Patho PrepU Ch.14 (Somatosensory Function, Pain, and Temperature)

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 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.

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

Abnormal discrimination pathway function Explanation: The discriminative dorsal column-medial lemniscus pathway is able to sense fine touch and discriminate between two points as close as 5 mm. This pathway also mediates sense of position. Loss of this pathway means only that the anterolateral pathway is functioning and is unable to make fine distinctions in touch proprioception and points. The test does not test reflexes or temperature.

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 Explanation: The assessment of pain in older adults can range from relatively simple in a well-informed, alert, cognitively intact person with pain from a single source and no comorbidities to extraordinarily difficult in a confused person. When possible, a person's report of pain is the gold standard, but behavioral signs of pain should also be considered. This is especially true when the client's cognitive function is impaired. While the other options should be considered, the client's nonverbal behaviors should be of particular interest to the nurse.

Which client/disease process would benefit from surgery to relieve severe, intractable pain?

Block transmission of phantom limb pain Explanation: Surgery for severe, intractable pain of peripheral or central origin has met with some success. It can be used to remove the cause or block the transmission of intractable pain from phantom limb pain, severe neuralgia, inoperable cancer of certain types, and causalgia.

Nonshivering thermogenesis occurs in which of the following to help the newborn infant fight hypothermia?

Brown fat Explanation: Nonshivering thermogenesis occurs in the liver, brown fat tissue, and the brain and helps the newborn infant fight hypothermia.

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.

A client taking the typical antipsychotic agent haloperidol experiences neuroleptic malignant syndrome. What nursing intervention is highest priority after stopping the medication?

Cooling blanket Explanation: Neuroleptic malignant syndrome (NMS) is a life-threatening condition most often triggered by typical antipsychotic agents such as haloperidol and chlorpromazine. The condition usually has sudden onset of hyperthermia, muscle rigidity, change in mental status, and autonomic dysfunction seen in labile blood pressure, dyspnea, and tachycardia. The priority interventions are to stop the medication and reduce the temperature using a cooling blanket or ice packs in the axillae and groin. Subsequent interventions of IV fluids and ventilator support are directed at controlling symptoms and supporting body systems. Dopamine agonists such as bromocriptine have been used to reduce the effect of the triggering neuroleptic agent. Benzodiazepines such as diazepam can be used to reduce anxiety.

A nurse assessing an older adult for signs and symptoms of infection in the absence of a fever should assess for which of the following? Select all that apply.

Decreased mental status Change in fuctional capacity Fatigue Explanation: Signs and symptoms of infection in an older adult in the absence of a fever include decreases in mental status and functional capacity, fatigue, weight loss, and weakness.

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.

Which type of thermometer is the best to use in determining an accurate temperature during an episode of hypothermia?

Electrical thermistor Explanation: An electrical thermistor probe is used to monitor temperatures as low as 25°C (77°F). Clinical thermometers, such as oral or rectal thermometers, are not able to register at lower levels that are associated with hypothermia. The use of a mercury thermometer is not recommended because of the hazards associated with mercury.

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

Increased heart rate Explanation: Characteristics of chronic pain do not include autonomic responses like increased heart and respiratory rate. Loss of appetite, disturbed sleep patterns, and depression are common among people dealing with chronic 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.

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

Pressure from a sharp object Explanation: Stimuli used to elicit a withdrawal reflex include pressure from a sharp object, strong electric current to the skin, or application of heat or cold of approximately 10°C above or below normal skin temperature.

The nurse needs to assess a 1-year-old child for fever. Which approach will produce the most accurate reading?

Rectal Explanation: Measurement of core body temperature is important when evaluating fever. The rectal route is considered the most accurate. In adults and older children, the oral route is lower, but still accurate; however, in young children the oral route may be unreliable. Forehead thermometers can predict trends, but are not as accurate as other routes. The axillary route requires up to 10 minutes for the temperature to register appropriately.

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 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. Explanation: Observation of a normal withdrawal reflex rules out peripheral nerve disease, disorders of the dorsal root and ganglion, disease of the myoneural junction, and severe muscle diseases. Having no response is abnormal and may identify neurologic damage. A verbal response is not a reflex response.

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

Ventricular dysrhythmia Explanation: The nurse should assess for ventricular dysrhythmia, decreased cerebral blood flow, and postoperative myocardial depression.

