NURSING 2349 Final Exam Questyions With Answers Latest 2023/2024 | GRADED

How does age and gender affect responses to pain?  Children learn indirectly from their parents and caregivers how to respond to pain, as far as the level of pain that justifies a complaint, how to express pain, when to stop complaining about the pain and who to approach for help when experiencing pain.  *Socialization of children will influence the way they respond to pain as adults  About 80% of the elderly experience chronic, moderate to severe pain.  National Institutes of Health stated that women believe emotions of fear and anxiety effect their perception of pain adversely, whereas men focus more on the physical aspects.  Women are known to have a lower pain threshold and tolerance, and seek medical attention more frequently than men.  *Heart attacks are the number one threat to women – since they do not experience typical symptoms and type of pain, they are not hospitalized and treated as aggressively as men.  Women also experience more microvascular changes such as narrowing of the small coronary vessels.  Most prevalent painful disorders seen in both genders, but mainly women include fibromyalgia, Raynaud’s disease, rheumatoid arthritis, multiple sclerosis, headaches, facial pain, and TMJ.  Most prevalent painful disorders seen in both genders, but mainly men include pancreatitis, duodenal ulcer, and ankylosing spondylitis.  Men have a higher chance of injury related to sports and motor vehicle accidents. 2. What is intractable pain? Examples?  Pain that is refractory or resistant to some or all forms of treatment. o Pain due to a known cause - such as malignancy, nerve compression or entrapment, phantom limb pain, spinal cord damage, and myofascial syndromes - and is resistant to therapy is referred to as chronic intractable pain. o Incurable pain – goal is to reduce discomfort 3. What is Neuropathic pain? Example?  Pain that results from injury to a nerve, malfunction of neural transmission process, or impaired regulation. o Frequently described as paroxysmal (sudden spasm-like pain) o Examples: pain associated with trigeminal neuralgia, postherpetic neuralgia, and diabetic peripheral neuropathy 4. What is nociceptive pain? Examples?  Pain in response to potentially damaging stimuli o Occurs when the pain impulse is processed normally over intact nerves o Two types of nociceptive pain: somatic and visceral 5. What somatic pain? Examples?  Pain that originates from the bones, joints, muscles, skin, and connective tissue o In the skin and superficial structures - sharp, pulsatile, and well-localized o In the deep structures – dull, aching, pulsatile, not well localized o Examples: burns, lacerations, fractures, infections, inflammatory conditions, 6. What is visceral pain? Example?  Pain arising from the body organs or gastrointestinal tract o Intermittent, achy, crampy pain – poorly localized o Examples: Menstrual cramps, GI pain, appendicitis, gall stones, angina, bowel distention, pancreatitis 7. Describe referred pain? Example?  Transfer of visceral pain sensations and deep somatic pain through the autonomic nervous system to a part of the body distant from the actual origin of the pain o Pain felt in area other than where stimulus occurs o Example: myocardial infarction felt in the jaw or down the left arm 8. What is breakthrough pain? Examples?  A transitory increase in pain that occurs in addition to persistent pain o Commonly seen in advanced stages of cancer and late-stage diseases such as AIDS. o Acute "flare up" of pain in a patient who is on regular doses of pain medication for persistent pain. o Treated by "rescue" pain meds. These are quick acting meds that don't stay in the body long...e.g. quick release morphine. o *Think cancer pain 9. Know differences between acute and chronic pain, S/S, examples of each and treatment options of each.  Acute pain: usually short term and quick onset. Responds well to treatment. Can be a new flare up during chronic pain. o S/S: Increases systolic BP, increased HR and force of contraction, increased respirations, dilated blood vessels to brain, increased alertness, dilated pupils, rapid speech o Example: burn, muscle injury, fractured bone, surgical wound o Treatment: Acetaminophen, NSAIDs, Opioids, Adjuvants o *goal is to find and remove underlying cause  Chronic pain: Sudden or slow onset of mild to severe pain that is usually long term – typically slow onset. Poorly localized, hard to treat. Pain that lasts more than 6 months. o S/S: mild to severe pain that does not go away as expected after illness or injury, described as shooting, burning, aching, or electrical pain, discomfort, soreness, tightness, or stiffness. o Example: migraine headaches, sickle cell crisis, osteoarthritis, rheumatoid arthritis, cancer pain, fibromyalgia o Treatment: Physical therapy, occupational therapy, NSAIDs, nerve blocks, opioids, nonsteroidal anti-inflammatory drugs 10. Describe prolonged stress response and the cascade of harmful effects to the body system-wide.  