Sleep Ch. 33/Pain ch 36

Which neurotransmitter levels are elevated during non-rapid eye movement (NREM) sleep? Select all that apply. A. Serotonin B. Melatonin C. Acetylcholine D. Norepinephrine E. Gamma aminobutyric acid (GABA)

Correct A, E Sleep consists of two phases, rapid eye movement sleep (REM) and non-rapid eye movement (NREM) sleep. Serotonin and GABA are neurotransmitters that induce NREM sleep; therefore, one can find high levels of these neurotransmitters during NREM sleep. Melatonin is a hormone, not a neurotransmitter, and its levels generally increase at night. The levels of neurotransmitters such as acetylcholine and norepinephrine increase during REM sleep.

A patient with bronchial carcinoma reports constipation for the past 2 months. The patient is on meperidine (Demerol) and ibuprofen (Advil) for pain relief for the past 6 months. The patient is also taking metformin and captopril (Capoten) for the past 10 years. What could be the most probable reason for constipation in the patient? 1. Side effect of opioid 2. Side effect of captopril 3. Interaction of metformin and captopril 4. Metastasis of cancer to other organs

1. Side effect of opioid Constipation is a common side effect of opioids that are used for pain relief. Captopril is an ACE-inhibitor drug that is used to treat hypertension. Cough is the common side effect of captopril. Metformin is an oral hypoglycemic drug. Interaction between metformin and captopril does not cause constipation. It is unlikely that metastasis of cancer caused the constipation.

A summer camp nurse is prescreening a school-age child who has a diagnosis of sleep enuresis. What intervention does the nurse expect the child to request while at camp? a. Separate sleeping area to use a bed alarm b. Separate sleeping area close to the bathroom c. Separate sleeping area for a later bedtime d. Separate sleep area with access to bedtime snacks

ANS: A Use of a bed alarm is an effective intervention for enuresis; having an area where the alarm can be used in privacy will decrease any stigma associated for the child. Children do not wake up in response to the urge to void, so being close to the bathroom will not decrease the enuresis. Enuresis is not affected by a later bedtime or bedtime snacks, although caffeinated foods or drinks may increase the incidence of enuresis.

The nurse knows that a desired outcome for a sleep-deprived patient has been met when the patient makes which comment? a. "I have less of a headache every morning." b. "I have enough energy to do my housework every day." c. "I only get up three times during the night to go to the bathroom." d. "I only smoke one pack of cigarettes per day now."

ANS: B A common result of sleep deprivation is fatigue during the day that prevents a person from completing required tasks, so an outcome of being able to do his or her work is a desirable outcome. With adequate sleep and oxygenation there should be no morning headaches. Getting up several times during the night to void adds to sleep deprivation. Tobacco products act as stimulants and their use will continue to disrupt sleep.

The nurse administered intravenous morphine at 0830. At what time will the nurse ask the patient if pain relief was obtained? a. 1000 b. 1030 c. 0900 d. 0930

Answer: c After administering intravenous medication, check the patient in 15 to 30 minutes for relief from pain. Intravenous medication is injected directly into the bloodstream and bypasses the gastric system metabolism.

A parent is the primary caregiver for a child with multiple disabilities requiring constant care. The parent reports sleeping in 45 minute blocks during the night, having trouble concentrating, and being increasingly irritable. The nurse recognizes that this parent is consistently missing what stage of sleep? a. Nonrapid eye movement (NREM) stage 2 b. Rapid eye movement (REM) stage c. Sleep latency stage d. Sleep arousal stage

ANS: B The rapid eye movement stage of sleep is needed to complete the restorative function of sleep and is needed to prevent cognitive effects of sleep deprivation. Nonrapid eye movement stages begin the sleep cycles, and reset with stage one if sleep is interrupted. Sleep latency occurs prior to sleep occurring, and sleep arousal is prior to awakening; neither is a specific stage of sleep.

Which statement best describes the dosage of pain medication that a nurse should administer given pharmacologic treatment considerations? a. The smallest dose possible to avoid opioid addiction b. The smallest dose possible to decrease adverse effects c. A dose that best manages pain with fewest side effects d. A large dose initially to decrease the initial level of pain.

Answer: c Based on the patient's report of pain, the nurse administers the dose of medication that is effective in relieving pain without causing adverse side effects. Administering too small of a dose does not relieve pain. Administering a large dose may result in unwanted side effects. Addiction to narcotics is rare.

A patient returns to the clinic requesting an increase in prescribed sleeping medication. What teaching should the nurse provide regarding the long-term use of sleeping medications? a. "Long-term use of sleeping medications is an appropriate treatment." b. "Adding diet changes will increase the effects of the medication." c. "More medication will cause hallucinations." d. "Long-term use of sleeping medications can increase sleep disorders."

ANS: D The long-term use of sleeping medications actually is detrimental to sleep promotion and is not recommended, even with any diet changes. Sleep deprivation can ultimately cause hallucinations.

Which drug does the nurse expect the primary health care provider to prescribe a patient who is recovering from a myocardial infarction? 1. Aspirin 2. Naloxone (Narcan) 3. Oxycodone (Dazidox) 4. Acetaminophen (Tylenol)

Correct 1. Aspirin A myocardial infarction occurs due to the aggregation of platelets in the arteries. Aspirin is a nonsteroidal antiinflammatory drug that acts against blood clots formed due to platelet aggregation. Naloxone (Narcan) is useful in treating respiratory depression caused by overdose of opioid analgesics. Oxycodone (Dazidox) is an agonist analgesic that is useful in treating severe pain. Acetaminophen (Tylenol) is useful in treating mild headaches and fever.

The nurse is assessing touch, pain, and temperature sensation of a patient who is diagnosed with diabetic neuropathy. Arrange the parts of the central nervous system through which pain sensation is carried in ascending order. 1. Cerebrum 2. Thalamus 3. Medulla, pons, midbrain 4. Spinal cord

Correct 1. medulla, pons, midbrain 2. spinal cord 3. thalamus 4. cerebrum Pain sensation is transmitted from afferent fibers to the spinal cord. From the spinal cord, the pain sensation is carried to medulla, pons, and midbrain. From here it continues through the spinothalamic tract to the thalamus and then to cerebrum.

