Chapter 16

Question 1

Pricking one’s finger with a needle would cause minimal pain, whereas experiencing abdominal surgery would produce more pain. This distinction is an example of which pain theory?
a. Gate control theory
b. Intensity theory
c. Specificity theory
d. Pattern theory

Answer 1

c. Specificity theory

According to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury.

Question 2

Which pain theory proposes that a balance of impulses conducted from the spinal cord to the higher centers in the central nervous system (CNS) modulates the transmission of pain?

a. GCT

b. Pattern theory

c. Specificity theory

d. Neuromatrix theory

Answer 2

a. GCT

Only the gate control theory (GCT) explains that a balance of impulses conducted to the spinal cord, where cells in the substantia gelatinosa function as a spinal gate, regulates pain transmission to higher centers in the CNS.

Question 3

Which type of nerve fibers transmits pain impulses?
a. A-alpha (Aa) fibers
b. A-beta (AB) fibers
c. A-delta (Ad) fibers
d. B fibers

Answer 3

c. A-delta (Ad) fibers

Of the available options, only medium-sized Ad fibers transmit pain impulses.

Question 4

Where are the primary-order pain transmitting neurons located within the spinal cord?
a. Lateral root ganglia
b. Dorsal root ganglia
c. Anterior root ganglia
d. Medial root ganglia

Answer 4

b. Dorsal root ganglia

The cell bodies of the primary-order neurons, or pain-transmitting neurons, reside only in the dorsal root ganglia just lateral to the spine along the sensory pathways that penetrate the posterior part of the cord.

Question 5

The gate in the GCT of pain is located in the:
a. Substantia gelatinosa
b. Marginal layer
c. Nucleus proprius
d. Dorsolateral tract of Lissauer

Answer 5

a. Substantia gelatinosa

The synaptic connections between the cells of the primary- and secondary-order neurons located in the substantia gelatinosa and other Rexed laminae function as a pain gate.

Question 6

Which spinal tract carries the most nociceptive information?
a. Archeospinothalamic
b. Paleospinothalamic
c. Dorsal spinothalamic
d. Lateral spinothalamic

Answer 6

d. Lateral spinothalamic

Most nociceptive information travels by means of ascending columns in the lateral spinothalamic tract (also called the anterolateral funiculus).

Question 7

The major relay station of sensory information is located in the:
a. Basal ganglia
b. Midbrain
c. Thalamus
d. Hypothalamus

Answer 7

c. Thalamus

Although the organization of all of the ascending tracts is complex, the principal target for
nociceptive afferents is the thalamus, which, in general, is the major relay station of sensory information

Question 8

Where in the CNS does a person’s learned pain response occur?
a. Cerebral cortex
b. Frontal lobe
c. Thalamus
d. Limbic system

Answer 8

a. Cerebral cortex

The cognitive-evaluative system overlies the individual’s learned behavior concerning the experience of pain and can modulate the perception of pain and is mediated only through the cerebral cortex.

Question 9

Massage therapy relieves pain by closing the pain gate with the stimulation which fibers?
a. AB
b. Ad
c. B
d. C

Answer 9

a. AB

Massaging stimulates different AB fibers to close the pain gate

Question 10

What part of the brain provides the emotional response to pain?
a. Limbic system
b. Parietal lobe
c. Thalamus
d. Hypothalamus

Answer 10

a. Limbic system

The limbic and reticular tracts are involved in alerting the body to danger, initiating arousal of the organism, and emotionally processing the perceived afferent signals, not just as stimuli, but also as pain.

Question 11

Which neurotransmitters inhibit pain in the medulla and pons?
a. Norepinephrine and serotonin
b. Gamma-aminobutyric acid (GABA) and aspartate
c. Glutamate and tumor necrosis factor-alpha
d. Neurokinin A and nitric oxide

Answer 11

a. Norepinephrine and serotonin

Norepinephrine and serotonin (5-hydroxytryptamine) contribute to pain modulation (inhibition) in the medulla and pons

Question 12

Which endogenous opioid is located in the hypothalamus and pituitary and is a strong u-receptor agonist?
a. Enkephalins
b. Endorphins
c. Dynorphins
d. Endomorphins

Answer 12

b. Endorphins

The synthesis and activity of B-endorphin is concentrated in the hypothalamus and the pituitary gland and act as strong μ-receptor agonist.

Question 13

What is the term that denotes the duration of time or the intensity of pain that a person will endure before outwardly responding?
a. Tolerance
b. Perception
c. Threshold
d. Dominance

Answer 13

a. Tolerance

Pain tolerance is the duration of time or the intensity of pain that an individual will endure before initiating overt pain responses.

