apply.

• Heat can loosen collagen fibers before therapy. • Avoid heat on areas with vascular impairment.

Which of the following interventions are appropriate for a patient with acute pain following abdominal surgery? Select all that apply.

• Hydrocodone (Vicodin) • Guided imagery • Cold therapy • Ibuprofen (Motrin)

Which of the following is an effective treatment for phantom limb pain? Select all that apply.

• Hypnosis • Transcutaneous electrical nerve stimulation (TENS) • Nerve block

A nurse is assessing a patient for manifestations of chronic pain. Which of the following is characteristic of chronic pain? Select all that apply.

• Mental depression • Loss of appetite • Withdrawal from activities

It is often necessary to assess a client's pain. What factors would the nurse assess when assessing pain? (Select all that apply.)

• Nature and severity of pain • Location and radiation of pain

A nurse is caring for a 30-year-old patient who experiences intense one-sided headaches. Which of the following additional characteristics would support a diagnosis of cluster headaches? Select all that apply.

• Pain behind the eye • Rhinorrhea on the same side as the headache

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

• Pain that radiates to the left arm • Substernal chest pain • Neck pain

A nurse is treating a patient who has chronic daily headache (CDH). In addition to possible administration of medication, Which of the following instructions should be included? Select all that apply.

• Reduce or eliminate caffeine . • Implement a guided imagery program. • Consider acupuncture treatment.

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

• Renal blood flow • Glomerular filtration rate • Tubular secretion

A patient with migraines asks the nurse about symptoms of an aura. Which of the following are characteristic of a migraine aura? Select all that apply.

• Seeing flickering lights or spots • Feeling numbness in fingers • Slurred speech

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

A patient who reports pain in the left ear and lower jaw is worried that the pain may indicate a heart attack. Which of the following additional manifestations indicate that it is temporomandibular joint pain (TMJ)? Select all that apply.

• The pain increases with jaw activity. • There is an accompanying headache.

In addition to medication efficacy, what should the nurse consider when assessing the appropriateness of a pain medication prescribed to an elderly client? Select all that apply

• The possibility of drug interaction • The effects of normal aging on metabolism • The existence of chronic illnesses • The cost of the medication

Which of the following types of sensation are transmitted via the discriminative pathway? Select all that apply.

• Two-point touch • Joint movement • Vibration

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

• Working in the office that has an air duct located directly overhead • One's significant other lightly stroking their face • Walking outside on a windy day