The nurse is learning about various stages of nonrapid eye movement (NREM) sleep. One particular stage of NREM lasts for 15 to 30 minutes. It is the deepest stage of sleep, and it is very difficult to arouse the sleeper from this stage. The vital signs are lower than normal waking hours. Which stage of NREM sleep is the nurse referring to? Record your answer using a whole number. __________

The stage 4 of NREM sleep is the deepest stage and lasts for 15 to 30 minutes. The stage is characterized by lowering of vital signs. It may be difficult to arouse the sleeper from this stage.

Which method is the most accurate way to determine the pain level of a patient who is alert and oriented? a. Evaluate whether the patient is crying or grimacing. b. Assess the patient's heart rate and blood pressure. c. Consider the seriousness of the patient's condition. d. Use a pain assessment tool and ask the patient to rate the pain level.

Answer: d Because pain is defined as what a patient says it is, a patient's report based on the pain scale is currently the most accurate way to determine the pain level of a cognitively alert patient. Crying or grimacing may be considered on a noncognitive scale for a nonverbal patient. Vital signs and the patient's condition contribute to a pain assessment, but they may not be the most accurate determinants.

Which symptom does the nurse recognize as a physiologic response to acute pain? a. Increased blood pressure b. Decreased pulse c. Increased temperature d. Restlessness

Answer: a Acute pain can increase blood pressure and pulse rate but may not affect temperature. Restlessness is a psychological response, not physiologic.

A patient who is trying to lose weight requests information from the nurse to improve sleep patterns. What recommendation would be appropriate for this patient? a. Do not drink diet colas for at least 4 hours prior to bed. b. Increasing evening exercise will increase sleepiness. c. High protein bedtime snacks are appropriate. d. Using diet pills will improve sleep patterns.

ANS: A Caffeine is commonly in cola drinks and interferes with sleep when ingested within 4 hours of bedtime. Exercise should not be done in the hours prior to sleep. A bedtime snack containing carbohydrates is preferred as protein helps the brain stay alert. Diet pills may contain stimulants that prevent good sleep.

A nurse is completing discharge planning for a new mother and newborn infant. Which statement by the mother indicates an understanding of infant care? a. "Sleep patterns of a newborn are irregular." b. "I will put a small pillow and bumpers in the crib." c. "My baby should sleep through the night within a week." d. "Babies sleep best when placed on their stomach."

ANS: A It is correct that sleep of the newborn is irregular. A caregiver who plans to place an infant on his or her stomach to sleep needs further teaching that the recommended position to decrease the risk for SIDS is supine, or on his or her back. Pillows and other soft objects should not be used in the crib to decrease the risk of suffocation, and babies do not sleep through the night until approximately 4 months of age.

A patient has been diagnosed with obstructive sleep apnea. What teaching regarding a common intervention for this disorder is the nurse likely to initiate? a. The proper use of devices to support the patency of the airway b. The correct administration of sleeping medications c. The use of a supine position for sleeping d. The use of caffeine to maintain alertness

ANS: A Obstructive sleep apnea is caused by airway collapse, so the use of an oral airway, continuous positive airway pressure, or other devices that keep the airway open are commonly prescribed. Sleep medications may further relax airway structures, increasing the problem. Sleeping in a supine position increases the risk of the tongue falling to the back of the throat and blocking the airway. Caffeine does maintain alertness and does not promote sleep.

A patient complains of shoulder pain during a gallbladder attack. How does the nurse document this pain? a. Referred pain b. Phantom pain c. Chronic pain d. Psychogenic pain

ANS: A Referred pain is pain in another area of the body from where the pain originated. Phantom pain is pain from an amputated extremity that is no longer present. Chronic pain is pain that lasts more than 6 months. Psychogenic pain is pain without a physical cause.

The patient has been experiencing chronic pain from fibromyalgia for the past six months. What change will the nurse note in the patient's vital signs? a. Increase in blood pressure and pulse b. Decrease in blood pressure and pulse c. Increase in temperature and respirations d. Decrease in temperature and respirations

ANS: B Chronic pain stimulates the parasympathetic system resulting in a decrease in blood pressure and pulse. Acute pain causes an increase in blood pressure and pulse. Temperature and respirations are not affected.

The patient who had surgery to remove part of the intestines is complaining of pain. What type of pain is the patient experiencing? a. Somatic pain b. Visceral pain c. Referred pain d. Radiating pain

ANS: B Visceral pain is pain originating from a body organ. Somatic pain is bone, muscle, etc. originating pain. Referred pain is pain in a different area from where pain originated. Radiating pain extends into another area of the body.

Which lifestyle changes should the nurse recommend to a patient with recent onset of insomnia related to a job change? a. Obtain a prescription for sleep medication. b. Increase evening alcohol intake to induce relaxation. c. Arise each day at the same time. d. Increase evening exercise to promote sleepiness.

ANS: C Arising at the same time each day is an important measure to help regulate circadian sleep patterns. Non-pharmacologic measures should be tried before medication due to the potential side effects of medications. While alcohol may initially relax some people, it interferes with later sleep patterns. Exercise should not be done for at least 2 hours before bedtime as it inhibits relaxation.

A patient admitted to the hospital complains of sharp, tingling sensations in his lower extremities that prevent him from sleeping. The nurse suspects the patient may have which sleep disorder? a. Obstructive sleep apnea b. Narcolepsy c. Restless leg syndrome d. Insomnia

ANS: C Restless leg syndrome is characterized by sharp, often painful sensations in the calves and legs that are relieved with walking or movement. Obstructive sleep apnea signs include fatigue, snoring, and periods of apnea while sleeping. Narcolepsy presents with sudden episodes of falling asleep even while doing tasks during the day. Insomnia presents as difficulty falling or staying asleep.

A patient reports using a combination of prescription sleeping medication and alcohol every night for the past 8 months after the loss of her job. She tells the nurse that she now wants to stop taking the sleeping medications. What teaching would be appropriate for the nurse to provide? a. The same sleep routine should be followed until the patient finds another job. b. An additional prescription medication will be needed. c. The medication should not be stopped suddenly. d. Diet changes will be needed before stopping the medication.

ANS: C Sleeping medications should not be stopped abruptly to minimize withdrawal symptoms. Sleep medications are best used short term, so continuing for an unknown length of time is not advisable. It is not recommended to add additional medications as medication effects will be much increased. Diet changes are not necessary when stopping sleep medications, although decreasing alcohol, caffeine, and tobacco use are recommended when starting sleep medications.

