NURS 535 ACTUAL 2026 TEST PAPER QUESTIONS AND
SOLUTIONS RATED A+
✔✔Compare and Contrast the sympathetic-adrenal-medullary system activation to the
hypothalamic-pituitary-adrenal (HPA) axis response that is activated during the stage of
resistance (adaptation). - ✔✔When a stress response is triggered, it sends signals to
two other structures: the pituitary gland and the adrenal medulla. These short term
responses are produced by the "fight or flight" response via the sympathetic-adrenal-
medullary system. Long term stress is regulated by the hypothalamic pituitary-adrenal
(HPA) system.
Sympathetic-adrenal-medullary system in the periphery releases catecholamines
(norepinephrine and epinephrine) - IS FAST ACTING
Hypothalamic-pituitary-adrenal (HPA) axis culminates cortisol - IS SLOWER ACTING
The activation of these two stress systems redirects adaptive energy to the CNS and
peripheral body sites to cope with stress.
✔✔Describe the physiology of pain, including the role of endorphins. - ✔✔Pain
perception is mediated via the limbic system & cerebral cortex. Pain modulation can
occur through endogenous opioid peptides, such as endorphins & enkephalins.
Descending inhibitory pathways from the PAG, raphe nucleus, & RVM release
norepinephrine & serotonin on interneruons on the dorsal horn. These interneurons
release endorphins & enkephalins from the interneuron terminal. Endorphins &
enkephalins act as inhibitory neurotransmitters.
✔✔Review the physiology of pain, including the role of endorphins - ✔✔The body
receives a stimulus from a noiceptor (transduction). Transmission along A delta and C
fibers move the impulse to the dorsal grey horn in terminate on interneurons on laminae
I or II (substantia gelatinosa). A delta fibers transmit cold temperatures and mechanical
stimuli rapidly because they are myelinated and C fibers transmit chemical, mechanical,
and hotter temperatures are a slower pace due to unmyelination. A delta fibers
✔✔What is pain modulation? - ✔✔descending pathways & neurotransmitters that inhibit
or amplify pain.
✔✔What are stressors? - ✔✔Anything that demands a response in order to maintain
homeostasis
✔✔What are examples of noxious stressors? - ✔✔Pain, cold, trauma, hunger, electric
shock
✔✔What are examples of non noxious stressors? - ✔✔Life events (ex. getting married);
Excitement
,✔✔How do stress and disease interact? - ✔✔Stress can precipitate or worsen an
existing disease
✔✔Pain Perception:
Behavioral Responses in Older Persons - ✔✔Individual responses vary and may be
influenced by presence of painful chronic diseases & decline in renal, intestinal, hepatic,
cardiovascular, & neurological function.
Individuals w/ cognitive impairment may demonstrate changes in behavior (e.g.,
become combative, withdrawn, or increased confusion)
✔✔Pain Perception:
Physiologic Symptoms in Older Persons - ✔✔↑ HR, BP, RR
Flushing or Pallor
Sweating
↓ Oxygen saturation
Nausea &/or Vomiting
May be ↓ in individuals w/ cognitive impairment
✔✔Pain Threshold in Older Persons - ✔✔Individual responses may vary but pain
threshold may be lower
✔✔Pain Perception:
Physiologic Symptoms in Neonates/Infants - ✔✔↑ HR, BP, RR
Flushing or Pallor
Sweating
↓ Oxygen saturation
✔✔Pain Threshold in Infants - ✔✔Painful neonatal experiences
↑ Pain sensitivity (lower threshold)
Pain may be ↑ w/ future procedures
✔✔What happens with allostatic overload? - ✔✔Parasympathetic system may decrease
its restraint of the sympathetic system, resulting in increased or prolonged inflammatory
responses.
✔✔When does the alarm stage begin? - ✔✔Begins when a stressor or noxious stimuli
triggers the actions of the hypothalamus and the sympathetic nervous system
✔✔Pain transmission - ✔✔axonal conduction
, ✔✔What is pain perception? - ✔✔cortical processing of stimuli
✔✔Pain tolerance - ✔✔the duration of time or the intensity of pain that an individual will
endure before initiating overt pain responses & is generally decreased with repeated
exposure to pain
✔✔Pain threshold - ✔✔the point at which a stimulus is perceived as pain
✔✔Etiology of Migraines - ✔✔Current Theory: Stimulation of the trigeminal nerve (CN
V) along with changes in the neurotransmitter levels in the CNS & alterations in blood
vessel tone
✔✔Clinical Manifestations of Migraines - ✔✔Severe unilateral pounding or throbbing
pain that is increased by activity
Nausea, vomiting, photophobia, phonophobia, lacrimation, nasal congestion, neck
muscle stiffness or pain, dizziness, changes in bowel patterns
Classical sx: aura & changes in vision proceeding headache
✔✔Risk Factors for Migraines - ✔✔Certain "triggers" may activate changes that lead to
headache: wine, cheese, skipped meals, artificial sweeteners, changes in sleep
patterns
Genetic predisposition to triggers that begin them
✔✔Clinical manifestations of fibromyalgia - ✔✔- Pain in several areas of the body that
come & go and does not follow a dermatomal distribution
- Pain worse w/ exertion
- Sleep disturbances
- Fatigue
- Depression & Anxiety
- Decreased attention & short-term memory
✔✔Etiology of Fibromyalgia - ✔✔* Unknown
* Theory is that it is a disordered central pain processing problem
✔✔Risk Factors for Fibromyalgia - ✔✔Medical history of excessive stress
trauma
sexual abuse
viral illness
endocrine disorder (ex. thyroid diseases)
SOLUTIONS RATED A+
✔✔Compare and Contrast the sympathetic-adrenal-medullary system activation to the
hypothalamic-pituitary-adrenal (HPA) axis response that is activated during the stage of
resistance (adaptation). - ✔✔When a stress response is triggered, it sends signals to
two other structures: the pituitary gland and the adrenal medulla. These short term
responses are produced by the "fight or flight" response via the sympathetic-adrenal-
medullary system. Long term stress is regulated by the hypothalamic pituitary-adrenal
(HPA) system.
