Question 1

The nurse is assigned to care for a patient with chronic low back pain.What adjustment in pain management does the nurse expect to make?&#10;A) Encouraging the patient to hold off taking a pain drug as long as possible to reduce the potential for addiction.&#10;B) Relying on patient report of pain rather than on changes in heart rate, blood pressure, and pulse rate.&#10;C) Keeping the environment as quiet as possible to avoid distracting or irritating the patient.&#10;D) Using nondrug measures in place of analgesics to relieve the patient's pain.

Accepted Answer

Adaptation to the presence of chronic pain is physiologic,not psychological.Thus the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain.

Question 2

Which statement about pain is true?&#10;A) Each patient perceives a painful event differently.&#10;B) Patients who cannot describe their pain do not really have pain.&#10;C) It is not necessary to assess for pain in patients who are sleeping.&#10;D) Infants and young children feel pain less intensely than adults do.

Accepted Answer

How we feel and react to pain depends on our emotional makeup along with our previous experiences with pain.Issues like culture,age,gender,and our interactions with society also affect our responses to pain.As a result,no two people perceive pain in exactly the same way.

Question 3

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.What is the nurse's best advice?&#10;A) &#34;Either increase the time between drug doses or take only half the dose at each scheduled time.&#34;&#10;B) &#34;Stop taking the Percocet and switch to acetaminophen alone.&#34;&#10;C) &#34;Wrap your foot tightly and walk for at least 30 minutes daily.&#34;&#10;D) &#34;Drink at least 3 liters of fluid daily and increase fiber intake.&#34;

Accepted Answer

This patient still needs the Percocet.Most patients taking opioids for 2 days or longer have constipation.Urge the patient to drink plenty of fluids.Increasing fiber intake,either with food containing fiber or with over-the-counter fiber supplements,can help reduce constipation.Although increasing activity can help reduce constipation,walking for 30 minutes with a fractured ankle is not permitted at this time.

Question 4

Pain is considered to be the &#34;fifth vital sign.&#34; How does this principle affect nursing care?&#10;A) It ensures that pain assessment occurs on a regular basis for all patients.&#10;B) It helps nurses understand that experiencing pain can change heart rate and respiratory rate.&#10;C) It helps nurses to ensure that vital organ function is adequate before administering drugs to reduce pain.&#10;D) It encourages nurses to assess two parameters during patient contact to improve time management.

Accepted Answer

Pain is common in patients and undertreated pain remains a major yet avoidable health problem.More frequent and more accurate assessment can improve pain management.Making pain assessment the "fifth vital sign" assists nurses to both recognize the presence of pain and see how the patient responds to drugs and other interventions.These actions increase the likelihood of appropriate pain management.

Question 5

Which statement by a patient indicates the need for more teaching about pain and pain control?&#10;A) &#34;If my pain interferes with my usual activities, I will take medication for it.&#34;&#10;B) &#34;There is no reason for me to take drugs for pain; after all, you can't cure old age.&#34;&#10;C) &#34;I don't mind taking pain drugs for my sprained ankle because I know it won't hurt this way forever.&#34;&#10;D) &#34;I will take enough pain medication to make me comfortable without making me too sleepy.&#34;

Accepted Answer

One cause of underreporting pain and undertreating it is that many patients and health care providers believe that pain is a normal part of aging.Pain may occur more frequently among older adults,but is never considered "normal." Patients of any age with pain for any reason deserve to have their pain reduced to a manageable level.

Question 6

How do morphine and other opioid pain medications relieve a patient's pain?&#10;A) They reduce tissue damage and alter the physical problems causing the pain.&#10;B) They bind to opioid receptors in the central nervous system and alter the perception of pain.&#10;C) They inhibit the generation of impulses along sensory nerve tracts and alter pain transmission.&#10;D) They redirect substance P release from nociceptors and alter the amount of neurotransmitters reaching the brain.

Accepted Answer

Morphine and other opioid agonists do nothing to change the cause or transmission of pain.They bind to naturally occurring opioid receptor sites and alter a patient's perception of the painful experience.