Question 14

Pain that warns of actual or impending tissue injury is referred to as what?
a. Chronic
b. Psychogenic
c. Acute
d. Phantom

Answer 14

c. Acute

Acute pain is a protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body

Question 15

Which description characterizes visceral pain?
a. Is sharp and well-defined when transmitted by A-delta (Ad) fibers.
b. Is perceived as poorly localized and is transmitted by the sympathetic nervous system.
c. Arises from connective tissue, muscle, bone, or skin.
d. Is perceived as dull, aching, and poorly localized when transmitted by C fibers.

Answer 15

b. Is perceived as poorly localized and is transmitted by the sympathetic nervous system.

Of the options provided, only visceral pain refers to pain in internal organs and the abdomen and is transmitted by sympathetic afferents. Visceral pain is poorly localized because of fewer nociceptors in the visceral structures.

Question 16

days, anxiety is likely to produce which physical signs that a nurse would expect to find?
a. Fever and muscle weakness or reports of fatigue
b. Irritability and depression or reports of constipation
c. Decreased blood pressure or reports of fatigue
d. Increased heart rate and respiratory rate with diaphoresis

Answer 16

d. Increased heart rate and respiratory rate with diaphoresis

Anxiety is common in acute pain states and is usually apparent in the alterations of vital signs and can include elevation of blood sugar levels, decreases in gastric acid secretion and intestinal motility, and a general decrease in blood flow to the viscera and skin. Nausea occasionally occurs.

Question 17

Enkephalins and endorphins act to relieve pain by which process?
a. Inhibiting cells in the substantia gelatinosa
b. Stimulating the descending efferent nerve fibers
c. Attaching to opiate receptor sites
d. Blocking transduction of nociceptors

Answer 17

c. Attaching to opiate receptor sites.

Enkephalins and endorphins are neurohormones that act as neurotransmitters by binding to one or more G protein-coupled opioid receptors and thus relieving pain.

Question 18

What is a long-term complication of rewarming as a treatment for hypothermia?
a. Acidosis
b. Dysrhythmias
c. Shock
d. Renal failure

Answer 18

d. Renal failure

Rewarming can result in long-term complications that include congestive heart failure, hepatic and renal failure, abnormal erythropoiesis, myocardial infarction, pancreatitis, and neurologic dysfunctions. Short-term complications of rewarming include acidosis, rewarming shock, and dysrhythmias.

Question 19

How does the release (increase) of epinephrine raise body temperature?
a. The release of epinephrine causes shivering.
b. It affects muscle tone.
c. It raises the metabolic rate.
d. It increases and strengthens the heart rate.

Answer 19

c. It raises the metabolic rate.

Epinephrine and norepinephrine produce a rapid transient increase in heat production by raising the body’s basal metabolic rate

Question 20

Using a fan to reduce body temperature is an example of which mechanism of heat loss?
a. Evaporation
b. Radiation
c. Convection
d. Conduction

Answer 20

c. Convection

Only convection causes the transfer of heat through currents of gases or liquids.

Question 21

Up to how many liters of fluid per hour may be lost by sweating?
a. 2
b. 4
c. 6
d. 8

Answer 21

a. 2

Sweating may cause as much as 2.2 L of fluid per hour to be lost.

Question 22

Heat loss from the body via radiation occurs by:
a. Emanations 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

Answer 22

a. Emanations of electromagnetic waves

Radiation refers to heat loss through electromagnetic waves.

Question 23

Which cytokines are endogenous pyrogens?
a. IL-3, IL-10, and IL-18
b. IL-2, IL-8, and IFN-B
c. IL-4, IL-12, colony-stimulating factor, and IFN-a
d. IL-1, IL-6, TNF-a, and IFN-g

Answer 23

d. IL-1, IL-6, TNF-a, and IFN-g

Question 24

Which hormones help diminish the febrile response?
a. Arginine vasopressin (AVP), melanocyte-stimulating hormone-alpha (a-MSH), and corticotropin-releasing factor
b. Adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone, and thyroxine (T4)
c. Antidiuretic hormone, growth hormone, and aldosterone
d. None; hormones only facilitate the increase of core body temperature.

Answer 24

a. Arginine vasopressin (AVP), melanocyte-stimulating hormone-alpha (a-MSH), and corticotropin-releasing factor.

During fever, AVP, a-MSH, and corticotropin-releasing factors are released from the brain, and anti-inflammatory cytokines (e.g., IL-1, IL-10) can act as endogenous cryogens or antipyretics to help diminish the febrile response.

