Chapter 40: Therapeutic Use of Heat and Cold Nursing School Test Banks

MULTIPLE CHOICE

1. The nurse is using cryotherapy for a patient with a sprained ankle. She is explaining the benefits to her patient. Which of the following statements made about the benefits of cryotherapy is correct?

a.

It causes vasodilatation.

b.

It provides local anesthesia.

c.

It increases nerve conduction velocity.

d.

It increases blood flow.

ANS: B

The reduction in temperature creates positive physiological and biological effects such as pain relief, reduced muscle spasms, decreased nerve conduction velocity, and decreased inflammation edema caused by constriction of blood vessels.

DIF: Cognitive Level: Application REF: Text reference: p. 977

OBJ: Identify the effects of heat and cold on the patient. TOP: Cryotherapy

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

2. You are developing evidence-based guidelines for the OR. Of the following methods of warming patients undergoing major surgery, which has been shown to be most beneficial?

a.

Placing warm blankets on the patient

b.

Using a circulating water device

c.

Using a forced air warming system

d.

None of the above

ANS: B

A study examining the best method to prevent hypothermia during surgery tested a variety of warming devices. This study noted that circulating warming devices were most effective in maintaining body temperature control during surgery.

DIF: Cognitive Level: Application REF: Text reference: p. 977

OBJ: Correctly apply heat and cold applications.

TOP: Prevention of Intraoperative Hypothermia

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. What procedure should the nurse follow when applying hot therapy to a patient with muscle spasm in response to an acute injury?

a.

Apply the source for 20- to 30-minute periods.

b.

Allow the patient to adjust the temperature for comfort.

c.

Encourage the patient to move the application.

d.

Position the patient so that he or she cannot move away from the temperature source.

ANS: A

When areas are prone to muscle spasm in response to an acute injury, you apply heat for 20 to 30 minutes. Do not allow the patient to adjust temperature settings. It is common for the patient to adapt to a temperature extreme and then think that the temperature should be adjusted. Discourage the patient from moving an application. This may cause injury to an unprotected area of the body and may decrease the effectiveness of therapy. Never position the patient so that the patient cannot move away from the temperature source.

DIF: Cognitive Level: Application REF: Text reference: p. 985

OBJ: Correctly apply heat and cold applications. TOP: Applying Heat

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

4. When reviewing the documentation of patients on the unit, a nurse determines that one of the patients is at higher risk for injury from a local heat application to an extremity. Which condition poses this risk?

a.

Arthritis

b.

Renal calculi

c.

Pulmonary disease

d.

Peripheral neuropathy

ANS: D

Patients with diabetes, victims of stroke or spinal cord injury, and patients with peripheral neuropathy and rheumatoid arthritis are particularly at risk for thermal injury. Arthritis, renal calculi, and pulmonary disease do not increase the patients risk for thermal injury.

DIF: Cognitive Level: Analysis REF: Text reference: p. 978

OBJ: Correctly apply heat and cold applications. TOP: Risk for Heat Injury

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

5. What procedure should the nurse follow when applying hot compresses to an open wound?

a.

Apply clean gloves.

b.

Cover all wound surfaces.

c.

Leave the application in place for 30 to 40 minutes.

d.

Apply an electrical heating unit directly over the compress.

ANS: B

Pack gauze snugly against the wound. Be sure that all wound surfaces are covered by a warm compress. Packing of compresses prevents rapid cooling from underlying air currents. Sterile gloves are used to contact an open wound. You apply heat for 20 to 30 minutes every 2 hours. Cover the moist compress with dry sterile dressing and a bath towel. Apply an aquathermia pad or a waterproof heating pad over the towel.

DIF: Cognitive Level: Application REF: Text reference: p. 981

OBJ: Correctly apply heat and cold applications. TOP: Sterile Warm Compress

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

6. A new staff nurse is assigned to the unit. The charge nurse evaluated that the new staff member knows proper use of the aquathermia pad when the:

a.

temperature was set between 95 F and 98 F.

b.

water in the reservoir was allowed to run out.

c.

pad was covered with a towel or a pillowcase.

d.

patient was positioned to lie directly over the pad.

