CH 14 SOMATOSENSORY FUNCTION, PAIN & TEMPERATURE

What can the nurse tell a client about antipyretic drugs during fever?

"Antipyretics help to protect the body."

An older adult tells the nurse, "My friend just developed shingles and has a lot of pain. Is there a way for me to protect myself from it?" Which of the following is an appropriate response from the nurse?

"Get a Zostavax vaccination."

A client is being taught how to use a TENS unit. The nurse determines that teaching was effective when the client states:

"I should take my medication and apply the TENS unit to the painful area as soon as I feel the pain."

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

Neospinothalamic tract

Which client manifestation indicates signs of drug fever?

Temperature reaches 40°C (104°F) every afternoon, pulse 76 beats/minute, pruritis

A client is said to be in the chill stage of the fever process when the nurse:

observes piloerection on the skin.

In the hospital setting, one of the best ways to lower the fever in a client with hyperthermia would be to facilitate conduction of heat from the body by:

placing the client on a cooling mattress that circulates a coolant solution through the mattress.

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

rectal

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.

A client is experiencing anorexia, myalgia, arthralgia, headache, and fatigue. The nurse should assess for:

temperature

A client with a rising temperature is pale and has begun to shiver. The nurse reports that the client is in which phase of fever development?

chill

A severe type of headache that occurs more frequently in men than women and is described as having unrelenting, unilateral pain located most frequently in the orbit is called:

cluster headache

The loss of heat from the body through the circulation of air currents is known as:

convection

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

visceral pain

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

Increased heart rate

A nurse notes that a client with a fever has begun to shiver. The nurse should assess for which event?

Increased temperature

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

brown fat

Clinical manifestations of hypothermia include which signs/symptoms? Select all that apply.

Impaired coordination Decreased respirations Slurred speech

Which client is exhibiting headache symptoms that indicate a need for further evaluation?

Pregnant mother with drowsiness and unrelenting headache

A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which statement is most accurate?

"Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus."

A beta-adrenergic blocker has been prescribed for a client diagnosed with migraines. The most important information for the nurse to teach the client would be:

"Take the medication daily as you have been directed."

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

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

Which temperature readings indicate to the nurse that the clients have fever? Select all that apply.

35-year-old with pulmonary artery reading of 37.9ºC (100.2ºF) 19-year-old with oral reading of 38.4ºC (101.1ºF) 3-day-old with rectal reading of 38ºC (100.4ºF)

A nurse is working at the medical booth at a marathon on a hot summer day. Which individual is at greatest risk for hyperthermia?

83-year-old spectator with congestive heart failure

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

Infants are at greater risk of hypothermia than children because of which of the following?

A high ratio of surface area to body mass

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

A client diagnosed with moderate hypothermia would likely experience the instillation of warmed fluids into the gastrointestinal tract and extracorporeal blood warming. This type of rewarming is referred to as:

Active core

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.

The nurse is performing an assessment for a client with diabetes who has peripheral neuropathy. When the nurse assesses pain response in the lower extremities, the client does not have any reaction. What would the nurse document this response as?

Analgesia

The nurse is caring for a team of clients with febrile illnesses. For which medication prescription would the nurse seek clarification?

Aspirin 650 mg every 4 hours for a 15-year-old with influenza

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

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

1) A nurse caring for a client with hypothermia anticipates that the client's temperature will be:

Below 35°C (95°F)

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

Bradykinin Serotonin Histamine Potassium

A client has been seen in the clinic with severe recurring sharp, stabbing pain in the face that begins after brushing teeth or being exposed to cold air. The client states that he feels no numbness. The nurse anticipates educating this client about which medication?

Carbamazepine

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

Carbamazepine is a first-line treatment.

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.

The nurse documents the results of a pain assessment. Which documentation is most complete?

Client is holding the wrist and sweating after a fall on ice and reporting sharp pain of 9 on a scale of 1 to 10; no relief since the fall

The nurse is assessing a client with an elevated temperature. Which additional assessment findings provide the most useful information for the nurse?

Client's heart rate is more rapid than anticipated.

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

Cooling blanket

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

A client has an increase in core temperature. What does the nurse expect to assess with this finding? Select all that apply.

Dilation of superficial blood vessels Sweating

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

Distraction by knitting Guided imagery Biofeedback

Sometimes recurrent fevers occur but do not follow a strictly periodic pattern. Causes of these recurrent fevers include genetic disorders such as familial Mediterranean fever. What are the characteristics of familial Mediterranean fever?