Chronic stress that disrupts nearly every system in the body: o Suppress immune system o Upset digestive and reproductive systems o Increase risk of heart attack and stroke o Speeds up the aging process  Can cause psychiatric illnesses such as anxiety disorders, clinical depression, and PTSD  Prolonged stress can result in crisis and burnout (p. 259) o Crisis: an event that drastically changes the person’s routine that is perceived as a threat to self. Usual coping mechanisms are ineffective, resulting in anxiety and inability to function adequately. 5 phases of crisis: precrisis, impact, crisis, adaptive, postcrisis o Burnout: person cannot cope effectively with physical and emotional demands of the workplace May result in grief, moral distress, guilt, physical illness, negative attitude, and maladaptive coping techniques (alcohol use, smoking…) 11. Know how to assess pain in a patient. What questions should you be asking?  Ask: what makes it better/worse, does it interfere with daily function, how often, intermittent/constant, where is it located, what is the quality of the pain, is there a pattern, when did it begin, how would you rate it (pain scales), have you had this type of pain before, what have you tried to relieve it. 12. How does pain affect vital signs?  Acute pain o Increases BP, HR, respirations oDilated pupils oDilated blood vessels to brain causing increased alertness o Rapid speech  Chronic pain oDecreased pulse rate o Changeable breathing patterns o Withdrawal o Constricted pupils o Slow/monotone speech  Behavioral response o Withdrawing from painful stimuli o Moaning o facial grimacing o crying o agitation o guarding  Psychological response o Anxiety oDepression o Anger o fear 13. Physiologic dependence involves what? What would the physiologic S/S be when opioids are removed from a patient who has a history of opioid abuse?  Involves emotional-motivational withdrawal symptoms such as a state of unease or dissatisfaction, a reduced capacity to experience pleasure, or anxiety, upon cessation of drug use or engagement in certain behaviors.  Early S/S o Watery eyes, runny nose, sweating, running, anxiety or irritability, poor sleep, muscle pain  Later S/S o Cramping, diarrhea, vomiting, increased BP & HR, restlessness, shakiness, chills, sweating, gooseflesh, dilated pupils 14. What is tolerance? How does it differ from abuse?  Tolerance is a state of progressively decreasing responsiveness to a frequently used drug. o Characterized by a person's diminished response to a drug, which occurs when the drug is used repeatedly and the body adapts to its presence. As a result, a larger dose of the drug is needed to achieve the effect originally obtained by a smaller dose.  Differs from abuse because abuse is when the person becomes dependent on the drug or medication and its effects, versus not receiving therapeutic effects 15. What are mind-body therapies? Examples?  Therapies in which there is a dynamic relationship between the mind and body and the ways in which the mental, emotional, spiritual, and social aspects interact and affect behavior and health.  They recognize individuals capacity for self-awareness, self-knowledge, and capacity to ignite self-healing  Examples: relaxation, meditation, guided imagery, biofeedback, hypnotherapy, journaling, support groups, cognitive-behavioral therapy, prayer, and music. 16. What are the 5 C’s of pain management? 1. Comprehensive assessment 2. Consistent use of assessment tools 3. Continuous reassessment 4. Customized plan of care 5. Collaborative approach 17. What is the role of interleukin? Released causes fever with infection  An interleukin is a group of naturally occurring proteins that mediate communication between cells.  They regulate cell growth, differentiation, and motility. They are particularly important in stimulating immune responses, such as inflammation. 18. What are specific age related concerns regarding thermoregulation?  The skin acts to control body temperature by conduction of hear through the skin for evaporation or absorption by other objects, radiation of heat from body surfaces, convection of heat by air currents, and evaporation of sweat.  Newborns cannot protect against heat loss. Infants and older adults are most susceptible for heat loss due to the effects of environmental temperature extremes.  Infants lose 30% of their body heat through their head, which is proportionally larger than the rest of their body.  Older adults have a decreased metabolism, decreased vasomotor control, and loss of subcutaneous tissue which is the cause for inability to maintain body heat. 19. What are some treatments for a fever that would be appropriate in caring for a patient with a fever?  