Chapter 13: Pain, Temperature, Sleep, and Sensory Function My Nursing Test Banks

Huether and McCance: Understanding Pathophysiology, 5th Edition

Chapter 13: Pain, Temperature, Sleep, and Sensory Function

Test Bank

MULTIPLE CHOICE

1. A patient asks the nurse where nociceptors can be found. How should the nurse respond? One location in which nociceptors can be found is the:

a.

Skin

b.

Spinal cord

c.

Efferent pathways

d.

Hypothalamus

ANS: A

Nociceptors are pain receptors and can be found in the skin.

Nociceptors are not located in the spinal cord.

Nociceptors are not located in efferent, but afferent pathways.

Nociceptors are not located in the hypothalamus, but can be found in the meninges.

REF: p. 326

2. A nurse is discussing an individuals conditioned or learned approach or avoidance behavior in response to pain. Which system is the nurse describing?

a.

Sensory-discriminative system

b.

Affective-motivational system

c.

Sensory-motivational system

d.

Cognitive-evaluative system

ANS: B

The affective-motivational system determines an individuals conditioned avoidance behaviors and emotional responses to pain.

The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain.

The sensory-motivational system is not a system in the response to pain.

The cognitive-evaluative system overlies the individuals learned behavior concerning the experience of pain and can modulate perception of pain.

REF: p. 326

3. When a neurologist explains how pricking a finger with a needle provides minimal pain while cutting the finger with a knife provides more severe pain, what theory is being described?

a.

Gate control theory

b.

Neuromatrix theory

c.

Specificity theory

d.

Neuromodulation

ANS: C

The specificity theory of pain proposes that the intensity of pain is directly related to the degree of associated tissue injury.

The gate control theory of pain suggests pain transmission is modulated by a balance of impulses conducted to the spinal cord, where cells in the substantia gelatinosa function as a gate that regulates the nociceptive (pain) transmission to higher centers in the central nervous system (CNS).

The neuromatrix theory proposes that the brain produces patterns of nerve impulses drawn from various inputs, including genetic, psychological, and cognitive experiences.

Neuromodulators of pain are found in the pathways that mediate information about painful stimuli throughout the nervous system.

REF: p. 324

4. A 5-year-old female breaks her leg after falling from a merry-go-round. Which of the following would be released from the midbrain to modulate her pain?

a.

-Endorphin

b.

Enkephalin

c.

Endomorphin

d.

Dynorphin

ANS: D

Dynorphins are the most potent of the endogenous opioids, binding strongly to receptors to impede pain signals.

-endorphins produce the greatest sense of exhilaration, as well as substantial natural pain relief.

Enkephalins are natural opioids.

Endomorphins have analgesic effects.

REF: p. 327

5. A 15-year-old female scrapes her knee while playing soccer and complains of sharp and well-localized pain. Which of the following should the nurse document to most accurately characterize her pain?

a.

Chronic pain

b.

Referred pain

c.

Somatic pain

d.

Visceral pain

ANS: C

Somatic pain is superficial, arising from the skin. It is typically well localized and described as sharp, dull, aching, or throbbing.

Chronic pain has been defined as lasting for more than 3 to 6 months.

Referred pain is felt in an area removed or distant from its point of origin; the area of referred pain is supplied by the same spinal segment as the actual site of pain.

Visceral pain is pain in internal organs and lining of body cavities and tends to be poorly localized with an aching, gnawing, throbbing, or intermittent cramping quality.

REF: p. 327

6. A nurse should document on the chart that chronic pain is occurring when the patient reports the pain has lasted longer than:

a.

1 month

b.

3 to 6 months

c.

1 year

d.

2 to 3 years

ANS: B

Chronic or persistent pain has been defined as lasting for more than 3 to 6 months.

One month is too short a time period to be classified as chronic pain.

Chronic or persistent pain has been defined as lasting for more than 3 to 6 months; 1 year is too long.

Chronic or persistent pain has been defined as lasting for more than 3 to 6 months; 2 to 3 years is too long.

