Chapter 12 Altered Somatic and Special sensory function

The nurse offers a client recovering from knee surgery a prescribed opioid analgesic. The client states, "I don't find the pain that severe. I think acetaminophen will be fine." How should the nurse respond?

"This is fine as long as your pain tolerance allows you to participate in the prescribed postoperative exercises."

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."

The nurse is teaching a client who will be undergoing fluorescein angiography to assess for macular degeneration (MD). Which information will the nurse include about this test? Select all that apply.

"The test requires the injection of a dye through an intravenous catheter." "Images of your retina will be taken to assess for changes consistent with MD."

The nurse is working in an outpatient laser-assisted in situ keratomileusis (LASIK) clinic. Which conditions does the nurse assist in treating? (Select all that apply.)

Myopia Hyperopia Astigmatism

For which type of hearing loss should the nurse assess in a child who has had recurrent otitis media since birth?

Conductive loss

An adult client has undergone testing for otosclerosis. Which interview question is most appropriate to the pathophysiology of this disease?

"Has anyone else in your family been diagnosed with this disease?"

Which of these clients' statements would be most suggestive of retinal detachment?

"I feel like there's a shadow that's blocking my vision."

A 2-year-old child has been diagnosed with uncomplicated acute otitis media by a nurse practitioner. When explaining the plan of care, which description is most appropriate?

"Let's keep a close eye on his condition for a couple of days before starting antibiotics."

The health care provider is reviewing the results of a client's caloric test. The results were as follows: the client's eyes exhibited a jerk nystagmus lasting 2 to 3 minutes, with the slow component toward the irrigated ear followed by rapid movement away from the ear. This would be interpreted as:

A functioning brain stem

Which client may be experiencing the effects of neuropathic pain?

A man with pain secondary to his poorly controlled diabetes

When pupillary dilation partially compensates for the reduced size of the retinal image by increasing the light entering the pupil, this is a component of which eye adjustment?

Accommodation

A client reports sudden, acute left eye pain with blurred vision and a headache on the affected side. The client is most likely experiencing:

Acute angle-closure glaucoma

For which older adult client would pain assessment likely be most challenging for the nurse?

An 87-year-old client with vascular dementia and numerous other health problems, such as heart failure

A client arrives at the emergency department after experiencing multiple trauma. During the assessment, the client was unable to discern which side of the body was feeling pain or stimulus, was nauseous, and failed the two-point discrimination test. Which spinal pathway is still intact?

Anterolateral tract

A diabetic client has developed diabetic neuropathy and is prescribed pharmacologic intervention. The medication most likely to be prescribed would be an:

Antiseizure

The nurse is caring for an older adult client who reports a recent decline in hearing acuity and suspects "wax buildup." Which action will the nurse take first?

Assess the client to ensure the tympanic membrane is intact.

A client presents with copious amounts of yellow-green drainage, conjunctival redness, and chemosis to the right eye. A culture of the eye drainage reveals S. pneumoniae. The client most likely developed:

Bacterial conjunctivitis

A client who has cut a finger drops the knife in pain. Which component of this pain signal was transmitted by third-order neurons?

Between the thalamus and the cerebral cortex

The client asks the health care provider, "What is the purpose of applying cold to a sprained ankle?" Which response by the health care provider is best?

Cold provides pain relief and suppresses the release of products from tissue damage.

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

Distraction by knitting Guided imagery Biofeedback

Which principles should underlie the pain control strategy in the care of a child with a diagnosis of cancer?

Dosing and timing should aim for a steady serum level of the prescribed drug.

Which characteristic differentiates open-angle glaucoma from angle-closure glaucoma?

Dysfunction of the aqueous humor drainage system

A parent of a child with otitis media with effusion (OME) asks, "How is this different from typical acute otitis media (AOM)?" Which response by the nurse correctly identifies the main difference?

Excess middle ear fluid

What is the major cause of sensorineural hearing loss in children?

Genetic causes

What is the result of depolarization of the hair cells inside the cochlea?

Impulse generation and transmission to the brain

A client presents to the ENT clinic with some vague signs/symptoms. The health care provider would suspect otosclerosis when the client reports which symptoms? Select all that apply.

Inability to hear whispering. When chewing food, sounds are much intensified. The person's own voice sounds unusually loud.

A client suffering from chronic sinusitis arrives at the urgent care center complaining of a sudden onset of dizziness and difficulty walking straight. What diagnosis does the admitting nurse suspects this client has?