Sympathetic-adrenal-medullary system in the periphery releases catecholamines
(norepinephrine and epinephrine) - IS FAST ACTING
Hypothalamic-pituitary-adrenal (HPA) axis culminates cortisol - IS SLOWER ACTING
The activation of these two stress systems redirects adaptive energy to the CNS and
peripheral body sites to cope with stress.
✔✔Describe the physiology of pain, including the role of endorphins. - ✔✔Pain
perception is mediated via the limbic system & cerebral cortex. Pain modulation can
occur through endogenous opioid peptides, such as endorphins & enkephalins.
Descending inhibitory pathways from the PAG, raphe nucleus, & RVM release
norepinephrine & serotonin on interneruons on the dorsal horn. These interneurons
release endorphins & enkephalins from the interneuron terminal. Endorphins &
enkephalins act as inhibitory neurotransmitters.
✔✔Review the physiology of pain, including the role of endorphins - ✔✔The body
receives a stimulus from a noiceptor (transduction). Transmission along A delta and C
fibers move the impulse to the dorsal grey horn in terminate on interneurons on laminae
I or II (substantia gelatinosa). A delta fibers transmit cold temperatures and mechanical
stimuli rapidly because they are myelinated and C fibers transmit chemical, mechanical,
and hotter temperatures are a slower pace due to unmyelination. A delta fibers
✔✔What is pain modulation? - ✔✔descending pathways & neurotransmitters that inhibit
or amplify pain.
✔✔What are stressors? - ✔✔Anything that demands a response in order to maintain
homeostasis
✔✔What are examples of noxious stressors? - ✔✔Pain, cold, trauma, hunger, electric
shock
✔✔What are examples of non noxious stressors? - ✔✔Life events (ex. getting married);
Excitement
,✔✔How do stress and disease interact? - ✔✔Stress can precipitate or worsen an
existing disease
✔✔Pain Perception:
Behavioral Responses in Older Persons - ✔✔Individual responses vary and may be
influenced by presence of painful chronic diseases & decline in renal, intestinal, hepatic,
cardiovascular, & neurological function.
Individuals w/ cognitive impairment may demonstrate changes in behavior (e.g.,
become combative, withdrawn, or increased confusion)
✔✔Pain Perception:
Physiologic Symptoms in Older Persons - ✔✔↑ HR, BP, RR
Flushing or Pallor
Sweating
↓ Oxygen saturation
Nausea &/or Vomiting
May be ↓ in individuals w/ cognitive impairment
✔✔Pain Threshold in Older Persons - ✔✔Individual responses may vary but pain
threshold may be lower
✔✔Pain Perception:
Physiologic Symptoms in Neonates/Infants - ✔✔↑ HR, BP, RR
Flushing or Pallor
Sweating
↓ Oxygen saturation
✔✔Pain Threshold in Infants - ✔✔Painful neonatal experiences
↑ Pain sensitivity (lower threshold)
Pain may be ↑ w/ future procedures
✔✔What happens with allostatic overload? - ✔✔Parasympathetic system may decrease
its restraint of the sympathetic system, resulting in increased or prolonged inflammatory
responses.
✔✔When does the alarm stage begin? - ✔✔Begins when a stressor or noxious stimuli
triggers the actions of the hypothalamus and the sympathetic nervous system
✔✔Pain transmission - ✔✔axonal conduction
, ✔✔What is pain perception? - ✔✔cortical processing of stimuli
✔✔Pain tolerance - ✔✔the duration of time or the intensity of pain that an individual will
endure before initiating overt pain responses & is generally decreased with repeated
exposure to pain
✔✔Pain threshold - ✔✔the point at which a stimulus is perceived as pain
✔✔Etiology of Migraines - ✔✔Current Theory: Stimulation of the trigeminal nerve (CN
V) along with changes in the neurotransmitter levels in the CNS & alterations in blood
vessel tone
✔✔Clinical Manifestations of Migraines - ✔✔Severe unilateral pounding or throbbing
pain that is increased by activity
Nausea, vomiting, photophobia, phonophobia, lacrimation, nasal congestion, neck
muscle stiffness or pain, dizziness, changes in bowel patterns
Classical sx: aura & changes in vision proceeding headache
✔✔Risk Factors for Migraines - ✔✔Certain "triggers" may activate changes that lead to
headache: wine, cheese, skipped meals, artificial sweeteners, changes in sleep
patterns
Genetic predisposition to triggers that begin them
✔✔Clinical manifestations of fibromyalgia - ✔✔- Pain in several areas of the body that
come & go and does not follow a dermatomal distribution
- Pain worse w/ exertion
- Sleep disturbances
- Fatigue
- Depression & Anxiety
- Decreased attention & short-term memory
✔✔Etiology of Fibromyalgia - ✔✔* Unknown
* Theory is that it is a disordered central pain processing problem
✔✔Risk Factors for Fibromyalgia - ✔✔Medical history of excessive stress
trauma
sexual abuse
viral illness
endocrine disorder (ex. thyroid diseases)
