prep U patho Exam 4
A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret
this pain as:
Somatic
Referred
Cutaneous
Visceral - ANSWER Referred
Referred pain is pain that is perceived at a site different from its point of origin but innervated by the
same spinal segment.
-Visceral pain originates in the visceral orgANSWER and is one of the most common pains produced
by disease,
-cutaneous pain arises from superficial structures, and
- somatic pain originates in deep body structures
A client with a history of migraine headaches tells the physician that he or she usually experiences an
aura before the onset of the headache. The client is most likely experiencing:
Lethargy
Visual disturbances
Dysphasia
Dizziness - ANSWER Visual disturbances
Migraine aura is associated with visual symptoms, including flickering lights, spots, or loss of vision;
sensory symptoms, including feeling of pins or needles, or numbness; and speech disturbances or
other neurologic symptoms.
Which scenario would be an example of a child born with congenital insensitivity to pain? A child
who:
cries every time the wind blows because it hurts his face and ears.
,fell off a skate board and fractured ankle but did not feel any pain, just noted swelling in foot.
skinned knee from a bike accident but only told parents when it started burning.
develops pins-and-needles sensation after jumping out of a tree. - ANSWER fell off a skate board and
fractured ankle but did not feel any pain, just noted swelling in foot.
Explanation:
Analgesia is the absences of pain on noxious stimulation or the relief of pain without loss of
consciousness. Congenital insensitivity is when a peripheral nerve defect apparently exists such that
the transmission of painful nerve impulses does not result in perception of pain. Pins-and-needles
sensation is called paresthesia. Burning sensations are usually associated with temperature
(hyperthermia). Pain associated with wind (or any non-noxious stimuli) is called allodynia.
A client reports a sudden intense headache. Which factor would indicate the presence of a possible
subarachnoid hemorrhage?
Sleep disturbance at night
Family history of migraine
Intractable pain
History of smoking - ANSWER Intractable pain
Explanation:
Subarachnoid hemorrhage causes a severe intractable headache. Headaches that disturb sleep or
occur with exercise or sexual activity may be caused by neurologic lesions. Migraine headaches tend
to run in families but do not contribute to hemorrhage.
The nurse is working with a client who has been diagnosed with recurring migraine headaches.
Which advice by the nurse is most appropriate?
"Migraine headaches usually respond poorly to medication, so I can help you explore
nonpharmacologic options."
"Migraines are poorly understood and are generally considered unavoidable, so always have your
medication with you."
,"Many people find that maintaining regular eating and sleeping habits is beneficial."
"It's likely in your best interest to move to a rural setting and explore getting a less stressful job." -
ANSWER "Many people find that maintaining regular eating and sleeping habits is beneficial."
Explanation:
Nonpharmacologic treatment includes the avoidance of migraine triggers, such as foods, that
precipitate an attack. Many persons with migraines benefit from maintaining regular eating and
sleeping habits. The client may need to change her lifestyle, but not to the extent of moving and
changing jobs. Migraines are avoidable, most of the time, if individuals adhere to their diets and
watch the triggers. Medication is very useful for most clients.
A beta-adrenergic blocker has been prescribed for a client diagnosed with migraines. The most
important information for the nurse to teach the client would be:
"Take the medication only when feeling a migraine start."
"Stop this medication immediately if you have dizziness after taking it."
"This medication will prevent you from having any more migraines."
"Take the medication daily as you have been directed." - ANSWER "Take the medication daily as you
have been directed."
Explanation:
Preventive medications such as beta-adrenergic blockers should be taken consistently to prevent
vascular changes from occurring. In most cases, preventive treatment must be taken daily for
months to years. They should not be stopped abruptly and should be weaned or tapered off.
A mother is placing her child into the bathtub. The child immediately jumps out of the tub and
begins to cry, stating her feet are "burning." The nurse in the emergency department knows that the
child's response is based on which pathophysiologic principle listed below?
Child react much quicker to contact with hot water than adults.
The thermal processing center is located on the rapid-conducting anterolateral system on the same
side of the brain as the injury.
, The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex
reacts first.
It takes a long time for thermal signals to be processed before the brain can send a signal through
the spinal cord and tell the foot to withdraw. - ANSWER The tactile sensation occurs well in advance
of the burning sensation. The local withdrawal reflex reacts first.
Explanation:
If a person places a foot in a tub of hot water, the tactile sensation occurs well in advance of the
burning sensation. The foot has been removed from the hot water by the local withdrawal reflex
well before the excessive heat is perceived by the forebrain.
A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is
reporting intense, diffuse pain in her abdomen. Which physiologic phenomenon is most likely
contributing to her complaint?
The client's C fibers are conducting pain in the absence of damaged Aδ (A-delta) fibers.
First order neurons are inappropriately signaling pain to the dorsal root ganglion.
Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve
pathways of the ANS.
The client is experiencing neuropathic pain. - ANSWER Nociceptive afferents are conducting the
sensation of pain along the cranial and spinal nerve pathways of the ANS.
Explanation:
Visceral pain, as characterized by the client's description of her pain, is conducted by way of
nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not
likely rooted in the inappropriate firing of first-order neurons or the substitution of conduction by C
fibers. Pain that is attributable to a pathological process apart from the neural pain network is not
normally considered to be neuropathic.
A client is experiencing chest pain that radiates to the left arm and neck. The nurse would interpret
this pain as:
Somatic
Referred
Cutaneous
Visceral - ANSWER Referred
Referred pain is pain that is perceived at a site different from its point of origin but innervated by the
same spinal segment.
