Deck 7: Drugs for Pain Control

Question 1

How do morphine and other opioid pain medications relieve a patient's pain?

A) They reduce tissue damage and alter the physical problems causing the pain.
B) They bind to opioid receptors in the central nervous system and alter the perception of pain.
C) They inhibit the generation of impulses along sensory nerve tracts and alter pain transmission.
D) They redirect substance P release from nociceptors and alter the amount of neurotransmitters reaching the brain.

Answer 1

They bind to opioid receptors in the central nervous system and alter the perception of pain.

Question 2

Which term best describes what occurs when long-term opioid is suddenly stopped?

A) Addiction
B) Tolerance
C) Withdrawal
D) Dependence

Answer 2

Withdrawal

Question 3

How long must pain be present to be considered "chronic pain?"

A) 6 days
B) 6 weeks
C) 6 months
D) 6 years

Answer 3

6 months

Question 4

What word describes pain that comes and goes?

A) Localized
B) Intermittent
C) Chronic
D) Referred

Question 5

Which statement by a patient indicates the need for more teaching about pain and pain control?

A) "If my pain interferes with my usual activities,I will take medication for it."
B) "There is no reason for me to take drugs for pain;after all,you can't cure old age."
C) "I don't mind taking pain drugs for my sprained ankle because I know it won't hurt this way forever."
D) "I will take enough pain medication to make me comfortable without making me too sleepy."

Question 6

Which statement about pain is true?

A) Each patient perceives a painful event differently.
B) Patients who cannot describe their pain do not really have pain.
C) It is not necessary to assess for pain in patients who are sleeping.
D) Infants and young children feel pain less intensely than adults do.

Question 7

What is another name for an opioid drug?

A) Nanogram
B) Narcoleptic
C) Nociceptor
D) Narcotic

Question 8

Pain is considered to be the "fifth vital sign." How does this principle affect patient care?

A) It ensures that pain assessment occurs on a regular basis for all patients.
B) It helps health care workers understand that experiencing pain can change heart rate and respiratory rate.
C) It helps health care workers to ensure that vital organ function is adequate before administering drugs to reduce pain.
D) It encourages health care providers to assess two parameters during patient contact to improve time management.

Question 9

What statement about cancer pain is true?

A) Cancer pain has more than one cause.
B) All patients with cancer have severe pain.
C) Cancer pain is considered chronic rather than acute.
D) Opioids are the only class of pain drugs that reduce cancer pain.

Question 10

Which event or condition is most likely to result in chronic pain?

A) Severe headache associated with a spinal tap
B) Insertion of a needle for intravenous (IV)therapy
C) Hip replacement surgery
D) Osteoarthritis

Question 11

Which is the best clinical definition of pain?

A) A state of extreme physical distress or discomfort
B) A condition of sensation caused by tissue damage
C) A cognitive awareness of a change in comfort
D) Whatever the patient says it is

Question 12

A patient with arthritis of the left knee reports pain extending from the knee half-way down the lower leg.What type of pain is this patient perceiving?

A) Localized
B) Referred
C) Radiating
D) Phantom

Question 13

Which schedule of controlled substance has the lowest potential for addiction?

A) Schedule II
B) Schedule III
C) Schedule IV
D) Schedule V

Question 14

A child who is taking gabapentin (Neurontin)for pain control has begun demonstrating all of the following behaviors.Which behavior represents a common side effect of this drug?

A) Fighting at school
B) Difficulty sleeping
C) Wetting the bed three to four nights per week
D) Crying more frequently for no apparent reason

Question 15

How do nonsteroidal anti-inflammatory drugs (NSAIDs)relieve a patient's pain?

A) By promoting release of anti-inflammatory chemicals and altering the sensitivity of nerve tracts.
B) By binding to opioid receptors in the central nervous system and altering the perception of pain.
C) By reducing the amount of bradykinin at the site of injury and altering the stimulation of nociceptors.
D) By inhibiting the generation of impulses along sensory nerve tracts and altering pain transmission.

Question 16

On a 0 to 10 pain rating scale,which of the following numbers reported by a patient represents the worst pain intensity?

A) 2
B) 4
C) 6
D) 8

Question 17

What is the most common side effect of an opioid used for 5 days?

A) Addiction
B) Hallucinations
C) Constipation
D) Excessive thirst

Question 18

In which controlled substance class or schedule does heroin belong?

A) Schedule I
B) Schedule II
C) Schedule III
D) Schedule IV
E) Schedule V

Question 19

Which problem is a psychologic response to chronic opioid use?

