Chapter 05: Comfort and Sedation

Chapter 05: Comfort and Sedation

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. 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.

 

 

ANS:  A

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.

 

DIF:    Cognitive Level: Remember/Knowledge                           REF:   p. 54

OBJ:   Discuss the physiology of pain and anxiety.

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

2. 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.

 

 

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

 

3. 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.

 

 

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

 

4. 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.

 

 

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 with varying levels of sedation.

 

DIF:    Cognitive Level: Understand/Comprehension                    REF:   p. 60

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