Chp. 14: Somatosensory Function, Pain, Headache, and Temperature Regulation
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 Neurogenic fever has its origin in the central nervous system and is usually caused by damage to the hypothalamus from trauma, intercranial bleeding, or increased intercranial pressure. The nurse should plan care for a patient with a neurogenic fever.
What can the nurse tell a client about antipyretic drugs during fever?
"Antipyretics help to protect the body." Antipyretic drugs are given to alleviate the discomfort of fever and protect vulnerable organs, such as the brain from extreme elevations in body temperature. They are usually effective
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."
Which assessment finding correlates to the prodromal stage of a fever?
Fatigue
A client is experiencing anorexia, myalgia, arthralgia, headache, and fatigue. The nurse should assess for:
Temperature Common clinical manifestations of fever include anorexia, myalgia, arthralgia, headaches, and fatigue; thus, the nurse should assess the patient's temperature.
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 determines that the participants understand the information when they identify that the heat index is the temperature sensed by the body when humidity and temperature are combined.
The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to nonpharmacologic therapy?
Tension Explanation: Tension-type headaches often are more responsive to nonpharmacologic techniques, such as biofeedback, massage, acupuncture, relaxation, imagery, and physical therapy, than other types of headache. For people with poor posture, a combination of range-of-motion exercises, relaxation, and posture improvement may be helpful. The other options are usually best treated with medications that focus on the cause of the pain
Which types of sensation are transmitted via the discriminative pathway? Select all that apply.
Two-point touch Joint movement Vibration
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 Explanation:Infants with a fever are at risk of urinary tract infections, which would be diagnosed through a urine test for culture and sensitivity. Electrolytes, BUN and creatinine, CT of the head, and abdominal ultrasound are not as closely associated with differential diagnosis of the child's fever.
Which client may be experiencing the effects of neuropathic pain?
A man with pain secondary to his poorly controlled diabetes
The sites of referred pain are determined by:
embryonic development of visceral and somatic structures.
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." Explanation: Herpes zoster is the viral infection caused by the varicella zoster virus. The first infection is called chicken pox. When there is a recurrence it is called shingles. The virus is believed to remain dormant in the nerve root until the patient has a decline in cellular immunity when the virus will replicate. The pain is often described as throbbing, burning, or stabbing. The best prevention is a vaccine for adults age 60 and older. Antivirals will lessen the severity at the time but will not prevent infection.
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." Explanation: Early intervention for pain relief is the best practice. The client should understand that he or she should take his or her pain medication and apply the TENS unit. TENS units are noninvasive and should be applied as soon as the client starts to perceive pain. It is often used in conjunction with pain-relieving medication.
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."
A client asks if pain threshold and pain tolerance are the same. The best response by the health care provider would be:
"Pain threshold is the point at which a stimulus is perceived as painful." Explanation: Pain threshold is closely associated with the point at which a nociceptive stimulus is perceived as painful. Pain tolerance relates more to the total pain experience; it is defined as the maximum intensity or duration of pain that a person is willing to endure before the he or she wants something done about the pain. Psychological, familial, cultural, and environmental factors significantly influence the amount of pain a person is willing to tolerate. The threshold for pain is fairly uniform from one person to another, whereas pain tolerance is extremely variable.
A 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." Explanation: Preventative medications such as beta-adrenergic blockers should be taken consistently to prevent vascular changes from occurring. In most cases, preventative treatment must be taken daily for months to years. They should not be stopped abruptly and should be weaned or tapered off
A hospital client has been reluctant to accept morphine sulfate despite visible signs of pain. Upon questioning, the client reveals that he is afraid of becoming addicted to the drug. How should the nurse respond to the client's concern?
"There's only a minute chance that you will become addicted to these painkillers when used for acute pain."
A client who has been exercising says to the nurse, "My skin is so hot!" What is the nurse's best response?
"Your body is trying to lower your temperature."
Which clients are showing manifestations of infection? Select all that apply.
- A 25-year-old, temperature 40°C (104°F), • A 2-month-old, temperature 38.3°C (100.4°F), lethargy, poor feeding, and cyanosis • A 75-year-old, temperature 37.3°C (99.2°F), declining mental status, weakness and fatigueAn older adult with an infection may have a minimal rise in temperature, but exhibit changes in mental status, weakness, fatigue, and weight loss. An infant younger than three months may have a relatively mild fever, but a serious infection.An adult with a high fever will exhibit sweating and chills. Aches and pains may occur with shivering and the infectious illness.- A client with a temperature within the normal range, exhibiting no other signs of change, is not considered to have an infection.
