Pathophysiology, Ch 16: Pain, Temp Regulation, Sleep

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

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

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 (Gate Control Theory)
b. Pattern theory
c. Specificity theory
d. Neuromatrix theory

Answer 2

ANS: A
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 fibers
b. A-beta fibers
c. A-delta fibers
d. B fibers

Answer 3

ANS: C

Of the available options, only medium-sized A delta 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

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.

Question 5

The gate in the GCT (Gate Control Theory) of pain is located in the:

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

Answer 5

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.

Question 6

Which spinal tract carries the most nociceptive information?

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

Answer 6

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 7

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

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

Answer 7

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.

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

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.

Question 9

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

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

Answer 9

ANS: A
Massaging stimulates different A beta fibers to close the pain gate. The remaining options do
not fulfill this objective.

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

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.

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

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.

Question 12

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

Answer 12

ANS: B
The synthesis and activity of beta-endorphin is concentrated in the hypothalamus and the
pituitary gland and act as strong μ-receptor (mu) agonist. The remaining options do not fulfill
this objective.

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

ANS: A
Pain tolerance is the duration of time or the intensity of pain that an individual will endure
before initiating overt pain responses. The other options are not related to the duration or
intensity of pain endured before the pain is recognized.

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

ANS: C
Acute pain is a protective mechanism that alerts the individual to a condition or experience
that is immediately harmful to the body. The remaining options do not fulfill this
objective.

Question 15

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

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.

Question 16

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 16

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.

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

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.

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

ANS: D
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

ANS: C
Epinephrine and norepinephrine produce a rapid transient increase in heat production by
raising the body’s basal metabolic rate. The other options are not correct descriptions of
the effects of epinephrine on body heat.

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

ANS: C

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

ANS: A

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

ANS: A
Radiation refers to heat loss through electromagnetic waves. None of the other options
accurately describes heat loss via radiation.

Question 23

Which cytokines are endogenous pyrogens?

a. IL-3, IL-10, and IL-18
b. IL-2, IL-8, and IFN-beta
c. IL-4, IL-12, colony-stimulating factor, and IFN-alpha
d. IL-1, IL-6, TNF-alpha, and IFN-gamma

Answer 23

ANS: D
Endogenous pyrogens include prostaglandin E2 (PGE2), interleukin-1 (IL-1), IL-6, tumor
necrosis factor–alpha (TNF-alpha), and interferon-gamma (IFN-gamma). The other options are not
endogenous pyrogens.

Question 24

Which hormones help diminish the febrile response?
a. Arginine vasopressin (AVP), melanocyte-stimulating hormone-alpha (alpha-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

ANS: A
During fever, AVP, alpha-MSH, and corticotropin-releasing factors are released from the
brain, and antiinflammatory cytokines (e.g., IL-1, IL-10) can act as endogenous cryogens
or antipyretics to help diminish the febrile response. The other options are not hormones
that 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

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.

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

ANS: B
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. The remaining options do not
fulfill this objective.

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

ANS: B
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. The remaining options do not occur during heat stroke.

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

ANS: C
Treatment includes the withdrawal of the provoking agents and the administration of
dantrolene sodium (a skeletal relaxant that inhibits calcium release during muscle
contraction). The other options are not effective in the treatment of malignant
hyperthermia.

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

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.

Question 30

Which neuropeptide promotes wakefulness?

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

Answer 30

ANS: C
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. The remaining options do not fulfill
this objective.

Question 31

Which term is also used to refer to paradoxic sleep?

a. Non-REM
b. Light
c. REM
d. Delta wave

Answer 31

ANS: C
REM sleep is also known as paradoxic sleep because the electroencephalographic (EEG)
pattern is similar to the normal awake pattern. None of the other terms are used to identify
paradoxic sleep.

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

ANS: A
Three types of parasomnias include arousal disorders such as confusional arousals,
sleepwalking (somnambulism), and night terrors (dream anxiety attacks). The remaining
options do not involve a sense or expression of fear or any other strong emotion.

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

ANS: C
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. The other options are not associated with coronary
artery disease.

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

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.

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

ANS: A
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. The remaining options do not exhibit the signs and
symptoms listed in the stem.

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

ANS: A
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

ANS: D
Acute bacterial conjunctivitis (pinkeye) is an inflammation of the conjunctiva (mucous
membrane covering the front part of the eyeball). The other structures are not affected by
this inflammation.

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

ANS: C
Open-angle glaucoma occurs because of an obstruction of the outflow of aqueous humor at
trabecular meshwork or Schlemm canal. The remaining options fail to accurately describe
the cause of open-angle glaucoma.

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

ANS: B
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

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.

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

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.

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

ANS: A
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

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 accurate statements
regarding this pain theory.

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

ANS: D
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.
The remaining statements are not true when discussing the GCT of pain.

Question 45

Which factors contribute to sensorineural hearing loss? (Select all that apply.)

a. Ménière disease
b. Aging
c. Diabetes mellitus
d. Noise exposure
e. Outer ear trauma

Answer 45

ANS: A, B, C, D
Impairment of the organ of Corti or its central connections causes a sensorineural hearing
loss. The hearing loss may be gradual or sudden. Conditions that commonly cause
sensorineural hearing loss include congenital and hereditary factors, noise exposure, aging,
Ménière disease, ototoxicity, and systemic disease (e.g., syphilis, Paget disease, collagen
diseases, diabetes mellitus). Outer ear trauma is not a typical cause of sensorineural
hearing loss.

Question 46

Why are children more susceptible to heat stroke than are adults? (Select all that apply.)

a. Children produce more metabolic heat when exercising.
b. They have more surface area–to-mass ratio.
c. Children have less sweating capacity.
d. They an underdeveloped hypothalamus.
e. Children have an overdeveloped ability to perceive heat.

Answer 46

ANS: A, B, C
Children are more susceptible to heat stroke than are adults because (1) they produce more
metabolic heat when exercising, (2) they have a greater surface area–to-mass ratio, and (3)
their sweating capacity is less than that of adults. The remaining options are not true of a
child.

Question 47

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 47

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 48

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 48

ANS: A, B, D, E
Fever is a complex, integrated cascade of behavioral, neurologic, and endocrine responses
to an immune challenge initiated by endogenous pyrogens or disorders of the
hypothalamus. Fever production aids responses to infectious processes through several
mechanisms and should be interrupted only when it might present an additional risk to the
individual.

Question 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

Answer 49

Deafferentation pain

Question 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

Answer 50

Neuropathic pain

Question 51

Pain that occurs after peripheral nerve injury and is described as continuous with severe
sensations and a burning quality

Answer 51

Sympathetically maintained pain

Question 52

Pain that is the result of muscle spasms, tenderness, and stiffness and leads to muscle
guarding that limits muscle motion

Answer 52

Myofascial pain syndrome