Patho PrepU Chapter 14
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." Explanation: Nonpharmacologic treatment includes the avoidance of migraine triggers, such as foods, that precipitate an attack. Many persons with migraines benefit from maintaining regular eating and sleeping habits. The client may need to change her lifestyle, but not to the extent of moving and changing jobs. Migraines are avoidable, most of the time, if individuals adhere to their diets and watch the triggers. Medication is very useful for most clients.
Which clients are showing manifestations of infection? Select all that apply.
-A 75-year-old, temperature 37.3°C (99.2°F), declining mental status, weakness and fatigue -A 25-year-old, temperature 40°C (104°F), sweating, shivering, states generalized pain -A 2-month-old, temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis Explanation: An older adult with an infection may have a minimal rise in temperature, but exhibit changes in mental status, weakness, fatigue, and weight loss. An infant younger than three months may have a relatively mild fever, but a serious infection. An adult with a high fever will exhibit sweating and chills. Aches and pains may occur with shivering and the infectious illness. A client with a temperature within the normal range, exhibiting no other signs of change, is not considered to have an infection.
In describing the ideal analgesic, what factors would be included? Select all that apply.
-Inexpensive -Have minimal adverse effects -Effective Explanation: The ideal analgesic would be effective, nonaddictive, and inexpensive. In addition, it would produce minimal adverse effects and not affect the person's level of consciousness.
Which client may be experiencing the effects of neuropathic pain?
A man with pain secondary to his poorly controlled diabetes Explanation: Conditions that can lead to pain by causing damage to peripheral nerves in a wide area include diabetes mellitus, alcohol consumption, hypothyroidism, rash, and trauma. Fractures, wounds, and cancer pain do not typically have an etiology that is rooted in the neurologic system.
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. Explanation: When giving opioids for relief of severe pain, such as that occurring after surgery, there is much evidence that opioids given routinely before the pain starts (preemptive analgesia) or becomes extreme are far more effective than those administered in a sporadic manner. People who are treated in this manner seem to require fewer doses and are able to resume regular activities sooner
An otherwise healthy client has been referred to a pain clinic because he is experiencing exquisite pain from the friction of his clothes on his torso. This client is likely to be diagnosed with which health problem?
Allodynia Explanation: Allodynia is pain that follows a non-noxious stimulus to apparently normal skin. Visceral pain is a deep, nonspecific pain that results from disruption of organs or deep tissues. Hypoalgesia is an abnormal decrease in pain sensitivity, whereas primary hyperalgesia describes pain sensitivity that occurs directly in damaged tissues.
Which intervention is an appropriate action by a nurse to take in attempting to decrease a client's temperature through conduction?
Apply cooling blanket Explanation: Conduction is the transfer of heat from one molecule to another. A nurse attempting to use conduction to lower a client's temperature should apply a cooling blanket, as this would conduct heat from the skin to the cool surface of the blanket.
The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. Which strategies would be best for the nurse to implement? Select all that apply.
Bubbles Music Television Games Explanation: Distraction helps children of any age divert their attention away from pain and onto other activities. Common diversions include bubbles, music, television, conversation, and games.
What will the nurse teach a client with trigeminal neuralgia about the condition?
Carbamazepine is a first-line treatment. Explanation: Trigeminal neuralgia is a condition in which clients experience brief, severe, repetitive lightninglike or throbbing pain along the distribution of one or more of the branches of the fifth cranial nerve. Clients should be taught to avoid triggers when possible, but although eating may be a trigger, it is necessary for the client to maintain nutrition. Social isolation is a possible problem arising from the condition. Time alone does not contribute significantly to improvement of the condition. Although treatment rarely provides total relief, trigeminal neuralgia can be controlled with carbamazepine and surgical release of vessels, nerve roots, or scar tissue. If other treatments are ineffective, partial destruction of the nerve branches with heat, balloon compression, or glycerol injection may be performed. Newer therapies to be considered are botulinum toxin injection and gamma radiation with stereotactic surgery.
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 Explanation: The discriminative pathway relays precise information regarding spatial orientation. This is the only pathway taken by the sensations of muscle and joint movement—vibration and delicate discriminative touch—as is required to differentiate the location of touch on the skin at two neighboring points. The anterolateral pathway (anterion and lateral spinothalamic pathways) provide transmission of sensory information such as pain, thermal sensations, crude touch, and pressure that does not require discrete localization or fine discrimination. The paleospinothalamic tract gives touch its affective or emotional aspects, such as heavy pressure.
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 Explanation: Part of the reluctance of health care workers to provide adequate relief for acute pain has been fear of addiction. However, addiction to opioid medications is thought to be virtually nonexistent when these drugs are prescribed for acute pain.
How will the nurse explain to a client the changes in blood flow during exercise?
Heat dilates blood vessels and increases local blood flow to skeletal muscles." Explanation: As the client exercises, blood vessels to skeletal muscles dilate to increase blood flow. Blood vessels to the organs constrict.
With which activity would a client experiencing astereognosis need help?
Identifying an object by touch Explanation: Astereognosis is the inability to identify objects by touch. The client would be able to describe the object's characteristics but not recognize it without visual cues.
A febrile, 3-week-old infant is currently undergoing a diagnostic workup to determine the cause of the fever. Which statement best conveys the rationale for this careful examination?
Infants are susceptible to serious infections because of their decreased immune function. Explanation: Fever in infants and children can be classified as low risk or high risk, depending on the probability of the infection progressing to bacteremia or meningitis and signs of toxicity. Infants between the ages of 1 to 28 days with fever should be considered to bave a bacterial infection that can cause bacteremia or meningitis. Younger children have decreased immunologic function and are more commonly infected with virulent organisms. Infants are at particularly high risk for serious bacterial infections that can cause bacteremia or meningitis. Infants are capable of thermoregulation, and fever is not necessarily indicative of a congenital disorder. Antipyretics are effective in the treatment of fever in infants.