ANS: C

Aquathermia pads and heating pads are common forms of dry heat therapy. Both are covered and applied directly to the skins surface; for this reason, the nurse needs to take extra precautions to prevent burns. In most health care institutions, the central supply department sets the temperature regulators to the recommended temperature, approximately 40.5 C to 43 C (105 F to 109.4 F). Never position the patient so that the patient is lying directly on the pad. This position prevents dissipation of heat and increases risk for burns.

DIF: Cognitive Level: Application REF: Text reference: p. 984

OBJ: Correctly apply heat and cold applications. TOP: Aquathermia Pads

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

7. The nurse is removing a heating pad when she notices that the skin beneath the pad is pink and warm to touch. How should the nurse respond?

a.

Keep the pad in place the next time by pinning it with a safety pin.

b.

Position the patient next time so that the patient is lying directly on the pad.

c.

Note the findings because this is a normal finding.

d.

Put the pad back on for an additional 20 to 30 minutes.

ANS: C

Vasodilation from heat exposure increases blood flow to the affected part. Do not pin the wrap to the pad because this may cause a leak in the device. Never position the patient so that patient is lying directly on the pad. This position prevents dissipation of heat and increases risk for burns. After 20 to 30 minutes (or time ordered by the physician), remove the pad and store. Continued exposure will result in burns.

DIF: Cognitive Level: Analysis REF: Text reference: p. 984

OBJ: Correctly apply heat and cold applications. TOP: Heat Application

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

8. Assessment of a patient reveals that the area directly under the heating pad is slightly red. How should the nurse respond?

a.

Continue the therapy.

b.

Apply a cold compress.

c.

Reduce the amount of heat.

d.

Remove the pad and reassess in 5 minutes.

ANS: D

If skin is reddened and sensitive to touch, the symptoms indicate first-degree burn. Remove the pad and reassess in 5 to 10 minutes.

DIF: Cognitive Level: Application REF: Text reference: p. 985

OBJ: Correctly apply heat and cold applications. TOP: Heat Application

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity

9. For which patient should the nurse consider an application of cold?

a.

Menstrual cramping

b.

Infected wound

c.

Fractured ankle

d.

Degenerative joint disease

ANS: C

Cold exerts a profound physiological effect on the body, reducing inflammation caused by injury to the musculoskeletal system. Application of cold is not indicated for the patient with an infected wound, as it reduces blood flow to the area. Application of heat to reduce muscle tension and pain would be more appropriate for the patient with menstrual cramping. The effects of heat application would also be more beneficial for the patient with degenerative joint disease.

DIF: Cognitive Level: Application REF: Text reference: p. 986

OBJ: Correctly apply heat and cold applications. TOP: Cold Therapy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. If a patient is to receive a cold application for a sprain, he or she should have:

a.

a prolonged application time.

b.

the body part carefully aligned.

c.

a colder temperature applied.

d.

extra packing under the cooling device.

ANS: B

Keep the injured part immobilized and in alignment. Movement can cause further injury to strains, sprains, or fractures. Cold should be applied directly over the injury. Extreme temperatures can cause tissue damage. After 15 to 20 minutes (or as ordered by the physician), apply clean gloves, remove the compress or pad, and gently dry off any moisture.

DIF: Cognitive Level: Application REF: Text reference: p. 987

OBJ: Correctly apply heat and cold applications. TOP: Cold Therapy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

11. The nurse is applying an ice pack to the patients knee. She notices moisture on the outside of the bag. How should the nurse respond?

a.

Discard the ice pack because it is leaking.

b.

Refill the ice pack to the top.

c.

Continue to apply the ice pack.

d.

Open the ice pack to allow air inside.

ANS: C

Moisture may form on the outside of the bag if room temperature is warm. This does not indicate a leak. Fill the bag two-thirds full with small ice chips. The bag is easier to mold over a body part when it is not full. Excess air in the bag interferes with cold conduction.