Question 25

Prolonged high environmental temperatures that produce dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia cause which disorder of temperature regulation?
a. Heat cramps
b. Heat stroke
c. Malignant hyperthermia
d. Heat exhaustion

Answer 25

d. Heat exhaustion

Of the options presented, only heat exhaustion, or collapse, is a result of prolonged high core or environmental temperatures resulting in dehydration, decreased plasma volumes, hypotension, decreased cardiac output, and tachycardia

Question 26

In acute hypothermia, what physiologic change shunts blood away from the colder skin to the body core in an effort to decrease heat loss?
a. Hypotension
b. Peripheral vasoconstriction
c. Voluntary muscle movements
d. Shivering

Answer 26

b. Peripheral vasoconstriction

Tissue hypothermia slows the rate of chemical reactions (tissue metabolism), increases the viscosity of the blood, slows blood flow through microcirculation, facilitates blood coagulation, and stimulates profound vasoconstriction

Question 27

A heat stroke is characterized by:
a. Core temperatures usually reaching approximately 39.9° C (103.9° F)
b. Sweat production on the face occurring even during dehydration
c. A rapidly decreasing core temperature as heat loss from the evaporation of sweat ceases
d. Symptoms caused by the loss of sodium and prolonged sweating

Answer 27

b. Sweat production on the face occurring even during dehydration.

When the core temperature reaches or exceeds 40.5° C (104.9° F), the brain may be preferentially cooled by maximal blood flow through the veins of the head and face, specifically the forehead. Sweat production on the face is maintained even during dehydration

Question 28

Which medication is used to reverse the effects of malignant hyperthermia?
a. Propranolol
b. Diazepam
c. Dantrolene sodium
d. Sodium carbonate

Answer 28

c. Dantrolene sodium

Treatment includes the withdrawal of the provoking agents and the administration of dantrolene sodium (a skeletal relaxant that inhibits calcium release during muscle contraction).

Question 29

The major sleep center is located in which section of the brain?
a. Thalamus
b. Brainstem
c. Frontal lobe
d. Hypothalamus

Answer 29

d. Hypothalamus

A small group of hypothalamic nerve cells, the suprachiasmatic nucleus (SCN), controls the timing of the sleep-wake cycle and coordinates this cycle with circadian rhythms (24-hour rhythm cycles) in areas of the brain and other tissues

Question 30

Which neuropeptide promotes wakefulness?
a. Prostaglandin D2
b. L-tryptophan
c. Hypocretins
d. Growth factors

Answer 30

c. Hypocretins

The hypothalamus, as a major sleep center, secretes hypocretins (orexins), which are neuropeptides that promote wakefulness and rapid eye movement (REM) sleep, as well as appetite, energy consumption, and pleasure or reward

Question 31

Which term is also used to refer to paradoxic sleep?

a. Non-REM

b. Light

c. REM

d. Delta wave

Answer 31

c. REM

REM sleep is also known as paradoxic sleep because the electroencephalographic (EEG) pattern is similar to the normal awake pattern

Question 32

The sudden apparent arousal in which a child expresses intense fear or another strong emotion while still in a sleep state characterizes which sleep disorder?
a. Night terrors
b. Insomnia
c. Somnambulism
d. Enuresis

Answer 32

a. Night terrors

Three types of parasomnias include arousal disorders such as confusional arousals, sleepwalking (somnambulism), and night terrors (dream anxiety attacks)

Question 33

Coronary artery disease is most affected by which component of sleep?
a. Non-REM
b. Light
c. REM
d. Delta wave

Answer 33

c. REM

Coronary artery disease is most affected during rapid eye movement (REM) sleep. During this component of sleep, dreams may provoke nocturnal angina, increased heart rate, and electrocardiographic (ECG) changes

Question 34

Rapid eye movement (REM) sleep occurs in cycles approximately every:
a. 45 minutes
b. 90 minutes
c. 120 minutes
d. 150 minutes

Answer 34

b. 90 minutes

REM sleep accounts for 20% to 25% of sleep time and is characterized by desynchronized, low-voltage, fast activity that occurs for 5 to 60 minutes approximately every 90 minutes, beginning after 1 to 2 hours of non-REM sleep.

Question 35

Loud snoring, a decrease in oxygen saturation, fragmented sleep, chronic daytime sleepiness, and fatigue are clinical manifestations of which sleep disorder?
a. Obstructive sleep apnea
b. Upper airway resistance syndrome
c. Somnambulism
d. Narcolepsy

Answer 35

a. Obstructive sleep apnea

Obstructive sleep apnea is characterized by repetitive increases in resistance to airflow within the upper airway with loud snoring, gasping, intervals of apnea lasting from 10 to 30 seconds, fragmented sleep, and chronic daytime sleepiness and fatigue, as well as a decrease in oxygen saturation.

