Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function

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
c. Specificity theory
b. Intensity theory
d. Pattern theo

Answer 1

ANS: C
According to the specificity theory, a direct relationship exists between the intensity of
pain and the extent of tissue injury. The remaining options are not related to the intensity
of perceived pain.

Question 2

Where are the primary-order pain transmitting neurons located within the spinal cord?

a. Lateral root ganglia
c. Anterior root ganglia
b. Dorsal root ganglia
d. Medial root ganglia

Answer 2

ANS: B
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.
PTS: 1 REF: Page 487

Question 3

The gate in the GCT of pain is located in the:

a. Substantia gelatinosa
c. Nucleus proprius
b. Marginal layer
d. Dorsolateral tract of Lissauer

Answer 3

ANS: A
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. The
remaining options do not act in this function.
PTS: 1 REF: Page 487

Question 4

Which spinal tract carries the most nociceptive information?

a. Archeospinothalamic
c. Dorsal spinothalamic
b. Paleospinothalamic
d. Lateral spinothalamic

Answer 4

ANS: D
Most nociceptive information travels by means of ascending columns in the lateral
spinothalamic tract (also called the anterolateral funiculus). The other tract options do not
carry the most nociceptive information.

Question 5

The major relay station of sensory information is located in the:

a. Basal ganglia
c. Thalamus
b. Midbrain
d. Hypothalamus

Answer 5

ANS: C
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. The remaining options do not fulfill this objective.
PTS: 1 REF: Page 487

Question 6

Where in the CNS does a person’s learned pain response occur?

a. Cerebral cortex
c. Thalamus
b. Frontal lobe
d. Limbic system

Answer 6

ANS: A
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.
PTS: 1 REF: Page 487

Question 7

Massage therapy relieves pain by closing the pain gate with the stimulation which fibers?

a. A beta
c. B
b. A delta
d. C

Answer 7

ANS: A
Massaging stimulates different AE fibers to close the pain gate. The remaining options do
not fulfill this objective.
PTS: 1 REF: Page 485

Question 8

What part of the brain provides the emotional response to pain?

a. Limbic system
c. Thalamus
b. Parietal lobe
d. Hypothalamus

Answer 8

ANS: A
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. The remaining options do not fulfill this objective.
PTS: 1 REF: Page 487

Question 9

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 9

ANS: A
Norepinephrine and serotonin (5-hydroxytryptamine) contribute to pain modulation
(inhibition) in the medulla and pons. The remaining options do not fulfill this objective.
PTS: 1 REF: Page 490

Question 10

Which description characterizes visceral pain?
a. Is sharp and well-defined when transmitted by A-delta (AG) 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 10

ANS: B
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.
PTS: 1 REF: Page 492

Question 11

When caring for a person who has experienced pain for 3 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 11

ANS: D
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. The other symptoms are not generally associated with an
anxiety response to acute pain.
PTS: 1 REF: Pages 491-492

Question 12

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 12

ANS: C
Enkephalins and endorphins are neurohormones that act as neurotransmitters by binding to
one or more G protein–coupled opioid receptors and thus relieving pain. The other options
are not accurate descriptions of how enkephalins and endorphins relieve pain.
PTS: 1 REF: Pages 490-49

Question 13

Using a fan to reduce body temperature is an example of which mechanism of heat loss?

a. Evaporation c. Convection
b. Radiation d. Conduction

Answer 13

ANS: C
Only convection causes the transfer of heat through currents of gases or liquids.
PTS: 1 REF: Page 497

Question 14

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
c. Malignant hyperthermia
b. Heat stroke
d. Heat exhaustion

Answer 14

ANS: D
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.
PTS: 1 REF: Page 500

Question 15

The major sleep center is located in which section of the brain?

a. Thalamus
c. Frontal lobe
b. Brainstem
d. Hypothalamus

Answer 15

ANS: D
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. The remaining options do
not fulfill this objective.
PTS: 1 REF: Pages 502-503

Question 16

Which neuropeptide promotes wakefulness?

a. Prostaglandin D2
c. Hypocretins
b. L-tryptophan
d. Growth factors

Answer 16

ANS: C

Question 17

Rapid eye movement (REM) sleep occurs in cycles approximately every:

a. 45 minutes
c. 120 minutes
b. 90 minutes
d. 150 minutes

Answer 17

ANS: B
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.
PTS: 1 REF: Page 503

Question 18

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 18

ANS: C
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.
PTS: 1 REF: Page 492

Question 19

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 19

ANS: B
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. The other options would not be considered a primary contributing
factors.
PTS: 1 REF: Page 494

Question 20

Heat exhaustion results in: (Select all that apply.)

a. Profuse sweating
b. Profound vasodilation
c. A need to ingest warm liquids
d. Permanent damage to the hypothalamus
e. An increased risk for future heat exhaustion

Answer 20

ANS: A, B, C
Internally high temperatures cause the appropriate hypothalamic response of profound
vasodilation and profuse sweating. The individual should be encouraged to drink warm
fluids to replace fluid lost through sweating. Heat exhaustion is a result of prolonged high
core or environmental temperatures that are unique to each incidence

Question 21

It is true that a fever: (Select all that apply.)

a. Is a complex cascade involving several different systems.
b. Can be a result of a dysfunctional hypothalamus.
c. Should be eliminated as quickly as possible.
d. Triggers endocrine responses.
e. Is in response to a pyrogen.

Answer 21

ANS: A, B, D, E

Question 22

Match the types of chronic pain with its description. Types of pain may be used more than
once.
______ A. Myofascial pain syndrome
______ B. Neuropathic pain
______ C. Deafferentation pain
______ D. Sympathetically maintained pain
49. Pain that results from tumor infiltration of nerve tissue, from trauma or chemical injury to
the nerve, or from damage from radiation, chemotherapy, or surgical sectioning of the
nerve
50. Pain that is thought to be caused by trauma or disease of nerves and leads to abnormal
processing of sensory information by the peripheral and central nervous systems
51. Pain that occurs after peripheral nerve injury and is described as continuous with severe
sensations and a burning quality
52. Pain that is the result of muscle spasms, tenderness, and stiffness and leads to muscle
guarding that limits muscle motion

Answer 22

49. ANS: C PTS: 1 REF: Page 494
    MSC: Deafferentation pain results from trauma or chemical injury to the peripheral nervous
    system, from tumor infiltration of nerve tissue, or from damage from radiation, chemotherapy, or
    surgical sectioning of a nerve with the loss of sensory input to the central nervous system.
50. ANS: B PTS: 1 REF: Page 494
    MSC: Neuropathic pain is the result of trauma or disease of nerves and leads to abnormal
    processing of sensory information by the peripheral and central nervous systems.
51. ANS: D PTS: 1 REF: Pages 494-495
    MSC: Sympathetically maintained pain (SMP) is another type of neuropathic pain that occurs
    after peripheral nerve or extremity injury and is characterized as continuous and severe with a
    burning quality.
52. ANS: A PTS: 1 REF: Pages 492-493
    MSC: Myofascial pain syndrome (MPS) is associated with injury to muscle, fascia, and tendons.