Deck 18: Drugs for the Control of Pain

Question 1

The patient has intractable pain,and the physician has proposed a nerve block.The nurse plans to teach the patient about nerve blocks.Which statement would be included in the best plan of the nurse?
1)A nerve block depresses the activity of the sympathetic nervous system.
2)A nerve block enhances the effect of most of the endogenous opioids.
3)A nerve block modifies sensory information being sent to the spinal cord.
4)A nerve block stops pain transmission along the nerve to stop the pain.

Answer 1

4

Question 2

Which of the following is an adverse effect associated with morphine,and would be the priority if present?
1)Restlessness
2)Constipation
3)Respiratory depression
4)Psychological dependence

Answer 2

3

Question 3

The patient receives morphine for pain.He asks the nurse how it works to relieve pain.What is the best response by the nurse?
1)"It inhibits the primary pain neurotransmitters in your brain."
2)"It stimulates the receptors that secrete endorphins in your brain."
3)"It stimulates a receptor in your brain that induces pleasure."
4)"It promotes the primary pleasure neurotransmitters in your brain."

Answer 3

3

Question 4

Identify the correct statement regarding opioid receptors.
1)The sigma and kappa receptors are of greatest concern from a pharmacologic standpoint.
2)Drugs that block opioid receptors inhibit the pain impulse.
3)Opioid agonists will activate mu and kappa receptors,producing analgesia.
4)Opioids exert their actions by interacting with a total of four receptors.

Question 5

What is a priority assessment to ask a postsurgical patient prior to administration of an opioid analgesic?
1)"Have you ever been addicted to prescription pain medications?"
2)"Why do you want to receive this pain medication?"
3)"Would you like me to help you change your position for comfort?"
4)"Would you please rate your pain on a scale of 1-to-10?"

Question 6

Identify the correct statement regarding the neural mechanism of pain
1)Once the pain impulse reaches the spinal cord,neurotransmitters inhibit the signal.
2)Alpha fibers are wrapped in myelin;C fibers are not.
3)When tissues are damaged,pain impulses go directly to the brain via alpha and beta fibers.
4)Myelin is a substance that slows nerve transmission.

Question 7

A patient on a morphine patient-controlled analgesic (PCA)IV pump has a respiratory rate of 8,and is difficult to arouse.Which of the following would be the priority intervention?
1)Administering activated charcoal
2)Lowering the dose of morphine
3)Administering a medication that blocks mu and kappa receptors
4)Intubation and mechanical ventilation

Question 8

The nurse teaches patients about nonpharmacological techniques for pain management.The nurse determines learning has occurred when the patients make which statement(s)? Credit will be given only if all correct choices and no incorrect choices are selected.
1)"Nonpharmacological techniques are a good adjunct to pharmacotherapy."
2)"Nonpharmacological techniques have not reached mainstream yet."
3)"Nonpharmacological techniques may be used in place of drugs."
4)"Nonpharmacological techniques include an aerobic exercise."
5)"Nonpharmacological techniques are not usually valued by nurses."

Question 9

A dull,aching pain is defined as
1)nerve pain.
2)somatic.
3)neuropathic.
4)visceral.

Question 10

What is an important instruction for the nurse to give to the patient who is taking acetaminophen (Tylenol)?
1)"Check your gums for bleeding when taking acetaminophen (Tylenol)."
2)"Do not take any narcotics with acetaminophen (Tylenol)."
3)"Do not drink alcohol with acetaminophen (Tylenol)."
4)"Do not take acetaminophen (Tylenol)on an empty stomach."

Question 11

The patient,addicted to heroin,is being treated for opioid dependence.He has been prescribed methadone (Dolophine).The patient asks how this will help because methadone (Dolophine)is another opioid.What is the best response by the nurse?
1)"Methadone (Dolophine)will make you really sick if you use heroin."
2)"Methadone (Dolophine)does not cause euphoria like heroin does."
3)"Methadone (Dolophine)cures your addiction to heroin."
4)"Methadone (Dolophine)causes you to have an allergy to heroin."