REF: p. 328

7. A 50-year-old male cut his hand off while working in a sawmill. Several years later he still sporadically feels pain in the absent hand. What type of pain should the nurse document in the chart?

a.

Neuropathic pain

b.

Visceral pain

c.

Phantom limb pain

d.

Chronic pain

ANS: C

The qualities we normally feel from the body, including pain, also can be felt in the absence of inputs from the body, such as is noted with phantom limb pain.

Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system.

Visceral pain refers to pain in internal organs and lining of body cavities.

Chronic pain lasts more the 3 to 6 months and is not associated with loss of a limb.

REF: p. 329

8. When planning care for a child in pain, which principle should the nurse remember? The pain threshold in children is _____ that of adults.

a.

Higher than

b.

Lower than

c.

The same as

d.

Not related to

ANS: B

The pain threshold in children is lower than that of adults.

The pain threshold in children is lower, not higher, than that of adults.

The pain threshold in children is lower, not the same, as that of adults.

The pain threshold in children is lower than that of adults.

REF: p. 330

9. When the nurse is taking a patients temperature, which principle should the nurse remember? Regulation of body temperature primarily occurs in the:

a.

Cerebrum

b.

Brainstem

c.

Hypothalamus

d.

Pituitary gland

ANS: C

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus.

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the cerebrum.

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the brainstem.

Temperature regulation (thermoregulation) is mediated primarily by the hypothalamus, not the pituitary gland.

REF: p. 330

10. When the nurse is discussing the patients cyclical temperature fluctuation occurring on a daily basis, what term should the nurse use?

a.

Thermogenesis cycle

b.

Thermoconductive phases

c.

Adaptive pattern

d.

Circadian rhythm

ANS: D

Internal temperature varies in response to activity, environmental temperature, and daily fluctuation (circadian rhythm).

Temperature fluctuation is related to circadian rhythm, not thermogenesis cycle.

Temperature fluctuation is related to circadian rhythm, not thermoconductive phases.

Temperature fluctuation is related to circadian rhythm, not adaptive pattern.

REF: p. 330

11. A nurse wants to teach about one of the primary organs responsible for heat production. Which organ should the nurse include?

a.

Pancreas

b.

Liver

c.

Adrenal gland

d.

Heart

ANS: C

The adrenal gland is one of the organs responsible for heat production because thyroxine acts on the adrenal medulla causing the release of epinephrine into the bloodstream. Epinephrine causes vasoconstriction that increases metabolic rates, thus increasing heat production.

The pancreas does not play a role in heat production; the adrenal gland does as it releases epinephrine. which increases metabolic rates and increases heat production.

The liver does not play a role in heat production; the adrenal gland does as it releases epinephrine, which increases metabolic rates and increases heat production.

The heart does not play a role in heat production; the adrenal gland does as it releases epinephrine, which increases metabolic rates and increases heat production.

REF: p. 330

12. Which statement by a patient indicates teaching was successful for heat loss? Heat loss from the body via convection occurs by:

a.

Evaporation of electromagnetic waves

b.

Transfer of heat through currents of liquids or gas

c.

Dilation of blood vessels bringing blood to skin surfaces

d.

Direct heat loss from molecule-to-molecule transfer

ANS: B

Convection occurs by transfer of heat through currents of gases or liquids, exchanging warmer air at the bodys surface with cooler air in surrounding space.

Convection occurs by transfer of heat through gases or liquids, not electromagnetic waves.

Convection occurs by transfer of heat through gases or liquids, not dilation of blood vessels bringing blood to skin surfaces.

Convection occurs by transfer of heat through gases or liquids, not direct heat loss from molecule-to-molecule transfer.

REF: p. 331

13. For evaporation to function effectively as a means of dissipating excess body heat, which one of the following conditions must be present?

a.

Moisture

b.

Fever

c.

Pyrogens

d.