A) Tolerance
B) Addiction
C) Withdrawal
D) Dependence

Question 20

A patient who is paralyzed from the waist down as a result of an injury that completely severed the spinal cord has an open wound on the right heel.Why is this patient unaware of any pain caused from this wound?

A) The nociceptors in the heel are no longer stimulated when injury occurs.
B) The patient has become completely desensitized to this type of chronic pain.
C) The severed spinal cord prevents the sensation of pain from reaching the brain.
D) The spinal cord injury results in chronic pain that can mask any acute pain sensation.

Question 21

What is the most important question to ask before administering the first dose of celecoxib (Celebrex)to a patient?

A) "Do you floss your teeth daily?"
B) "Are you allergic to sulfa drugs?"
C) "Do you have diabetes mellitus?"
D) "Have you ever had glaucoma?"

Question 22

You are assigned to care for a patient with chronic low back pain.What adjustment in pain management do you expect to make?

A) Encouraging the patient to hold off taking a pain drug as long as possible to reduce the potential for addiction.
B) Relying on patient report of pain rather than on changes in heart rate,blood pressure,and pulse rate.
C) Keeping the environment as quiet as possible to avoid distracting or irritating the patient.
D) Using nondrug measures in place of analgesics to relieve the patient's pain.

Question 23

You note all of the following changes in the last week in a 72-year-old nursing home patient taking nortriptyline (Pamelor)for chronic pain.For which problem do you immediately notify the prescriber?

A) Heart rate decreased from 80 to 72 beats/min.
B) Respiratory rate decreased from 20 to 16 breaths/min.
C) Weight increased from 128 to 137 lb.
D) Morning blood glucose increased from 86 to 94 mg/dL.

Question 24

A patient taking warfarin (Coumadin)has mild to moderate pain after exercising.Which over-the-counter pain reliever should you recommend?

A) Aspirin (Bufferin)
B) Ibuprofen (Advil)
C) Naproxen (Aleve)
D) Acetaminophen (Tylenol)

Question 25

A patient is receiving morphine (MS Contin)for severe cancer pain.His wife states that he has difficulty swallowing and asks if the tablets can be crushed and given with applesauce or pudding.What is your best response?

A) "That is an excellent solution and will make it much easier for him to swallow his pain medicine."
B) "It might be best if we talk with the prescriber about having a feeding tube placed for medication administration."
C) "You can dissolve the tablets in water then give the drug to your husband mixed with juice."
D) "I will contact the prescriber about this because your husband may need to be prescribed a different form of morphine for his pain."

Question 26

A patient tells you that the usual dose of an opioid drug for cancer pain no longer relieves the pain.What is your best response?

A) "We have to be careful about increasing opioid drug dosages to prevent drug addiction."
B) "You may be developing dependence on the drug and that is why it no longer relieves your pain."
C) "Your body may be adjusting to the drug,eliminating it more rapidly,and thus you will need a higher dose to achieve pain relief."
D) "The danger of increasing your opioid drug dosage is that you may experience respiratory failure."

Question 27

A patient is taking acetaminophen (Tylenol)for mild headache pain.Which precaution is most important for you to teach the patient?

A) "Avoid alcoholic beverages while taking this drug."
B) "Avoid coffee and other caffeinated drinks while taking this drug."
C) "If any decrease in vision occurs,stop the drug and notify your prescriber immediately."
D) "Do not drive or operate dangerous machinery until you know how this drug affects you."

Question 28

Which key point should you teach a pregnant woman who is prescribed opioids drugs during pregnancy?

A) Your child may become addicted to opioids and go through withdrawal after birth.
B) These drugs do not cross the placenta so are safe to use during pregnancy.
C) Some opioids have been found to cause birth defects in animal studies.
D) Opioids are not present in breast milk so it is safe to breastfeed.

Question 29

You check a patient for pain relief 1 hour after administering 15 mg of morphine intramuscularly.The patient is sleeping and has a respiratory rate of 10 breaths/min.What is your best first action?

A) Attempt to arouse the patient by calling his or her name and lightly shaking the arm.
B) Administer oxygen by mask or nasal cannula and notify the prescriber.
C) Check the patient's oxygen saturation and raise the head of the bed.
D) Document the finding as the only action.

Question 30

After receiving the first dose of an opioid drug,a patient is sleeping and has a respiratory rate of less than 8 per minute.When called by name the patient does not respond.What is your next best action?

