Deck 25: Pharmacotherapy of Severe Pain and Migraines

Question 1

The client is experiencing mild pain secondary to a minor ankle sprain.Which is the drug class of choice for the client's pain?

A)Nonopioid analgesics
B)Opioid analgesics
C)Adjuvant analgesics
D)Patient-controlled analgesics

Answer 1

Nonopioid analgesics

Question 2

What is the mechanism of action that differentiates opioid agonists from opioid agonist-antagonists?

A)Opioid agonists block two receptors; opioid agonist-antagonists have no effect on any receptors.
B)Opioid agonists activate two receptors; opioid agonist-antagonists occupy only one receptor.
C)Opioid agonists activate one receptor; opioid agonist-antagonists activate both receptors.
D)Opioid agonists block one receptor; opioid agonist-antagonists block both receptors.

Answer 2

Opioid agonists activate two receptors; opioid agonist-antagonists occupy only one receptor.

Question 3

The client is experiencing pain after orthopedic surgery,and is prescribed opioid analgesic medication.The client complains to the nurse that the surgical joint is still uncomfortable,despite around-the-clock medication.What is the nurse's best response?

A)You just had your medication; you will have to tolerate the pain for a little while."
B)Let's try a cold pack on the area to help control the pain."
C)I will call your provider to increase your dose of medication."
D)I wonder if you are starting to get addicted to your medication."

Answer 3

Let's try a cold pack on the area to help control the pain."

Question 4

To increase the awareness of pain treatment among health care professionals,the American Pain Society coined which phrase?

A)Pain: Assess daily"
B)Pain: Optimum pain relief"
C)Pain: The fifth vital sign"
D)Pain: Obtain relief"

Question 5

Gate control therapy proposes a mechanism to explain which phenomenon?

A)Pain modulation
B)Pain transmission
C)Pain perception
D)Pain transduction

Question 6

When clients are aware that health care providers are actively engaged in pain management,research shows that the clients often respond in which manner?

A)They report a decrease in chronic pain.
B)They experience less anxiety.
C)There is no change in pain levels.
D)They report less acute pain.

Question 7

The client asks the nurse why he is receiving combination therapy of opioid and nonopioid drugs to manage his pain.The nurse should explain which benefit of combination therapy?

A)Combination therapy prevents addiction to the opioid drug.
B)Using combination therapy helps to relieve pain synergistically and decreases the risk of side effects.
C)Combination therapy eliminates the need for follow-up laboratory monitoring.
D)Combination therapy is standard therapy for all pain management clients.

Question 8

How is pain perception best defined?

A)Pain perception is based on the client's culture and previous experience with pain.
B)Pain perception is the conscious experience of pain that occurs in the brain.
C)Pain perception is the unconscious experience of pain that occurs in the brain.
D)Pain perception is the pain score rating for a client before drug therapy begins.

Question 9

What is one of the benefits of the use of nonpharmacologic interventions in pain management?

A)Nonpharmacologic interventions allow for pain medication to be given on an as-needed basis only.
B)Nonpharmacologic interventions provide adequate pain relief without the use of medication.
C)Nonpharmacologic interventions do not require additional training of the health care team.
D)Nonpharmacologic interventions allow for lower doses and fewer drug-related adverse effects of pain medications.

Question 10

Pain transduction begins when which event occurs?

A)Pain travels on the nociceptor to the spinal cord.
B)The pain impulse reaches the spinal cord to pass messages to neurons.
C)Local tissue injury causes release of chemical mediators of inflammation.
D)The pain impulse reaches the brain,to respond with a variety of actions.

Question 11

How is acute pain defined?

A)Pain associated with chronic illness
B)Pain associated with an injury or surgery
C)Pain associated with malignant pain
D)Pain associated with nerve injury

Question 12

A 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 plans care for this client based on which goal?

A)Eliminating all pain in clients with chronic pain
B)Allowing the client to perform activities of daily living
C)Preventing the client from becoming addicted to the medication
D)Allowing the nurse to assess if the treatment is successful

Question 13

The client is being treated for severe pain with opioid analgesics.The pain has neuropathic qualities.The nurse chooses a prn order for which type of analgesic to aid the client's pain management?