Question 36

What are the expected changes in sleep patterns of older adults?
a. Older adults experience difficulty falling asleep with less time spent in REM sleep.
b. They experience sound sleep during the night with approximately 50% of the time spent in REM sleep and dreaming.
c. Older men commonly experience interrupted sleep patterns later in life than do older women.
d. Older adults awaken often but with a rapid return to sleep; they awaken refreshed but often later in the morning.

Answer 36

a. Older adults experience difficulty falling asleep with less time spent in REM sleep.

The sleep pattern of the older adult differs from the younger adult in that total sleep time is
decreased, and the older individual takes longer to initiate and maintain sleep. Older adults
tend to go to sleep earlier in the evening and awaken more frequently during the night and earlier in the morning. Rapid eye movement (REM) and slow-wave sleep decreases. The alteration in sleep pattern typically appears approximately 10 years later in women than it does in men.

Question 37

Pinkeye is characterized by inflammation of which structure?
a. Eyelids
b. Sebaceous glands
c. Meibomian glands
d. Conjunctiva

Answer 37

d. Conjunctiva

Acute bacterial conjunctivitis (pinkeye) is an inflammation of the conjunctiva (mucous membrane covering the front part of the eyeball).

Question 38

Open-angle glaucoma occurs because of:
a. Decreased production of aqueous humor
b. Increased production of vitreous humor
c. Obstructed outflow of aqueous humor
d. Excessive destruction of vitreous humor

Answer 38

c. Obstructed outflow of aqueous humor

Open-angle glaucoma occurs because of an obstruction of the outflow of aqueous humor at trabecular meshwork or Schlemm canal

Question 39

How can glaucoma cause blindness?
a. Infection of the cornea
b. Pressure on the optic nerve
c. Opacity of the lens
d. Obstruction of the venous return from the retina

Answer 39

b. Pressure on the optic nerve

Loss of visual acuity as a result of pressure on the optic nerve is the only reason glaucoma can result in blindness.

Question 40

When comparing the effects of acute and chronic pain on an individual, chronic pain is more often:
a. The external event that results in a sense of fear
b. Viewed as being meaningful but undesirable.
c. A factor that contributes to depression
d. A sense of internal unease

Answer 40

c. A factor that contributes to depression

Chronic pain is often associated with a sense of hopelessness and helplessness as relief becomes more elusive and the timeframe more protracted. The pain is perceived as meaningless, and depression is often a concomitant finding, as either a result of the chronic pain state or as a contributor to its development. Individuals often psychologically respond to acute pain with fear (e.g., fear of diagnosis, fear of continued pain), anxiety, and a general sense of unpleasantness or unease.

Question 41

When considering the risk factors for the development of phantom limb pain, the nurse recognizes which as a primary contributing factor?
a. Age, with adolescent patients being at a higher risk than adults
b. Presence of pain in the limb before amputation
c. Patient’s previous experience with managing pain
d. Cultural views regarding the acceptance of pain

Answer 41

b. Presence of pain in the limb before amputation.

Phantom limb pain is pain that an individual feels in an amputated limb after the stump has completely healed. It is more likely to appear in individuals who experienced pain in the limb before amputation

Question 42

Based on an understanding of the physiologic process of nociceptors, the nurse expects which surgical procedure to create more pain?
a. Repair of several crushed fingers
b. External fixation of a dislocated shoulder
c. Cyst removal on the internal surface of an ovary
d. Repair of a ruptured spleen

Answer 42

a. Repair of several crushed fingers

The variable nature and distribution of nociceptors affect the relative sensitivity to pain in different areas of the body; the tips of the fingers have more nociceptors than the skin on the back, and all skin has many more nociceptors than the internal organs including bone

Question 43

The basis of the specificity theory of pain is that:

a. Injury to specific organs results in specific types of pain.

b. Chronic pain is generally less intense than acute pain.

c. The greater the tissue injury, the greater the pain.

d. Acute pain is specific only to certain injuries

Answer 43

c. The greater the tissue injury, the greater the pain.

According to the specificity theory, a direct relationship exists between the intensity of pain and the extent of tissue injury

Question 44

Which statement is true regarding the gate control theory (GCT) of pain?

a. The pain gate is located in the brain.

b. A closed gate increases pain perception

c. The brain primarily controls the pain gate.

d. An open gate facilitates the brain in processing the pain.

Answer 44

d. An open gate facilitates the brain in processing the pain.

The open gate in the spinal cord regulates the transmission of pain impulses that ascend to the brain for further processing and interpretation, thus leading to the management of pain