A nurse who was hired to work in a sleep lab understands that the most common type of sleep apnea is caused by which factor? a. Airway collapse b. Lack of exercise c. Dietary factors d. Medication use

Answer: a Airway collapse of the soft structures of the upper airway is the most common cause of sleep apnea. Lack of exercise and certain dietary factors may adversely affect sleep patterns, especially the initiation of sleep. Medications in the proper dose seldom cause sleep apnea unless improperly combined with other medications or taken with alcohol.

When administering medications to elderly patients, what information does the nurse need to understand? a. Start with a low dosage, and increase the dosage as needed for pain relief. b. Start with a high dosage, and decrease the dosage as pain is relieved. c. Start with a mid-range dosage, and increase or decrease the dosage as needed for pain. d. Start with a low dosage, and decrease the dosage as indicated for pain

Answer: a Due to decreased metabolism and clearance of medications, start with a lower dose and increase as indicated for pain relief. A high dose may result in drug toxicity. Too low of a dose will not relieve pain.

The patient who had a below the knee amputation 3 days ago complains of pain from the amputated extremity. Which statement by the nurse best explains what the patient is experiencing? a. "The phantom pain will subside when the brain realizes the lower extremity is no longer there." b. "The radiating pain will continue for months because the lower extremity is no longer there." c. "You are suffering from referred pain, which you will always have, but it will lessen with time." d. "You are experiencing psychogenic pain because loss of an extremity is an emotional loss."

Answer: a Feeling an extremity after amputation is phantom pain. This type of pain decreases over time as the brain adjusts to the missing extremity. Radiating, referred, and psychogenic types of pain are not the source of this patient's discomfort.

A patient who has a serious back injury received intravenous medication for pain approximately 1 hour earlier. The patient practices relaxation techniques but still is reporting pain at a level of 9 of 10. What intervention should the nurse implement next? a. Report the lack of pain relief to the primary care provider. b. Tell the patient to give the medication more time. c. Reposition the patient, and try diversion activities. d. Document in the nurse's notes that the patient has a low pain tolerance.

Answer: a If the patient with a serious injury is not obtaining pain relief from pharmacologic and nonpharmacologic interventions, the primary care provider should be notified. Waiting longer and using more nonpharmacologic interventions are not likely to relieve pain in this situation.

The endocrine system releases excessive hormones during episodes of acute pain. The nurse should monitor patients experiencing acute pain for which potential problem? a. Hyperglycemia b. Migraine headache c. Hyperkalemia d. Diarrhea

Answer: a Release of hormones causes the blood glucose level to increase, causing hyperglycemia. Hypokalemia may result from the metabolic effects of genitourinary injury. Constipation results from decreased intestinal motility. Migraine headaches are not a result of hormone release during acute pain.

A mother brings her toddler for a well-child checkup and mentions that she is having a lot of trouble getting the child to go to bed. Which intervention can the nurse teach the mother to help her toddler establish good sleep habits? a. Establish and maintain a consistent bedtime routine. b. Put the child to bed immediately after the evening meal. c. Allow the child to stay up as long as desired to increase sleepiness. d. Allow the child to sleep with the parents until the child is older.

Answer: a Toddlers and preschoolers benefit from a consistent routine to help their sleep patterns. Putting the child to bed too early (right after a meal) will not help sleep; any bedtime snacks should be a light snack containing carbohydrates. The child will become too tired if allowed to stay up as long as desired, with consequent sleep disruption the next day. The American Academy of Pediatrics does not recommend that children sleep with parents.

A patient with a fractured femur thinks about vacationing on the beach to relieve pain. What nonpharmacologic pain relief technique should the nurse document the patient is using? a. Distraction b. Imagery c. Relaxation d. Biofeedback

Answer: b Imagery is the use of visual concentration to change the perception of pain. Distraction is the use of music or television to occupy the mind to decrease concentration on pain. Relaxation is muscle relaxation to decrease anxiety created by pain. Biofeedback enables voluntary control over the body to decrease pain.

An elderly patient complains of difficulty sleeping after the death of his spouse of 56 years. What would be an appropriate nursing assessment for this patient? a. Assess the patient for possible use of sedatives. b. Obtain a health history regarding sleep hygiene. c. Assess the patient's weight over the past year. d. Request a sleep study to rule out sleep apnea.

Answer: b Obtaining a health history of the patient's sleep hygiene will help determine interventions that might promote relaxation and sleep. Sedatives are prescribed for only some patients with chronic, ongoing sleep disturbances that interfere with daily life after nonpharmacologic methods have been tried. Although assessing the patient's weight is an important part of a physical exam, weight is not related to the type of sleep problem described. No symptoms of sleep apnea have been reported, so the nurse would not request a sleep study.

A nurse is working a night shift after several months of working day shift. What action does the nurse take to protect patient safety? a. Take a meal break at midnight. b. Plan critical tasks for early in the shift. c. Ask another nurse to administer all medications. d. Turn up lights on the unit to maintain alertness.

Answer: b The 4 A.M. window is when most people become the sleepiest during the night, so it is important that noncritical tasks be planned for this time and that extra care be taken with patient care tasks. A meal break at midnight may be too early to prevent hunger for the entire shift and is not directly related to patient safety. It is not necessary to have another nurse administer all medications if the nurse is aware of the high risk time for care tasks. Increasing the amount of light is likely to impair the sleep of all patients on the unit.

A patient complains of not being able to sleep while in the hospital. What action would be a priority for the nurse to implement? a. Administer a sleeping medication with the evening meal. b. Restrict visitors for the patient in the evening. c. Decrease noise around the patient during the night. d. Offer a hot drink of regular tea at bedtime.

Answer: c Noise is a primary cause for disturbed sleep in the hospital. Administering sleeping medications with the evening meal is too early to help the patient sleep throughout the night. Restricting visitors may be helpful if the patient requests it, but visitors often provide emotional support and reassurance to the patient, which helps with relaxation. Regular tea contains caffeine, which is not helpful in sleep promotion.

A patient has been referred for polysomnography to confirm a diagnosis of narcolepsy. What behavior would the nurse expect the patient to be exhibiting? a. Excessive use of sleeping medications b. A lack of dreaming during sleep c. Consistent use of relaxation techniques d. Unexpected daytime sleeping episodes

Answer: d Narcolepsy is characterized by uncontrolled and unexpected episodes of falling asleep during the day. Because of sleeping too much, sleep medications and relaxation techniques are not needed. The patient goes almost directly to rapid eye movement (REM) sleep on falling asleep, so vivid dreaming would be expected.