A)Adjuvant analgesics
B)Nonopioid analgesics
C)Parenteral opioids
D)Patient-controlled analgesics

Question 14

Which objective method should the nurse use to assess the client's pain level?

A)Ask the client to describe the pain sensation.
B)Assess pain only when the client complains of pain.
C)Observe whether the client appears to be in pain or appears comfortable.
D)Use a pain rating scale such as the numeric rating scale.

Question 15

Nociceptor pain responds well to which type of drug therapy?

A)Analgesic drugs
B)Serotonin receptor blockers
C)Antidepressant medications
D)Nonanalgesic drugs

Question 16

A client is prescribed an opioid-nonopioid drug combination.The nurse explains that the drug is composed of hydrocodone and acetaminophen.The client says,Why am I getting this? 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?

A)I am not really sure; it really can't hurt you."
B)You still might run a fever; this will prevent it."
C)Why,are you allergic to acetaminophen?"
D)The two drugs work together to relieve your pain."

Question 17

A client who has neuropathy of the lower extremities is prescribed an opioid analgesic for pain.The provider adds 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?

A)This drug will also help with the nerve pain you are having in your feet."
B)It is to help you sleep at night instead of using the opioid."
C)Sometimes people get depressed with chronic pain."
D)Maybe this is a mistake,if you are not depressed."

Question 18

When administering opioid drugs,the nurse should have an opioid antagonist readily available in case the client experiences which effects?

A)Nausea and vomiting
B)Hyperventilation
C)Hypoventilation
D)Hypovolemia

Question 19

Clients and health care providers often have beliefs about pain that can interfere with successful pain management.What is a common myth related to pain?

A)Clients in pain do not necessarily look and act as if they are in pain.
B)Clients can sleep even when experiencing pain.
C)Vital signs are reliable indicators of pain.
D)Clients rarely become addicted to pain medication.

Question 20

Somatic pain is a type of nociceptor pain that is usually experienced in which area?

A)Internal organs
B)Cancer or tumors
C)Muscles and joints
D)The nerves

Question 21

The nurse is teaching a client who is prescribed sumatriptan therapy for treatment of migraine headaches.The nurse instructs the client to take the drug at which time?

A)At the first sign of aura or headache
B)First thing in the morning if expecting a headache
C)When the client can lie down for one hour after taking the drug
D)About 30 minutes after the start of the headache

Question 22

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?

A)Maybe you should put off having surgery until you don't have the urge to abuse drugs."
B)We will have to use only complementary therapies for you.I am afraid you may still have some pain."
C)We can use nonopioid drugs,which have a very low risk of dependency."
D)How long have you been drug-free? If it has been more than two years,we can use opioids."

Question 23

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 St.John's wort as a natural treatment for depression,and asks if it is all right to continue taking this herb.What is the nurse's best response?

A)If it is a natural substance,it should be OK,and you should not have to worry about any drug interactions."
B)Why are you using an herb? You could treat your depression better with conventional medication."
C)St.John's wort can decrease the analgesic effect of morphine sulfate.You might want to wait until you no longer need pain management."
D)As long as you don't take them at the same time,you should be OK.Just space them about two hours apart."

Question 24

The nurse should an order for tramadol (Ultram)for which client?

A)An 18-year-old female with a femur fracture
B)A 65-year-old male with prostate cancer
C)A 59-year-old male with COPD
D)A 60-year-old female with hypertension

Question 25

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 (Narcan).What is the purpose of this action?

A)To help wake up the client to obtain the name of the drug
B)To help diagnosis if the overdose was an opioid drug
C)To prevent vomiting while the client is unconscious
D)To reduce the psychoactive effects of the drug overdose

Question 26

For which client should the nurse an order for tramadol?

A)A 35-year-old female with migraine headaches
B)A 60-year-old female with osteoarthritis
C)A 55-year-old male with a history of anxiety disorder
D)A 50-year-old male with a seizure disorder

Question 27

The nurse is performing medication teaching for a client after surgery.The nurse explains that the client will go home on tramadol,a nonopioid analgesic,for pain management.The client states,I can't take that,I'm allergic to NSAIDs." How should the nurse respond?