Question 7

A patient is taking acetaminophen (Tylenol).Which precaution is most important for the nurse to teach the patient?&#10;A) &#34;Avoid alcoholic beverages while taking this drug.&#34;&#10;B) &#34;Avoid coffee and other caffeinated drinks while taking this drug.&#34;&#10;C) &#34;If any decrease in vision occurs, stop the drug and notify your prescriber immediately.&#34;&#10;D) &#34;Do not drive or operate dangerous machinery until you know how this drug affects you.&#34;

Accepted Answer

Acetaminophen can cause severe liver damage and even liver failure when taken at high doses or too often.This adverse reaction is much more likely to occur in people who drink alcoholic beverages while on acetaminophen therapy.

Question 8

The nurse prepares to give a patient the next scheduled dose of an opioid analgesic.The patient arouses easily but the respiratory rate remains at 10 breaths per minute.What is the nurse's 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.

Accepted Answer

Many people experience mild respiratory depression with opioid analgesics.If the patient is easily arousable and the oxygen saturation is at normal levels,it is not necessary to apply oxygen,call the Rapid Response Team,or prepare to administer an opioid antagonist.If the patient's oxygen saturation level is acceptable and he or she is in pain,it is alright to give the next scheduled opioid dose.Checking the patient's normal respiratory rate is also a good idea.Most people have a usual respiratory rate that is at least 12 breaths per minute,but some patients may have a usual rate of only 10 breaths per minute.Although this is not a customary response and you should document it in the nursing notes,check other indicators of breathing adequacy before notifying the prescriber.

Question 9

How do nonsteroidal anti-inflammatory drugs (NSAIDs)relieve a patient's pain?&#10;A) By promoting release of anti-inflammatory chemicals and altering the sensitivity of nerve tracts.&#10;B) By binding to opioid receptors in the central nervous system and altering the perception of pain.&#10;C) By reducing the amount of bradykinin at the site of injury and altering the stimulation of nociceptors.&#10;D) By inhibiting the generation of impulses along sensory nerve tracts and altering pain transmission.

Accepted Answer

When pain mediators are released from damaged tissue,especially substance P and bradykinin (which is also an inflammatory mediator),they bind to the nociceptors and activate them.NSAIDs reduce pain by suppressing some part of the inflammatory pathway and reducing the amounts of pain-mediating chemicals,especially bradykinin,present.With less bradykinin present,less stimulation of the nociceptors occurs.As a result,pain is reduced.

Question 10

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.

Accepted Answer

Pain is perceived in the brain,not in the area of tissue injury.When the nociceptors are stimulated by tissue damage,the impulse must be transmitted to the brain before it can be "felt" as pain.With a completely severed spinal cord,the pain impulses are not transmitted to the brain.

Question 11

The nurse checks 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 per minute.What is the nurse's 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.

Accepted Answer

The answer of The nurse checks a patient for pain...

Question 12

After surgery,a patient expresses to the nurse the fear of becoming addicted to the opioid analgesic that has been prescribed for pain.What is the nurse's best response?&#10;A) &#34;Opioid-based drugs are not addictive.&#34;&#10;B) &#34;Have you or anyone in your family ever been addicted to drugs?&#34;&#10;C) &#34;When opioid drugs are taken for acute pain, they are rarely addictive.&#34;&#10;D) &#34;If you take the medication no more frequently than every 4 hours, it is not possible for you to become addicted.&#34;

Accepted Answer

The answer of After surgery,a patient expresses to the nurse...

Question 13

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?&#10;A) Localized&#10;B) Referred&#10;C) Radiating&#10;D) Phantom

Accepted Answer

The answer of A patient with arthritis of the left...

Question 14

A patient taking warfarin (Coumadin)has mild to moderate pain after exercising.Which over-the-counter pain reliever does the nurse recommend?&#10;A) aspirin (Bufferin)&#10;B) ibuprofen (Advil)&#10;C) naproxen (Aleve)&#10;D) acetaminophen (Tylenol)

Accepted Answer

The answer of A patient taking warfarin (Coumadin)has mild to...