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 symptom indicates the next stage of a fever after a prodrome?
A chill The physiologic behaviors that occur during the development of fever can be divided into four successive stages: prodrome, chill, flush, and defervescence. The stages are successive.
Which client most likely faces the highest risk of neuroleptic malignant syndrome?
A young adult client who is taking antipsychotic medications for the treatment of schizophrenia. Antipsychotics are often implicated in cases of neuroleptic malignant syndrome. Surgery, medications for Alzheimer's disease, and fever are not risk factors.
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
A nurse conducting a community education program on hypothermia includes which of the following as a risk factor?
Alcohol Alcohol is a risk factor for hypothermia, as it dulls mental awareness to cold and impairs judgment to seek shelter or put on additional clothing as well as inhibiting shivering. Other risk factors include sedative drugs, malnutrition, cardiovascular disease, cerebrovascular disease, spinal cord injury, and hypothyroidism.
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 reports general malaise and has a temperature is 103.8°F (39.9°C). What is the rationale for administering a prescribed aspirin, an antipyretic, to this client?
Antipyretics protect vulnerable organs, such as the brain, from extreme temperature elevation.
Which intervention is an appropriate action by a nurse to take in attempting to decrease a client's temperature through conduction?
Apply 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
When conducting a health assessment that focuses on the pain experienced by an older client diagnosed with early dementia, the nurse will pay particular attention to which of the following?
Behavioral signs of pain demonstrated by the client Explanation: The assessment of pain in older adults can range from relatively simple in a well-informed, alert, cognitively intact person with pain from a single source and no comorbidities to extraordinarily difficult in a confused person. When possible, a person's report of pain is the gold standard, but behavioral signs of pain should also be considered. This is especially true when the client's cognitive function is impaired. While the other options should be considered, the client's non verbal behaviors should be of particular interest to the nurse
A nurse caring for a client with hypothermia anticipates that the client's temperature will be:
Below 35°C (95°F)
Nonshivering thermogenesis occurs in which of the following to help the newborn infant fight hypothermia?
Brown fat
The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. Which strategies would be best for the nurse to implement? Select all that apply.
Bubbles Television Music Games Explanation: Distraction helps children of any age divert their attention away from pain and onto other activities. Common attention diverters include bubbles, music, television, conversation, and games.
What can the nurse assume about a child's behavior when faced with the need to repeat a painful procedure?
Children act to avoid pain based on their memory of past painful events. Explanation: Children do feel pain and have been shown to reliably and accurately report pain. They also remember pain. This is evidenced in studies of children with cancer, whose distress during painful procedures increases over time without intervention, and in neonates in intensive care units, who demonstrate protective withdrawal responses to a heel stick after repeated episodes. The other options may not necessarily be true of most children.
A 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 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. Explanation: Cold prevents the release of products of tissue damage and provides pain relief (produces vasoconstriction at the site). Application of heat would cause blood vessels to dilate and more blood to be drawn to the local area.
The loss of heat from the body through the circulation of air currents is known as:
Convection
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
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
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 FUO is associated with HIV. The other aspects of the client's circumstances are not noted to correlate with FUO.
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?
Heatstroke Explanation:Symptoms of heatstroke include a body temperature greater than 104°F (40°F), absence of sweating, and central nervous system abnormalities such as delirium, convulsions, and loss of consciousness
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
The nurse knows that chronic pain lacks which of the characteristic pain-related reactions?
Increased heart rate Explanation: Characteristics of chronic pain do not include autonomic responses like increased heart and respiratory rate. Loss of appetite, disturbed sleep patterns and depression are common among people dealing with chronic pain.
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 notes that a client with a fever has begun to shiver. The nurse should assess for which event?
Increased temperature
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 describing the ideal analgesic, what factors would be included? Select all that apply.
Inexpensive Effective Have minimal adverse effects Explanation: The ideal analgesic would be effective, nonaddictive, and inexpensive. In addition, it would produce minimal adverse effects and not affect the person's level of consciousness.
A febrile, 3-week-old infant is currently undergoing a diagnostic workup to determine the cause of the fever. Which statement best conveys the rationale for this careful examination?
Infants are susceptible to serious infections because of their decreased immune function.