A)Tramadol is an NSAID that doesn't cause GI bleeds,so you should be OK."
B)Are you sure? I don't see that allergy listed."
C)Not all nonopioids are NSAIDs.Tramadol is not an NSAID."
D)Then you will probably have to stay on a low dose of your opioid analgesic."

Question 28

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 clients in pain?
Select all that apply.

A)Treat all clients alike.
B)Listen carefully as the client's comments about pain are translated.
C)Show respect for the client's preferences even if they are very different from the nurse's.
D)Ask questions about the client's beliefs and customs regarding pain management.
E)Watch how other nurses provide care to their clients.

Question 29

A client is being switched from abortive therapy for migraines to preventive therapy.The client asks the nurse to explain the difference between the two types of therapy.What is the nurse's best response?

A)Preventive therapy will allow you to get pregnant while on medication."
B)Preventive therapy will help you have less pain with each headache."
C)Preventive therapy will help prevent headaches,rather than treating them when you get them."
D)Preventive therapy will prevent drug side effects,which are worse with abortive therapy."

Question 30

The nurse is teaching an older adult client about morphine sulfate drug therapy.Important safety teaching for this client should include which instruction?

A)Do not take the drug with food or milk.
B)Take the drug only when absolutely necessary.
C)Always have someone stand by while using the toilet.
D)Change positions slowly to avoid dizziness and fainting.

Question 31

An adult client with a history of migraine headaches tells the nurse that in the past six months,she has needed to use her medication to abort headaches on the average of 5 to 6 times a month,despite avoiding her migraine triggers.The nurse explains that the next step in her therapy might be to take which action?

A)Review her migraine triggers and look for new ones.
B)Try a different drug to abort the headaches.
C)Try a drug to prevent the headaches.
D)Take a drug holiday to clear out her system.

Question 32

The nurse plans care for the client receiving nonopioid analgesic drugs based on which benefit these drugs have over opioids?

A)Lower risk of dependency
B)Few or no GI side effects
C)Cost-effectiveness
D)No risk of dizziness or hallucinations

Question 33

The client is prescribed morphine sulfate (MS Contin)for chronic back pain resulting from inoperable disk degeneration.What nursing actions are indicated?
Select all that apply.

A)Use the prn order of docusate (Dulcolax)routinely every night.
B)Ask the dietary department to add bran cereal to the client's breakfast trays.
C)Ask the health care provider to write an order for an indwelling urinary catheter.
D)Review the trending of the client's hemoglobin and hematocrit levels.
E)Check the medical record for a prn order for an antiemetic.

Question 34

The nurse monitoring a client receiving morphine therapy would be watchful for which common adverse side effects?

A)Hypertension,diarrhea,and sedation
B)Hypertension,respiratory depression,and constipation
C)Hypotension,diarrhea,and insomnia
D)Hypotension,respiratory depression,and constipation

Question 35

An adult 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 to this about sumatriptan (Imitrex)?

A)Your peripheral vascular disease is a contraindication for the drug."
B)You have asthma,so you cannot use the drug."
C)I think it will be good for you.Bring in the ad."
D)Once you lose some weight,the drug will be perfect for you."

Question 36

The nurse is teaching a group of student nurses the role of naloxone in treating opioid toxicity.How should the nurse explain the mechanism of action?

A)Naloxone blocks the pain transmission sites.
B)Naloxone competes with the opioid at the receptor sites.
C)Naloxone binds with the opioid to prevent the action of the opioid.
D)Naloxone blocks the pain perception of the client.

Question 37

The home hospice nurse is completing the initial assessment of a client who is has terminal congestive heart failure.The client frequently has pain with breathing.Which questions should the nurse ask?
Select all that apply.

A)How much pain are you willing to tolerate?"
B)What do you like to do throughout the day?"
C)Have you ever been addicted to a pain medication?"
D)Are there any pain medications you would like to avoid?"
E)What things besides drugs help with your pain?"

