Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function

MULTIPLE CHOICE
1. Pricking ones 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
c. Specificity theory
b. Intensity theory
d. Pattern theory
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.
PTS: 1

REF: Page 485

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?
c. Specificity theory
d. Neuromatrix theory

a. GCT
b. Pattern theory
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.
PTS: 1

REF: Page 485

3. Which type of nerve fibers transmits pain impulses?

a. A-alpha (A) fibers
c. A-delta (A) fibers
b. A-beta (A) fibers
d. B fibers
ANS: C

Of the available options, only medium-sized A fibers transmit pain impulses.

PTS: 1

REF: Page 486

4. Where are the primary-order pain transmitting neurons located within the spinal cord?
a. Lateral root ganglia
c. Anterior root ganglia
b. Dorsal root ganglia
d. Medial root ganglia
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.
PTS: 1

REF: Page 487

5. The gate in the GCT of pain is located in the:

a. Substantia gelatinosa
c. Nucleus proprius

b. Marginal layer

d. Dorsolateral tract of Lissauer

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.
PTS: 1

REF: Page 487

6. Which spinal tract carries the most nociceptive information?

a. Archeospinothalamic
c. Dorsal spinothalamic
b. Paleospinothalamic
d. Lateral spinothalamic
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.
PTS: 1

REF: Page 487

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

a. Basal ganglia
c. Thalamus
b. Midbrain
d. Hypothalamus
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.
PTS: 1

REF: Page 487

8. Where in the CNS does a persons learned pain response occur?

a. Cerebral cortex
c. Thalamus
b. Frontal lobe
d. Limbic system
ANS: A

The cognitive-evaluative system overlies the individuals learned behavior concerning the
experience of pain and can modulate the perception of pain and is mediated only through the
cerebral cortex.
PTS: 1

REF: Page 487

9. Massage therapy relieves pain by closing the pain gate with the stimulation which fibers?
a. A
c. B
b. A
d. C
ANS: A

Massaging stimulates different A fibers to close the pain gate. The remaining options do not
fulfill this objective.
PTS: 1

REF: Page 485

10. What part of the brain provides the emotional response to pain?
a. Limbic system
c. Thalamus
b. Parietal lobe
d. Hypothalamus
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.
PTS: 1

REF: Page 487

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 factoralpha
d. Neurokinin A and nitric oxide
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.
PTS: 1

REF: Page 490

12. Which endogenous opioid is located in the hypothalamus and pituitary and is a strong -

receptor agonist?
a. Enkephalins
b. Endorphins

c. Dynorphins
d. Endomorphins

ANS: B

The synthesis and activity of -endorphin is concentrated in the hypothalamus and the
pituitary gland and act as strong -receptor agonist. The remaining options do not fulfill this
objective.
PTS: 1

REF: Page 491

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

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.
PTS: 1

REF: Page 491

14. Pain that warns of actual or impending tissue injury is referred to as what?
a. Chronic
c. Acute
b. Psychogenic
d. Phantom
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.
PTS: 1

REF: Pages 491-492

15. Which description characterizes visceral pain?

a. Is sharp and well-defined when transmitted by A-delta (A) 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.
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.
PTS: 1

REF: Page 492

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
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.
PTS: 1

REF: Pages 491-492

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
ANS: C

Enkephalins and endorphins are neurohormones that act as neurotransmitters by binding to

one or more G proteincoupled opioid receptors and thus relieving pain. The other options are
not accurate descriptions of how enkephalins and endorphins relieve pain.
PTS: 1

REF: Pages 490-491

18. What is a long-term complication of rewarming as a treatment for hypothermia?

a. Acidosis
c. Shock
b. Dysrhythmias
d. Renal failure

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.
PTS: 1

REF: Page 501

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.
ANS: C

Epinephrine and norepinephrine produce a rapid transient increase in heat production by

raising the bodys basal metabolic rate. The other options are not correct descriptions of the
effects of epinephrine on body heat.
PTS: 1

REF: Page 496

20. Using a fan to reduce body temperature is an example of which mechanism of heat loss?
a. Evaporation
c. Convection
b. Radiation
d. Conduction
ANS: C

Only convection causes the transfer of heat through currents of gases or liquids.
PTS: 1

REF: Page 497

21. Up to how many liters of fluid per hour may be lost by sweating?
a. 2
c. 6
b. 4
d. 8
ANS: A

Sweating may cause as much as 2.2 L of fluid per hour to be lost.

PTS: 1

REF: Page 497

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
ANS: A

Radiation refers to heat loss through electromagnetic waves. None of the other options
accurately describes heat loss via radiation.
PTS: 1

REF: Page 497

23. Which cytokines are endogenous pyrogens?

a.
b.
c.
d.

IL-3, IL-10, and IL-18

IL-2, IL-8, and IFN-
IL-4, IL-12, colony-stimulating factor, and IFN-
IL-1, IL-6, TNF-, and IFN-

ANS: D

Endogenous pyrogens include prostaglandin E2 (PGE2), interleukin-1 (IL-1), IL-6, tumor

necrosis factoralpha (TNF-), and interferon-gamma (IFN-). The other options are not
endogenous pyrogens.
PTS: 1

REF: Page 498

24. Which hormones help diminish the febrile response?

a. Arginine vasopressin (AVP), melanocyte-stimulating hormone-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.
ANS: A

During fever, AVP, -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.
PTS: 1

REF: Page 498

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
c. Malignant hyperthermia
b. Heat stroke
d. Heat exhaustion
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.
PTS: 1

REF: Page 500

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
c. Voluntary muscle movements
b. Peripheral vasoconstriction
d. Shivering
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.