Question 15

What is the best way for the nurse to determine a patient's need for pain medication on the second day after an abdominal laparotomy?&#10;A) Check when the patient last received medication for pain.&#10;B) Assess the patient's facial expression and vital signs.&#10;C) Consider the patient's age and ethnicity.&#10;D) Ask the patient to rate his or her pain.

Accepted Answer

The answer of What is the best way for the...

Question 16

What is the most important question for the nurse to ask before administering the first dose of celecoxib (Celebrex)to a patient?&#10;A) &#34;Do you floss your teeth daily?&#34;&#10;B) &#34;Are you allergic to sulfa drugs?&#34;&#10;C) &#34;Do you have diabetes mellitus?&#34;&#10;D) &#34;Have you ever had glaucoma?&#34;

Accepted Answer

The answer of What is the most important question for...

Question 17

An older adult is taking an oral opioid drug at home for pain control.Which precaution to prevent injury is important for the nurse to teach this patient?&#10;A) &#34;Increase room lighting to reduce the risk for tripping.&#34;&#10;B) &#34;Sleep in a sitting position to reduce respiratory problems.&#34;&#10;C) &#34;Drink at least 3 liters of fluids daily to reduce constipation.&#34;&#10;D) &#34;Avoid drinks containing caffeine to prevent inactivating the drug.&#34;

Accepted Answer

The answer of An older adult is taking an oral...

Question 18

Which event or condition is most likely to result in chronic pain?&#10;A) Severe headache associated with a spinal tap&#10;B) Insertion of a needle for intravenous (IV) therapy&#10;C) Hip replacement surgery&#10;D) Osteoarthritis

Accepted Answer

The answer of Which event or condition is most likely...

Question 19

Which is the best clinical definition of pain?&#10;A) A state of extreme physical distress or discomfort&#10;B) A condition of sensation caused by tissue damage&#10;C) A cognitive awareness of a change in comfort&#10;D) Whatever the patient says it is

Accepted Answer

The answer of Which is the best clinical definition of...

Question 20

The nurse notes 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 does the nurse immediately notify the prescriber?

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

Accepted Answer

The answer of The nurse notes all of the following...

Question 21

A patient is prescribed a drug for insomnia.Which precaution is most important for the nurse to teach the patient?&#10;A) &#34;Avoid drinking fluids with caffeine before bedtime.&#34;&#10;B) &#34;Rinse your mouth frequently with water or saline.&#34;&#10;C) &#34;Avoid driving within 8 hours of taking this drug.&#34;&#10;D) &#34;Do not take this drug for more than 1 week.&#34;

Accepted Answer

The answer of A patient is prescribed a drug for...

Question 22

Which symptoms are expected to be seen in a patient with insomnia?&#10;A) Difficulty falling asleep&#10;B) Sleeping too much&#10;C) Waking often during the night&#10;D) Feeling unrested after sleep&#10;E) Uncontrollable urge to sleep&#10;F) Sleepwalking at least once per week&#10;G) Nightmares most of the night

Accepted Answer

The answer of Which symptoms are expected to be seen...

Question 23

A patient who has been taking flurazepam (Dalmane)for insomnia is now prescribed zolpidem (Ambien)instead.The patient asks the nurse why the prescription was changed.What is the nurse's best response?&#10;A) &#34;Zolpidem (Ambien) is a first-line drug for the treatment of insomnia.&#34;&#10;B) &#34;Flurazepam (Dalmane) is a benzodiazepine drug that can be habit-forming.&#34;&#10;C) &#34;Zolpidem (Ambien) is also used to treat any anxiety or stress that may contribute to your insomnia.&#34;&#10;D) &#34;Flurazepam (Dalmane) has both hypnotic and sedative effects that are less effective in the treatment of insomnia.&#34;

Accepted Answer

The answer of A patient who has been taking flurazepam...