At a routine clinic visit, an athlete training for a major sports event reports difficulty sleeping that is affecting the training schedule. What would be the best recommendation by the nurse for this patient? a. Increase the use of electrolyte-enriched drinks to increase stamina. b. Obtain a short-term prescription for sleeping medications. c. Plan to arise later in the morning to accommodate sleep changes. d. Avoid vigorous exercise for at least 2 hours before bedtime.

Answer: d Vigorous exercise in the hours before bedtime will cause stimulation that prevents sleep. Adjusting the training schedule to account for this effect is the preferred first step for improving the athlete's sleep, rather than starting medications that may affect alertness during the day. A regular sleep schedule is preferred to maintain sleep promotion, including getting up at the same time each day no matter when bedtime occurred.

When assessing the patient for pain, which factors should the nurse consider? (Select all that apply.) a. Previous medical history b. Physical appearance c. Age, gender, and culture d. Lifestyle and loss of appetite e. Hair color and style

Answers: a, b, c, d Medical history, physical appearance, age, gender, culture, lifestyle, and loss of appetite should be considered when conducting a pain assessment. Hair color and style are not necessary components of a pain assessment.

The nurse is completing a sleep assessment for a newly admitted patient. Which data reported by the patient would cause the nurse to suspect obstructive sleep apnea? (Select all that apply.) a. Morning headaches b. Sudden weight loss c. Loud snoring during sleep d. Daytime sleepiness e. Deep sleep during the night f. Increased blood pressure problems

Answers: a, c, d, f Signs of obstructive sleep apnea include headaches from hypoxemia on first awakening, loud snoring related to airway collapse, daytime sleepiness from nonrestorative sleep at night, and increased hypertension. Sudden weight loss is not associated with obstructive sleep apnea, although it can be related to other medical disorders such as cancer. Deep sleep is not obtained with obstructive sleep apnea, because the affected person experiences many awakenings during the night.

An elderly, tense patient is having trouble relaxing enough to sleep. Which measures should be implemented by the nurse to help promote sleep? (Select all that apply.) a. Give the patient a back rub. b. Take the patient for a brisk walk right before bedtime. c. Provide a warm, quiet environment. d. Encourage the patient to eat a large meal in the evening. e. Give the patient a diet cola. f. Play soft music during the 30 minutes before bedtime.

Answers: a, c, f Giving a back rub, providing a warm and quiet environment, and playing soft music enhance relaxation, which will lead to easier transition into sleep. Brisk exercise, caffeine drinks, and large meals all are contraindicated in the evening because they induce changes that will interfere with sleep.

A patient reports that the prescribed sleeping medication is no longer effective. What information would be appropriate for the nurse to recommend to the patient? (Select all that apply.) a. Take the medication with an alcoholic drink. b. Use relaxation techniques before sleep. c. Do not study in the bedroom before bedtime. d. Adjust sleep temperature for comfort. e. Sleep in a different room of the home.

Answers: b, c, d Tolerance frequently develops to sleeping medications, especially with long-term use, and additional sleep hygiene practices such as mindful relaxation, only sleeping in the bedroom, and creating a comfortable environment can be effective adjunctive measures. Alcohol plus a sleeping medication is a dangerous combination. Sleeping in an alternate room removes the patient from the familiar setting and is more likely to disrupt sleep.

A patient with a history of a stroke that left her confused and unable to communicate returns from interventional radiology following placement of a gastrostomy tube. The healthcare provider's prescription reads as follows: "Vicodin 1 tab, per tube, q4 hours, prn." Which action by the nurse is most appropriate? 1. No action is required by the nurse because the prescription is appropriate. 2. Request to have the prescription changed to ATC (around the clock) for the first 48 hours. 3. Ask for a change of medication to meperidine (Demerol) 50 mg IVP, q3 hours, prn. 4. Begin the Vicodin when the patient shows nonverbal signs of pain.

Correct 2. Request to have the prescription changed to ATC (around the clock) for the first 48 hours. The American Pain Society (2003) states that if pain is anticipated for most of the day, the provider should consider ATC administration. Insertion of a gastrostomy tube is painful. This patient will most likely experience pain for at least the next 48 hours.

A patient is admitted to the hospital for multiple injuries and is put on an intravenous analgesia. After a couple of hours, the patient is still in severe pain. The nurse finds that the skin around the intravenous catheter is red and swollen. The nurse finds no other changes in the patient's condition. What should be the immediate response of the nurse? 1. Notify the primary healthcare provider. 2. Change the pain medication. 3. Change the intravenous access line. 4. Increase the dose of pain medication.

Correct 3. Change the intravenous access line. The nurse should continuously monitor the intravenous access line to check its patency. Pain medication or analgesics are effective only if the intravenous (IV) access is patent. The swelling around the intravenous catheter indicates that the IV line is blocked. Therefore, the nurse should first change the intravenous access line. If there is no improvement in the patient's condition after changing the IV line, then the nurse should notify the primary healthcare provider. The primary healthcare provider would change the analgesic or increase the dose of the analgesic drug if necessary.

Which type of pain does a patient experience after undergoing minor surgery? 1. Chronic pain 2. Referred pain 3. Nociceptive pain 4. Psychogenic pain

Correct 3. Nociceptive pain Nociceptors are present on the sensory neurons on the skin and internally in the tissues and organs. These receptors carry sensory stimuli, including pain stimuli, from the site of injury to the cerebral cortex. Surgery involves cutting the patient's skin and the tissues that contain nociceptors, so a patient who has undergone surgery experiences nociceptive pain. Chronic pain refers to pain that lasts for a long period of time, approximately 3 to 6 months. This type of pain is observed in conditions such as arthritis, fibromyalgia, and neuropathy. The patient would not likely experience chronic pain after minor surgery. Referred pain is observed in a patient who has pain at one particular site, but the perception of pain is felt at another site. It is observed in cases of appendicitis and myocardial infarction. Pain after surgery would be perceived at the site of the operation. Psychogenic pain occurs due to persistent mental and emotional factors, and there is no physical cause for the pain.

A patient informs the nurse of an aching, crushing, stabbing, numbing, burning, shooting, or tingling sensation. Which classes of drug may the primary health care provider prescribe in combination to treat the patient's condition? Select all that apply. A. Anticonvulsant drugs B. Antidepressant drugs C. Antihistamine drugs D. Local anesthetic drugs E. Nonsteroidal antiinflammatory drugs

Correct A, B Burning and stabbing sensations indicate neuropathic pain, which is caused by neuronal hyperexcitability and can be reduced by the action of anticonvulsants. Antidepressants are also occasionally used to relieve neuropathic pain in patients with psychological disorders. Antihistamine medications are used as a coanalgesic medication and are used in conjunction with morphine to relieve itching. Local anesthetic drugs and nonsteroidal antiinflammatory drugs help to relieve nociceptive pain in different areas of the body; these do not specifically treat neuropathic pain.

