PrepU CH. 35

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.

Which of the following types of pain is characterized by severe, brief, often repetitive pain?

Neuralgia

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

Pressure from a sharp object

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

Referred

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

Second-order neurons

A student is feeling inside her backpack to find her mobile phone. There are a number of other items in the bag other than the phone. The nurse knows that which of the following terms best describes one's ability to sense of shape and size of an object in the absence of visualization?

Stereognosis.

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

A nurse is teaching a patient with a history of migraines about how to prevent attacks. Which of the following instructions should the nurse include? Select all that apply.

"Avoid foods containing chocolate." "Get a consistent amount of sleep." "Engage in yoga or meditation."

A patient with diabetes mellitus has just undergone a right, below the knee amputation following gangrene infection. A few days post-op, the patient confides in the nurse that he still feels his right foot. Knowing the pathophysiologic principles behind this, the nurse can:

Explain that many amputees have this sensation and that one theory surmises the end of a regenerating nerve becomes trapped in the scar tissue of the amputation site.

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 nurse is assessing the pain level of an adult with the use of a visual analog scale. Select the response that best indicates the client's rating using this tool.

"My pain level falls above the 5-cm mark."

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 patient denies feeling pain. Which of the following responses will help the nurse best manage this patient's pain?

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

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

Carbamazepine is a first-line treatment.

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

Inexpensive • Have minimal adverse effects • Effective

A nurse on a post-surgical unit is providing care for a 76 year-old female client who is two days post-hemiarthroplasty (hip replacement) and who states that her pain has been out of control for the last several hours, though she is not exhibiting signs of pain. Which of the following guidelines should the nurse use for short-term and long-term treatment of the client's pain?

Knowing that the client's self-report of pain is the most reliable indicator of pain.

A nurse is assessing a patient for manifestations of chronic pain. Which of the following is characteristic of chronic pain? Select all that apply.

Mental depression Loss of appetite Withdrawal from activities

Which of the following will conduct injurious stimuli to alert the body of potential damage?

Nociceptors

Which of the following patients is exhibiting headache symptoms that indicate a need for further evaluation?

Pregnant mother with drowsiness and unrelenting headache

The renal excretion of drugs in children is dependent on which factors? Select all that apply.

Renal blood flow Glomerular filtration rate Tubular secretion

Which tactile receptors will signal when an athlete experiences a joint injury?

Ruffini's end organs

A client is experiencing acute pain. The nurse would anticipate the client to manifest:

Tachycardia

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.

Nonopioids, such as acetaminophen (Tylenol), are the first line of therapy for managing mild to moderate pain in the elderly because they are safe.

True

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 30 year-old female has suffered a third-degree burn to her hand after spilling hot oil on it in a kitchen accident. Which of the following teaching points by a member of her care team is most appropriate?

"Opioids aren't without side effects, but we will take action to manage these side effects so you can continue getting these drugs."

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 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 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

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

Using surgery to relieve severe, intractable pain has been successful to a degree. What can surgery be used for when a person is in pain?

Block transmission of phantom limb pain

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. What medication does the nurse anticipate educating this client regarding?

Carbamazepine (Tegretol)

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 what?

Cluster headache

The client asks the health care provider to explain what the purpose is for the application of cold to a sprained ankle. The best response would be:

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

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

Increased heart rate

A patient reports a sudden intense headache. Which of the following factors would indicate the presence of a possible subarachnoid hemorrhage?

Intractable pain

Which of the following explains how nonsteroidal anti-inflammatory drugs (NSAIDs) control pain?

NSAIDs block the enzyme that synthesizes prostaglandins.

Migraine headaches affect millions of people worldwide. What are first-line agents for the treatment of migraine headaches?

Naproxen sodium and metoclopramide

A patient 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 of the following pain theories is best supported by this event?

Neuromatrix

If the patient's dorsal columns are not functioning, the nurse will observe which of the following responses during neuro testing, where the nurse asks the patient to close their eyes and then proceeds to touch corresponding parts of the body on each side simultaneously with two sharp points?

No response to two-point discrimination.

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

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

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

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

Paresthesia from temporary nerve compression

The nurse asks the client if she would like medication for pain after an appendectomy. The client states that she would like to wait and does not want to take anything at this time. What does the nurse understand may influence this client not to take pain medication? Select all that apply.

Psychological factors Cultural factors Environmental factors Familial factors

A 7 year old child had an emergency appendectomy during the night. When trying to assess their pain, the nurse should:

Show them a scale with faces of actual children and have them point to the picture that best describes how they are feeling.

A 25-year-old woman who works as an air-traffic controller presents with facial pain and severe headache. She reports that she sometimes feels the pain in her neck or ear and that it is particularly bad during very busy times at the airport. What is the most likely diagnosis?

Temporomandibular joint syndrome

The nurse learns that different types of headaches respond to different therapies. Which headache is most responsive to non-medication centered therapy?

Tension

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 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

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

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

A nurse is assessing the pain level of a client who has just had surgery. The client tells the nurse he does not think he should take any medication until the pain becomes extreme. The best response would be:

"The use of pain medication before the pain becomes extreme will help prevent hyperexcitability of the CNS."

