Question 1

Chronic pain is a complex problem. Some specific strategies to deal with it include:&#10;A) Telling the patient to &#34;let pain be your guide&#34; to using treatment therapies&#10;B) Prescribing pain medication on a &#34;PRN&#34; basis to keep down the amount used&#10;C) Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment&#10;D) All of the above&#10;

Accepted Answer

Option A is not an effective strategy as it puts the burden of treatment solely on the patient, who may not have the knowledge or resources to manage their pain effectively. Option B is not ideal as it may lead to undermedication or inconsistent pain management. Option C is the best choice as it ensures that the patient's pain is regularly monitored and addressed, potentially preventing a painful flare-up.

Question 2

Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true?&#10;A) Preterm and newborn infants do not yet have functional pain pathways.&#10;B) Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child.&#10;C) Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness.&#10;D) Decreases in pain tolerance are evident in older adults.&#10;

Accepted Answer

Preterm and newborn infants do have functional pain pathways, and they can experience pain. However, their pain responses may differ from older children and adults due to their immature neurological system. It is important to manage pain in newborns and infants to prevent negative consequences on their development and long-term outcomes.

Question 3

Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the:&#10;A) Sensory aspects of pain&#10;B) Discriminative aspects of pain&#10;C) Motivational aspects of pain&#10;D) Cognitive aspects of pain&#10;

Accepted Answer

The reticular and limbic systems in the brain are responsible for the motivational aspects of pain, such as the emotional response to pain and the motivation to seek relief or avoid further pain. The sensory and discriminative aspects of pain involve other areas of the brain, such as the somatosensory cortex and thalamus. The cognitive aspects of pain involve higher brain regions, such as the prefrontal cortex.

Question 4

A treatment plan for management of chronic pain should include:&#10;A) Negotiation with the patient to set personal goals for pain management&#10;B) Discussion of ways to improve sleep and stress&#10;C) An exercise program to improve function and fitness&#10;D) All of the above&#10;

Accepted Answer

A treatment plan for management of chronic pain should include negotiation with the patient to set personal goals for pain management, discussion of ways to improve sleep and stress, and an exercise program to improve function and fitness. All of these are important components in managing chronic pain and improving overall quality of life for patients.

Question 5

The chemicals that promote the spread of pain locally include:&#10;A) Serotonin&#10;B) Norepinephrine&#10;C) Enkephalin&#10;D) Neurokinin A&#10;

Accepted Answer

Neurokinin A promotes the spread of pain locally by increasing the sensitivity of nearby nerves and enhancing inflammation. Serotonin and norepinephrine typically serve to inhibit pain signals. Enkephalin functions as an endogenous pain reliever by binding to opiate receptors in the nervous system.

Question 6

The Pain Management Contract is appropriate for:&#10;A) Patients with cancer who are taking morphine&#10;B) Patients with chronic pain who will require long-term use of opiates&#10;C) Patients who have a complex drug regimen&#10;D) Patients who see multiple providers for pain control&#10;

Accepted Answer

The Pain Management Contract is appropriate for patients with chronic pain who will require long-term use of opiates, as it helps to ensure safe and effective use of opioids over an extended period of time. Patients with cancer who are taking morphine may also require opioid therapy but may not necessarily require a Pain Management Contract. Patients who have a complex drug regimen or see multiple providers for pain control may benefit from a pain management plan, but a contract may not be necessary.

Question 7

Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a &#34;red flag&#34; about potential chemical dependency?&#10;A) Use of more than one drug to treat the pain&#10;B) Multiple times when prescriptions are lost with requests to refill&#10;C) Preferences for treatments that include alternative medicines&#10;D) Presence of a family member who has abused drugs&#10;

Accepted Answer

Multiple requests to refill prescriptions due to lost medications can be a sign of potential chemical dependency, particularly if it becomes a frequent occurrence. Using multiple drugs to treat pain or having a preference for alternative medicines are not necessarily indicative of chemical dependency. Having a family member with a history of drug abuse may increase the risk for chemical dependency, but it is not a definitive marker.

Question 8

Which of the following statements is true about acute pain?&#10;A) Somatic pain comes from body surfaces and is only sharp and well-localized.&#10;B) Visceral pain comes from the internal organs and is most responsive to acetaminophen and opiates.&#10;C) Referred pain is present in a distant site for the pain source and is based on activation of the same spinal segment as the actual pain site.&#10;D) Acute neuropathic pain is caused by lack of blood supply to the nerves in a given area.&#10;

Accepted Answer

Referred pain occurs when pain is felt in an area distant from the source of the pain, but it is perceived there because the pain shares the same spinal segment as the actual site of the pain. This phenomenon is due to the way pain signals are processed in the central nervous system.