Question 24

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?&#10;A) Fighting at school&#10;B) Difficulty sleeping&#10;C) Wetting the bed 3 to 4 nights per week&#10;D) Crying more frequently for no apparent reason

Accepted Answer

The answer of A child who is taking gabapentin (Neurontin)for...

Question 25

The nurse is preparing to teach a patient about oxybate (Xyrem)for the treatment of narcolepsy.Which precaution does the nurse stress?&#10;A) &#34;Avoid drinking alcohol while taking this drug.&#34;&#10;B) &#34;Be sure to take this drug with food or milk.&#34;&#10;C) &#34;Report constipation to your prescriber.&#34;&#10;D) &#34;Use mints to prevent dry mouth.&#34;

Accepted Answer

The answer of The nurse is preparing to teach a...

Question 26

A drug for narcolepsy is prescribed for a 70-year-old nursing home patient.What adjustment in drug administration does the nurse expect to make for this patient?&#10;A) Ensuring that the drug is taken with a meal to prevent nausea.&#10;B) Giving the drug earlier in the day to prevent nighttime incontinence.&#10;C) Giving a lower-than-normal dose to avoid changes in thinking patterns.&#10;D) Crushing the capsule and mixing it with gelatin to make swallowing easier.

Accepted Answer

The answer of A drug for narcolepsy is prescribed for...

Question 27

Which drug for insomnia can cause amnesia?&#10;A) amitriptyline (Elavil)&#10;B) diphenhydramine (Benadryl)&#10;C) temazepam (Restoril)&#10;D) trazodone (Desyrel)

Accepted Answer

The answer of Which drug for insomnia can cause amnesia?&#10;A)...

Question 28

Which statement about narcolepsy is true?&#10;A) Narcolepsy is an acute neurologic disorder.&#10;B) With narcolepsy, the brain cannot regulate sleep-wake cycles.&#10;C) The underlying problem in narcolepsy is increased oxygenation.&#10;D) Sleep episodes with narcolepsy usually occur during the evening hours.

Accepted Answer

The answer of Which statement about narcolepsy is true?&#10;A) Narcolepsy...

Question 29

Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs)?&#10;A) Bleeding&#10;B) Constipation&#10;C) Drowsiness&#10;D) Dry mouth&#10;E) Gastrointestinal ulcers&#10;F) Hypertension&#10;G) Memory loss (temporary)

Accepted Answer

The answer of Which side effects are commonly associated with...

Question 30

A patient is scheduled for a procedure to test mental function at 6 a.m.At 3 a.m.the patient requests something for sleep.What is the nurse's best response?&#10;A)&#34;I'll call your prescriber and request an order for something to help you sleep.&#34;&#10;B)&#34;Your prescriber has ordered temazepam (Restoril).I will give you a dose now.&#34;&#10;C)&#34;I'm sorry,but there is not enough time for sleep now before your procedure.&#34;&#10;D)&#34;I'm sorry,but you already received a dose of temazepam last evening at 9.&#34;

Accepted Answer

The answer of A patient is scheduled for a procedure...

Question 31

The nurse is teaching a young adult female about modafinil (Provigil)for narcolepsy.Which precaution does the nurse stress to the patient?&#10;A) &#34;Provigil increases your susceptibility to sexually transmitted infections.&#34;&#10;B) &#34;Loss of inhibition while taking this drug can increase sexual behavior.&#34;&#10;C) &#34;Provigil can be used during pregnancy but not while breastfeeding.&#34;&#10;D) &#34;This drug reduces the effectiveness of birth control pills.&#34;

Accepted Answer

The answer of The nurse is teaching a young adult...

Question 32

A patient taking a drug for insomnia reports becoming sunburned even when only minimally exposed to the sun.What is the nurse's best action?&#10;A) Ask the patient whether he or she usually burns when exposed to the sun.&#10;B) Instruct the patient to stop the drug and notify the prescriber immediately.&#10;C) Teach the patient to use sunscreen and wear protective clothing when outdoors.&#10;D) Document the report as the only action and reassure the patient that this problem is temporary.