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. Malignant hyperthermia is an autosomal dominant metabolic disorder that occurs in response to particular triggers such as general anesthesia (particularly halothane, and the depolarizing muscle relaxant succinylcholine), trauma, exercise, environmental heat, and infection. If the uncle experienced this condition, the client could also carry the RYR1 gene. The anesthesiologist could select a different anesthetic agent. While the other actions are important, it is essential that the nurse take action to prevent harm to the client.
In which client with a transecting spinal cord injury should the nurse anticipate an impaired ability for temperature regulation?
Injury at T2 Spinal cord injuries that transect the cord at T6 or above can seriously impair temperature regulation because the thermoregulatory centers in the hypothalamus can no longer control skin blood flow and sweating. T9, L4, and L1 injuries are below the level of T6 and do not impair the hypothalamus' ability to control skin blood flow and sweating.
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 Intermittent fever patterns are very changeable, but they do return to normal at least once every 24 hours.-A remitting fever pattern temperature does not return to normal and varies a few degrees in either direction.- In a sustained fever pattern, the temperature remains above normal with minimal variations.-A relapsing fever is one in which there is one or more episodes of fever, each as long as several days, with 1 or more days of normal temperature between episodes.
A client's temperature readings are as follows: 99.6°F (37.5°C) at 4 pm; 102°F (38.9°C) at 8 pm; and 97.9°F (36.6°C) at 12 am. The nurse's hand-off should include which note?
Intermittent fever
A client reports a sudden intense headache. Which factor would indicate the presence of a possible subarachnoid hemorrhage?
Intractable pain Explanation: Subarachnoid hemorrhage causes a severe intractable headache. Headaches that disturb sleep or occur with exercise or sexual activity may be caused by neurologic lesions. Migraine headaches tend to run in families but do not contribute to hemorrhage.
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
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
A nurse is assessing a client for manifestations of chronic pain. Which finding is characteristic of chronic pain? Select all that apply.
Mental depression Withdrawal from activities Loss of appetite Explanation: Acute pain generally is classified as being of short duration and arises from a specific pathologic process that resolves. Acute pain may lead to tachycardia, increased sympathetic activity such as sweating, decreased mobility, and shallow breathing. Chronic pain lasts longer than expected and may fluctuate. Signs of chronic pain include insomnia, depression, and loss of appetite. Patients may withdraw from outside activities.
Which tactile receptors will signal continuous touch on the skin?
Merkel discs Merkel discs transmit an initial strong signal but decrease in strength, indicating continuous pressure on the skin. Meissner corpuscles respond to light touch and low-frequency vibration. Ruffini end-organs are found in skin and deeper structures like joint capsules. Hair-follicle receptors are near the skin surface and respond to light touch.
Which statement is true of migraine headaches?
Migraines may have a hormonal etiology in some clients.
Which statement explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?
NSAIDs block the enzyme that synthesizes prostaglandins. Explanation: Nociceptors respond to three different types of stimuli: chemical, thermal, and mechanical. The chemical mediators such as bradykinin, histamine, serotonin, and potassium activate or sensitize nociceptors and continue the inflammatory response by releasing prostaglandins. Aspirin, ibuprofen, and other NSAIDs block inflammation by blocking the enzyme needed to synthesize prostaglandins.
Migraine headaches affect millions of people worldwide. What are first-line agents for the treatment of migraine headaches?
Naproxen sodium and metoclopramide Explanation: Based on clinical trials, first-line agents include acetylsalicylic acid, combinations of acetaminophen, acetylsalicylic acid, and caffeine and nonsteroidal anti-inflammatory drug analgesics (e.g., naproxen sodium, ibuprofen), serotonin (5-HT1) receptor agonists (e.g., sumatriptan, naratriptan, rizatriptan, zolmitriptan), ergotamine derivatives (e.g., dihydroergotamine), and antiemetic medications (e.g., ondansetron, metoclopramide). Morphine, tramadol, and syrup of ipecac are not first-line drugs in the treatment of migraine.
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. Explanation: Visceral pain, as characterized by the client's description of her pain, is conducted by way of nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not likely rooted in the inappropriate firing of first order neurons or the substitution of conduction by C fibers. Pain that is attributable to a pathologic process apart from the neural pain network is not normally considered to be neuropathic
What will conduct injurious stimuli to alert the body to potential damage?
Nociceptors Explanation: Nociceptors are sensitive to painful and noxious stimuli and alert the system to injury. Thermoreceptors will perceive heat, proprioceptors will perceive body position, and odorant receptors will perceive the sensation of smell.
