Deck 18: Drugs for the Control of Pain

Question 1

A nurse is providing community education on the increase in heroin use. Which information would be included?

A) Heroin is an opioid drug.
B) Heroin is a narcotic drug.
C) Heroin causes CNS agitation.
D) Heroin is the same drug as morphine.
E) Heroin is not as dangerous as oxycodone.

Answer 1

Heroin is an opioid drug.
Heroin is a narcotic drug.

Question 2

The nurse provides care for several patients. For which patient would the nurse assess acetaminophen (Tylenol) to be contraindicated?

A) A 2-year-old with a high fever due to the flu
B) A 65-year-old with osteoarthritis
C) A 19-year-old with a bladder infection
D) A 55-year old who drinks alcohol

Answer 2

A 55-year old who drinks alcohol

Question 3

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?

A) The use of opioid analgesics will depress the patient's blood pressure.
B) The patient may not be able to communicate his level of pain.
C) Opioids will not effectively relieve pain in the patient's periphery.
D) Opioids can mask changes in the patient's level of consciousness.

Answer 3

Opioids can mask changes in the patient's level of consciousness.

Question 4

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?

A) Plan to administer the morphine again.
B) Plan to administer the propoxyphene 100 (Darvon 100).
C) Plan to have the patient do some distraction techniques.
D) Plan to assess the patient's level of pain.

Question 5

The nursing instructor teaches the nursing students about neural mechanisms of pain. What does the nursing instructor teach about substance P?

A) Substance P modifies sensory information in the spinal cord.
B) Substance P is also known as an endogenous opioid.
C) Substance P stimulates pain receptors in the spinal cord.
D) Substance P controls which pain signals reach the brain.

Question 6

The nurse teaches patients about nonpharmacological techniques for pain management. The nurse determines learning has occurred when the patients make which statement(s)?

A) "Nonpharmacological techniques are a good adjunct to pharmacotherapy."
B) "Nonpharmacological techniques have not reached mainstream yet."
C) "Nonpharmacological techniques may be used in place of drugs."
D) "Nonpharmacological techniques include an aerobic exercise."
E) "Nonpharmacological techniques are not usually valued by nurses."

Question 7

Which finding is an adverse effect associated with morphine and would be the priority if present?

A) The patient is very restless and cannot lie still.
B) The patient has not had a bowel movement in 3 days.
C) The patient's respiratory effort is slow and shallow.
D) The patient says, "I can't live without my morphine patches."

Question 8

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?

A) Plan to teach the patient not to drive until the effects of the medication are known.
B) Plan to teach the patient to avoid pseudoephedrine (Sudafed) with this medication.
C) Plan to teach the patient the importance of taking the medication with protein.
D) Plan to instruct the patient to take the medication with food to avoid ulcers.
E) Plan to teach the patient to increase fluid intake with this medication.

Question 9

The nurse educator is reviewing the process of pain transmission. Students should place these steps in which sequence?

A) Substance P continues pain message.
B) A and C fibers transmit the pain signal.
C) Nociceptors are stimulated.
D) Pain impulses reach the spinal cord.
E) Pain impulses reach the brain.
Standard Text: Click and drag the options below to move them up or down.

Question 10

A patient complains of dull, aching pain in the lower back. The nurse plans to provide relief from which kind of pain?

A) Acute pain
B) Somatic pain
C) Neuropathic pain
D) Visceral pain

Question 11

What is a priority assessment question to ask a postsurgical patient prior to administration of an opioid analgesic?

A) "Have you ever been addicted to prescription pain medications?"
B) "Why do you want to receive this pain medication?"
C) "Would you like me to help you change your position for comfort?"
D) "Would you please rate your pain on a scale of 1 to 10?"

Question 12

What is an important instruction for the nurse to give to the patient who is taking acetaminophen (Tylenol)?

A) "Check your gums for bleeding when taking acetaminophen (Tylenol)."
B) "Do not take any narcotics with acetaminophen (Tylenol)."
C) "You may experience diarrhea while taking acetaminophen (Tylenol)."
D) "Acetaminophen (Tylenol) can cause drowsiness."

Question 13

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?

A) Naloxone (Narcan) enhances the effect of the opioid in the patient-controlled analgesia (PCA) pump and increases analgesia.
B) Naloxone (Narcan) is the antidote if an anaphylactic reaction to the opioid in the patient-controlled analgesia (PCA) pump occurs.
C) Naloxone (Narcan) is available to treat any systemic side effects, like constipation, of the opioid in the patient-controlled analgesia (PCA) pump.
D) Naloxone (Narcan) will reverse the effects of the narcotic in the patient-controlled analgesia (PCA) pump if an overdose occurs.

Question 14

A patient brought to the emergency department for oxycodone overdose has a respiratory rate of 8 and is difficult to arouse. What is the priority nursing intervention?

A) Administering activated charcoal
B) Administering an opioid agonist
C) Administering an opioid antagonist
D) Preparing for intubation and mechanical ventilation

Question 15

The patient receives morphine for pain. Which comment by the patient does the nurse assess to be a side effect of morphine?