Trauma

ANS: A

Moisture must be present because heat is lost through evaporation from the surface of skin and lining of mucous membranes, a major source of heat reduction connected with increased sweating in warmer surroundings.

Fever is not required for evaporation to occur, but moisture is.

Pyrogens are heat producers and do not assist with evaporation, but moisture is required.

Trauma is not a portion of the evaporative process of heat loss.

REF: p. 331

14. A 25-year-old female received a prescription for a weight loss pill. One effect of the pills is to increase the release of epinephrine. Which of the following would be expected to also occur?

a.

Decreased vascular tone

b.

Increased skeletal muscle tone

c.

Increased heat production

d.

Decreased basal metabolic rate

ANS: C

Epinephrine causes vasoconstriction, stimulates glycolysis, and increases metabolic rates, thus increasing heat production.

Epinephrine increases vascular tone, but this does not lead to heat production.

Epinephrine does not increase skeletal muscle tone.

Epinephrine increases metabolic rate.

REF: p. 330

15. When a patient has a fever, which of the following thermoregulatory mechanisms is activated?

a.

The bodys thermostat is adjusted to a lower temperature.

b.

Temperature is raised above the set point.

c.

Bacteria directly stimulate peripheral thermogenesis.

d.

The bodys thermostat is reset to a higher level.

ANS: D

Fever (febrile response) is a temporary resetting of the hypothalamic thermostat to a higher level in response to endogenous or exogenous pyrogens.

Fever is the result of the bodys attempt to raise temperature, not adjust it to a lower level.

When fever occurs, the temperature is raised, but the rise is due to a reset of the thermostat.

Bacteria do not stimulate peripheral thermogenesis, but their endotoxins do.

REF: p. 331

16. A patient has researched exogenous pyrogens on the Internet. Which information indicates the patient has a good understanding? Exogenous pyrogens are:

a.

Interleukins

b.

Endotoxins

c.

Prostaglandins

d.

Corticotropin-releasing factors

ANS: B

Exogenous pyrogens are endotoxins.

Exogenous pyrogens are endotoxins, not interleukins.

Exogenous pyrogens are endotoxins, not prostaglandins.

Exogenous pyrogens are endotoxins, not corticotropin-releasing factors.

REF: p. 331

17. Hikers are attempting to cross the Arizona desert with a small supply of water. The temperatures cause them to sweat profusely and become dehydrated. The hikers are experiencing:

a.

Heat cramping

b.

Heat exhaustion

c.

Heat stroke

d.

Malignant hyperthermia

ANS: B

Heat exhaustion results from prolonged high core or environmental temperatures, which cause profound vasodilation and profuse sweating, leading to dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia. Symptoms include weakness, dizziness, confusion, nausea, and fainting.

Heat cramping is severe, spasmodic cramps in the abdomen and extremities that follow prolonged sweating and associated sodium loss. Heat cramping usually occurs in those not accustomed to heat or those performing strenuous work in very warm climates.

Heat stroke is a potentially lethal result of an overstressed thermoregulatory center. With very high core temperatures (>40 C; 104 F), the regulatory center ceases to function, and the bodys heat loss mechanisms fail.

Malignant hyperthermia is a potentially lethal complication of a rare inherited muscle disorder that may be triggered by inhaled anesthetics and depolarizing muscle relaxants.

REF: p. 332

18. A 10-year-old male sneaks into a meat freezer at the local supermarket. Fearing he will get caught if he comes out, he decides to stay in there for several hours until the store closes. While in the cooler his body is most likely experiencing:

a.

Increased respirations

b.

Ischemic tissue damage

c.

CNS excitation

d.

Increased cellular metabolism

ANS: B

Hypothermia (marked cooling of core temperature) produces depression of the central nervous and respiratory systems, vasoconstriction, alterations in microcirculation, coagulation, and ischemic tissue damage.

Hypothermia does not lead to increased respirations; it leads to ischemia.

Hypothermia does not lead to CNS excitation; it leads to ischemia.

Hypothermia does not lead to increased cellular metabolism; it leads to ischemia.