Labyrinthitis

A 5-month-old infant is being treated for acute otitis media (AOM) for the second time in the past 10 weeks. Which action should the nurse recommend to prevent future recurrences?

Limiting the infant's exposure to large group settings

The health care provider is obtaining a pain history from a client. Which information is most important to obtain? Select all that apply.

Localization Quality Self-report Intensity Pain onset

Which statement is true of migraine headaches?

Migraines may have a hormonal etiology in some clients.

Nociceptors are sensory receptors that are activated by which type of stimuli?

Noxious stimuli

To maintain fixation on stable objects during head rotation, the eyes slowly drift in the opposite direction and then jump rapidly back toward the direction of rotation. This process is known by what term?

Nystagmus

Which visual deficit is a clinician justified in attributing to the normal aging process?

Presbyopia

With aging, progressive inelasticity and thickening of the lens causes which accommodation disorder?

Presbyopia

The nurse is assessing a client's hearing and wants to determine if the client has hearing loss of certain frequencies. Which audiometry test will the nurse perform?

Pure-tone audiometry

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

Referred

A client expresses concern about feeling fullness in the ear. Which additional manifestation leads the health care provider to suspect Menière disease?

Rotary vertigo and tinnitus

A client with rheumatoid arthritis has taken high doses of aspirin for several years. Which type of hearing loss is this client at high-risk of developing due to ototoxicity?

Sensorineural hearing loss

What are the clinical manifestations of Meniere disease? Select all that apply.

Severe ringing in the ear(s) Feeling of fullness in the ear(s) Episodes of disabling vertigo Dizziness triggered by turning the head

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

Somatosensory cortex

The nurse is performing an eye assessment on a client who presents with a red eye. The nurse determines that the redness is related to bacterial conjunctivitis based on which additional symptom(s)?

Tearing, itching, and burning

A client has been diagnosed with sensorineural hearing loss. What should the care team assess to determine a plausible cause?

The client's recent medication use

A nurse working in an outpatient pediatric clinic notes a large number of ear infections among children. What is the nurse's understanding of this increased rate?

The eustachian tube is narrower in children.

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

Which pain disorder is a manifestation of a disruption of cranial nerve function?

Trigeminal neuralgia

A 2-year-old child who has had otitis media (OM) for 4 months and been treated with several courses of antibiotics now appears to have some hearing loss. The nurse anticipates that the most appropriate treatment for the child would be:

Tympanostomy tube insertion

While playing outside in the snow a young child did not keep gloves on. In the emergency department, the child reported painful fingertips. The nurse knows this painful sensation is a result of which transmission of proprioceptive somatosensory information?

Type C dorsal root ganglion neurons

A client with a history of migraine headaches tells the physician that he or she usually experiences an aura before the onset of the headache. The client is most likely experiencing:

Visual disturbances

Which characteristic differentiates a migraine with aura from a migraine without aura?

Visual symptoms such as flickering lights precede the headache

The nurse is caring for a client recovering from surgery to resect a portion of intestine. In the immediate postoperative period, which terms would the nurse apply when documenting the type of pain expected from this procedure? Select all that apply.

acute nociceptive cutaneous visceral

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

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

A client who experiences constant cloudiness of vision, sees floaters, and has an opaque lens is diagnosed with a cataract. The most appropriate treatment would be:

surgical lens replacement to correct vision.

An older adult client is scheduled for outpatient cataract surgery. While taking a presurgery history, which statement by the client correlates to the manifestations of cataracts, thereby verifying the client has received information about the condition?

"I have blurred vision in both my eyes and my vision is distorted."

An older adult client has been diagnosed with macular degeneration. Which statement by the client best demonstrates an accurate understanding of the new diagnosis?

"I suppose that this may be one of the things that happens when you get older."

The nurse is working with a client who has been diagnosed with recurring migraine headaches. Which advice by the nurse is most appropriate?

"Many people find that maintaining regular eating and sleeping habits is beneficial."

The nurse is caring for a client with visual impairment who states recent difficulty seeing clearly at night. Which condition does the nurse suspect the client may suffer from?

Vitamin A deficiency

The nurse is teaching a client about the treatment of open-angle glaucoma. The most appropriate information for the nurse to give the client would be:

administration of topical beta-adrenergic antagonists to lower the pressure.

Although both vertigo and dizziness can result from peripheral or central vestibular disorders, vertigo is distinctly different because it causes:

an illusion of motion.