A) "My ears are constantly ringing."
B) "My heart feels like it is skipping beats."
C) "I feel like I am going to throw up."
D) "I feel cold shivers all over."

Question 16

Identify the correct statement regarding opioid receptors.

A) The sigma and kappa receptors are of greatest concern from a pharmacologic standpoint.
B) Drugs that block opioid receptors inhibit the pain impulse.
C) Opioid agonists will activate mu and kappa receptors, producing analgesia.
D) Opioids exert their actions by interacting with a total of three receptors.

Question 17

A 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?

A) "Methadone (Dolophine) will make you really sick if you use heroin."
B) "Methadone (Dolophine) does not cause euphoria like heroin does."
C) "Methadone (Dolophine) cures your addiction to heroin."
D) "Methadone (Dolophine) causes you to have an allergy to heroin."

Question 18

Identify the correct statement regarding the neural mechanism of pain.

A) Once the pain impulse reaches the spinal cord, neurotransmitters inhibit the signal.
B) Alpha fibers are wrapped in myelin; C fibers are not.
C) When tissues are damaged, pain impulses go directly to the brain via alpha and beta fibers.
D) Myelin is a substance that slows nerve transmission.

Question 19

The patient receives aspirin. The nurse assesses an adverse effect to this drug when the patient makes which response?

A) "My stools have been dark in color."
B) "My nose is stuffed up."
C) "Bright lights give me a headache."
D) "I have to get up a lot at night to urinate."

Question 20

The patient receives morphine for pain. He asks the nurse how it works to relieve pain. What is the best response by the nurse?

A) "It inhibits the primary pain neurotransmitters in your brain."
B) "It stimulates the receptors that secrete endorphins in your brain."
C) "It interacts with receptors in your body that produce analgesia."
D) "It promotes the primary pleasure neurotransmitters in your brain."

Question 21

During report on a newly assigned patient, the nurse learns that buccal fentanyl has been ordered. What can the nurse learn from this information?

A) The patient is already on fentanyl.
B) The patient has breakthrough pain.
C) The patient is opioid naïve.
D) The patient has migraine headaches.
E) The patient is a child under 16 years of age.

Question 22

Which statement is accurate concerning the management of migraine headaches?

A) Acute treatment and prevention are achieved via the same medications.
B) There are no pharmacologic agents available to prevent migraine headaches.
C) NSAIDs are used to prevent migraine development.
D) Vasoconstriction of cranial arteries helps reduce acute headache pain.

Question 23

The patient has been started on morphine sulfate (MS Contin) for chronic back pain resulting from inoperable disk degeneration. What nursing actions are indicated?

A) Use the prn order of MiraLax routinely every night.
B) Ask the dietary department to add bran cereal to the patient's breakfast trays.
C) Ask the health care provider to write an order for an indwelling urinary catheter.
D) Review the trending of the patient's daily weights.
E) Check the medical record for a prn order for an antiemetic.

Question 24

Which statement is accurate concerning the use of aspirin (ASA) to treat pain?

A) High doses are necessary (1 gram) to achieve anticoagulant effects.
B) Enteric-coated capsules are available to reduce GI side effects.
C) Increase consumption of herbs such as garlic and ginger to potentiate the anti-inflammatory effects.
D) In low doses (325 mg), it significantly reduces inflammation.

Question 25

Which patient would be at greatest risk for developing opioid dependence?

A) 24-year-old with sickle-cell anemia
B) 33-year-old with diabetes
C) 17-year-old with a broken arm
D) 75-year-old with congestive heart failure

Question 26

The patient has advanced cancer and is experiencing pain. How should the nurse plan to manage this pain?

A) Monitor for subtle signs of pain.
B) Set up a dosing schedule that provides for around-the-clock doses.
C) Encourage the patient to wait 10 minutes after pain medication is required to ask for a dose.
D) Augment the patient's regimen with other pharmaceutical and nonpharmaceutical pain relief measures for breakthrough pain.
E) Counsel the patient that it is not possible to eliminate all the pain of cancer and that some must be tolerated.

Question 27

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?

A) Ibuprofen
B) Acetaminophen
C) Sumatriptan (Imitrex)
D) Ergotamine (Ergostat)
E) Amitriptyline (Elavil)

Question 28

What medication teaching would the nurse provide for a patient who is newly prescribed a nasal medication for migraine headache?

A) Use the medication at the first sign of migraine.
B) Overusing this medication may result in rebound headaches.
C) Instill the spray into one nostril only.
D) Increase dietary intake of tyramine-containing foods.
E) Pain relief will not begin for up to an hour after administration.

Question 29

How should the nurse plan to manage caring for patients in pain?

A) Treat all patients alike.
B) Listen carefully to the patient's comments about pain.
C) Show respect for the patient's preferences.
D) Ask questions about the patient's beliefs and customs regarding pain management.
E) Watch how other nurses provide care to their patients.

Question 30

For which patient suffering a migraine headache would sumatriptan (Imitrex) be indicated?

A) 73-year-old with angina pectoris
B) 36-year-old female with preeclampsia
C) 45-year-old diabetic male
D) 27-year-old asthmatic male