Which substances may produce insomnia if consumed in the evening? Select all that apply. A. Alcohol B. Nicotine C. Caffeine D. Light meal E. Protein-rich diet

Correct A, B, C Consumption of alcohol, nicotine, and caffeine in the evening produces insomnia. Nicotine and caffeine act as stimulants and produce sleeplessness. Alcohol interferes with the quality of sleep. A light meal and protein-rich diet do not cause insomnia.

Which sleep disorders are dyssomnias? Select all that apply. A. Narcolepsy B. Hypersomnia C. Somnambulism D. Sleep deprivation E. Nocturnal enuresis

Correct A, B, D Dyssomnia is primary sleep disorder characterized by a decreased amount or quality of sleep or by irregular sleep timings. Dyssomnias include narcolepsy, hypersomnia, and sleep deprivation. Parasomnias include abnormal sleep behaviors and include somnambulism and nocturnal enuresis.

An elderly patient complains of severe pain in both lower extremities. The patient becomes tearful when describing the pain and states that it is intolerable. How should the nurse develop a healing relationship with the patient? Select all that apply. A. By inquiring how the pain is affecting the patient's daily routine. B. By telling the patient about various pain-relieving interventions. C. By encouraging the patient to be strong and deal with the pain positively. D. By asking the family to help the patient cope with pain and anxiety. E. By administering pain medications and encouraging the patient to exercise.

Correct A, B, D To establish a healing relationship and a helping role, the nurse should not just look at the patient's leg pain as a medical problem. The nurse should also try to understand how it affects patient's daily life and spirituality, and work to improve the patient's overall well-being. By informing the patient about various methods to alleviate pain, the nurse mobilizes hope in the patient. The nurse should also help the patient use social resources, such as friends and family, who can help the patient deal with her health condition. Asking the patient to be strong and deal with the pain may decrease spirituality and increase stress and anxiety. The nurse should focus on more than just medications and exercise to develop a healing relationship.

Which instruction is crucial for the nurse to give to both family members and the patient who is about to be started on a patient-controlled analgesia (PCA) of morphine? 1. Only the patient should push the button. 2. Do not use the PCA until the pain is severe. 3. The PCA prevents overdoses from occurring. 4. Notify the nurse when the button is pushed.

Correct 1. Only the patient should push the button. Patient preparation and teaching are critical to the safe and effective use of PCA devices. Patients need to understand PCA and be physically able to locate and press the button to deliver the dose. Be sure to instruct family members not to push the button for the patient.

What are the withdrawal symptoms of barbiturate sedative-hypnotics? Select all that apply. A. Tremors B. Restlessness C. Skin irritation D. Increased pulse rate E. Claustrophobia sensations

Correct A, B, D Withdrawal symptoms occur upon the abrupt cessation of drugs after prolonged use. Barbiturate sedative-hypnotics that are used to reduce anxiety can cause physical and psychological dependence and result in withdrawal symptoms. Barbiturates bind to the gamma-aminobutyric acid (GABA) receptor site and show indirect agonist action on these receptors. This may be responsible for the occurrence of tremors upon withdrawal. Barbiturate sedative-hypnotics may also cause central nervous system stimulation and hyperadrenergic activity upon withdrawal. Thus, it may cause restlessness and increase the patient's pulse rate. Skin irritation and claustrophobia sensations are side effects of continuous positive airway pressure, which is used to treat obstructive sleep apnea.

Which of these are included under secondary sleep disorders? Select all that apply. A. Fear B. Jet lag C. Anxiety D. Depression E. Sleep terrors

Correct A, C, D A secondary sleep disorder is a condition in which sleep is hindered due to an underlying medical condition or medication taken by the individual. Mental problems such as fear, anxiety, and depression cause sleep-wake cycle disturbances and are included in the secondary sleep disorders. In primary sleep disorders, the sleep-wake cycle is altered due to endogenous disturbances such as hormonal imbalance. Dysomnia and parasomnia are the primary sleep disorders. Jeg lag is a dysomnia in which the circadian rhythms are altered due to changed time zones. Sleep terror is a parasomnia in which a person wakes suddenly in a terrified state from deep sleep.

A nurse has a sleep disorder due to working on rotating shifts. Which physiologic symptoms are observed in the nurse? Select all that apply. A. Fatigue B. Increased reflexes C. Difficulty concentrating D. Decreased neuromuscular coordination E. Increased visual alertness

Correct A, C, D Sleep deprivation can occur due to rotating shifts, as the human biologic clock becomes maladjusted. It can lead to symptoms of fatigue, headache, nausea, increased sensitivity to pain, decreased neuromuscular coordination, irritability, and difficulty concentrating.

Which patients would be appropriate for application of acupuncture therapy? Select all that apply. A. A patient with back pain B. A patient with a skin infection C. A patient with myofascial pain D. A patient with a bleeding disorder E. A patient with a migraine headache

Correct A, C, E Acupuncture therapy regulates the vital energy, which flows like a river through the body in channels that form a system of pathways. Back pain, myofascial pain, and migraine headaches are chronic conditions believed to be caused by a disruption to flow of energy in the body. Acupuncture helps to realign the flow of energy and relieve symptoms of back pain, myofascial pain, and migraine headaches. Acupuncture therapy is contraindicated for clients who have a skin infection or bleeding disorder.

The nurse is gathering a sleep history from a patient who is being evaluated for obstructive sleep apnea. Which common symptoms does the patient most likely report? Select all that apply. A. Headache B. Early wakening C. Excessive daytime sleepiness D. Difficulty falling asleep E. Snoring

Correct A, C, E Common symptoms for obstructive sleep apnea include headache, snoring, and excessive daytime sleepiness caused by poor sleep during the night. The other symptoms are not related to obstructive sleep apnea.

Which symptoms are likely to be found in a patient who has obstructive sleep apnea? Select all that apply. A. Snoring B. Nausea C. Drowsiness D. Muscle weakness E. Morning headaches

Correct A, C, E Obstructive sleep apnea is a periodic, partial, or complete obstruction of the upper airway during sleep. Snoring, drowsiness, and morning headaches are symptoms of obstructive sleep apnea. Patients with obstructive sleep apnea do not typically experience nausea. Patients who have difficulty tolerating anesthesia may experience nausea. Muscular weakness is not related to obstructive sleep apnea. Patients with underlying musculoskeletal disorders may develop increased weakness after surgery.