Question 12

The patient comes to the emergency department with a head injury,broken ribs,and internal bleeding.Opioid analgesics are contraindicated.What does the nurse recognize as the primary rationale for this?
1)The use of opioid analgesics will depress the patient's blood pressure.
2)The patient may not be able to communicate his level of pain.
3)Opioids will not effectively relieve pain in the patient's periphery.
4)Opioids can mask changes in the patient's level of consciousness.

Question 13

The postsurgical patient has an order for morphine 2 mg IV push every 2 hours and propoxyphene 100 (Darvon 100)every 3 hours.He received the morphine 2 hours ago,and is complaining of pain again.What will the best plan of the nurse include?
1)Plan to administer the morphine again.
2)Plan to administer the propoxyphene 100 (Darvon 100).
3)Plan to have the patient do some distraction techniques.
4)Plan to assess the patient's level of pain.

Question 14

The nurse provides care for several patients.For which patient would the nurse assess acetaminophen (Tylenol)to be contraindicated?
1)A 2-year-old with a high fever due to the flu
2)A 65-year-old with osteoarthritis
3)A 19-year-old with a bladder infection
4)A 55-year old who socially drinks alcohol

Question 15

Which of the following treatments has the highest potential to provide total pain relief?
1)Chiropractic manipulation
2)Neuronal injection of alcohol
3)Acupuncture
4)Transcutaneous electrical nerve stimulation (TENS)

Question 16

The patient has a patient-controlled analgesia (PCA)pump following surgery.The nurse keeps naloxone (Narcan)in the patient's room as per protocol.What does the nurse recognize as the rationale for this protocol?
1)Naloxone (Narcan)enhances the effect of the opioid in the patient-controlled analgesia (PCA)pump and increases analgesia.
2)Naloxone (Narcan)is the antidote if an anaphylactic reaction to the opioid in the patient-controlled analgesia (PCA)pump occurs.
3)Naloxone (Narcan)is available to treat any systemic side effects,like constipation,of the opioid in the patient-controlled analgesia (PCA)pump.
4)Naloxone (Narcan)will reverse the effects of the narcotic in the patient-controlled analgesia (PCA)pump if an overdose occurs.

Question 17

The patient receives morphine for pain.Which comment by the patient does the nurse assess to be a side effect of morphine?
1)"My ears are constantly ringing."
2)"My heart feels like it is skipping beats."
3)"I feel like I am going to throw up."
4)"I feel cold shivers all over."

Question 18

The patient receives aspirin.The nurse assesses an adverse effect to this drug when the patient makes which response?
1)"My stools have been gray in color."
2)"There is a constant ringing in my ears."
3)"Bright lights give me a headache."
4)"I have to get up a lot at night to urinate."

Question 19

The nursing instructor teaches the nursing students about neural mechanisms of pain.What does the nursing instructor teach about substance P?
1)Substance P modifies sensory information in the spinal cord.
2)Substance P is also known as an endogenous opioid.
3)Substance P stimulates pain receptors in the spinal cord.
4)Substance P controls which pain signals reach the brain.

Question 20

The patient is to start on sumatriptan (Imitrex)for migraine headaches.What will the best plan of the nurse include as it relates to this medication? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Plan to teach the patient not to drive until the effects of the medication are known.
2)Plan to teach the patient to avoid pseudoephedrine (Sudafed)with this medication.
3)Plan to teach the patient the importance of taking the medication with protein.
4)Plan to instruct the patient to take the medication with food to avoid ulcers.
5)Plan to teach the patient to increase fluid intake with this medication.