Question 38

The client rings the nurse call button and requests pain medication.Upon assessment,the nurse finds the client sitting up in a chair,watching television with a friend.Vital signs are normal and the client's skin is warm and dry.Which nursing actions are appropriate?
Select all that apply.

A)Ask the client to rate his pain on the pain scale.
B)Tell the client that he does not look as if he is in pain.
C)Have the client go back to bed and ask the visitor to leave.
D)Check to see when the client last received pain medication.
E)Have another nurse assess the client.

Question 39

The nurse is teaching the client how to use sumatriptan (Imitrex)to treat migraine headaches.Which common side effects should the nurse include in this teaching?

A)Dizziness and nausea
B)Hypotension and irritability
C)Constipation and sedation
D)Anxiety and agitation

Question 40

The client has advanced cancer and is experiencing malignant pain.How should the nurse plan to manage this pain?
Select all that apply.

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

Question 41

The client 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 client 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?
Select all that apply.

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

Question 42

The nurse and the client have established this goal: The client will verbalize safety considerations for use of tramadol (Ultram)before being dismissed from the hospital." Which client statements would support evaluation that this goal has been achieved?
Select all that apply.

A)I will not drive until I know how I am going to react to the tramadol."
B)I will limit my alcohol intake to a couple of glasses of wine with dinner."
C)I will avoid taking my regular dose of kava while I am on this drug."
D)I will not eat aged cheese while taking tramadol."
E)I will work with my health care provider to taper off the dose of this medication when it is no longer needed."

Question 43

The nurse receives a medication order for fentanyl patches (Duragesic)for a new home health client.What should the nurse check before ordering these patches from the pharmacy?
Select all that apply.

A)Is the client allergic to amitriptyline (Elavil)?
B)Was the client's morphine discontinued?
C)Has the client ever taken opioids?
D)Can the client manage changing the patch every morning?
E)Has the client had adverse reactions to morphine?

Question 44

A client has been treated for a migraine headache,given a prescription for sumatriptan (Imitrex),and is being dismissed from the clinic.Which client statements would the nurse evaluate as meeting the goal that,prior to dismissal,the client will verbalize symptoms that indicate the need to contact the health care professional?
Select all that apply.

A)I should report any tightness in my chest."
B)I should expect some dizziness and blurred vision until I get acclimated to this drug,so that should not be reported."
C)If I get a headache after drinking alcoholic beverages,I should notify my health care provider."
D)If I get a really bad headache,I should report it."
E)If I notice a rash when I have a headache,I should report it."

Question 45

A client who is allergic to morphine has been receiving meperidine (Demerol)75-100 mg IM every 6 hours for the last 3 days.Five hours after the last dose,the client calls the nursing desk and says,I need some pain medication.I am hurting so badly that I am shaking." What should the nurse do?
Select all that apply.

A)Administer the 100 mg dose.
B)Administer the 75 mg dose.
C)Administer 50 mg of meperidine.
D)Collaborate with the client's health care provider regarding the medication and schedule.
E)Ask the client when the shaking first began.

Question 46

A client with a history of migraine headache has decided to augment drug therapy with lifestyle changes to prevent migraine attacks.Which information should the nurse include in teaching for this client?
Select all that apply.

A)You should consider wearing sunglasses when in bright light."
B)In some people,pickles will trigger migraines."
C)Some people find it is helpful to drink hot coffee,tea,or chocolate when they first experience a migraine aura."
D)Try drinking a glass of wine before bed each evening."
E)Try to modify the way you deal with the stress in your life."

Question 47

The client has been prescribed duloxetine (Cymbalta)for the treatment of diabetic neuropathic pain.What information should the nurse provide to this client?
Select all that apply.

A)The prescription is for a small number of capsules because the medication will be discontinued if it doesn't work in a week."
B)This is a corticosteroid,so you may notice an increased thirst."
C)Your dose is lower than your wife's because her prescription is for a different reason."
D)You may feel relief in as few as 5 days."
E)This drug is a narcotic,so be certain to keep it in a safe place."