The nurse is caring for a patient who underwent surgery and has a diagnosis of acute pain. Which clinical manifestations does the nurse expect to find in this patient? Select all that apply. A. Tachycardia B. Bradycardia C. Hypertension D. Hypotension E. Constipation

Correct A, C, E Surgery may cause acute pain (pain that lasts for less than 6 months). Acute pain causes an increase in the sympathetic nerve activity; thus, it causes an increase in heart rate (tachycardia) and an increase in blood pressure (hypertension). Pain normally affects the gastrointestinal tract by decreasing gastric motility and thereby causes constipation. Chronic pain causes a decreased heartbeat (bradycardia) and a decrease in blood pressure (hypotension).

Which complications does the nurse expect to find in a patient who is on beta blockers? Select all that apply. A. Insomnia B. Irritability C. Drowsiness D. Nightmares E. Restlessness

Correct A, D Beta blockers inhibit the effects of the adrenaline hormone and also inhibit nighttime secretion of melatonin, a hormone involved in regulating both sleep and the body's circadian clock. Reduced secretions of melatonin, which induces sleep, result in insomnia and nightmares. Irritability occurs due to sleep deprivation. Drowsiness and restlessness occur due to overusage of medications such as barbiturates, amphetamines, and antidepressants.

A patient reports difficulty falling asleep. Further assessment shows that the patient consumes alcohol. What are the effects of alcohol on sleep? Select all that apply. A. Alcohol promotes sleep. B. Alcohol prevents the patient from falling asleep. C. Alcohol causes the patient to remain awake. D. Alcohol awakens the patient early and causes difficulty returning to sleep. E. Alcohol limits rapid eye movement (REM) sleep.

Correct A, D, E Small amounts of alcohol may help some people fall asleep, but alcohol increases wakefulness in the last half of the night. Ingesting large quantities of alcohol creates difficulty falling asleep and limits REM sleep, and this may cause a restless sleep and the sensation of a "hangover" on arising.

Energy therapies are used to treat various disease conditions and diminish pain. Which energy therapy involves hand placement to correct or balance energy fields? 1. Reiki therapy 2. Hypnosis 3. Magnet therapy 4. Biofeedback

Correct 1. Reiki therapy Reiki therapy involves the use of hand placement to correct or balance energy fields, which restores health by restoring communication among cells, thereby diminishing pain. In this therapy, the practitioner places hands on or above the body area and transfers universal life energy. It provides strength, harmony, and balance to treat a patient's health disturbances. Hypnosis, magnet therapy, and biofeedback can be used to diminish pain but do not involve hand placement to correct or balance energy fields.

The nurse is assessing a patient with acute pain. Which statements are true about acute pain? Select all that apply. A. Patients with acute pain are more likely to suffer from depression and fatigue. B. Acute pain has an identifiable cause. C. Acute pain lasts less than 6 months. D. Anxiety increases the severity of acute pain. E. Patients with acute pain seek numerous healthcare providers.

Correct B, C, D Acute pain has an identifiable cause. The duration of acute pain is less than 6 months, and that of chronic pain is longer than 6 months. In acute pain, the presence of anxiety increases the severity of the pain experienced, reduces the individual's tolerance to pain, and decreases the ability to cope with pain. Individuals with chronic pain are more likely to suffer from depression and fatigue and are more likely to attempt suicide. A patient with chronic pain may seek numerous healthcare providers if the pain has an unknown cause.

A patient reports difficulty falling asleep. The nurse asks questions to assess the symptoms of insomnia and analyzes the different stages of the patient's sleep cycle. What are the characteristics of stage 2 of nonrapid eye movement (NREM) sleep? Select all that apply. A. Sleepwalking may occur. B. Body functions become slow. C. Arousal remains relatively easy. D. Muscles relaxation increases. E. Vital signs are significantly lower than during waking hours.

Correct B, C, D In stage 2 of nonrapid eye movement (NREM) sleep, the body functions become slow. The sleeper can be easily aroused in this stage. The muscles continue to relax. A person may sleepwalk during stage 4 of NREM sleep. Also during stage 4, the vital signs are lower than they are during waking hours.

Which of these herbs have pain-relieving properties? Select all that apply. A. Senna B. Ginger C. Rosehips D. Aloe vera E. Black cohosh

Correct B, C, E Ginger, rosehips, and black cohosh have pain-relieving (analgesic) properties. Ginger acts on serotonin receptors and thus relieves pain. Rosehips relieve pain by inhibiting the functioning of nociceptors. Black cohosh acts as a selective estrogen receptor modulator; it relieves pain by the serotonergic pathway. Senna and aloe vera are herbs that can be useful in treating constipation.

What are the signs of opioid withdrawal? Select all that apply. A. Itching B. Anxiety C. Vomiting D. Drowsiness E. Hypertension

Correct B, C, E Opioid drugs are categorized as narcotic analgesics that have addictive properties. Sudden withdrawal might be lethal, so opioid doses should be gradually tapered off. They may cause withdrawal symptoms that are very uncomfortable to the patient, including anxiety, restlessness, fear, and nervousness. The patient may also experience vomiting and hypertension. Itching is a histaminic reaction, not a withdrawal symptom, observed in patients who take opioid analgesics. Drowsiness is also a side effect of opioid analgesics, but it is not evident upon withdrawal.

A nurse is assessing a hospitalized patient with acute pain. Which questions should the nurse ask the patient for an appropriate assessment? Select all that apply. A. "How bad is your pain now?" B. "What makes your pain worse?" C. "Describe your pain." D. "What is the worst pain you have had in the past 24 hours?" E. "Show me where you hurt. Does it stay there or does it spread?"

Correct B, C, E When assessing a patient with acute pain, the questions should be specific. The questions should aim to determine intensity, location, and quality of pain. Ask for provocative factors like what makes the pain worse. Ask about the region of the pain and the radiation of pain. Asking how bad the pain is may not yield specific details. Instead the patient should be asked to rate the pain on a scale of 0 to 10. Other details can be asked once the patient is comfortable.