Which of the following hospital patients is most likely to be diagnosed with complex regional pain syndrome II (CRPS II)?

A man who has been admitted for treatment of continuing hyperalgesia after sustaining a nerve injury in a motor vehicle accident.

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

Staff at the care facility note that a woman has started complaining of back pain in recent weeks and occasionally groans in pain. She has many co-morbids that require several prescription medications. The nurse knows that which of the following factors is likely to complicate the clinician's assessment and treatment of the client's pain?

Assessment and treatment are possibly complicated by the large number of drugs that the client receives.

A patient reports experiencing seeing flickering lights for about 10 minutes before developing nausea and a pounding right-sided headache. Which of the following factors would correspond to a diagnosis of migraine headache? Select all that apply.

Family history of migraine, Duration of 1-2 days, and Occurring with menstruation.

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

With which of the following activities would a patient experiencing astereognosis need help?

Identifying an object by touch

The nurse instructs the certified nursing assistant (CNA) 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 CNA to avoid?

Mechanical stimuli

A woman with severe visual and auditory deficits is able to identify individuals by running her fingers lightly over their face. Which of the following sources is most likely to provide the input that allows for the woman's unique ability?

Meissner corpuscles

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

Meissner corpuscles

A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is complaining of intense, diffuse pain in her abdomen. Which of the following physiological phenomena is most likely contributing to her complaint?

Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve pathways of the ANS.

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

Paleospinothalamic tract

A nurse assesses a patient with a cerebral infarct for sensation. Which of the following results indicates that second-order neurons are intact?

Patellar reflex +2

Which of the following factors influence pharmacologic choices for pain management in older adults? Select all that apply.

Poor nutrition may lead to poor drug distribution. • Organ function may be less efficient. • Polypharmacy may cause drug interactions.

A client is experiencing deep somatic pain. The client would manifest: Select all that apply.

Radiation of pain, pain reproduced by stimuli

A nurse is treating a patient who has chronic daily headache (CDH). In addition to possible administration of medication, Which of the following instructions should be included? Select all that apply.

Reduce or eliminate caffeine . Implement a guided imagery program. Consider acupuncture treatment.

A client is experiencing a cluster headache. The client would most likely manifest:

Severe pain behind the eye

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

While batting, a baseball player is struck in the ribs by a pitch. Place the following components of the player's pain pathway in the chronological order as they contribute to the player's sensation of pain. Use all the options.

Thalamus Dorsal root ganglion body Dorsal root ganglion periphery Axon Cerebral cortex

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 is caring for a 60-year-old patient who experiences headaches several times a month. Which of the following additional characteristics would support a diagnosis of tension headaches? Select all that apply.

The pain is described as dull and aching. The pain responds to NSAIDs.

In addition to medication efficacy, what should the nurse consider when assessing the appropriateness of a pain medication prescribed to an elderly client? Select all that apply

The possibility of drug interaction The effects of normal aging on metabolism The existence of chronic illnesses The cost of the medication

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 mother is placing her child into the bathtub. The child immediately jumps out of the tub and begins to cry, stating their feet are 'burning'. The nurse in the emergency department knows that the child's response is based on which of the following pathophysiological principles listed below?

The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex reacts first.

A patient 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.

A 58-year-old woman 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 only on one side of her face; it seems to be triggered when she chews, brushes her teeth, or sometimes when she merely touches her face. There is no numbness associated with the pain. What is most likely causing her pain?

Trigeminal neuralgia

A client has been admitted to the emergency department after a bicycle accident. When he fell, he landed on his back and has been unable to move since the accident, despite the absence of obvious head injuries. The physician will most likely assess the client's neurologic status by testing:

each dermatome.

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

• Bradykinin • Serotonin • Histamine • Potassium

The nurse on the pediatric unit is implementing distraction strategies for a child who is experiencing pain. The best strategies for the nurse to implement would be: Select all that apply.

• Bubbles • Music • Television • Games

Which of the following conditions or events commonly trigger neuropathic pain? Select all that apply.

• Diabetes mellitus • Shingles

Which of the following sensations will be impaired in a patient 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

A patient in pain uses analgesic medications and heat for pain control. Which of the following should the nurse teach the patient about the safe application of heat? Select all that apply.

• Heat can loosen collagen fibers before therapy. • Avoid heat on areas with vascular impairment.

Which of the following patients is an example of referred pain? Select all that apply.

• One with a myocardial infarction who states, "an elephant is sitting on my chest." • One with gallstones who states, someone is stabbing between my shoulder blades." • One with renal calculi who describes a cramping colicky pain in the scrotum.

Which of the following factors are characteristic of acute pain? Select all that apply.

• Pulse rate 120 beats/min • Shallow breathing, 26 breaths/min • Sweating

A patient who reports pain in the left ear and lower jaw is worried that the pain may indicate a heart attack. Which of the following 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.

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 patient has lower back muscle spasms following an injury. Which of the following is the cause of the spasm?

Protective guarding

Which of the following is the most accurate method of assessing pain in children ages 8 years and older?

Using a numeric 1-10 scale

Which of the following conditions or events commonly trigger nociceptive pain? Select all that apply.

• Surgery • Osteoarthritis • Chemical burn