REF: p. 333

19. Which finding indicates the patient is having complications from heat stroke?

a.

Mild elevation of core body temperatures

b.

Cerebral edema and degeneration of the CNS

c.

Spasmodic cramping in the abdomen and extremities

d.

Alterations in calcium uptake

ANS: B

Symptoms of heat stroke include high core temperature, absence of sweating, rapid pulse, confusion, agitation, coma, and complications include cerebral edema and degeneration of the CNS.

Characteristics of heat stroke include cerebral edema and degeneration of CNS, not mild elevation of core body temperature.

Characteristics of heat stroke include cerebral edema and degeneration of the CNS, not cramping.

Characteristics of heat stroke include cerebral edema and degeneration of the CNS, not alterations in calcium uptake.

REF: p. 332

20. For which patient would the primary care provider order therapeutic hypothermia? A patient with:

a.

Malnutrition

b.

Hypothyroidism

c.

Reimplantation surgery

d.

Parkinson disease

ANS: C

Therapeutic hypothermia is seen with reimplantation surgery.

Therapeutic hypothermia is seen with reimplantation surgery, not malnutrition.

Therapeutic hypothermia is seen with reimplantation surgery, not hypothyroidism.

Therapeutic hypothermia is seen with reimplantation surgery, not Parkinson disease.

REF: p. 333

21. A patient is undergoing a sleep lab test. When the sleep lab worker notices EEG patterns with brain activity similar to the normal awake pattern, which phase of sleep is occurring?

a.

Non-rapid eye movement (REM)

b.

Fast wave

c.

REM

d.

Delta wave

ANS: C

REM sleep is called paradoxical sleep because the EEG pattern is similar to the normal awake pattern and the brain is very active with dreaming.

Non-REM sleep does not produce EEG patterns similar to the normal awake pattern.

Fast wave sleep does not produce EEG patterns similar to the normal awake pattern.

Delta wave sleep does not produce EEG patterns similar to the normal awake pattern.

REF: p. 333

22. A patient asks when most dreams occur. What is the nurses best response? Most dreams occur during _____ sleep.

a.

Non-REM

b.

Alpha wave

c.

REM

d.

Delta wave

ANS: C

Dreams occur during REM sleep.

Dreams occur during REM sleep, not non-REM sleep.

Dreams occur during REM sleep, not alpha wave sleep.

Dreams occur during REM sleep, not delta wave sleep.

REF: p. 13 | p. 19 | p. 33

23. During the sleep cycle, when does loss of temperature control occur?

a.

Non-REM sleep

b.

Light sleep

c.

REM sleep

d.

Delta wave sleep

ANS: C

Loss of temperature control occurs during REM sleep.

Loss of temperature control occurs during REM sleep, not non-REM sleep.

Loss of temperature control occurs during REM sleep, not light sleep.

Loss of temperature control occurs during REM sleep, not delta wave sleep.

REF: p. 333

24. A patient asks the nurse how often REM sleep occurs. How should the nurse respond? About every _____ minutes.

a.

15

b.

30

c.

60

d.

90

ANS: D

REM sleep occurs every 90 minutes.

REM sleep occurs every 90 minutes, not every 15.

REM sleep occurs every 90 minutes, not every 30.

REM sleep occurs every 90 minutes, not every 60.

REF: p. 333

25. A 52-year-old male enters a sleep study to gather information about his sleep disturbances. He reports that his wife will not let him sleep in the bed with her until he stops snoring so loudly. He also reports feeling tired a lot through the day. When the nurse checks the chart, what is the most likely diagnosis?

a.

Insomnia

b.

Obstructive sleep apnea syndrome (OSAS)

c.

Somnambulism

d.

Jet-lag syndrome

ANS: B

OSAS generally results from upper airway obstruction recurring during sleep with excessive snoring and multiple apneic episodes that last 10 seconds or longer.

Insomnia is the inability to fall or stay asleep and may be mild, moderate, or severe. It does not involve snoring.