A client is said to be in the chill stage of the fever process when the nurse:
Observes piloerection on the skin During the second stage or chill, there is the uncomfortable sensation of being chilled and the onset of generalized shaking (rigors).-Vasoconstriction and piloerection usually precede the onset of shivering. At this point, the skin is pale and covered with goose flesh.-Sweating is an indication of the third stage or flushing.-The other options are not descriptive of stages but rather interventions.
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 Explanation: First-order neurons transmit sensory information from the periphery of the neurons to the central nervous system. Second-order neurons communicate directly with the thalamus and work with the reflex networks and sensory pathways in the spinal cord. Third-order neurons relay information from the thalamus to the cerebral cortex. Level of consciousness does not indicate sensation
When testing nociceptive stimuli to elicit a withdrawal reflex in the body, what stimuli are commonly used?
Pressure from a sharp objectExplanation: Stimuli used include pressure from a sharp object, strong electric current to the skin, or application of heat or cold of approximately 10°C above or below normal skin temperature. The other answers are incorrect
A client has a mild headache and fatigue. He also states he has some aches and pains. Which stage of fever does the nurse determine the client is experiencing?
Prodrome
Place the four successive stages of fever in correct order.
Prodrome Chill Flush Defervescence
When assessing a newborn (7 days old), which finding indicates the infant may have a bacterial infection?
Rectal temperature of 100.4°F (38°C).
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 Fever can be beneficial under certain circumstances. Relatively small increases in fever can stimulate immune response by T lymphocyte proliferation. The growth of many microbes is inhibited at temperatures in the fever range. Fever can cause discomfort such as headache and body aches. Fever above 42.2ºC (108ºF) can cause cell damage and life-threatening acidosis, hypoxia, and hyperkalemia. Older adults with cardiac or pulmonary conditions who develop fever are at risk of hypoxia because each degree of temperature elevation in Celsius raises the basal metabolic rate by about 7%. In a client with an average body temperature of about 37ºC (98.6ºF), the rise to 38.3ºC would increase the metabolic demand by more than 7%. A client with longstanding COPD would have difficulty maintaining adequate oxygen saturation.
A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret this pain as:
Referred Explanation: Referred pain is pain that is perceived at a site different from its point of origin but innervated by the same spinal segment. Visceral pain originates in the visceral organs and is one of the most common pains produced by disease, cutaneous pain arises from superficial structures, and somatic pain originates in deep body structures
A nurse reading a client's history and physical notes that the client has had a remitting fever. The nurse interprets this to mean that the client's temperature has done what?
Remained elevated but varied a few degrees
A nurse is conducting a health promotion education program on heat cramps that cause painful muscle cramps. What is the likely cause of these cramps?
Salt depletion from heavy sweating
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 Explanation: Second-order neurons communicate with various reflex networks and sensory pathways in the spinal cord and travel directly to the thalamus. First-order neurons transmit sensory information from the periphery to the CNS. Third-order neurons relay information from the thalamus to the cerebral cortex.
A client is experiencing a cluster headache. The client would most likely manifest:
Severe pain behind the eye Explanation: Symptoms of cluster headache include severe, unrelenting unilateral pain located in the orbital area. The pain radiates behind the eye to the ipsilateral trigeminal nerve. The client may also experience symptoms such as restlessness or agitation, conjunctival redness, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. The other options are all associated with migraine headache.
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 Explanation:Shivering and vasoconstriction can increase core body temperature, whereas vasodilation and sweating can decrease core body temperature.
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
Full localization, discrimination of intensity, and interpretation of somatosensory stimuli requires processing by which region of the brain?
Somatosensory cortex
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 Explanation: Stimulus-induced analgesia is one of the oldest known methods of pain relief. Electrical stimulation methods of pain relief include TENS, electrical acupuncture, and neurostimulation. A physical agent would be the use of heat or cold. Distraction is a nonpharmacologic method of reduction of pain by distracting the patient from his pain. Biofeedback is used to provide feedback to a person concerning the current status of some body function, temperature, temporal artery pulsation, blood pressure, or muscle tension
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 Modification of the environment ensures that the environmental temperature facilitates heat transfer away from the body. Sponge baths with cool water or an alcohol solution can be used to increase evaporative heat losses.-More profound cooling can be accomplished through the use of a cooling blanket or mattress, which facilitates the conduction of heat from the body into the coolant solution that circulates through the mattress.- Care must be taken so that cooling methods do not produce vasoconstriction and shivering that decrease heat loss and increase heat production.