Question 9

One of the main drug classes used to treat acute pain is NSAIDs. They are used because:&#10;A) They have less risk for liver damage than acetaminophen.&#10;B) Inflammation is a common cause of acute pain.&#10;C) They have minimal GI irritation.&#10;D) Regulation of blood flow to the kidney is not affected by these drugs.&#10;

Accepted Answer

NSAIDs are particularly effective in treating acute pain that is caused by inflammation, such as pain from swelling or injury. They work by blocking the production of certain chemicals in the body that cause pain and inflammation. NSAIDs are not necessarily safer than acetaminophen, and they can cause significant GI irritation and other side effects. Additionally, they can affect blood flow to the kidney, which is why they should be used with caution in individuals with kidney disease or other kidney problems.

Question 10

The goal of treatment of acute pain is:&#10;A) Pain at a tolerable level where the patient may return to activities of daily living&#10;B) Reduction of pain with a minimum of drug adverse effects&#10;C) Reduction or elimination of pain with minimum adverse reactions&#10;D) Adequate pain relief without constipation or nausea from the drugs&#10;

Accepted Answer

The goal of treatment of acute pain is the reduction or elimination of pain with minimum adverse reactions. While options A, B, and D are also important considerations in treating acute pain, the primary goal is to relieve the pain itself, rather than simply reduce it to a tolerable level.

Question 11

Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to:&#10;A) Determine if the diagnosis of source of pain is correct&#10;B) Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required&#10;C) Determine if the patient is willing and able to be an active participant in his or her pain management&#10;D) All of the above&#10;

Accepted Answer

The answer of Pain assessment to determine adequacy of pain...

Question 12

If interventions to resolve the cause of pain (e.g., rest, ice, compression, and elevation) are insufficient, pain medications are given based on the severity of pain. Drugs are given in which order of use?

A) NSAIDs, opiates, corticosteroids
B) Low-dose opiates, salicylates, increased dose of opiates
C) Opiates, non-opiates, increased dose of non-opiate
D) Non-opiate, increased dose of non-opiate, opiate

Accepted Answer

The answer of If interventions to resolve the cause of...

Question 13

Which of the following statements is true about age and pain?&#10;A) Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.&#10;B) Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.&#10;C) Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.&#10;D) Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.&#10;

Accepted Answer

The answer of Which of the following statements is true...

Question 14

Patients need to be questioned about all pain sites because:&#10;A) Patients tend to report the most severe or important in their perception.&#10;B) Pain tolerance generally decreases with repeated exposure.&#10;C) The reported pain site is usually the most important to treat.&#10;D) Pain may be referred from a different site to the one reported.&#10;

Accepted Answer

The answer of Patients need to be questioned about all...

Question 15

Narcotics are exogenous opiates. They act by:&#10;A) Inhibiting pain transmission in the spinal cord&#10;B) Attaching to receptors in the afferent neuron to inhibit the release of substance P&#10;C) Blocking neurotransmitters in the midbrain&#10;D) Increasing beta-lipoprotein excretion from the pituitary gland&#10;

Accepted Answer

The answer of Narcotics are exogenous opiates. They act by:&#10;A)...

Question 16

Pathological similarities and differences between acute pain and chronic pain include:&#10;A) Both have decreased levels of endorphins.&#10;B) Chronic pain has a predominance of C-neuron stimulation.&#10;C) Acute pain is most commonly associated with irritation of peripheral nerves.&#10;D) Acute pain is diffuse and hard to localize.&#10;

Accepted Answer

The answer of Pathological similarities and differences between acute pain...

Question 17

Opiates are used mainly to treat moderate to severe pain. Which of the following is NOT true about these drugs?&#10;A) All opiates are scheduled drugs which require a DEA license to prescribe.&#10;B) Opiates stimulate only mu receptors for the control of pain.&#10;C) Most of the adverse effects of opiates are related to mu receptor stimulation.&#10;D) Naloxone is an antagonist to opiates.&#10;

Accepted Answer

The answer of Opiates are used mainly to treat moderate...

Deck 52: Pain Management: Acute and Chronic Pain