Chapter 14 PrepU
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."
The nurse caring for older adults in an extended care facility suspects one of the clients has an infection. What is the earliest manifestation the client could exhibit?
Increased mental confusion
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
Which tract in the spinal cord conducts the diffuse, dull, aching sensations that are associated with chronic and visceral pain?
Neospinothalamic tract
Which of the following types of pain is characterized by severe, brief, often repetitive pain?
Neuralgia
Which client manifestation indicates signs of drug fever?
Temperature reaches 40°C (104°F) every afternoon, pulse 76 beats/minute, pruritis
A nurse conducting a community education program on hypothermia includes which of the following as a risk factor?
Alcohol
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
How will the nurse explain to a client the changes in blood flow during exercise?
"Heat dilates blood vessels and increases local blood flow to skeletal muscles."
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 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."
Place the four successive stages of fever in correct order. 1Chill 2Flush 3Prodromal 4Defervescence
4, 2, 1, 3
Which symptom indicates the next stage of a fever after a prodrome?
A chill
A nurse who is testing a client's response to passive movement of the fingers with the client's eyes closed notes that the client cannot accurately identify on which side the movement occurred or in what position the finger was placed. What is an appropriate interpretation of this result?
Abnormal discrimination pathway function
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
An otherwise healthy client has been referred to a pain clinic because he is experiencing exquisite pain from the friction of his clothes on his torso. This client is likely to be diagnosed with which health problem?
Allodynia
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
A 38-year-old male client is brought to hospital by ambulance with mild hypothermia following a prolonged hike in the rain. Which set of vital signs would be most characteristic of the client's diagnosis?
BP 138/84; RR 28; HR 111
A nurse caring for a client with hypothermia anticipates that the client's temperature will be:
Below 35°C (95°F)
Which client/disease process would benefit from surgery to relieve severe, intractable pain?
Block transmission of phantom limb pain
Which factors influence pharmacologic choices for pain management in children? Select all that apply. Body size requires dosage adjustment. Liver function is less efficient in an infant. Risk for opioid addiction requires avoidance. One goal is to minimize side effects. Premature infants may have reduced renal function.
Body size requires dosage adjustment. Liver function is less efficient in an infant. One goal is to minimize side effects. Premature infants may have reduced renal function.
Nonshivering thermogenesis occurs in which of the following to help the newborn infant fight hypothermia?
Brown fat
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.
A client who has had a spinal injury now has sensory changes on the distal forearm and fourth and fifth fingers. The nurse can predict that this client has experienced an injury to which cervical spine region?
Cervical (C) 8
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.
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.
The loss of heat from the body through the circulation of air currents is known as:
Convection
A client with multiple sclerosis complains of chronic burning and aching pain. Which principle explains the cause of this type of pain?
Damage, causing central mechanisms to respond to pain abnormally
Which risk factor presents the greatest risk for injury in an older adult who is experiencing a dysfunction in temperature regulator function?
Delayed initiation of appropriate treatment
Which conditions or events commonly trigger neuropathic pain? Select all that apply. Osteoarthritis Shingles Myocardial infarction Diabetes mellitus Surgery
Diabetes mellitus Shingles
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.
Which assessment finding correlates to the prodromal stage of a fever?
Fatigue
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 Firm pressure in knees Sense of hot and cold
Fine touch in the thumb Pressure sense in lips Sense of hot and cold
A client experiencing acute pain finds relief for several hours after the light touch of a soft-bristled brush has been applied over the area. Which pain theory is best supported by this event?
Gate control
With which activity would a client experiencing astereognosis need help?
Identifying an object by touch
There are two types of stimuli that affect the raising or lowering of body temperature. What are these stimuli?
Innocuous and noxious
Which intervention is usually the first line of therapy when treating moderate pain in the older adult population?
Nonopioids such as acetaminophen
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 nurse assesses a client with a cerebral infarct for sensation. Which result indicates that second-order neurons are intact?
Patellar reflex +2
Which factor influence pharmacologic choices for pain management in older adults? Select all that apply. Polypharmacy may cause drug interactions. Risk for opioid addiction requires avoidance. Organ function may be less efficient. Poor nutrition may lead to poor drug distribution.
Polypharmacy may cause drug interactions. Organ function may be less efficient. Poor nutrition may lead to poor drug distribution.
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. Immerse client in an ice bath. Keep the environment cool. Remove client's heavy clothing. Administer dantrolene.
Provide fluid resuscitation. Keep the environment cool. Remove client's heavy clothing.
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
The nurse is caring for a client with acute pain from broken humerus. Which direction will the nurse provide the client related to pain management?
Requesting pain medication before the pain is severe can reduce how much medication is needed.
Antipyretic drugs, such as aspirin, ibuprofen, and acetaminophen, are often used to alleviate the discomforts of fever and protect vulnerable organs, such as the brain, from extreme elevations in body temperature. The use of aspirin is limited in children, however, because it can sometimes cause which disease?
Reye syndrome
Which tactile receptors will signal when an athlete experiences a joint injury?