A client has recently been diagnosed with chronic back pain that requires the daily use of hydromorphone, an opioid analgesic. For the first few weeks, the client achieved relief with 4 mg every 6 hours. However, the client now requires 6 mg doses to achieve the same effect. How should the nurse best interpret this phenomenon?
The client is developing opioid tolerance, which is expected Explanation: The client is developing a tolerance to the opioid, which is not unexpected and which is not synonymous with addiction. There may be a need to include nonpharmacologic interventions or NSAIDs, but these do not need to replace the opioid.
A 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 student is feeling inside her backpack to find her mobile phone. There are a number of other items in the backpack. Which component of somatosensory conduction is most likely to provide the detailed sensory information that will help her distinguish her phone from other items?
The primary dorsal root ganglion neuron, dorsal column neuron, and the thalamic neuron Explanation: The discriminative pathway, which is associated with the fine touch of item discrimination, involves just three neurons: the primary dorsal root ganglion neuron, the dorsal column neuron, and the thalamic neuron. Slow-conduction and anterolateral pathways that involve the reticular activating system are associated with pain, thermal sensation, and indiscriminate touch
The health care provider is assessing the functional integrity of all spinal nerves utilizing a pinpoint pressed against the skin. A normal response would be interpreted as:
The withdrawal reflex is activated. Explanation: Observation of a normal withdrawal reflex rules out peripheral nerve disease, disorders of the dorsal root and ganglion, disease of the myoneural junction, and severe muscle diseases. Having no response is abnormal and may identify neurological damage. A verbal response is not a reflex response.
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 The first stage of a fever is marked by headache and body aches, the-second stage is marked by the chills, and the-third stage is the flush state. The-fourth stage is defervescence.
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. Explanation: The overriding principle in all pediatric pain management is to treat each child's pain on an individual basis and to match the analgesic agent with the cause and the level of pain. The other answers are incorrect.
A client reports chronic pain. Assessment indicates it is located at the T6 dermatome. How will this information assist the nurse to develop an effective plan of care?
Treatment can be tailored to the specific location. Explanation: A dermatome is the region of the body wall that is supplied by a single pair of dorsal root ganglia. Isolating the location of the pain allows for focused treatment. Pain commonly interferes with ADLs. Interventions are designed to minimize disruption of ADLs. Management may reduce referred pain but may not alleviate them because the visceral and somatic neurons share the same dorsal horn projections. Clients with chronic pain benefit most from interventions that include physical, emotional, financial, and spiritual components of care. Using biologic treatments alone is less effective than the combination of all modalities.
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 Headache is a common accompaniment of fever and is thought to result from the vasodilatation of cerebral vessels occurring with fever. The coronary arteries would not contribute/cause the headache.
A recovery room nurse monitoring a client for adverse effects of cold cardiplegia assesses for:
Ventricular dysrhythmia Explanation:The nurse should assess for ventricular dysrhythmia, decreased cerebral blood flow, and postoperative myocardial depression.
Which characteristic differentiates a migraine with aura from a migraine without aura?
Visual symptoms such as flickering lights precede the headache
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. Antipsychotics are often implicated in cases of neuroleptic malignant syndrome. Surgery, medications for Alzheimer disease and fever are not risk factors.
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 The probable mechanisms for the blunted fever response in older adults include a disturbance in sensing of temperature by the thermoregulatory center in the hypothalamus. Heat loss by evaporation tends to decrease with age, and the closure of AV shunts results in increased core temperature. The presence of comorbidities is not noted to contribute to reduced fever response in older adults
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. Drugs are a frequent cause of fevers that are unrelated to infection. For this reason, a review of the client's medication history would likely be prioritized over vital signs, provided the client is not in immediate distress.
Which client is most likely to be susceptible to developing a neurogenic fever?
sustained a head injury in a bicycle crash Neurogenic fever is the result of damage to the hypothalamus caused by central nervous system trauma, intracerebral bleeding, or an increase in intracranial pressure. All these problems may be precipitated by a head injury. Alzheimer disease and drug administration are not typical causes of a neurogenic fever.
While talking about their migraine headaches, two women have found that they have some common triggers for their migraines, which may include: Select all that apply.
their menstrual cycle. consuming chocolate.
Which pain disorder is a manifestation of a disruption of cranial nerve function?
trigeminal neuralgia caused by damage to the fifth cranial nerve, which carries impulses of touch, pain, pressure, and temperature to the brain from the face and jaw.
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 Signs and symptoms of infection in an older adult in the absence of a fever include decreases in mental status and functional capacity, fatigue, weight loss, and weakness
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