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Chapter 10- Alterations in Temperature Regulation
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1.
The medical team is assessing a newly admitted patient who is hypothermic following a night spent lost on a ski slope. The health care professionals would recognize that which of the following phenomena most likely contributed to minimizing the client's heat loss in a cold environment?
A)
The high heat conductivity of subcutaneous tissue protected against core heat loss.
B)
Increased blood flow to the outer shell prevented superficial freezing and loss of heat.
C)
The tissue thickness of the outer shell increased and preserved heat.
D)
Shell temperature dropped, minimizing the temperature variance between the core temperature and environmental temperature.
Ans:
C
Feedback:
The thickness of the outer shell is modifiable in response to the environmental temperature and can be increased through decreased blood flow. Subcutaneous tissue provides protection due to its low, not high, conductivity. Blood flow decreases to the outer shell in low temperatures, and the lowering of the shell temperature does not necessarily minimize heat loss.
2.
In the ICU setting, a patient transported from surgery following open heart bypass grafting will likely have his core temperature measured by a/an
A)
rectal tube inserted to prevent evacuation from bowels while recovering from anesthesia.
B)
temperature probe taped behind his ear.
C)
esophageal flexible thermometer monitoring aorta distention.
D)
pulmonary artery catheter being used to measure cardiac output.
Ans:
D
Feedback:
Core temperature may be obtained by a rectal tube, by using an esophageal flexible thermometer, from a pulmonary artery catheter used for thermodilution measurement of cardiac output, or from a urinary catheter with a thermosensor that measures the temperature of urine in the bladder. Since CABG patients have their core temperature decreased to the 80s, the pulmonary artery catheter is the best choice for measuring core temperature while they are still under the influence of anesthesia.
3.
A nurse is providing care for several clients on a neurological unit of a hospital. In which of the following clients would the nurse be justified in predicting a problem with thermoregulation?
A)
A 66-year-old male with damage to his thalamus secondary to a cerebral vascular accident
B)
A 22-year-old male with damage to his cerebellum secondary to a motorcycle accident
C)
A 68-year-old male with end-stage neurosyphilis
D)
A 45-year-old female with a T8 fracture secondary to a diving accident
Ans:
A
Feedback:
The thalamus is involved in the sensation and regulation of body temperature. Syphilis, a T8 fracture, and damage to the cerebellum would unlikely manifest by difficulties with thermoregulation.
4.
An 8-year-old boy has fallen through the ice while skating on a frozen pond. By the time paramedics arrive, the boy has been removed from the water by his friends, but his core body temperature is 31.1B0C (88.0B0F). The responders would recognize that which of the following physiological processes would have been active during the boy's accident?
A)
Production and release of cortisol as a heat generation process
B)
Stimulation of the thyroid gland in order to increase cellular activity
C)
Heat production through increased body metabolism
D)
Energy generation through the release of epinephrine and norepinephrine
Ans:
C
Feedback:
An immediate response to low temperature is a heat-generating increase in metabolism. Cortisol is not involved in heat generation, and the thyroid is only capable of a longer-term effect on metabolic activity. Epinephrine and norepinephrine shift activity away from energy production and toward heat production.
5.
An agricultural worker is picking fruit on a day when the air temperature is 106B0F. Which of the following processes will most likely be occurring while he works?
A)
Conduction of heat from the air will be heating his skin surface and raising his core temperature.
B)
Blood volume at his skin surface will be increasing to dissipate heat.
C)
His autonomic nervous system will be stimulating him to sweat.
D)
Radiation from his skin surfaces will be dissipating heat into the environment.
Ans:
B
Feedback:
In response to high temperatures, blood volume at the surface increases in order to dissipate heat. Heat exchange between his body and the air is radiation, not conduction, and the sympathetic, not autonomic, nervous system will be in control of the sweating process. Because the air temperature exceeds his body temperature, he will not be able to lose heat in this way.
6.
A health educator is teaching a group of colleagues about the physiology of thermoregulation. Which of the following statements is most accurate?
A)
?Endogenous pyrogens induce host cells to produce exogenous pyrogens.?
B)
?Prostaglandin E2 (PGE2) exerts a direct fever-producing effect on the hypothalamus.?
C)
?PGE2 induces Kupffer cells to initiate a fever response via hepatic sinusoids.?
D)
?Arachidonic acid induces cytokines to act on the temperature regulation center.?
Ans:
B
Feedback:
PGE2 is the protein that exerts control on the hypothalamus and induces fever. Exogenous pyrogens induce host cells to produce endogenous pyrogens, and Kupffer cells produce PGE2. Cytokines do not act directly in the hypothalamus.
7.
A physician is noting the recent vital signs for several patients on an acute medical ward of a hospital. Which of the following hospital patients with noninfectious diagnoses would most likely have a fever?