Which conditions does the nurse identify as causes of visceral pain? Select all that apply. A. Arthritis B. Appendicitis C. Fibromyalgia D. Pancreatitis E. Pyelonephritis

Correct B, D, E Viscera generally refers to the soft internal organs of the body such as the appendix, pancreas, and kidneys. Appendicitis refers to inflammation of the appendix, which causes pain in the abdomen. Pancreatitis refers to inflammation of the pancreas, which causes severe upper abdominal pain radiating to the back. Pyelonephritis refers to kidney infection, which causes pain in the back and on the side of the abdomen. Arthritis refers to joint pain, which is not considered visceral pain because it is not related to the soft internal organs. Fibromyalgia refers to chronic muscle pain at tender points and limbs, which are somatic organs.

Which complementary therapies are most easily learned and applied by the nurse? Select all that apply. A. Massage therapy B. Traditional Chinese medicine C. Progressive relaxation D. Guided imagery E. Reiki and therapeutic touch

Correct C, D Progressive relaxation and guided imagery are nurse-accessible complementary therapies. Massage therapists are licensed by local governmental agencies, and additional educational preparation is required to practice. Traditional Chinese medicine practitioners also attend training/educational programs, typically accredited by the Accreditation Commission for Acupuncture and Oriental Medicine.

What complications does the nurse expect to find in a patient who has circadian rhythm sleep disorders? Select all that apply. A. Tremors B. Cataplexy C. Depression D. Hypertension E. Sexual dysfunction

Correct C, D, E Improper sleep due to circadian rhythm sleep disorders decreases dopamine levels, which causes depression. Increases in stress hormones due to insufficient sleep cause hypertension. The metabolic rate decreases due to improper sleep; this causes an imbalance in sex hormones and results in sexual dysfunction. Tremors occur due to withdrawal of barbiturate-sedative hypnotics. Cataplexy is the loss of muscle tone that occurs in a patient who has narcolepsy.

The nurse is attending to a patient diagnosed with restless legs syndrome (RLS). What are the characteristics of this syndrome? Select all that apply. A. It is usually associated with nocturia. B. It occurs immediately after waking up. C, Patients have intense, abnormal, lower-extremity sensations of crawling or tingling feelings. D. It is more common in those having thrombocytopenia. E. Patients have recurrent disagreeable leg movements.

Correct C, E Restless legs syndrome is a familial sleep disorder characterized by disagreeable leg movements resulting from intense, abnormal, lower-extremity sensations of crawling or tingling feelings. The sensations cause a delay in sleep onset. This disorder leads to constant leg movement during the day and insomnia at night. Restless legs syndrome can occur at any age but is more common in elderly individuals. No association between restless legs syndrome and nocturia has been cited. This syndrome occurs usually before sleep onset rather than waking. RLS is not related to thrombocytopenia but its incidence is more common in people with iron deficiency anemia.

The nurse is preparing a patient with spastic cerebral palsy for a surgical procedure that involves severing of the nerve roots in the spinal cord. What procedure is the patient undergoing? 1. Rhizotomy 2. Cordotomy 3. Neurectomy 4. Sympathectomy

Correct 1. Rhizotomy Spastic cerebral palsy is a kind of neuromuscular disorder in which muscle rigidity is prominent. Rhizotomy is a neurosurgical procedure that involves removing the problematic nerve roots in the spinal cord that cause pain. Cordotomy is a surgical procedure that involves disabling the pain-conducting tracts in the spinal cord. Neurectomy is useful in treating chronic pain; it involves the removal of a nerve or a group of nerves. Sympathectomy is performed to disrupt the pain signals to the brain; it involves the surgical dissection of nerve tissue in the cervical, thoracic, or lumbar spine regions.

The nurse explains patient-controlled analgesia to a patient. If the patient has understood this information, what would be the patient's most appropriate statement? 1. The device reduces the risk of overdose of medication. 2. The caregivers can operate the device if the patient is unable to do so. 3. The patient will be lying down in a prone lying position during the procedure. 4. The patient will decide about the loading dose of the analgesic drug.

Correct 1. The device reduces the risk of overdose of medication. A nurse should teach about the use of patient-controlled analgesia to a patient before any procedure. It is important to tell the patient that PCA reduces any risk of overdose. It should be emphasized to the patient that the patient-controlled analgesia device (PCA device) should not be operated by caregivers. The caregivers are not able to perceive the patient's pain and thus cannot decide the amount of drug required. The patient would be placed in a comfortable position in which the IV line is accessible. This prone position is not likely to be a comfortable position for the patient. The patient does not decide the loading dose of the drug; the loading dose is already prescribed.

Which stage of sleep cycle is associated with snoring? 1. NREM 1 2. NREM 2 3. NREM 3 4. NREM 4

Correct 2. NREM 2 Snoring is a condition characterized by noisy breathing during the second stage of non-rapid eye movement (NREM) sleep. As the physiological functions become slower in this stage, sleep becomes deeper and snoring occurs. Snoring does not occur in the other stages of sleep. Drowsiness occurs in NREM 1 stage. Vital signs decrease and muscles relax in NREM 3 stage. Somnambulism and nocturnal enuresis may occur in NREM 4 stage.

The nurse is caring for a young patient with cancer who is intubated and conscious. How does the nurse best assess pain in this patient? 1. By using the Wong-Baker Facial Grimace Scale 2. By monitoring the patient's blood pressure and pulse rate 3, By asking the patient to point out his or her pain score on a pain assessment tool 4. By asking the patient to verbally report the pain score on a pain assessment tool

Correct 3. By asking the patient to point out his or her pain score on a pain assessment tool The patient is conscious and is intubated. In this case, the nurse explains the pain assessment tool to the patient and then asks the patient to point out the pain score on the tool. The patient is young and not cognitively impaired; therefore, the nurse need not assess pain with the Wong-Baker Facial Grimace Scale. The patient is conscious; therefore, the nurse need not monitor the patient's blood pressure and pulse rate to assess pain as would be done for an intubated patient who is sedated. The patient is intubated and therefore would not be able to verbally communicate a score on a pain assessment tool.

The nurse understands that providing holistic care includes treating: 1. Disease, spirit, and family interactions 2. Desires and emotions of the patient 3. Mind-body-spirit of patients and their families 4. Muscles, nerves, and spine disorders

Correct 3. Mind-body-spirit of patients and their families You could argue that when you consider the totality of the patient/family, all of these come into play, but AHNA/ANA Standards of Holistic Nursing speak specifically to the mind-body-spirit focus of holistic nursing.