Accepted Answer

The answer of A patient taking a drug for insomnia...

Question 33

A 2-year-old patient weighs 15 kg and is prescribed 50 mcg/kg of morphine (morphine sulfate)intravenously.How many micrograms of morphine does the correct dose contain?&#10;_____ mcg

Accepted Answer

The answer of A 2-year-old patient weighs 15 kg and...

Question 34

How does oxybate (Xyrem)prevent or treat narcolepsy?&#10;A) It increases sedation to ensure a good night's sleep.&#10;B) It increases general central nervous system stimulation.&#10;C) It antagonizes the sleep induction receptors of the brain.&#10;D) It causes a paradoxical reaction resulting in hyperactivity.

Accepted Answer

The answer of How does oxybate (Xyrem)prevent or treat narcolepsy?&#10;A)...

Question 35

A patient is prescribed methylphenidate (Ritalin).The patient asks the nurse how this drug will help treat narcolepsy.What is the nurse's best response?&#10;A) &#34;This drug reduces the input to your central nervous system sleep centers.&#34;&#10;B) &#34;This drug sedates you so that you can get a good night's sleep and be less drowsy during the day.&#34;&#10;C) &#34;This drug stimulates your brain to keep you awake and decrease daytime episodes of sudden sleep.&#34;&#10;D) &#34;This drug continuously stimulates the brain stem areas ensuring that you breathe more deeply at night.&#34;

Accepted Answer

The answer of A patient is prescribed methylphenidate (Ritalin).The patient...

Question 36

What is the most common sleep problem?&#10;A) Inappropriate sleeping&#10;B) Sleep deprivation&#10;C) Insomnia&#10;D) Napping

Accepted Answer

The answer of What is the most common sleep problem?&#10;A)...

Question 37

A patient with insomnia also has liver disease.What precaution does the nurse include in this patient's care plan?&#10;A) Monitor carefully for increased side effects and adverse effects.&#10;B) Teach the patient that a higher dose is needed for effective action.&#10;C) Check the patient's electrolytes before administering the drug.&#10;D) Assess the patient's mental status every four hours.

Accepted Answer

The answer of A patient with insomnia also has liver...

Question 38

A patient is taking modafinil (Provigil)for narcolepsy.Which precaution is most important for the nurse to teach the patient?&#10;A) &#34;Take this drug 1 hour before or 2 hours after a meal.&#34;&#10;B) &#34;Report episodes of sleepwalking to your prescriber.&#34;&#10;C) &#34;Check your pulse for rate and regularity twice daily.&#34;&#10;D) &#34;Avoid eating grapefruit or drinking grapefruit juice.&#34;

Accepted Answer

The answer of A patient is taking modafinil (Provigil)for narcolepsy.Which...

Question 39

What are the major symptoms of narcolepsy?&#10;A) Amnesia for events occurring after narcolepsy&#10;B) One-sided seizure activity&#10;C) Cataplexy&#10;D) Total paralysis at beginning or end of sleep&#10;E) Incontinence of urine&#10;F) Frequently waking up at night&#10;G) Colorful hallucinations&#10;H) Loss of involuntary muscle tone

Accepted Answer

The answer of What are the major symptoms of narcolepsy?&#10;A)...

Question 40

The nurse is preparing to teach a patient who has been prescribed zaleplon (Sonata)for insomnia.What does the nurse include in the teaching plan related to the action of this drug?&#10;A) &#34;This drug may take from 30 minutes to an hour to work.&#34;&#10;B) &#34;Go to bed immediately after taking a dose of this drug.&#34;&#10;C) &#34;Be sure to report any side effects to your prescriber.&#34;&#10;D) &#34;There is a danger of becoming dependent on this drug.&#34;

Accepted Answer

The answer of The nurse is preparing to teach a...

Deck 7: Drugs for Pain and Sleep Problems