SOLE Chapter 05 Comfort and
Sedation TEST BANK LATEST EXAM
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,Nociceptors differ from other nerve receptors in the body in that they:
a. adapt very little to continual pain response.
b. inhibit the infiltration of neutrophils and eosinophils.
c. play no role in the inflammatory response.
d. transmit only the thermal stimuli. - correct ans:Nociceptors are stimulated by mechanical, chemical,
or thermal stimuli. Nociceptors differ
from other nerve receptors in the body in that they adapt very little to the pain response. The
body continues to experience pain until the stimulus is discontinued or therapy is initiated.
This is a protective mechanism so that the body tissues being damaged will be removed from
harm. Nociceptors usually initiate inflammatory responses near injured capillaries. As such,
the response promotes infiltration of injured tissues with neutrophils and eosinophils.
A postsurgical patient is on a ventilator in the critical care unit. The patient has been tolerating
the ventilator well and has not required any sedation. On assessment, the nurse notes the
patient is tachycardic and hypertensive with an increased respiratory rate of 28 breaths/min.
The patient has been suctioned recently via the endotracheal tube, and the airway is clear. The
patient responds appropriately to the nurse's commands. The nurse should:
a. assess the patient's level of pain.
b. decrease the ventilator rate.
c. provide sedation as ordered.
d. suction the patient again. - correct ans:ANS: A
Pulse, respirations, and blood pressure frequently result from activation of the sympathetic
nervous system by the pain stimulus. Because the patient is postoperative, the patient should
be assessed for the presence of pain and need for pain medication. Decreasing the ventilator
rate will not help in this situation. Providing sedation may calm the patient but will not solve
the problem if the physiological changes are from pain. The patient has just been suctioned
and the airway is clear. There is no need to suction again.
DIF: Cognitive Level: Analyze/Analysis REF: p. 55
OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients.
, TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit
signs of anxiety, the nurse's first priority is to
a. administer antianxiety medications as ordered.
b. administer pain medication as ordered.
c. identify and treat the underlying cause.
d. reassess the patient hourly to determine whether symptoms resolve on their own. - correct ans:ANS:
C
When patients exhibit signs of anxiety or agitation, the first priority is to identify and treat the
underlying cause, which could be hypoxemia, hypoglycemia, hypotension, pain, or
withdrawal from alcohol and drugs. Treatment is not initiated until assessment is completed.
Medication may not be needed if the underlying cause can be resolved.
DIF: Cognitive Level: Apply/Application REF: p. 70 | Table 5-11
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or
Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in
critically ill patients. The BIS and PSI monitors are simpler to use because they
a. can be used only on heavily sedated patients.
b. can be used only on pediatric patients.
c. provide raw EEG data and a numeric value.
d. require only five leads. - correct ans:ANS: C
The BIS and PSI have very simple steps for application, and results are displayed as raw EEG
data and the numeric value. A single electrode is placed across the patient's forehead and is
attached to a monitor. These monitors can be used in both children and adults and in patients
Sedation TEST BANK LATEST EXAM
VERSION With Expected real and
comprehensive Questions and
Revised Correct Answers Guarantee
Pass A+
Professional Academic Assistance Services
Services Offered
Proctored Exam Assistance
Online Class Management (Full Course Support)
Exam Preparation & Study Materials
Assignments and Coursework Support
Essays and Research Papers
Discussion Posts and Replies
,Nociceptors differ from other nerve receptors in the body in that they:
a. adapt very little to continual pain response.
b. inhibit the infiltration of neutrophils and eosinophils.
c. play no role in the inflammatory response.
d. transmit only the thermal stimuli. - correct ans:Nociceptors are stimulated by mechanical, chemical,
or thermal stimuli. Nociceptors differ
from other nerve receptors in the body in that they adapt very little to the pain response. The
body continues to experience pain until the stimulus is discontinued or therapy is initiated.
This is a protective mechanism so that the body tissues being damaged will be removed from
harm. Nociceptors usually initiate inflammatory responses near injured capillaries. As such,
the response promotes infiltration of injured tissues with neutrophils and eosinophils.
A postsurgical patient is on a ventilator in the critical care unit. The patient has been tolerating
the ventilator well and has not required any sedation. On assessment, the nurse notes the
patient is tachycardic and hypertensive with an increased respiratory rate of 28 breaths/min.
The patient has been suctioned recently via the endotracheal tube, and the airway is clear. The
patient responds appropriately to the nurse's commands. The nurse should:
a. assess the patient's level of pain.
b. decrease the ventilator rate.
c. provide sedation as ordered.
d. suction the patient again. - correct ans:ANS: A
Pulse, respirations, and blood pressure frequently result from activation of the sympathetic
nervous system by the pain stimulus. Because the patient is postoperative, the patient should
be assessed for the presence of pain and need for pain medication. Decreasing the ventilator
rate will not help in this situation. Providing sedation may calm the patient but will not solve
the problem if the physiological changes are from pain. The patient has just been suctioned
and the airway is clear. There is no need to suction again.
DIF: Cognitive Level: Analyze/Analysis REF: p. 55
OBJ: Describe the positive and negative effects of pain and anxiety in critically ill patients.
, TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
The assessment of pain and anxiety is a continuous process. When critically ill patients exhibit
signs of anxiety, the nurse's first priority is to
a. administer antianxiety medications as ordered.
b. administer pain medication as ordered.
c. identify and treat the underlying cause.
d. reassess the patient hourly to determine whether symptoms resolve on their own. - correct ans:ANS:
C
When patients exhibit signs of anxiety or agitation, the first priority is to identify and treat the
underlying cause, which could be hypoxemia, hypoglycemia, hypotension, pain, or
withdrawal from alcohol and drugs. Treatment is not initiated until assessment is completed.
Medication may not be needed if the underlying cause can be resolved.
DIF: Cognitive Level: Apply/Application REF: p. 70 | Table 5-11
OBJ: Describe methods and tools for assessing pain and anxiety in the critically ill patient.
TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
Both the electroencephalogram (EEG) monitor and the Bispectral Index Score (BIS) or
Patient State Index (PSI) analyzer monitors are used to assess patient sedation levels in
critically ill patients. The BIS and PSI monitors are simpler to use because they
a. can be used only on heavily sedated patients.
b. can be used only on pediatric patients.
c. provide raw EEG data and a numeric value.
d. require only five leads. - correct ans:ANS: C
The BIS and PSI have very simple steps for application, and results are displayed as raw EEG
data and the numeric value. A single electrode is placed across the patient's forehead and is
attached to a monitor. These monitors can be used in both children and adults and in patients