Somnambulism is sleep-walking.

Jet-lag syndrome is a disorder of waking and sleeping and does not involve snoring.

REF: p. 334

26. A 14-month-old child suffers from sudden apparent arousals in which she expresses intense fear or other emotion. Her mother reports that she seems to wake screaming, but that she is difficult to waken completely. The child most likely suffers from:

a.

Night terrors

b.

Parasomnia

c.

Somnambulism

d.

Enuresis episodes

ANS: A

Night terrors are characterized by sudden apparent arousals in which the child expresses intense fear or emotion.

Parasomnia is unusual behaviors during sleep.

Somnambulism is sleep-walking.

Enuresis episodes are bed wetting.

REF: p. 334

27. The ophthalmologist is teaching about the structure of the eye that prevents light from scattering in the eye. What structure is the ophthalmologist describing?

a.

Iris

b.

Pupil

c.

Choroid

d.

Retina

ANS: C

The choroid is the deeply pigmented middle layer that prevents light from scattering inside the eye.

The iris is a part of the choroid and contains the pupil, which lets light into the eye.

The pupil allows light to enter the eye.

The retina is the innermost layer of the eye.

REF: p. 335

28. A 50-year-old diabetic patient experiences visual disturbances and decides to visit his primary care provider. After examination, the primary care provider tells the patient that the cells that allow him to see are degenerated. Which of the following structures is most likely damaged?

a.

Lens

b.

Pupil

c.

Cornea

d.

Retina

ANS: D

The retina is the innermost layer of the eye, converting light energy into nerve impulses.

Light entering the eye is focused on the retina by the lens.

The pupil allows light to enter the eye.

The cornea is the portion of the sclera in the central anterior region that allows light to enter

the eye.

REF: p. 335

29. A young child presents to the ophthalmologist for visual difficulties secondary to eye deviation. One of the childs eyes deviates outward, thereby decreasing the visual field. Which of the following diagnoses is most likely?

a.

Entropia

b.

Extropia

c.

Diplopia

d.

Nystagmus

ANS: B

The deviation of the eye outward is extropia.

The deviation of the eye inward is entropia.

Diplopia is double vision.

Nystagmus is an involuntary unilateral or bilateral rhythmic movement of the eyes.

REF: p. 336

30. A patient has increased intraocular pressure. Which diagnosis will the nurse observe on the chart?

a.

Glaucoma

b.

Ocular degeneration

c.

Diplopia

d.

Nystagmus

ANS: A

Glaucoma is the result of increased intraocular pressure.

Ocular degeneration results in changes in vision, but not intraocular pressure.

Diplopia is double vision.

Nystagmus is an involuntary unilateral or bilateral rhythmic movement of the eyes.

REF: p. 336

31. A 70-year-old male presents to his primary care provider reporting loss of vision. He reports that he has hypertension and smokes cigarettes. Which of the following disorders is most likely causing his visual loss?

a.

Presbyopia

b.

Macular degeneration

c.

Strabismus

d.

Amblyopia

ANS: B

Age-related macular degeneration (AMD) is a severe and irreversible loss of vision and a major cause of blindness in older individuals. Hypertension and cigarette smoking are risk factors.

Presbyopia is a condition associated with aging in which the patient experiences reduced near vision.

In strabismus, one eye deviates from the other when the person is looking at an object.

In amblyopia, vision is reduced in the affected eye caused by cerebral blockage of the visual stimuli.

REF: p. 336

32. Which group of people is most prone to red-green color blindness?

a.

Males

b.

Females

c.

Elderly persons

d.

Children

ANS: A

Color blindness affects 8% of the male population and 0.5% of the female population.

Color blindness occurs most often in males, not females.

Color blindness occurs most often in males, not the elderly.

Color blindness occurs most often in males, not children.

REF: p. 337

33. A 35-year-old female presents with watering and severely reddened eyes. She reports being very sensitive to light. Her primary care provider determined it was viral conjunctivitis caused by:

a.

