Deck 29: Pharmacotherapy of Severe Pain and Migraines

Question 1

Pain perception is best defined as:
1)The conscious experience of pain that occurs in the brain.
2)The unconscious experience of pain that occurs in the brain.
3)The pain score rating from a client before drug therapy begins.
4)Based on the client's culture and previous experience with pain.

Answer 1

3

Question 2

The client is being treated for severe pain with opioid analgesics.The pain has neuropathic qualities.The nurse knows that which type of analgesics should be used to aid the client's pain management?
1)Parenteral opioids
2)Non-opioid analgesics
3)Adjuvant analgesics
4)Patient-controlled analgesics

Answer 2

3

Question 3

Somatic pain is a type of nociceptor pain that is usually experienced in:
1)Cancer or tumors.
2)The nerves.
3)Internal organs.
4)Muscles and joints.

Answer 3

4

Question 4

The client asks the nurse why he is receiving combination therapy of opioid and non-opioid drugs to manage his pain.The nurse explains that the benefit of combination therapy is:
1)To prevent the client from becoming addicted to the opioid drug.
2)To eliminate the need for follow-up laboratory monitoring.
3)Standard therapy for all pain management clients.
4)To relieve pain synergistically, and to decrease risk of side effects.

Question 5

Acute pain is defined as:
1)Pain associated with chronic illness.
2)Pain associated with an injury or surgery.
3)Pain associated with nerve injury.
4)Pain associated with malignant pain.

Question 6

The mechanism of action that differentiates the opioid agonists from the opioid agonist-antagonists is:
1)Opioid agonists activate two receptors, the opioid agonist-antagonists only occupy one receptor.
2)Opioid agonists block one receptor, the opioid agonist-antagonists block both receptors.
3)Opioid agonists activate one receptor, the opioid agonist-antagonists activate both receptors.
4)Opioid agonists block two receptors, the opioid agonist-antagonists have no effect on any receptors.

Question 7

The one major benefit of the non-opioid analgesic drugs over the opioid analgesic drugs is:
1)No risk of dizziness or hallucinations.
2)Less risk of dependency.
3)Few or no GI side effects.
4)They are more cost-effective.

Question 8

The client is being treated for pain after a surgical procedure.After the patient controlled analgesia is discontinued the client is started on an opioid-non-opioid drug combination.The nurse explains to the client that the drug is composed of hydrocodone and acetaminophen.When he is receiving the acetaminophen, the client says, "I don't have a fever, and I don't think that will be enough for my pain." Which is the best response from the nurse?
1)"You still might run a fever after surgery; this will prevent it."
2)"I am not really sure; it really can't hurt you."
3)"The two drugs work together to relieve your pain."
4)"Why are you allergic to acetaminophen?"

Question 9

To increase the awareness of pain treatment among health care professionals, the American Pain Society coined the phrase:
1)"Pain: Assess daily."
2)"Pain: Obtain relief."
3)"Pain: Optimum pain relief."
4)"Pain: The fifth vital sign."

Question 10

A client is experiencing neuropathy of the lower extremities, and has been receiving an opioid analgesic for pain.The client continues to experience pain, and the provider has added a tricyclic antidepressant medication (TCA)for pain management.The client asks the nurse, "Why am I getting this new drug? I am not depressed, my feet just burn." What is the best response from the nurse?
1)"Sometimes people get depressed with chronic pain."
2)"Maybe this is a mistake, if you are not depressed."
3)"It is to help you sleep at night instead of using the opioid."
4)"These drugs also help with the nerve pain you are having in your feet."

Question 11

Nociceptor pain responds well to which type of drug therapy?
1)Analgesic drugs
2)Non-analgesic drugs
3)Anti-depressant medications
4)Serotonin receptor blockers

Question 12

When clients are aware that health care providers are actively engaged in pain management, the clients experience:
1)Less acute pain.
2)A decrease in chronic pain.
3)Less anxiety.
4)No change in pain levels.

Question 13

The client is experiencing pain after orthopedic surgery, and is being treated with opioid analgesic medication.The client complains to the nurse that the surgical joint is still uncomfortable, despite around-the-clock medication.The best response from the nurse is:
1)"Let us try a cold pack on the area to help control the pain."
2)"I will call your provider to increase your dose of medication."
3)"You just had your medication; you will have to deal with it."
4)"I wonder if you are starting to get addicted to your medication."

Question 14

Clients and health care providers' beliefs can often interfere with successful pain management.A commonly held myth is:
1)Clients cannot sleep when experiencing pain.
2)Clients will not become addicted to their medication.
3)Clients must look and act like they are in pain.
4)Vital signs are unreliable indicators of pain.

Question 15

When administrating opioid drugs, an opioid antagonist should be readily available in case of which of the following?
1)The client experiences hyperventilation.
2)The client experiences hypoventilation.
3)The client has nausea and vomiting.
4)The client has hypovolemia.

Question 16

An objective method for the nurse to assess the client's pain level is to:
1)Use a pain rating scale such as the numeric rating scale.
2)Ask the client to describe the pain sensation.
3)Observe whether the client appears to be in pain or appears comfortable.
4)Assess pain only when the client complains of pain.

Question 17

The client is experiencing mild pain secondary to a minor ankle sprain.The drug class of choice for the client's pain is:
1)Opioid analgesics.
2)Non-opioid analgesics.
3)Adjuvant analgesics.
4)Patient-controlled analgesics.

Question 18

The client who is being treated for cancer tells the nurse that she is still having trouble getting to the toilet without experiencing significant pain.The nurse understands that when assessing and treating chronic pain:
1)The goal is to completely eliminate all pain in chronic pain clients.
2)The goal is to prevent the client from becoming addicted to the medication.
3)The goal is allow the client to perform activities of daily living.
4)The goal is for the nurse to assess if the treatment is successful.