DIF: Cognitive Level: Application REF: Text reference: p. 988

OBJ: Correctly apply heat and cold applications. TOP: Cold Therapy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

12. The nurse removes an ice pack and notices that the area underneath the ice pack is blue. What action should the nurse take?

a.

Reapply the ice pack.

b.

Discontinue the use of ice packs.

c.

Refill the ice pack to the top.

d.

Reapply the ice pack without the wrapping.

ANS: B

Do not reapply the ice pack to red or bluish areas; continual use of the ice pack makes ischemia worse. When filling an ice pack, fill the bag two-thirds full with small ice chips. The bag is easier to mold over a body part when it is not full. However, in this case, do not reapply the ice pack.

DIF: Cognitive Level: Application REF: Text reference: p. 988

OBJ: Correctly apply heat and cold applications.

TOP: Cold Therapy on Red or Bluish Areas

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

13. The patient is receiving cold therapy and complains to the nurse that the area being treated is numb. How should the nurse respond?

a.

Continue application of therapy.

b.

Stop cold therapy.

c.

Apply more ice to the ice pack.

d.

Check for moisture on the ice pack, indicating leakage.

ANS: B

Stop cold therapy when the patient complains of a burning sensation or when skin begins to feel numb.

DIF: Cognitive Level: Application REF: Text reference: p. 989

OBJ: Correctly apply heat and cold applications. TOP: Numbness

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

14. When applying a hypothermia or hyperthermia blanket, the nurse should:

a.

wrap the patients hands and feet.

b.

monitor the patients axillary temperature every hour.

c.

put the patient directly onto the heating or cooling blanket.

d.

place the patient onto the blanket and then start the heating or cooling process.

ANS: A

Wrap the patients hands and feet in gauze. This reduces the risk for thermal injury to the bodys distal areas. Monitor the patients temperature and vital signs every 15 minutes during the first hour and after every 30 minutes of therapy thereafter. Cover the hypothermia or hyperthermia blanket with a thin sheet or bath blanket. Precool or prewarm the blanket, setting the pad temperature to the desired level.

DIF: Cognitive Level: Application REF: Text reference: p. 991

OBJ: Explain common guidelines used to protect patients who receive heat and cold applications.

TOP: The Hypothermia-Hyperthermia Blanket

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

15. If a patient on a hypothermia blanket starts to shiver, what action should the nurse take?

a.

Discontinue treatment.

b.

Place more padding around the patient.

c.

Discuss with the physician the use of a metabolic stimulant.

d.

Increase the temperature to a more comfortable range.

ANS: D

Adjust the temperature to a more comfortable range and assess whether shivering decreases. If shivering continues, stop treatment and notify the physician.

DIF: Cognitive Level: Application REF: Text reference: p. 992

OBJ: Correctly apply heat and cold applications.

TOP: The Hypothermia-Hyperthermia Blanket

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

16. Which of the following would require using caution in applying cold therapy?

a.

Chronic pain

b.

Joint trauma

c.

Circulatory insufficiency

d.

Sprains

ANS: C

Conditions that require caution with cold therapy include circulatory insufficiency, cold allergy, and advanced diabetes. Cold therapy is used immediately after direct trauma such as sprains, strains, fractures, or muscle spasms; after superficial lacerations or puncture wounds; after minor burns; with chronic pain of arthritis and joint trauma; with delayed-onset muscle soreness; and with inflammation.

DIF: Cognitive Level: Application REF: Text reference: p. 977

OBJ: Correctly apply heat and cold applications. TOP: Cold Therapy Precautions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

17. You are explaining to the patient the reason why you are using dry heat. Which of the following statements indicates understanding of the advantage of dry heat application for the patient?

a.

It maintains temperature changes longer.

b.

It reduces drying of the skin.

c.

It penetrates tissue layers deeply.

d.

It conforms better to body surfaces.

ANS: A

Dry heat maintains temperature changes longer than moist heat treatments. Moist heat reduces the drying of skin and softens wound exudate. Moist heat also penetrates more deeply into tissue layers and conforms better to the body area being treated.