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. Explanation: Visceral pain, as characterized by the client's description of her pain, is conducted by way of nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not likely rooted in the inappropriate firing of first order neurons or the substitution of conduction by C fibers. Pain that is attributable to a pathologic process apart from the neural pain network is not normally considered to be neuropathic. An overlap of nerve fiber distribution between the dermatomes occurs with cutaneous pain, not visceral pain.
What will conduct injurious stimuli to alert the body to potential damage?
Nociceptors Explanation: Nociceptors are sensitive to painful and noxious stimuli and alert the system to injury. Thermoreceptors will perceive heat, proprioceptors will perceive body position, and odorant receptors will perceive the sensation of smell.
A two-day postoperative client's temperature was 98.5°F (36.9°C) at 3:00 pm. At 6:00 pm, the unlicensed assistant (UAP) notifies the nurse that the client's temperature is 102°F (38.9°C). Which action should the nurse take?
Notify the physican. Explanation: The nurse should contact the physician, as the increase in the client's temperature is outside of the normal range and/or the normal diurnal variation in temperature.
Which client is exhibiting headache symptoms that indicate a need for further evaluation?
Pregnant mother with drowsiness and unrelenting headache Explanation: Primary headaches such as migraine, tension headache, cluster headache, and chronic daily headache do not require additional evaluation. Clients with secondary headaches should receive further evaluation. Possible causes of secondary headaches are cerebral hemorrhage or aneurysm, meningitis, cancer, and nerve lesions. Additionally, clients requiring further evaluation include those with sudden onset or progression of headaches, someone who is immunosuppressed, or a woman who is pregnant.
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 Explanation: Treatment of phantom limb pain has been accomplished by the use of sympathetic blocks, TENS of the large myelinated afferents innervating the area, hypnosis, and relaxation training. There is no extremity to place the warm compresses on.
A client is experiencing anorexia, myalgia, arthralgia, headache, and fatigue. The nurse should assess for:
Temperature Explanation: Common clinical manifestations of fever include anorexia, myalgia, arthralgia, headaches, and fatigue; thus, the nurse should assess the client's temperature.
The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy?
Tension Explanation: Tension-type headaches often are more responsive to nonpharmacologic techniques, such as biofeedback, massage, acupuncture, relaxation, imagery, and physical therapy, than other types of headache. For people with poor posture, a combination of range-of-motion exercises, relaxation, and posture improvement may be helpful. The other options are usually best treated with medications that focus on the cause of the pain
A nurse caring for an older adult who has been diagnosed with a urinary tract infection checks the client's temperature on admission and finds that it is 96.6°F (35.9°C). Which statement describes how the nurse should interpret the finding?
The client may be exhibiting a blunted or absent febrile response. Explanation: The nurse should interpret the finding as a blunted or absence febrile response to the infection. It has been suggested that as many as 30% of older adults with serious infections present with absent or blunted febrile response, and this may delay diagnosis and initiation of antimicrobial treatment.
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 Explanation: The discriminative pathway, which is associated with the fine touch of item discrimination, involves just three neurons: the primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron. Slow-conduction and anterolateral pathways that involve the reticular activating system are associated with pain, thermal sensation, and indiscriminate touch.
Which pain disorder is a manifestation of a disruption of cranial nerve function?
Trigeminal neuralgia Explanation: Trigeminal neuralgia is manifested by facial tics or spasms and characterized by paroxysmal attacks of stabbing pain that usually are limited to the unilateral sensory distribution of one or more branches of the trigeminal cranial nerve (CN V). Cranial nerve involvement is not implicated in postherpetic neuralgia, phantom limb pain, or TMJ syndrome.
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 Explanation: Visceral pain has its origin in the visceral organs and is one of the most common pains produced by disease. While similar to somatic pain in many ways, both the neurologic mechanisms and the perception of visceral pain differ from somatic pain. One of the most important differences between surface pain and visceral pain is the type of damage that causes pain. Strong contractions, distention, or ischemia affecting the walls of the viscera can induce severe pain.
Which characteristic differentiates a migraine with aura from a migraine without aura?
Visual symptoms such as flickering lights precede the headache Explanation: An aura is visual (flickering lights, spots, or loss of vision), sensory (feeling of pins and needles, or numbness), and/or speech disturbance that precedes a migraine. Nonpharmacologic treatments may be used with varying success in both types of migraine, and nausea and vomiting may precede or accompany each. Changes in mood and affect are not central to an aura.
A client is said to be in the chill stage of the fever process when the nurse:
observes piloerection on the skin. Explanation: During the second stage or chill, there is the uncomfortable sensation of being chilled and the onset of generalized shaking (rigors). Vasoconstriction and piloerection usually precede the onset of shivering. At this point, the skin is pale and covered with goose flesh. Sweating is an indication of the third stage or flushing. The other options are not descriptive of stages but rather interventions.
Which symptom indicates the next stage of a fever after a prodrome?
A chill Explanation: The physiologic behaviors that occur during the development of fever can be divided into four successive stages: prodrome, chill, flush, and defervescence. The stages are successive.
Which risk factor presents the greatest risk for injury in an older adult who is experiencing a dysfunction in temperature regulator function?
Delayed initiation of appropriate treatment Explanation: Older adults often have a lower baseline temperature (36.4°C [97.6°F]) than younger persons, and although their temperature increases during an infection, it may fail to reach a level that is equated with significant fever. The absence of fever may delay diagnosis and initiation of antimicrobial treatment. Absence of fever does not result in misdiagnosis. While the remaining options may occur, they are not the greatest risks for injury.