The nurse is caring for a client who reports having a mildly painful, itchy ear canal with no other associated symptoms. For which condition will the nurse assess the client based on the presenting symptoms?

external otitis (acute otitis externa or swimmer's ear)

A client tells the health care provider he has noticed a recent change in his vision: he can bring distant images into focus, but near images become blurred. The client has most likely developed:

hyperopia.

The ophthalmologist is performing a client's annual eye exam and notes an increase in intraocular pressure. The condition most likely is the result of:

imbalance between aqueous production and outflow.

The nurse is caring for a client experiencing phantom limb pain after amputation. The nurse applies which theory of pain to best help explain the client's pain?

neuromatrix

Which stimulus would be used to elicit the withdrawal reflex when testing response to nociceptive stimuli?

pressure from a sharp object

The nurse is teaching a client about various methods of pain control. Which information will the nurse include when teaching the client about applying heat for pain control?

"Heat promotes more blood flow to the area to improve oxygen supply."

The nurse is teaching a client who has tinnitus about suggested dietary modifications. What information is most important for the nurse to include?

"Try cutting down on foods high in monosodium glutamate."

A client reports occasional ringing in the ears that worsens toward the end of the day. The most important question for the nurse to ask would be:

"What prescription medication and over-the-counter medication do you take?"

A new mother brings her infant to the clinic reporting that the child is not sleeping or eating much. Upon assessment, the health care provider notes that the infant's ear canal is reddened with a bulging tympanic membrane. Which other data collected would lead to the diagnosis of acute otitis media (AOM)? Select all that apply.

"Yes, he has been pulling at his ear." "He's been very irritable and fussy the past couple of days."

A middle-aged client whose father experienced progressive vision loss from macular degeneration (MD) asks the nurse if there is anything that can reduce the risk of developing MD. How should the nurse respond?

"You can reduce your risk by preventing high blood pressure and maintaining a healthy weight."

The nurse is explaining the role of aqueous humor in the development of glaucoma to a client who has just been diagnosed with the condition. How should the nurse describe the role of aqueous humor in the pathogenesis of glaucoma?

Aqueous humor is continually produced and drained to maintain the appropriate pressure. In glaucoma, the normal drainage is impeded and the increased pressure can damage the optic nerve.

A client presents to the clinic complaining, "I have something in my eye." When questioned, the client admits to a scratching and burning sensation and light sensitivity. The health care provider suspects the client has developed:

Conjunctivitis

A client is brought to the emergency department after a bicycle accident. He landed on his back and has been unable to move since the accident, despite the absence of obvious head injuries. The physician will focus assessment of the client's neurologic status by testing which aspects of his body?

Each dermatome

The nurse is assessing a client who has been diagnosed with esotropia. The nurse would expect the assessment findings to include:

Medial deviation

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

Meissner corpuscles

Causes of eyelid weakness include neurologic causes. There can be damage to the cranial nerves (CN) that innervate the eyelids, or there can be damage to the central nuclei of the cranial nerves. Where are the central nuclei of cranial nerve III (oculomotor nerve) and CN VII (facial nerve)?

Midbrain and caudal pons

A 38-year-old client who has begun to develop hearing loss is being evaluated by the nurse practitioner. The client tells the nurse that hearing improves when she is on the telephone and that chewing sounds very loud. What does the nurse practitioner suspect?

Otosclerosis

The nurse is caring for an older adult client with a suspected diagnosis of presbycusis. Select the most likely manifestation.

Sensorineural hearing loss caused by natural aging

The nurse is making a plan of care for a client in the initial stage of otosclerosis. Which assessment finding correlates to the early development of this diagnosis?

inability to hear whispering

A 55-year-old client has been diagnosed with acute angle-closure glaucoma. The client's ophthalmologist is recommending immediate and aggressive drug treatment because the:

increase in intraocular pressure will cause degradation of the optic nerve.

A client has been diagnosed with open-angle glaucoma during a routine eye exam. The client has been prescribed a topical β-adrenergic antagonist. Client teaching about how this drug works should include which of the following statements? β-adrenergic antagonists:

lower intraocular pressure by decreasing aqueous humor production.

A client seeks medical care when he wrecks his car because of poor eyesight. At the time of admission, his blood glucose level was 390 mg/dL. The client is diagnosed with diabetes (type 2). The ophthalmologist must perform an urgent intravitreal injection. The nurse explains this to the client by stating the doctor will:

put a needle with syringe into your eyeball and inject some medication to decrease active bleeding.