Question 21

Which patient would be at greatest risk for developing opioid dependence?
1)24-year-old with sickle-cell anemia
2)33-year-old with diabetes
3)17-year-old with a broken arm
4)75-year-old with congestive heart failure

Question 22

Which statement is accurate concerning the use of aspirin (ASA)to treat pain?
1)High doses are necessary (1 gram)to achieve anticoagulant effects.
2)Enteric-coated capsules are available to reduce GI side effects.
3)Increase consumption of herbs such as garlic and ginger to potentiate the anti-inflammatory effects.
4)In low doses (325 mg),it significantly reduces inflammation.

Question 23

The patient has been keeping a "headache diary" of her migraines.Upon review of this diary,the nurse notes that the headaches are described as mild and have happened four times in the last 3 months.The patient reports that she "generally just lies down until they pass" but that her new job will not allow that time.She is requesting information about pain medication.What medications would the nurse expect to be prescribed? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Ibuprofen
2)Acetaminophen and caffeine
3)Sumatriptan (Imitrex)
4)Ergotamine (Ergostat)
5)Amitriptyline (Elavil)

Question 24

The patient rings the nurse call button and requests pain medication.Upon assessment,the nurse finds the patient sitting up in a chair,watching television with a friend.Vital signs are normal and the patient's skin is warm and dry.Which nursing actions are appropriate? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Ask the patient to rate his pain on the pain scale.
2)Tell the patient that he does not look as if he is in pain.
3)Have the patient go back to bed and ask the visitor to leave.
4)Check to see when the patient last received pain medication.
5)Have another nurse assess the patient.

Question 25

Which statement is accurate concerning the management of migraine headaches?
1)Acute treatment and prevention are achieved via the same medications.
2)There are no pharmacologic agents available to prevent migraine headaches.
3)Chronic headache pain is managed via daily NSAID use.
4)Vasoconstriction of cranial arteries helps reduce acute headache pain.

Question 26

The patient has advanced cancer and is experiencing malignant pain.How should the nurse plan to manage this pain? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Use the intravenous route for pain medication administration.
2)Set up a dosing schedule that provides for around-the-clock doses.
3)Encourage the patient to wait 10 minutes after pain medication is required to ask for a dose.
4)Augment the patient's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain.
5)Counsel the patient that it is not possible to eliminate all the pain of cancer and that some must be tolerated.

Question 27

The nurse has just taken a job in a hospital that cares for an ethnically diverse population and is concerned about being culturally sensitive.How should the nurse plan to manage caring for patients in pain? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Treat all patients alike.
2)Listen carefully as the patient's comments about pain are translated.
3)Show respect for the patient's preferences even if they are very different from the nurse's.
4)Ask questions about the patient's beliefs and customs regarding pain management.
5)Watch how other nurses provide care to their patients.

Question 28

The home hospice nurse is completing the initial assessment of a patient who is has terminal congestive heart failure.The patient frequently has pain with breathing.What s should the nurse ask? Credit will be given only if all correct choices and no incorrect choices are selected.
1)"How much pain are you willing to tolerate?"
2)"What do you like to do throughout the day?"
3)"Have you ever been addicted to a pain medication?"
4)"Are there any pain medications you would like to avoid?"
5)"What things besides drugs help with your pain?"

Question 29

For which of the following patients suffering a migraine headache would sumatriptan (Imitrex)be indicated?
1)73-year-old with angina pectoris
2)36-year-old female with preeclampsia
3)45-year-old diabetic male
4)27-year-old asthmatic male

Question 30

The patient has been started on morphine sulfate (MS Contin)for chronic back pain resulting from inoperable disk degeneration.What nursing actions are indicated? Credit will be given only if all correct choices and no incorrect choices are selected.
1)Use the prn order of docusate (Dulcolax)routinely every night.
2)Ask the dietary department to add bran cereal to the patient's breakfast trays.
3)Ask the health care provider to write an order for an indwelling urinary catheter.
4)Review the trending of the patient's hemoglobin and hematocrit levels.
5)Check the medical record for a prn order for an antiemetic.