Secondary bacterial infections

b.

Cytomegalovirus

c.

Herpes virus

d.

Adenovirus

ANS: D

Viral conjunctivitis is caused by an adenovirus and is manifested by symptoms of watering, redness, and photophobia.

Bacterial infections are not manifested by photophobia.

Cytomegalovirus infections are not manifested by photophobia.

Adenovirus infections are not manifested by photophobia.

REF: p. 338

34. A nurse is teaching about the structure that connects the middle ear with the pharynx. Which structure is the nurse describing?

a.

Organ of Corti

b.

Eustachian tube

c.

Semicircular canal

d.

Auditory canal

ANS: B

The Eustachian tube connects the middle ear to the pharynx.

The organ of Corti contains the hair cells.

The semicircular canal is one of the three bones of the labyrinth.

The auditory canal leads to the middle ear.

REF: p. 338

35. The most common form of sensorineural hearing loss in the elderly is:

a.

Conductive hearing loss

b.

Acute otitis media

c.

Presbycusis

d.

Mnire disease

ANS: C

Presbycusis is the most common form of sensorineural hearing loss in elderly people.

Conductive hearing loss does not occur as frequently as presbycusis.

Otitis media is an infection in the middle ear and is not defined as a hearing loss.

Mnire disease leads to vertigo, not hearing loss.

REF: p. 340

36. A 15-year-old female is diagnosed with an outer ear infection. Which of the following is most likely to cause this infection?

a.

Haemophilus

b.

Streptococcus pneumonia

c.

Moraxella catarrhalis

d.

Escherichia coli

ANS: D

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus.

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus, not Haemophilus.

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus, not Streptococcus.

The most common causes of acute infections are bacterial microorganisms including Pseudomonas, Escherichia coli, and Staphylococcus aureus, not Moraxella catarrhalis.

REF: p. 340

37. The nurse would expect the patient with an alteration in proprioception to experience vertigo which is manifested by:

a.

Headache

b.

Light sensitivity

c.

A sensation that the room is spinning

d.

Loss of feeling in the lips

ANS: C

Alterations in proprioception are manifested by a sensation that the room is spinning.

Alterations in proprioception are manifested by a sensation of spinning, not headache.

Alterations in proprioception are manifested by a sensation that the room is spinning. Light sensitivity does not occur.

Alterations in proprioception are manifested by a sensation that the room is spinning. Loss of feeling in the lips does not occur.

REF: p. 341

38. Which system modulates a patients perception of pain?

a.

Sensory-discriminative system

b.

Affective-motivational system

c.

Cognitive-evaluative system

d.

Reticular-activating system

ANS: C

The cognitive-evaluative system overlies the individuals learned behavior concerning the experience of pain and can modulate perception of pain.

The sensory-discriminative system is mediated by the somatosensory cortex and is responsible for identifying the presence, character, location, and intensity of pain.

The affective-motivational system determines an individuals conditioned avoidance behaviors and emotional responses to pain.

The reticular-activating system does not play a role in the perception of pain.

REF: p. 326

MULTIPLE RESPONSE

1. While planning care for infants, which principles should the nurse remember? (Select all that apply.) Infants have problems with thermoregulation because they:

a.

Cannot conserve heat

b.

Do not shiver

c.

Rarely sweat

d.

Have decreased metabolic rates

e.

Have excess subcutaneous fat

ANS: A, B

Infants cannot conserve heat; thus, they have a problem with thermoregulation because of their small size. Infants are unable to shiver, do have the ability to sweat, have an increased metabolic rate, and have little subcutaneous fat.

REF: p. 330

COMPLETION

1. Fever of unknown origin (FUO) is characterized by a fever of ____ F or greater

ANS:

101

FUO is a fever of greater than 38.3 C (101 F) that remains undiagnosed after three days of hospital investigation or two or more outpatient visits.

REF: p. 331

Mosby items and derived items 2012 Mosby, Inc., an imprint of Elsevier Inc.

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