-Visceral pain originates in the visceral orgANSWER and is one of the most common pains produced
by disease,
-cutaneous pain arises from superficial structures, and
- somatic pain originates in deep body structures
A client with a history of migraine headaches tells the physician that he or she usually experiences an
aura before the onset of the headache. The client is most likely experiencing:
Lethargy
Visual disturbances
Dysphasia
Dizziness - ANSWER Visual disturbances
Migraine aura is associated with visual symptoms, including flickering lights, spots, or loss of vision;
sensory symptoms, including feeling of pins or needles, or numbness; and speech disturbances or
other neurologic symptoms.
Which scenario would be an example of a child born with congenital insensitivity to pain? A child
who:
cries every time the wind blows because it hurts his face and ears.
,fell off a skate board and fractured ankle but did not feel any pain, just noted swelling in foot.
skinned knee from a bike accident but only told parents when it started burning.
develops pins-and-needles sensation after jumping out of a tree. - ANSWER fell off a skate board and
fractured ankle but did not feel any pain, just noted swelling in foot.
Explanation:
Analgesia is the absences of pain on noxious stimulation or the relief of pain without loss of
consciousness. Congenital insensitivity is when a peripheral nerve defect apparently exists such that
the transmission of painful nerve impulses does not result in perception of pain. Pins-and-needles
sensation is called paresthesia. Burning sensations are usually associated with temperature
(hyperthermia). Pain associated with wind (or any non-noxious stimuli) is called allodynia.
A client reports a sudden intense headache. Which factor would indicate the presence of a possible
subarachnoid hemorrhage?
Sleep disturbance at night
Family history of migraine
Intractable pain
History of smoking - ANSWER Intractable pain
Explanation:
Subarachnoid hemorrhage causes a severe intractable headache. Headaches that disturb sleep or
occur with exercise or sexual activity may be caused by neurologic lesions. Migraine headaches tend
to run in families but do not contribute to hemorrhage.
The nurse is working with a client who has been diagnosed with recurring migraine headaches.
Which advice by the nurse is most appropriate?
"Migraine headaches usually respond poorly to medication, so I can help you explore
nonpharmacologic options."
"Migraines are poorly understood and are generally considered unavoidable, so always have your
medication with you."
,"Many people find that maintaining regular eating and sleeping habits is beneficial."
"It's likely in your best interest to move to a rural setting and explore getting a less stressful job." -
ANSWER "Many people find that maintaining regular eating and sleeping habits is beneficial."
Explanation:
Nonpharmacologic treatment includes the avoidance of migraine triggers, such as foods, that
precipitate an attack. Many persons with migraines benefit from maintaining regular eating and
sleeping habits. The client may need to change her lifestyle, but not to the extent of moving and
changing jobs. Migraines are avoidable, most of the time, if individuals adhere to their diets and
watch the triggers. Medication is very useful for most clients.
A beta-adrenergic blocker has been prescribed for a client diagnosed with migraines. The most
important information for the nurse to teach the client would be:
"Take the medication only when feeling a migraine start."
"Stop this medication immediately if you have dizziness after taking it."
"This medication will prevent you from having any more migraines."
"Take the medication daily as you have been directed." - ANSWER "Take the medication daily as you
have been directed."
Explanation:
Preventive medications such as beta-adrenergic blockers should be taken consistently to prevent
vascular changes from occurring. In most cases, preventive treatment must be taken daily for
months to years. They should not be stopped abruptly and should be weaned or tapered off.
A mother is placing her child into the bathtub. The child immediately jumps out of the tub and
begins to cry, stating her feet are "burning." The nurse in the emergency department knows that the
child's response is based on which pathophysiologic principle listed below?
Child react much quicker to contact with hot water than adults.
The thermal processing center is located on the rapid-conducting anterolateral system on the same
side of the brain as the injury.
, The tactile sensation occurs well in advance of the burning sensation. The local withdrawal reflex
reacts first.
It takes a long time for thermal signals to be processed before the brain can send a signal through
the spinal cord and tell the foot to withdraw. - ANSWER The tactile sensation occurs well in advance
of the burning sensation. The local withdrawal reflex reacts first.
Explanation:
If a person places a foot in a tub of hot water, the tactile sensation occurs well in advance of the
burning sensation. The foot has been removed from the hot water by the local withdrawal reflex
well before the excessive heat is perceived by the forebrain.
A client on an acute medicine unit of a hospital with a diagnosis of small bowel obstruction is
reporting intense, diffuse pain in her abdomen. Which physiologic phenomenon is most likely
contributing to her complaint?
The client's C fibers are conducting pain in the absence of damaged Aδ (A-delta) fibers.
First order neurons are inappropriately signaling pain to the dorsal root ganglion.
Nociceptive afferents are conducting the sensation of pain along the cranial and spinal nerve
pathways of the ANS.
The client is experiencing neuropathic pain. - ANSWER Nociceptive afferents are conducting the
sensation of pain along the cranial and spinal nerve pathways of the ANS.
Explanation:
Visceral pain, as characterized by the client's description of her pain, is conducted by way of
nociceptive afferents that use the cranial and spinal nerve pathways of the ANS. The problem is not
likely rooted in the inappropriate firing of first-order neurons or the substitution of conduction by C
fibers. Pain that is attributable to a pathological process apart from the neural pain network is not
normally considered to be neuropathic.