Ruffini end-organs
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 Moist skin Cognitive changes Dizziness Pallor
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
About 30 minutes following the morning medication pass, the nurse's aide informs the nurse that one of the clients on their team is complaining of "hot sweats." The aide also states that the client's temperature is now 101.5°F (38.6°F). Knowing that some medications can cause hyperthermia, the nurse reviews the medications. Which client is at high risk for developing an elevated temperature?
Suicidal client who overdosed on a monoamine oxidase (MOA) inhibitor
A client with pneumonia is admitted with these vital signs: temperature 99.7ºF (37.6°F), pulse 80 beats/min, respirations 18/minute, and BP 120/80 mm Hg. Which set of vital signs does the nurse anticipate when the client begins to shiver and requests another blanket several hours later?
T 100.9ºF (38.3°C), P 90/min, R 20/min, BP 126/80 mm Hg
Following an automobile accident that resulted in a traumatic amputation of the right lower leg, the client complains of feeling tingling, heaviness, and shooting pain in the amputated limb. The health care providers treat phantom limb pain by using which interventions? Select all that apply. TENS of the large myelinated afferents innervating the area Hypnosis Relaxation techniques Warm, moist compresses Use of mirrors to visualize the limb is no longer there
TENS of the large myelinated afferents innervating the area Hypnosis Relaxation techniques
A client is experiencing anorexia, myalgia, arthralgia, headache, and fatigue. The nurse should assess for:
Temperature
A client who has been exercising for a few weeks begins to sweat as soon as he exercises. What will the nurse determine from this assessment?
The client is reacting normally.
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.
A client with a diagnosis of lung cancer has developed bone metastases resulting in severe and protracted pain. Which assessment components should the nurse prioritize when assessing the client's pain?
The client's subjective report of the character and severity of pain
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.
The nurse is conducting a neurologic assessment and has gently poked the client's forearm with two ends of a paper clip 0.5 cm apart. The client is unable to state that there were two discrete points of contact. Which is the nurse's best interpretation of this finding?
This is a normal finding when assessing discrimination at this location.
A nurse is assisting a client, who has a fever, order lunch. What would be the most appropriate food choice?
Toast
Which interventions are effective treatments for phantom limb pain? Select all that apply. Nerve block Transcutaneous electrical nerve stimulation (TENS) Bisphosphonates NSAIDs Hypnosis
Transcutaneous electrical nerve stimulation (TENS) Hypnosis nereve block
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 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
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
Fever and hyperthermia describe conditions in which body temperature is higher than the normal range. When does hyperthermia occur?
When the body's set point is unchanged, but the temperature goes up
A nurse is assessing a client for manifestations of chronic pain. Which finding is characteristic of chronic pain? Select all that apply. Withdrawal from activities Loss of appetite Breathing shallow, 26 breaths/min Mental depression Sweating Pulse rate 120 beats/min
Withdrawal from activities Loss of appetite Mental depression
A nurse assess an older adult client for signs and symptoms of infection. In the absence of a fever, for which will the nurse assess? Select all that apply. weight gain decreased mental status fatigue change in functional capacity depression
decreased mental status fatigue change in functional capacity
Stretch-sensitive receptors in the skin (Ruffini end organs, Pacinian corpuscles, and Merkel cells) help signal postural information and are processed through the:
dorsal column-medial lemniscus pathway.
A nurse instructing unlicensed assistive personnel (UAP) on temperature regulation includes as part of the teaching that core body and skin temperatures are sensed by which part of the brain? medulla pituitary hypothalamus cerebellum
hypothalamus
A nurse notes that a client with a fever has begun to shiver. The nurse should assess for which finding?
increased temperature
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.
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.
A client is experiencing a cluster headache. The client would most likely manifest:
severe pain behind the eye.
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. umbilicus pain. pain that radiates to the left arm. deep, right-sided abdominal pain.
substernal chest pain. neck pain. pain that radiates to the left arm.
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."
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."
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 client may be experiencing the effects of neuropathic pain?
A man with pain secondary to his poorly controlled diabetes
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
Which intervention is an appropriate action by a nurse to take in attempting to decrease a client's temperature through conduction?
Apply cooling blanket
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 provider is testing the client's ability to identify the specific location of skin touch in two different areas. This ability is communicated through which pathway?
Discriminative
A client has an increase in core temperature. What does the nurse expect to assess with this finding? Select all that apply. Constriction of superficial blood vessels Dilation of superficial blood vessels Cool, pale skin Hyperactivity Sweating
Dilation of superficial blood vessels Sweating
An older adult's blood cultures have come back positive, despite the fact that the client's oral temperature remains within normal range. Which phenomena underlies the alterations in fever response that occur in older adults?
Disturbance in the functioning of the thermoregulatory center
In describing the ideal analgesic, what factors would be included? Select all that apply. Have minimal adverse effects Effective Inexpensive Addictive Decrease the level of consciousness
Have minimal adverse effects Effective Inexpensive
During an intense aerobic activity, how does the body regulate temperature during a well-trained athlete's workout?
Increasing heat loss by producing sweat
In which client with a transecting spinal cord injury should the nurse anticipate an impaired ability for temperature regulation?