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 Explanation: Migraine aura is associated with visual symptoms, including flickering lights, spots, or loss of vision; sensory symptoms, including feeling of pins or needles, or numbness; and speech disturbances or other neurologic symptoms.

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.

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. Explanation: Modification of the environment ensures that the environmental temperature facilitates heat transfer away from the body. Sponge baths with cool water or an alcohol solution can be used to increase evaporative heat losses. More profound cooling can be accomplished through the use of a cooling blanket or mattress, which facilitates the conduction of heat from the body into the coolant solution that circulates through the mattress. Care must be taken so that cooling methods do not produce vasoconstriction and shivering that decrease heat loss and increase heat production.

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.

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 has been diagnosed with osteomyelitis and admitted to the hospital. The client's fever persists throughout most of the day but returns to normal at least twice a day. Which pattern of fever is this client displaying?

Intermittent Explanation: Intermittent fever patterns are very changeable, but they do return to normal at least once every 24 hours. A remitting fever pattern temperature does not return to normal and varies a few degrees in either direction. In a sustained fever pattern, the temperature remains above normal with minimal variations. A relapsing fever is one in which there is one or more episodes of fever, each as long as several days, with 1 or more days of normal temperature between episodes.

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 Explanation: The nurse's hand-off report should include the presence of intermittent fever—a temperature that returns to normal at least once every 24 hours.

A client has a mild headache and fatigue. He also states he has some aches and pains. Which stage of fever does the nurse determine the client is experiencing?

Prodrome Explanation: During the first or prodromal period there are nonspecific complaints such as mild headache and fatigue, general malaise, and fleeting aches and pains.

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 Explanation: The nurse determines that the participants understand the information when they identify that the heat index is the temperature sensed by the body when humidity and temperature are combined.

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 client 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. Explanation: A dermatome is the region of the body wall that is supplied by a single pair of dorsal root ganglia. Isolating the location of the pain allows for focused treatment. Chronic pain is best handled by a multidisciplinary team that includes specialists in areas such as anesthesiology, nursing, physical therapy, social services, and surgery. Management may reduce referred pain but may not alleviate it because the visceral and somatic neurons share the same dorsal horn projections. Clients with chronic pain benefit most from interventions that include physical, emotional, financial, and spiritual components of care. Using biologic treatments alone is less effective than the combination of all modalities.

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

Using a faces scale Explanation: Children between ages 3 and 8 years can accurately point to a scale of faces that ranges from very tearful to very happy to indicate their pain level. Children older than 8 are accurately able to report pain on a numeric scale, or using words ranging from "none" to "the most I have ever had." Physiologic responses to pain, such as tachycardia and guarding, are not very accurate because they are nonspecific and may not occur with chronic pain.

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." Explanation: Pain threshold is closely associated with the point at which a nociceptive stimulus is perceived as painful. Pain tolerance relates more to the total pain experience; it is defined as the maximum intensity or duration of pain that a person is willing to endure before the he or she wants something done about the pain. Psychological, familial, cultural, and environmental factors significantly influence the amount of pain a person is willing to tolerate. The threshold for pain is fairly uniform from one person to another, whereas pain tolerance is extremely variable.

A client who has been exercising says to the nurse, "My skin is so hot!" What is the nurse's best response?

"Your body is trying to lower your temperature." Explanation: After exercise, the body dilates blood vessels and shunts blood to the skin to help to decrease the temperature. Skin typically feels hot and sweaty. Evaporation of sweat from the skin surface contributes to loss of heat. As the heat is lost through the skin, the skin typically feels hot. The nurse should calm the client and explain that this is a normal response to exercise.

A client has been diagnosed with a fever of unknown cause. The nurse recognizes this as:

A prolonged fever that does not have an identified source Explanation: A prolonged fever for which the cause is difficult to ascertain is often referred to as fever of unknown origin (FUO). FUO is defined as a temperature elevation of 38.3°C (101°F) or higher that is present for 3 weeks or longer. An FUO can occur in children or adults.

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. Explanation: There is little research to support the belief that fever is harmful unless the temperature rises to extreme levels; it has been shown that small elevations in temperature, such as those that occur with fever, enhance immune function. Antipyretics are effective in lowering core body temperature. They alleviate discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature.

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.