A) Place an ice cube on his or her forehead.
B) Firmly shake his or her leg or arm.
C) Apply pressure to his or her nail bed.
D) Squeeze his or her trapezius muscle.

Question 31

What is the best way for you to determine a patient's need for pain medication on the second day after an abdominal laparotomy?

A) Check when the patient last received medication for pain.
B) Assess the patient's facial expression and vital signs.
C) Consider the patient's age and ethnicity.
D) Ask the patient to rate his or her pain.

Question 32

You prepare to give a patient the next scheduled dose of an opioid analgesic.The patient arouses easily but the respiratory rate remains at 10 breaths/min.What is your best first action?

A) Hold the dose and notify the prescriber.
B) Hold the dose and apply oxygen by mask or nasal cannula.
C) Check the patient's oxygen saturation and ask about his or her pain level.
D) Call the Rapid Response Team and prepare to administer the prescribed opioid antagonist.

Question 33

An older adult is taking an oral opioid drug at home for pain control.Which precaution to prevent injury is important for you to teach this patient?

A) "Increase room lighting to reduce the risk for tripping."
B) "Sleep in a sitting position to reduce respiratory problems."
C) "Drink at least 3 L of fluids daily to reduce constipation."
D) "Avoid drinks containing caffeine to prevent inactivating the drug."

Question 34

For which opioid pain drug order should you contact and question the prescriber?

A) Adult male,hydromorphone (Dilaudid)4 mg orally every 4 hours
B) Older adult,meperidine (Demerol)50 mg IM every 3 hours
C) Child,codeine 0.5 mg/kg orally every 6 hours
D) Adult women,hydrocodone with acetaminophen (Vicodin)5 mg orally every 6 hours

Question 35

A patient taking oxycodone with acetaminophen (Percocet)for pain at home 3 days after fracturing an ankle reports constipation and continuing moderate to severe pain that is relieved by the prescribed drug.What is your best advice?

A) "Either increase the time between drug doses or take only half the dose at each scheduled time."
B) "Stop taking the Percocet and switch to acetaminophen alone."
C) "Wrap your foot tightly and walk for at least 30 minutes daily."
D) "Drink at least 3 L of fluid daily and increase fiber intake."

Question 36

You are administering the first dose of an opioid drug to a patient.Which specific related actions should you take before and after giving the dose?

A) Ask if the patient is allergic to sulfa drugs and monitor for a reaction after giving the drug.
B) Place the patient on bed rest before giving the drug and keep him or her on bed rest after to avoid accidental falling.
C) Check the patient's respiratory rate and oxygen saturation before and after giving the drug and monitor for respiratory depression.
D) Administer a drug such as naloxone (Narcan)both before and after giving the opioid drug to prevent respiratory depression.

Question 37

The patient who received a first dose of an opioid drug is not arousable and has an oxygen saturation of 88% (five percentage points lower than his or her normal saturation)even when fully awake.What is your best next action?

A) Wait 2 minutes and recheck respiratory rate and oxygen saturation.
B) Shake the patient firmly and keep trying to arouse him or her.
C) Notify respiratory therapy to draw an arterial blood gas.
D) Call for help and apply supplemental oxygen.

Question 38

After surgery,a patient expresses the fear of becoming addicted to the opioid analgesic that has been prescribed for pain.What is your best response?

A) "Opioid-based drugs are not addictive."
B) "Have you or anyone in your family ever been addicted to drugs?"
C) "When opioid drugs are taken for acute pain,they are rarely addictive."
D) "If you take the medication no more frequently than every 4 hours,it is not possible for you to become addicted."

Question 39

Eight weeks after surgery,a patient without pain still takes oxycodone and acetaminophen (Percocet)four to six times a day.What phenomenon do you recognize?

A) Addiction
B) Dependence
C) Withdrawal
D) Tolerance

Question 40

Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs)? (select all that apply. )

A) Bleeding
B) Constipation
C) Drowsiness
D) Dry mouth
E) Gastrointestinal ulcers
F) Hypertension

Question 41

A 64 lb child with a broken arm is prescribed to receive morphine 75 mcg/kg by intravenous push immediately.The drug available is morphine 1 mg/mL (1000 mcg/mL).What is the correct dose for this patient,in mL?

Question 42

A 2-month-old infant who weighs 11 lb is prescribed to receive acetaminophen 8 mg/kg by oral liquid.The drug on hand is acetaminophen liquid with a concentration of 80 mg/0.8 mL.How many milliliters is the correct dose for this patient?