A)
A 71-year-old female with limited mobility, chronic obstructive pulmonary disease, and vascular dementia
B)
A 33-year-old female with a postoperative deep vein thrombosis and pulmonary embolism
C)
A 51-year-old obese male with hepatic encephalopathy secondary to alcohol abuse
D)
A 71-year-old male with congestive heart failure and peripheral edema
Ans:
B
Feedback:
Pulmonary emboli can produce a fever. The other diagnoses do not.
8.
A 54-year-old man presents with a temperature of 38.8B0C (101.8B0F), a racing heart, fatigue, and an upset stomach after spending an afternoon building a deck on a very hot, humid day. The physician assessing the man is performing a differential diagnosis as part of her assessment. Which of the following findings would suggest fever rather than hyperthermia as a cause of the elevation in the man's temperature?
A)
Moist skin
B)
Dizziness
C)
Shivering
D)
Cognitive changes
Ans:
C
Feedback:
Shivering is a response to a signal for increased heat production. It would only occur on a hot day if the set point for temperature regulation were increased, as in the case of fever but not hyperthermia. Moist skin, cognitive changes, and dizziness can occur with either fever or hyperthermia.
9.
A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which of the following characteristics of the client's history is most likely to have a bearing on his current diagnosis?
A)
The client is cachexic and an African American.
B)
The client is HIV positive and homeless.
C)
The client is malnourished, hypomagnesemic, and hypocalcemic.
D)
The client is receiving intravenous normal saline with 20 mEq KCl.
Ans:
B
Feedback:
FUO is associated with HIV. The other aspects of the client's circumstances are not noted to correlate with FUO.
10.
In the hospital setting, one of the best ways to lower a hyperthermic patient's fever would be to facilitate conduction of heat from the body by
A)
providing frequent sponge baths with cool water.
B)
taking all covers/clothing off and pouring alcohol on the skin.
C)
placing him or her on a cooling mattress that circulates a coolant solution through the mattress.
D)
placing IV solutions into the freezer for 30 minutes prior to hanging them.
Ans:
C
Feedback:
Cooling mattress facilitates the conduction of heat from the body into the coolant solution that circulates through the mattress. Care must be taken so that the cooling method does not produce vasoconstriction and shivering. Sponge baths and alcohol solutions increase evaporative heat loss but may cool them too quickly. IV solutions should not be placed in a freezer.
11.
A child aged 33 days is presented to the emergency department of a hospital by her parents following a 2-day fever. Her temperature is 38B0C (100.4B0F) tympanically. Which of the following diagnostic tests is most clearly indicated?
A)
Electrolytes, blood urea nitrogen (BUN), and creatinine levels
B)
Abdominal ultrasound
C)
Computed tomography (CT) of the head
D)
Urine for culture and sensitivity
Ans:
D
Feedback:
Infants with a fever are at risk of urinary tract infections, which would be diagnosed through a urine test for culture and sensitivity. Electrolytes, BUN and creatinine, CT head, and abdominal ultrasound are not as closely associated with differential diagnosis of the child's fever.
12.
An 88-year-old resident of a long-term care home has been suffering from a 3-day onset of increased shortness of breath and decreased oxygen saturation. At the hospital, an anterior-posterior chest x-ray and sputum culture and sensitivity have confirmed a diagnosis of bacterial pneumonia, yet the client's tympanic temperature has not exceeded 37.3B0C (99.2B0F). The health care team would recognize that which of the following phenomena likely underlies this situation?
A)
An older adult is often insensitive to exogenous pyrogens.
B)
An older adult is sometimes incapable of vasodilation.
C)
An older adult's hypothalamus has diminished thermoregulatory ability.
D)
Infections manifest by cognitive changes in older adults.
Ans:
C
Feedback:
The hypothalamus in older adults is often less capable of thermoregulation than in younger clients. There are sometimes alterations in the release of endogenous pyrogens and deficits in vasoconstriction. While infections do often manifest with cognitive changes in older adults, this does not explain why fever is precluded.
13.
A 14-year-old boy is participating in his school's track meet; the outdoor temperature is 99B0F, and a teacher has found the boy sitting restless in the shade and disoriented to time. The teacher notes that the student has dry skin in spite of the high temperature and the fact that he has recently completed a running event. The teacher calls for the school nurse, who will recognize which of the following potential diagnoses and anticipated hospital treatments?
A)
Heat exhaustion, likely treated with rest, shelter from the sun, and salt tablets
B)
Heat stroke, likely treated with submersion in cold water
C)
Heat stroke, likely treated with rehydration by intravenous hypotonic solution
D)
Heat exhaustion, likely treated with oral rehydration with cool water
Ans:
B
Feedback:
Cognitive changes and lack of sweating are signs of heat stroke as opposed to heat exhaustion. A common treatment for heat stroke is immersion in cold water to rapidly decrease the core and shell temperature. Salt tablets, hypotonic IV rehydration, and oral water rehydration would not be appropriate treatments.
14.
About 30 minutes following the morning medication pass, the nurse's aide informs the nurse that one of the patients on their team is complaining of ?hot sweats.? The aide also states that his temperature is now 101.5B0F. Knowing that some medications can cause hyperthermia, the nurse reviews his medications. From the following patient list, which patient is at high risk for developing an elevated temperature?