Have them drink fluids  OTC fever reducers – acetaminophen, NSAIDs  Remove excess clothing  Cool packs  Cooling blanket  Cool fluids PO/IV  Gastric lavage with cool fluids  Antipyretics 20. What are the methods for taking a temperature? What can cause variations of temperatures when using oral thermometer? Which method is considered the most accurate for obtaining a core temperature?  Oral o Variations that impact oral temp: air temperature, probe placement, and ingestion of fluids  Rectal o Most accurate!  Axillary  Temporal  Tympanic  Body surface temperature 21. Describe the classification of fevers. Constant, intermittent, relapsing, remittent.  Intermittent: spike  Remittent: mild fluctuation  Constant: barely any fluctuation, temperature remains elevated  Relapsing: fever disappears for 24 hours, then reappears  Sustained: continuous  Crisis: extreme drop  Lysis: return to normal at natural rate  Hyperpyrexia: dangerously close to 105 degrees 22. Know how heat is lost through evaporation, conduction, convection and radiation. Know examples of each and interventions for each.  Evaporation: when water is converted to vapor and lost from skin or mucous membranes o Maintain humidity in the air – use a humidifier  Conduction: process where heat is transferred from a warm to cool surface by direct contact oDress appropriately o Protect skin from cool contact  Convection: transfer of heat through currents of air or water o Emersion in warm bath  Radiation: the loss of heat through electromagnetic waves emitting from surfaces that are warmer than the surrounding air o Wear a hat outside oUse heat lamp to acquire heat 23. What is malignant hyperthermia? What are the risk factors? What are the assessment findings? What are treatment options for it?  Malignant hyperthermia – a life threatening, acute pharmacogenic disorder, developing during or after general anesthesia. oGenetic predisposition and one or more triggering agents provoke MH Triggering agents: all volatile anesthetics (chloroform, ether, halothane, enflurane, isoflurane, sevoflurane, and desflurane) and depolarizing muscle relaxants (suxamethonium).  Risk factors – genetic predisposition, multiminicore myopathy, central core disease  Assessment findings – tachycardia, arrhythmia, rise in temperature, masseter spasms, metabolic acidosis, elevated creatinine, rise of end expiratory CO2, rigor of muscles, hypoxemia, skin flushing o rhabdomyolysis indicates severity  Treatment – stop anesthesia, hyperventilate with 100% O2, deepen anesthesia with benzodiazepines, barbiturates, opioids, or propofol. Dantrolene profusion, check ABGs immediately, then in 30 mins, 4 hours, 12 hours, and 24 hours. Begin overall body cooling through NG tube. 24. What are the S/S of hyperthermia? Primary interventions? Why would you not use a fan in the hospital setting?  Example: heat exhaustion, heat stroke  S/S: o Elevated body temperature, convulsions, flushed skin, tachycardia, tachypnea, warmth to the touch  Interventions: o Fever treatment, malignant hyperthermia precautions, temperature regulation, and vital sign and temperature monitoring every 2 hours, determine cause of fever, observe for clinical signs that accompany fever.  Fans are discouraged due to infection control concerns, and may dry out respiratory passages 25. What are the S/S of hypothermia? Primary interventions?  S/S: o Body temperature less than 95°F oDecreased, irregular pulse, respirations, BP o Severe shivering (initially) o Pale, cool, shiny skin oDecreased urine output oDisorientation and/or drowsiness  Interventions: o Temperature regulation o Vital sign monitoring o For pts with temp 85°F: warmed IV fluids, heating pads, heating blankets, warm pads o *DO NOT use electric blankets – vasoconstricted skin burns easily o *DO NOT apply pulse oximetry probes to a vasoconstricted finger 26. What are risk factors for impaired thermoregulation?  Lower body temperature  Diminished response to infection  Residing in very cold or hot climates  Age – young and old  Low socioeconomic status  Impaired cognition  Underlying health conditions  Genetics  Environmental exposure  Substance abuse 27. What are the 7 rights to drug administration? 1. Right medication 2. Right patient 3. Right dosage 4. Right route 5. Right time 6. Right reason 7. Right documentation 28. What are safety precautions a nurse should employ when dealing with an angry or unstable patient?  Stay between the patient and the door  Get help  Use restraints only if needed 29. What disease processes might make a patient a higher risk for falls?  Orthostatic hypotension  Fainting episodes  Sensory deficits  Dementia  Bone degeneration  Osteoporosis  Degenerative joint disease  Stroke  Seizures  Multiple sclerosis  Peripheral neuropathy 30. What is a sentinel event?  any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness 31. What are the interventions to prevent post-op complications?