Which concept do many complementary and alternative therapies share? 1. The use of herbs is a cornerstone of good health. 2. Touch should be used to relieve pain and reduce anxiety. 3. Patients are capable of decision making and should be a part of the healthcare team. 4. Patients should place the responsibility for their health and healing in the hands of alternative healers.

Correct 3. Patients are capable of decision making and should be a part of the healthcare team. The emphasis of alternative and complementary therapies is that the patient is viewed as a whole being, capable of decision making and an integral part of the healthcare team. The patient should be aware that proper nutrition, adequate rest, relaxation, exercise, and emotional health, not herbs, are cornerstones of good health. The use of touch has many forms and is used for a multitude of purposes such as increasing circulation, decreasing edema, promoting lymphatic drainage, relieving muscle tension, and improving the functioning of certain body systems. The road to healing is an individual journey; patients are encouraged to take responsibility for their health and healing.

While reviewing a patient's polysomnography results, the nurse finds that the patient has severe obstructive sleep apnea (OSA). Which assessment finding led the nurse to suspect this condition? 1. 4 apneic or hypopneic episodes per hour 2. 10 apneic or hypopneic episodes per hour 3. 20 apneic or hypopneic episodes per hour 4. 35 apneic or hypopneic episodes per hour

Correct 4. 35 apneic or hypopneic episodes per hour Polysomnography is a diagnostic test used to confirm OSA. It includes the number of apneic or hypopneic episodes per hour. The absence of breathing indicates apnea. If the patient experiences more than 30 apneic or hypopneic episodes per hour, it indicates severe OSA. Because the patient is experiencing 35 apneic episodes per hour, the nurse concludes that the patient has severe OSA. If the patient experiences four or fewer apneic or hypopneic episodes per hour, it indicates that the patient is normal. If the patient experiences 5 to 15 apneic or hypopneic episodes per hour, it indicates mild OSA. If the patient experiences 15 to 30 apneic or hypopneic episodes per hour, it indicates moderate OSA.

The nurse is caring for a patient who reports mild headache and fever. Which medication does the nurse expect the primary health care provider to recommend for this patient? 1. Docusate (Colace) 2. Naloxone (Narcan) 3. Atenolol (Tenormin) 4. Acetaminophen (Tylenol)

Correct 4. Acetaminophen (Tylenol) Acetaminophen (Tylenol) is an analgesic drug that helps in relieving pain at various locations of body; therefore, it can also help in relieving a headache. Acetaminophen (Tylenol) also acts as an antipyretic and is used to reduce fever. Docusate (Colace) is useful in treating constipation. Naloxone (Narcan) is useful in treating respiratory depression caused by an overdose of opioid analgesics. Atenolol (Tenormin) is a drug that is useful in treating hypertension.

A patient who recently immigrated to the United States tells the nurse, "I am unable to sleep and concentrate on my work." What might be the reason for this condition? 1. Sleep apnea 2. Hypersomnia 3. Sleep terror disorder 4. Circadian rhythm sleep disorder

Correct 4. Circadian rhythm sleep disorder When a person travels from one time zone to another, he or she may face difficulty in adjusting to the time changes. This causes difficulty in sleeping, memory problems, depression, weight gain, and impaired concentration levels. This type of sleep disorder is termed as circadian rhythm sleep disorder. Sleep apnea is shallow or absent breathing during sleep. Hypersomnia is a sleep-wake disorder in which a person sleeps excessively during the daytime, even after a normal 8 to 12 hours of sleep at night. A patient who has sleep terror disorder wakes suddenly in terrified state from deep sleep.

A nurse is caring for a patient with hyperthyroidism. What is the nurse likely to observe in the patient? 1. Fatigue 2. Chest pain 3. Sleepwalking 4. Difficulty falling asleep

Correct 4. Difficulty falling asleep Hyperthyroidism is characterized by increased levels of thyroxine hormones. Due to the hormonal imbalance, hyperthyroidism affects the sleep cycle of the patient. As a result, the patient takes more time to fall asleep. Fatigue, chest pain, and sleepwalking are not associated with hyperthyroidism.

A patient is under preoperative care for an elective surgery. After understanding the explanation given by the nurse about spinal anesthesia, the patient expresses fear of becoming paralyzed due to spinal anesthesia. How should the nurse respond in this situation? 1. Send the patient home as it is not a surgical emergency. 2. Ask the healthcare provider to postpone the surgery without patient's permission. 3. Arrange an appointment with a surgical counselor as soon as possible. 4. Reassure the patient and explain that numbness, tingling, and coldness are common symptoms.

Correct 4. Reassure the patient and explain that numbness, tingling, and coldness are common symptoms.The nurse should be aware that many patients fear paralysis when they learn about spinal or epidural anesthesia. This is because epidural and spinal injections come close to the spinal cord. Therefore, the nurse should reassure the patient and explain that numbness, tingling, and coldness are common following spinal anesthesia. Sending the patient home or asking the healthcare provider to postpone the surgery may not help to relieve the patient's fears. An appointment with the surgical counselor may be arranged if the nurse is unable to reassure the patient.

A patient with iron deficiency anemia reports rhythmic movements of the feet and legs and an itching sensation in the muscles before sleep. Which condition is likely to be found in the patient? 1. Insomnia 2. Cataplexy 3. Narcolepsy 4. Restless legs syndrome

Correct 4. Restless legs syndrome Rhythmic movements of the feet and legs and an itching sensation in the muscles before sleep are symptoms of restless legs syndrome, which may be caused by iron deficiency anemia. In cataplexy, sudden muscle weakness occurs during intense emotions such as sadness, anger, or laughter. Insomnia refers to difficulty falling asleep. Narcolepsy is a dysfunction of mechanisms that regulate sleep and wake states.

The nurse is caring for a neonate who is grimacing, cries vigorously, and has a gagging breath pattern. The nurse also finds rapid extension of the arms and legs, and the infant's state of arousal is fussy. What would the pain score be on the neonatal infant pain scale? Record your answer using a whole number. Answer: ____________

The neonatal infant pain scale is the pain assessment tool used to determine the necessity of administrating pain medication to a neonate. It is calculated by giving scores to the type of facial expression, cry, breathing pattern, movement of the arms and legs, and state of arousal. The score given for grimacing = 1; a vigorous cry = 2; a gagging breath pattern = 1; rapid extension of arms and legs = 1 + 1; and a fussy state of arousal = 1. Therefore, the neonatal infant pain scale rating for this neonate is 7.