A)
Patient with hypertension being treated with Prinivil (Lisinopril).
B)
Suicidal patient who overdosed on his monoamine oxidase (MOA) inhibitor.
C)
Postoperative patient receiving Oxycodone (OxyContin) for his pain.
D)
Patient with C. difficile receiving Vancocin (Vancomycin) IV every 6 hours.
Ans:
B
Feedback:
Overdoses of serotonin reuptake inhibitors or use in people taking MOA inhibitors can cause agitation, hyperactivity, and hyperthermia.
15.
A 20-year-old female has been brought to the emergency department from a rave party where she collapsed on the dance floor. Her accompanying friends acknowledge that the woman took ecstasy early in the evening. Her heart rate is regular at 89 beats/minute and temperature 39.8B0C (103.6B0F) orally. The emergency team would recognize that which of the following phenomena, related to the drug, is a likely contributor to the woman's status?
A)
Increased peripheral vasoconstriction
B)
The direct pyrogenic effect of ecstasy
C)
The initiation of an inappropriate immune response
D)
Impaired temperature regulation by the hypothalamus
Ans:
A
Feedback:
Amphetamines such as ecstasy can induce hyperthermia by increasing peripheral vasoconstriction. They are not associated with direct hypothalamic effect, pyrogenic effect, or an immune response.
16.
During surgery, the anesthesia personnel noticed the patient is having a steady rise in his end-tidal carbon dioxide level. At this time, the nurse anesthetist begins to assess the patient for malignant hyperthermia. The initial (priority) assessment for this disorder may include
A)
hypotension.
B)
acute renal failure.
C)
skeletal muscle rigidity.
D)
sudden cardiac arrest.
Ans:
C
Feedback:
In addition to a steady rise in end-tidal carbon dioxide levels, an initial sign of the disorder, when the condition occurs during anesthesia, is skeletal muscle rigidity.
17.
In the ED, a homeless patient is brought in with severe hypothermia. The police officers also state that they found a ?bottle of booze? on the sidewalk next to him. This puts the nurse on high alert since alcohol contributes to hypothermia by
A)
interfering with the appetite center in the brain causing the person to not respond to hunger pains.
B)
causing the person to have less fat on his body.
C)
dulling the mental awareness that impairs judgment to seek shelter.
D)
increasing his basal metabolic rate, so he will run out of ATP faster than expected.
Ans:
C
Feedback:
Alcohol and sedative drugs dull mental awareness to cold and impair judgment to seek shelter or put on additional clothing. Alcohol also inhibits shivering. It does not interfere with the appetite center. Malnutrition causes the person to have less fat. Alcohol may initially increase pulse, but as the hypothermia continues, the pulse rate will lower.
18.
An 80-year-old woman is undergoing total hip replacement surgery as treatment for severe osteoarthritis. During the procedure, the patient's core temperature falls to 31.6B0C (88.9B0F), necessitating interventions to address her hypothermia. The surgical team recognizes that there are likely multiple causes of patient's hypothermia. Which of the following factors would the team be most justified in ruling out as a contributor?
A)
The cold environment in most operating theaters
B)
Decreased vasoconstriction as a result of anesthetic
C)
Decreased temperature adaptation due to her unconscious state
D)
Impaired thermoregulatory mechanisms due to anesthetic
Ans:
C
Feedback:
Unconsciousness in and of itself is not an identified contributor to surgical hypothermia. The cold environment, decreased vasoconstriction, and impaired thermoregulation resulting from an anesthetic are all potential contributors.
19.
A 38-year-old male client with mild hypothermia following a prolonged hike in the rain is brought to hospital by ambulance. Which of the following sets of vital signs would be the most characteristic of the client's diagnosis?
A)
BP 178/102; RR 12; HR 58
B)
BP 109/68; RR 9; HR 130
C)
BP 160/99; RR 30; HR 66
D)
BP 138/84; RR 28; HR 111
Ans:
D
Feedback:
Mild hypothermia is associated with accelerated HR, slightly increased BP, and hyperventilation; these parameters are best characterized by the vital signs referred in answer D.
20.
Following a cardiothoracic surgery, where controlled therapeutic hypothermia was utilized to decrease metabolic demands, the nurse responsible for recovering this patient should be assessing for which of the following potential complications to cold cardioplegia?
A)
Development of a first-degree AV block
B)
Vasoconstriction resulting in weak pedal pulses, requiring the use of a Doppler
C)
Frequent premature ventricular contractions (PVCs) on the telemetry monitor
D)
Cyanosis in lower extremities with no blanching in the toes
Ans:
C
Feedback:
Potential complications to cold cardioplegia include such signs and symptoms as ventricular dysrhythmias, decreased cerebral blood flow, and postoperative myocardial depression. First-degree AV block is common in patients with heart problems. Vasoconstriction of vessels is an expected effect of cold cardioplegia along with cold, bluish lower extremities.
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