Injury at T2
A client has been diagnosed with osteomyelitis and admitted to the hospital. The client's fever persists throughout most of the day but returns to normal at least twice a day. Which pattern of fever is this client displaying?
Intermittent
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.
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
Select the tactile receptors that are sensitive to the movement of very light objects over the surface of the skin.
Meissner corpuscles
The nurse asks the client if she would like medication for pain after an appendectomy but the client decides to wait. What does the nurse understand may influence this client's pain threshold and tolerance? Select all that apply. Psychological factors Familial factors Trust factors Cultural factors Environmental factors
Psychological factors Cultural factors Environmental factors Familial factors
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
The route considered the most accurate to measure a core body temperature is:
Rectal
The health care provider is obtaining a pain history from a client. Which information is most important to obtain? Select all that apply. Self-image Gender Self-report Pain onset Quality Intensity Localization
Self-report Pain onset Quality Intensity Localization
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 is a crushing sensation. The pain increases with jaw activity. There is a rapid pulse rate. The client is sweating and anxious. There is an accompanying headache.
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
A child age 33 days is presented to the emergency department of a hospital by her parents following a 2-day fever. Her temperature is 38°C (100.4°F) tympanically. Which diagnostic test is most clearly indicated?
Urine for culture and sensitivity
Which of the following is an accurate method of assessing pain in children ages 3 to 8 years?
Using a faces scale
A surgical client is at greatest risk for hypothermia during a surgical procedure related to:
impaired thermoregulatory mechanisms brought on by anesthesia.
Which client(s) is showing manifestations of infection? Select all that apply. 75-year-old client with temperature 37.3°C (99.2°F), declining mental status, weakness and fatigue 25-year-old client with temperature 40°C (104°F), sweating, shivering, states generalized pain 50-year-old client with temperature 36.5°C (97.7°F), heart rate 65 beats/min, fatigue 2-month-old client with temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis 5-year-old client with temperature 36.8°C (98.2°F), distracted and irritable
75-year-old client with temperature 37.3°C (99.2°F), declining mental status, weakness and fatigue 25-year-old client with temperature 40°C (104°F), sweating, shivering, states generalized pain 2-month-old client with temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis
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
Chronic pain is difficult to treat. Cancer, a common cause of chronic pain, has been especially addressed by the World Health Organization (WHO). What has WHO created to assist clinicians in choosing appropriate analgesics?
An analgesic ladder for pain control
Which statement characterizes complex regional pain syndrome?
Disproportionate pain response to the original injury
The nurse is taking the history of a client scheduled for surgery with general anesthesia. What is the first response by the nurse to the client's statement that an uncle died after receiving general anesthesia?
Ensure the anesthesiologist is made aware of the information.
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 client in pain uses analgesic medications and heat for pain control. Which instructions should the nurse give the client about the safe application of heat? Select all that apply. Heat can loosen collagen fibers before therapy. Avoid heat on areas with vascular impairment. Alternate heat and ice for acute injuries. Use heat up to 115°F (46.1°C)
Heat can loosen collagen fibers before therapy. Avoid heat on areas with vascular impairment.
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
An 8-year-old boy has fallen through the ice while skating on a frozen pond. By the time paramedics arrive, the boy has been removed from the water by his friends, but his core body temperature is 31.1°C (88.0°F). The responders would recognize that which physiologic process would have been active during the boy's accident?
Heat production through increased body metabolism
Neurogenic fevers begin in the central nervous system. By what characteristics are neurogenic fevers known?
High temperatures that are not associated with sweating
A client with schizophrenia develops sudden onset of fever, muscle rigidity, altered level of consciousness, and tachycardia. What is the appropriate response by the nurse? Select all that apply. Give dantrolene Hold the neuroleptic medication Administer bromocriptine Provide calcium gluconate Limit fluid intake
Hold the neuroleptic medication Administer bromocriptine Give dantrolene
Which statement explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?
NSAIDs block the enzyme that synthesizes prostaglandins.
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
It is often necessary to assess a client's pain. What factors would the nurse consider when assessing pain? Select all that apply. Spinal reflex involvement and nature of pain Location and radiation of pain Severity and spinal reflex involvement of pain Nature and severity of pain Spinal tract involvement and radiation of pain
Nature and severity of pain Location and radiation of pain
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 physician.
Nociceptors are sensory receptors that are activated by which type of stimuli?
Noxious stimuli
The nurse is assessing clients who are febrile. Which client is at greatest risk due to fever?
Older adult client with heart failure
The renal excretion of drugs in children is dependent on which factors? Select all that apply. Urinary output Tubular secretion Glomerular filtration rate Renal blood flow Oral fluid intake Child's weight
Renal blood flow Glomerular filtration rate Tubular secretion
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
A nurse conducting a community education program on hyperthermia determines that the participants understand the information when they identify that the heat index is which of the following?
Temperature sensed when temperature and humidity are combined
The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy?
Tension
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
Which is considered the most accurate method of assessing pain in children ages 8 years and older?
Using a numeric 1-10 scale
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