Early age of onset (<20 years) and high fever

A client experiencing an increased temperature reports weakness and fatigue. Which explanation accurately accounts for these symptoms?

Epinephrine and norepinephrine shift the body metabolism to heat production rather than energy generation.

A nurse who is providing a staff development in-service determines that the participants understand the information when they state that which bodily function aids heat conservation by reducing surface area for heat loss?

Erection of pilomotor muscles

A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which characteristic of the client's history is most likely to have a bearing on his current diagnosis?

HIV positive and homeless

Neurogenic fevers begin in the central nervous system. By what characteristics are neurogenic fevers known?

High temperatures that are not associated with sweating

What is the most common cause of drug fever?

Hypersensitivity reaction to medication

A nurse instructing unlicensed assistive personnel (UAP) on temperature regulation includes as part of her teaching that core body and skin temperatures are sensed by which part of the brain?

Hypothalmus

With which activity would a client experiencing astereognosis need help?

Identifying an object by touch

A nurse teaching a client about the cervical mucus basal body temperature (CMBBT) method of birth control says that during the postovulation time frame, the core body temperature does which of the following?

Increases 0.5°C to 1.0°C

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

A client reports a sudden intense headache. Which factor would indicate the presence of a possible subarachnoid hemorrhage?

Intractable pain

After resuscitation, a client who experienced a sudden cardiac arrest is placed in controlled hypothermia. The family asks how this treatment is intended to help the client. What is an accurate response by the nurse?

It prevents ischemic injury.

The nurse instructs the unlicensed assistive personnel (UAP) to be sure to turn the client every 2 hours in order to avoid pressure on the skin and avoid a pressure ulcer. What type of stimuli is the nurse encouraging the UAP to avoid?

Mechanical stimuli

Select the tactile receptors that are sensitive to the movement of very light objects over the surface of the skin.

Meissner corpuscles

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.

Music Bubbles Games Television

Which statement explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?

NSAIDs block the enzyme that synthesizes prostaglandins.

A client has a fever that was induced by damage to the hypothalamus due to intercranial bleeding. The nurse plans care for which type of fever?

Neurogenic

A client experiencing phantom limb pain after a traumatic amputation finds that opioids, biofeedback, a transcutaneous electrical nerve stimulation unit, and relaxation therapy are all needed to reduce the pain to a tolerable level. Which pain theory is best supported by this event?

Neuromatrix

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.

What will conduct injurious stimuli to alert the body to potential damage?

Nociceptors

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.

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

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

When a peripheral nerve is irritated enough, it becomes hypersensitive to the noxious stimuli, which results in increased painfulness or hyperalgesia. Health care professionals recognize both primary and secondary forms of hyperalgesia. What is primary hyperalgesia?

Pain sensitivity that occurs directly in damaged tissues

A client reports feeling a tingling sensation in the last two fingers of one hand after hitting the inner surface of the elbow on a desk. What is the cause of this symptom?

Paresthesia from temporary nerve compression

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

Pressure from a sharp object

Place the four successive stages of fever in correct order.

Prodromal Chill Flush Defervescence

An emergency nurse working in a military hospital admits a new military recruit who collapsed during a heavy training exercise in the desert. The skin is moist, the pulse is 120 beats/minute, and the respirations are 28/minute. What interventions will the nurse implement? Select all that apply.

Provide fluid resuscitation. Remove client's heavy clothing. Keep the environment cool.

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

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

REFERRED

An older adult client with a history of chronic obstructive pulmonary disease (COPD) develops a fever of 38.3ºC (101ºF). What is the primary reason for the nurse to implement temperature-lowering measures?

Reduce oxygen demand

While a nurse is taking a client's history, the client states that he had a fever 2 days ago that went away for a day and then returned. The nurse documents this as being which type of fever?

Relapsing

Phantom limb pain is a little understood pain that is difficult to treat, even though the client is experiencing severe pain. Which treatments will most likely help the phantom limb pain?

Relaxation training and transcutaneous electrical nerve stimulation on the afferents in the area

The nurse is studying sensory systems. She understands that signal transduction of an impulse to the thalamus for processing is accomplished by:

Second-order neurons

Which intervention would be an appropriate action for a nurse to take in attempting to decrease a client's temperature through radiation heat loss?

Set the room to a lower temperature

The nurse is conducting a community education course on hyperthermia and heatstroke. The nurse determines that the participants understand the information when they state that which bodily function increases core temperature?