DIF: Cognitive Level: Application REF: Text reference: p. 977

OBJ: Correctly apply heat and cold applications. TOP: Advantages of Dry Heat

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. When the skin is exposed to warm or hot temperatures, which of the following occurs? (Select all that apply.)

a.

Vasodilatation

b.

Vasoconstriction

c.

Perspiration

d.

Piloerection

ANS: A, C

Systemically, when the skin is exposed to warm or hot temperatures, vasodilatation and perspiration occur to promote heat loss. As perspiration evaporates from the skin, cooling occurs. In cryotherapy, when the skin is exposed to cool or cold temperatures, the systemic response includes vasoconstriction and piloerection to conserve heat. Shivering occurs in response to cooler temperatures, producing heat through skeletal muscle contraction.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 976

OBJ: Identify the effects of heat and cold on the patient. TOP: The Hypothalamus

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The use of cold (cryotherapy) to treat certain injuries is beneficial because of which of the following effects? (Select all that apply.)

a.

Relief of pain

b.

Decreased muscle spasm

c.

Increased nerve conduction

d.

Decreased edema

ANS: A, B, D

The reduction in temperature creates positive physiological and biological effects, such as pain relief, reduction in muscle spasm, decreased nerve conduction velocity, and decreased inflammation edema, caused by constriction of blood vessels.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 977

OBJ: Identify the effects of heat and cold on the patient. TOP: Cryotherapy

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

3. Which of the following conditions are best treated with cold therapy? (Select all that apply.)

a.

Localized inflammatory responses

b.

Hemorrhage

c.

Muscle spasm

d.

Pain

ANS: A, B, C, D

Cold therapy treats localized inflammatory responses that lead to edema, hemorrhage, muscle spasm, or pain.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 986

OBJ: Differentiate the types of injuries or conditions that benefit from heat and cold applications.

TOP: Cold Application KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

4. Hot applications are used with caution in which of the following conditions? (Select all that apply.)

a.

Pregnancy

b.

Laminectomy sites

c.

Malignancy

d.

Spinal cord injury

ANS: A, B, C, D

Caution is used with heat therapy in cases of pregnancy, at laminectomy sites, with spinal cord injury, malignancy, or vascular insufficiency, and near the eyes or testes.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 977

OBJ: Correctly apply heat and cold applications. TOP: Heat Therapy Precautions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

5. Advantages of moist heat over dry heat include which of the following? (Select all that apply.)

a.

Reduces drying of skin

b.

Softens wound exudate

c.

Does not cause skin maceration

d.

Penetrates deeply into tissue layers

ANS: A, B, D

Advantages of moist heat include reduced drying of skin and softening of wound exudate, conforming well to the body area being treated, penetration deeply into tissue layers, and decreased sweating and insensible fluid loss. However, moist heat can cause maceration of the skin with prolonged exposure.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 977

OBJ: Correctly apply heat and cold applications. TOP: Advantages of Moist Heat

KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity

COMPLETION

1. ___________ exerts a profound physiological effect on the body, reducing inflammation caused by injury to the musculoskeletal system.

ANS:

Cold

Cold exerts a profound physiological effect on the body, reducing inflammation caused by injury to the musculoskeletal system.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 986

OBJ: Correctly apply heat and cold applications. TOP: Cold Application

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

2. The ________________ blanket raises, lowers, or maintains body temperature through conductive heat or cold transfer between the blanket and the patient.

ANS:

hypothermia-hyperthermia

The hypothermia-hyperthermia blanket raises, lowers, or maintains body temperature through conductive heat or cold transfer between the blanket and the patient.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 989

OBJ: Correctly apply heat and cold applications.

TOP: The Hypothermia-Hyperthermia Blanket

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. Besides monitoring the controls on the hypothermia blanket every 30 minutes, the nurse will need to assess the patients ____________ every 4 hours.

ANS:

rectal temperature

The patients core body temperature must be monitored by taking a rectal temperature reading every 4 hours to assess the effectiveness of the treatment and to indicate when it may be discontinued.

DIF: Cognitive Level: Application REF: Text reference: p. 991

OBJ: Correctly apply heat and cold applications.

TOP: The Hypothermia-Hyperthermia Blanket

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

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