PTS: 1

REF: Page 501

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
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.
PTS: 1

REF: Page 500

28. Which medication is used to reverse the effects of malignant hyperthermia?

a. Propranolol
c. Dantrolene sodium
b. Diazepam
d. Sodium carbonate
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.
PTS: 1

REF: Pages 500-501

29. The major sleep center is located in which section of the brain?
a. Thalamus
c. Frontal lobe
b. Brainstem
d. Hypothalamus
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.
PTS: 1

REF: Pages 502-503

30. Which neuropeptide promotes wakefulness?

a. Prostaglandin D2
c. Hypocretins
b. L-tryptophan
d. Growth factors
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.
PTS: 1

REF: Page 503

31. Which term is also used to refer to paradoxic sleep?

a. Non-REM
c. REM
b. Light
d. Delta wave
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.
PTS: 1

REF: Page 503

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
c. Somnambulism
b. Insomnia
d. Enuresis
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.
PTS: 1

REF: Page 505

33. Coronary artery disease is most affected by which component of sleep?

a. Non-REM
c. REM
b. Light
d. Delta wave
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.
PTS: 1

REF: Page 506

34. Rapid eye movement (REM) sleep occurs in cycles approximately every:
a. 45 minutes
c. 120 minutes
b. 90 minutes
d. 150 minutes
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.
PTS: 1

REF: Page 503

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
c. Somnambulism
b. Upper airway resistance syndrome
d. Narcolepsy
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.
PTS: 1

REF: Page 504

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.

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.
PTS: 1

REF: Page 504

37. Pinkeye is characterized by inflammation of which structure?

a. Eyelids
c. Meibomian glands
b. Sebaceous glands
d. Conjunctiva
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.
PTS: 1

REF: Page 507

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
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.
PTS: 1

REF: Page 511 | Table 16-5

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
ANS: B

Loss of visual acuity as a result of pressure on the optic nerve is the only reason glaucoma can
result in blindness.
PTS: 1

REF: Pages 510-511

40. When comparing the effects of acute and chronic pain on an individual, chronic pain is more

often:
The external event that results in a sense of fear
Viewed as being meaningful but undesirable
A factor that contributes to depression
A sense of internal unease

a.
b.
c.
d.

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.
PTS: 1

REF: Page 492

41. When considering the risk factors for the development of phantom limb pain, the nurse

recognizes which as a primary contributing factor?

Age, with adolescent patients being at a higher risk than adults
Presence of pain in the limb before amputation
Patients previous experience with managing pain
Cultural views regarding the acceptance of pain

a.
b.
c.
d.

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.
PTS: 1

REF: Page 494

42. Based on an understanding of the physiologic process of nociceptors, the nurse expects which

surgical procedure to create more pain?

Repair of several crushed fingers
External fixation of a dislocated shoulder
Cyst removal on the internal surface of an ovary
Repair of a ruptured spleen

a.
b.
c.
d.

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.

PTS: 1

REF: Pages 485-486

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.
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.
PTS: 1

REF: Page 485

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.
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.
PTS: 1

REF: Page 485

MULTIPLE RESPONSE
45. Which factors contribute to sensorineural hearing loss? (Select all that apply.)
a. Mnire disease
b. Aging
c. Diabetes mellitus
d. Noise exposure
e. Outer ear trauma
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, Mnire 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.
PTS: 1

REF: Page 517

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 areato-mass ratio.
c. Children have less sweating capacity.

d. They an underdeveloped hypothalamus.

e. Children have an overdeveloped ability to perceive heat.
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 areato-mass ratio, and (3)
their sweating capacity is less than that of adults. The remaining options are not true of a
child.
PTS: 1

REF: Page 500

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
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.
PTS: 1

REF: Page 500

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.
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.
PTS: 1

REF: Pages 498-500

MATCHING

Match the types of chronic pain with its description. Types of pain may be used more than
once.
______ A. Myofascial pain syndrome
______ B. Neuropathic pain
______ C. Deafferentation pain
______ D. Sympathetically maintained pain

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
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
51. Pain that occurs after peripheral nerve injury and is described as continuous with severe
sensations and a burning quality
52. Pain that is the result of muscle spasms, tenderness, and stiffness and leads to muscle guarding
that limits muscle motion
49. ANS: C
PTS: 1
REF: Page 494
MSC: Deafferentation pain results from trauma or chemical injury to the peripheral nervous system,
from tumor infiltration of nerve tissue, or from damage from radiation, chemotherapy, or surgical
sectioning of a nerve with the loss of sensory input to the central nervous system.
50. ANS: B
PTS: 1
REF: Page 494
MSC: Neuropathic pain is the result of trauma or disease of nerves and leads to abnormal processing
of sensory information by the peripheral and central nervous systems.
51. ANS: D
PTS: 1
REF: Pages 494-495
MSC: Sympathetically maintained pain (SMP) is another type of neuropathic pain that occurs after
peripheral nerve or extremity injury and is characterized as continuous and severe with a burning
quality.
52. ANS: A
PTS: 1
REF: Pages 492-493
MSC: Myofascial pain syndrome (MPS) is associated with injury to muscle, fascia, and tendons.