Shivering

A client presents with a temperature of 38.8°C (101.8°F), a racing heart, fatigue, and an upset stomach after working outside in a hot day. Which assessment findings suggest fever rather than hyperthermia as a cause of the elevation in the man's temperature? Select all that apply.

Shivering Pallor

The nurse is providing nonpharmacologic pain relief for a client who has a pain level of 2 in the leg. What intervention provided by the nurse would be considered distraction?

Sitting with the client and having a conversation

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

Stimulus-induced analgesia

The nurse working in the neurologic intensive care unit is performing a neurologic assessment of somatosensory function for a client who was involved in a motor vehicle accident with suspected spinal cord injury. What should the nurse be sure to include in this assessment?

Testing the integrity of spinal segmental nerves

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

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.

Which client should be assessed for fever based on other presenting symptoms? Select all that apply

The client with anorexia The client with myalgia

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

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

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

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.

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

Malignant hyperthermia is a disorder in which the body's core temperature can rise by 1°C every 5 minutes. Although it is often caused by a halogenated anesthetic agent in combination with succinylcholine, there are also nonoperative precipitating factors. What nonoperative factors can precipitate malignant hyperthermia? Select all that apply.

Trauma Exercise Infection Environmental heat stress

Children feel pain just as much as adults do. What is the major principle in pain management in the pediatric population?

Treat on individual basis and match analgesic agent with cause and level of pain.

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

Ventricular dysrhythmia

Which client most likely faces the highest risk of neuroleptic malignant syndrome?

Young adult client who is taking antipsychotic medications for the treatment of schizophrenia

A nurse conducting a community education program on hypothermia includes which of the following as a risk factor?

alcohol

Which intervention is an appropriate action by a nurse to take in attempting to decrease a client's temperature through conduction?

apply a cooling blanket

Fever in infants and young children is not an uncommon event. Many trips to the pediatrician's office occur because of fever in children ages 1 day to 3 years. Which sign or symptom does not indicate fever in an infant?

avid feeding

A client's body temperature has been documented as follows: 12 noon: 37°C (98.6°F); 6 pm: 37.5°C (99.5°F); 3 am: 36°C (96.8°F). Which action should the nurse take?

document the temperature

A nurse's hand-off reports states that the client has pyrexia. The nurse plans care for the client who has:

fever

A hiker presents to the emergency department with reports of flu-like symptoms—thirst, nausea, and inability to urinate. Upon assessment, it is determined that the client has a rectal temperature of 102.2°F (39°C) and is tachycardic. These symptoms support a diagnosis of:

heat exhaustion

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?

heat stroke

A surgical client is at greatest risk for hypothermia during a surgical procedure related to:

impaired thermoregulatory mechanisms brought on by anesthesia.

A hospital client who is being treated for acute kidney injury has developed an oral temperature of 39.1°C (102.4°F) despite the absence of other signs and symptoms of infection. When attempting to determine the etiology of the client's fever, the nurse should:

review the client's recent medication history.

When lecturing about heart attacks (myocardial infarctions), the instructor will emphasize the client may present with:

substernal chest pain. neck pain. pain that radiates to the left arm.

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy?

tension

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

their menstrual cycle. consuming chocolate.

A 33-year-old client is brought into the emergency room with a core temperature of 39°C (102.2°F). The client is red in the face, chest, and back due to significant cutaneous vasodilation. The client is likely in which stage of fever?

third

A client who has developed a fever is now reporting a headache. The nurse would recognize this manifestation as a result from the:

vasodilatation of cerebral vessels.

When giving pain medicine for acute pain, health care workers are reluctant to provide much-needed opioid pain medicine. What is the major concern of health care workers when providing opioid pain relief?

FEAR OF ADDICTION

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

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

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

Inexpensive Have minimal adverse effects Effective

The nurse is taking the history of a client scheduled for surgery with general anesthesia. What is the best response by the nurse to the client's statement that an uncle died after receiving general anesthesia?

Inform the anesthesiologist.

In which client with a transecting spinal cord injury should the nurse anticipate an impaired ability for temperature regulation?

Injury at T2

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

Joint movement Two-point touch Vibration

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

Large diameter, myelinated

An emergency room nurse caring for a 24-day-old infant for signs of bacterial infection toxicity should assess for which symptoms? Select all that apply.

Lethargy Poor feeding Cyanosis

Most febrile illnesses are due to common infections and are relatively easy to diagnose. In certain instances, however, it is difficult to establish the cause of a fever. In these instances, the elevation in temperature is referred to as a fever of unknown origin (FUO). What is a common cause of FUO?

Malignancies