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. Explanation: Children do feel pain and have been shown to reliably and accurately report pain. They also remember pain. This is evidenced in studies of children with cancer, whose distress during painful procedures increases over time without intervention, and in neonates in intensive care units, who demonstrate protective withdrawal responses to a heel stick after repeated episodes. The other options may not necessarily be true of most children.

A nurse is planning care for a client coming into the emergency department via ambulance on a hot summer day with the following symptoms: temperature of 105°F (40.5°C), absence of sweating, and loss of consciousness. The nurse anticipates that the client has which condition?

Heatstroke Explanation: Symptoms of heatstroke include a body temperature greater than 104°F (40°F), absence of sweating, and central nervous system abnormalities such as delirium, convulsions, and loss of consciousness.

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

Paleospinothalamic tract Explanation: The paleospinothalamic tract is a slower-conducting, multisynaptic tract concerned with the diffuse, dull, aching, and unpleasant sensations that commonly are associated with chronic and visceral pain.

The route considered the most accurate to measure a core body temperature is:

Rectal Explanation: The rectal temperature is used as a measure of core temperature and is least invasive of all of these options.

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

Somatosensory cortex Explanation: The full localization, discrimination of the intensity, and interpretation of the meaning of the stimuli require processing by the somatosensory cortex. The anterolateral pathway gives off numerous branches that travel to the reticular formation of the brain stem; the branches provide the basis for increased wakefulness or awareness after strong somatosensory stimulation and for the generalized startle reaction that occurs with sudden and intense stimuli. They also stimulate autonomic nervous system. Ruffini end-organs are found in the skin and deeper structures and detect tissue vibration, heavy and continuous touch, and pressure. Stretch-sensitive receptors in the skin (i.e., Ruffini endings, Pacinian corpuscles, and Merkel cells) also signal postural information. In the thalamus, sensory information is roughly localized and perceived in a crude sense.

A client with a diagnosis of lung cancer has developed bone metastases resulting in severe and protracted pain. Which assessment components should the nurse prioritize when assessing the client's pain?

The client's subjective report of the character and severity of pain Explanation: Although objective signs of pain may or may not be evident, the priority component of any pain assessment is the client's self-report. Self-report is usually regarded as the most reliable estimate of pain.

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.

A nurse is monitoring the temperature of a client with hypothermia during the rewarming process. Which location for the temperature probe will provide the most accurate results?

Pulmonary artery Explanation: Temperatures in different parts of the body vary according to how close the probe is to the body core. Skin is the coolest. Rectal temperatures are considered the most accurate for general use. However, when a client's temperature is changing rapidly as in someone being rewarmed, or treated for acute hyperthermia, core body temperature is best measured by a probe near the heart and thoracic organs.

A client in the intensive care unit has been having rapidly changing core body temperatures that requires close monitoring. The client is intubated and has a pulmonary artery catheter and a Foley catheter. The nurse should obtain and/or record the temperature from which of the following?

Pulmonary artery catheter Explanation: The pulmonary artery catheter is the preferred measurment when body temperatures are rapidly changing and need to be monitored closely on a critically ill person in an intensive care unit.

A client has recently been diagnosed with chronic back pain that requires the daily use of hydromorphone, an opioid analgesic. For the first few weeks, the client achieved relief with 4 mg every 6 hours. However, the client now requires 6 mg doses to achieve the same effect. How should the nurse best interpret this phenomenon?

The client is developing opioid tolerance, which is expected Explanation: The client is developing a tolerance to the opioid, which is not unexpected and which is not synonymous with addiction. There may be a need to include nonpharmacologic interventions or NSAIDs, but these do not need to replace the opioid.

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. Explanation: Exercise training helps the body adapt and the rate of sweat production increases to help regulate temperature. For instance, exercise can increase metabolic head production 10-fold. Thermoregulatory responses such as sweating simultaneously increase heat loss, thus keeping body temperature from rising dangerously high. The trained person begins to sweat sooner, often within 1 to 2 minutes of the start of exercise. The client is reacting normally.

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.

A client 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 on only one side of her face. It seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. Often it is accompanied by involuntary grimacing. What diagnosis is most likely?

Trigeminal neuralgia Explanation: Her symptoms are characteristic of trigeminal neuralgia, caused by damage to cranial nerve V, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw. Postherpetic neuralgia is a complication of shingles. Migraine headache symptoms feel as if they occur in one or more regions of the head, not the face. Complex regional pain syndrome affects either one arm or leg.

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.