Question 19

Gate control therapy proposed a mechanism to explain which of the following?
1)Pain transduction
2)Pain transmission
3)Pain perception
4)Pain modulation

Question 20

Pain transduction begins when which of the following occurs?
1)Pain travels on the nociceptor to the spinal cord.
2)Local tissue injury causes release of chemical mediators of inflammation.
3)The pain impulse reaches the brain, to respond with a variety of actions.
4)The pain impulse reaches the spinal cord to pass messages to neurons.

Question 21

The nurse is performing medication teaching for a client after surgery.The nurse is explaining that the client will go home on tramadol, a non-opioid analgesic, for pain management.The client states, "I can't take that, I am allergic to NSAIDs." How should the nurse respond?
1)"Then you will probably have to stay on a low dose of your opioid analgesic."
2)"Not all non-opioids are NSAIDs.Tramadol is not an NSAID."
3)"Are you sure? I don't see that allergy listed."
4)"Tramadol is an NSAID that doesn't cause GI bleeds, so you should be OK."

Question 22

A client arrives unconscious in the Emergency Department in respiratory depression from an unknown drug overdose.To help diagnose the overdose, the client is given small doses of naloxone.The purpose of this treatment is:
1)To help wake up the client to obtain the name of the drug.
2)To prevent vomiting while the client is unconscious.
3)To help diagnosis if the overdose was an opioid drug.
4)To reduce the psychoactive effects of the drug overdose.

Question 23

The nurse is teaching the older adult client about morphine sulfate drug therapy.Important safety teaching for this client about morphine sulfate should include which of the following?
1)Change positions slowly to avoid dizziness and fainting.
2)Not to take the drug with food or milk
3)Always have someone stand by while using the toilet.
4)Take the drug only when absolutely necessary.

Question 24

The nurse is teaching the client how to use sumatriptan to treat the client's migraine headaches.The nurse teaches the client that the most common side effects of sumatriptan therapy are:
1)Constipation and sedation.
2)Dizziness and nausea.
3)Hypotension and irritability.
4)Anxiety and agitation.

Question 25

The nurse is interviewing the client before minor surgery.The client is worried about pain management."I have a history of addiction; I have to be careful what I get for pain." What is the best response from the nurse?
1)"We can use non-opioid drugs for you; they have a very low risk of dependency."
2)"We will have to use only complementary therapies for you.I am afraid you may still have some pain."
3)"How long have you been drug-free? If it has been more than two years, we can use opioids."
4)"Maybe you should put off having surgery until you don't have the urge to abuse drugs."

Question 26

A 52-year-old client with a history of obesity, asthma, peripheral vascular disease, and migraine headaches tells the nurse she saw an advertisement in a magazine for a drug for migraine headaches."The drug was Imitrex; it looked very effective, and I wonder why my provider hasn't talked to me about using it for my headaches." What is the nurse's best response?
1)"I think it will be good for you, bring in the ad."
2)"You have asthma, so you cannot use the drug."
3)"Your peripheral vascular disease is a contraindication for the drug."
4)"Once you lose some weight, the drug will be perfect for you."

Question 27

The nurse is teaching a client who is being discharged from the hospital.The client will be going home on morphine sulfate therapy.The client tells the nurse that at home, the client was using Saint John's wort as a natural treatment for depression, and asks the nurse if it is OK to continue taking this herb.The best response from the nurse is:
1)"Why are you using an herb? You could treat you depression better with conventional medication."
2)"Saint John's wort can decrease the analgesic effect of morphine sulfate; you might want to wait until you no longer need the pain management."
3)"If it is a natural substance, it should be OK, and you should not have to worry about any drug interactions."
4)"As long as you don't take them at the same time, you should be OK; just space taking them about two hours apart."

Question 28

The nurse is teaching a group of student nurses the role of naloxone in treating opioid toxicity.The nurse explains the mechanism of action is to:
1)Bind with the opioid to prevent the action of the opioid.
2)Compete with the opioid at the receptor sites.
3)Block the pain transmission sites.
4)Block the pain perception of the client.

Question 29

The nurse should question the order of which client for whom tramadol was ordered?
1)A 59-year-old male with COPD
2)A 60-year-old female with hypertension
3)A 65-year-old male with prostate cancer
4)An 18-year-old female with a femur fracture

Question 30

The nurse is teaching a client who is starting sumatriptan therapy for treatment of migraine headaches.The nurse instructors the client to take the drug:
1)First thing in the morning if expecting a headache.
2)About 30 minutes after the start of the headache.
3)When the client can lie down for one hour after taking the drug.
4)At the first sign of aura or headache.

Question 31

For which of the following clients should the nurse question an order for tramadol?
1)A 35-year-old female with migraine headaches
2)A 50-year-old male with a seizure disorder
3)A 60-year-old female with osteoarthritis
4)A 55-year-old male with a history of anxiety disorder

Question 32

A client is being switched from abortive therapy for her migraines to preventative therapy.The client asks the nurse what is the difference in the therapy in regard to her migraine headaches.The nurse's best response is:
1)"To prevent drug side effects, which are worse with the abortive therapy."
2)"To help you have less pain with each headache."
3)"To help prevent you from getting headaches, rather than treating them when you get them."
4)"To allow you to get pregnant while on medication."

Question 33

A 35-year-old client with a history of migraine headaches tells the nurse at her provider's office that in the past six months, she has needed to use her medication to abort her headaches on the average of 5-6 times a month, despite avoiding her migraine triggers.The nurse discusses with the client that the next step in her therapy might be to:
1)Try a different drug to abort the headaches.
2)Try a drug to prevent the headaches.
3)Review her migraine triggers and look for new ones.
4)Take a drug holiday to clear out her system.