INSTANT DOWNLOAD WITH ANSWERS
|Test Bank for Understanding Pharmacology Essentials For Medication Safety By M. Linda Workman – Test Bank|
Sample: Chapter 06: Anti-Inflammatory DrugsWorkman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition MULTIPLE CHOICE BASIC CONCEPTS
- Which stage of the inflammatory response involves capillary leak syndrome?
ANS: AThe first stage of the inflammatory response involves white blood cells releasing chemical substances that act on blood vessels, making the pores larger so that fluid leaks out of the blood vessels into the damaged tissue. DIF: Cognitive Level: Remembering REF: p. 84
- Which corticosteroid is applied topically to the skin?
ANS: BBetemethasone and dexamethosone are oral drugs. Methylprednisolone is a parenteral drug. Of the drugs on this list, only triamcinolone is applied as a topical drug. DIF: Cognitive Level: Remembering REF: p. 86
- Which problem is a common side effect of long-term corticosteroid use?
|c.||Redness and pain|
|d.||Low blood pressure|
ANS: ACorticosteroid use has many side effects including weight gain (not loss), retention of sodium and water leading to high blood pressure (not low blood pressure), and a lot of skin changes, including acne. Corticosteroids are used to reduce inflammation, so they eliminate redness and pain, they do not cause these side effects. DIF: Cognitive Level: Remembering REF: p. 87
- Which side effect of corticosteroid therapy is permanent even after the drug is stopped?
ANS: BAfter corticosteroid therapy is stopped, many side effects resolve although this can take months to years. The sleep disturbance, weight gain, and moon-shaped face do go away over time. The stretch marks are permanent although they usually change from reddish-purple to silver over time so that they are less noticeable. DIF: Cognitive Level: Remembering REF: p. 87
- Which anti-inflammatory drug is classified as a “COX-1” inhibitor?
ANS: DNaproxen is the only COX-1 class anti-inflammatory drug on this list. Hydrocortisone is a corticosteroid. Celecoxib is a COX-2 inhibitor, not COX-1. Zyleuton is a leukotriene inhibitor. DIF: Cognitive Level: Remembering REF: p. 90
- Which NSAID is a COX-2 inhibitor?
ANS: ACelecoxib is the only drug from the COX-2 inhibitor class on this list. Aspirin, ibuprofen, and ketorolac are all COX-1 inhibitors. DIF: Cognitive Level: Remembering REF: p. 90
- Which drug should NOT be given to children?
ANS: CAspirin is associated with a disorder known as Reye’s syndrome when given to a child who has a viral infection. It is not recommended to be given to anyone under 18 years of age. Prednisone, ibuprofen, and acetaminophen can be given to children if needed. DIF: Cognitive Level: Remembering REF: p. 93
- Which drug should be avoided during the last 3 months of pregnancy?
ANS: CAlthough a pregnant woman should avoid taking any unnecessary drugs, some have a low likelihood of increasing the risks for birth defects or fetal damage. Prednisone, montelukast, and dyphenhydramine have this designation. Indomethicin is not given during the last 3 months of pregnancy because it can cause an important opening in fetal circulation to close too early and interfere with the unborn baby’s oxygenation. DIF: Cognitive Level: Remembering REF: p. 93
- What is the most common side effect of antihistamines?
ANS: ANearly all antihistamine drugs cause some degree of drowsiness although some are worse for this than are others. Most antihistamines can cause some degree of urinary retention, not excessive urination. These drugs make breathing easier, not harder. None are associated with true weight gain. DIF: Cognitive Level: Remembering REF: p. 94
- Which drug is a leukotriene inhibitor?
ANS: CThe only drug on this list that works by inhibiting leukotriene is mentelukast. Loratidine and diphenhydramine are antihistamines. Piroxicam is a COX-1 inhibitor. DIF: Cognitive Level: Remembering REF: p. 96
- Which body-produced substance is targeted and inhibited by most disease modifying antirheumatic drugs (DMARDs)?
|a.||Tumor necrosis factor (TNF)|
|b.||White blood cells (WBCs)|
ANS: AMost DMARDs are antibodies to the substance tumor necrosis factor (TNF), which is produced by the body as part of the inflammatory response and can attack and destroy normal body tissues. DIF: Cognitive Level: Remembering REF: p. 96
- Why is inflammation considered a nonspecific body response?
|a.||Inflammation is the basis for almost every type of chronic disease.|
|b.||Infection by bacteria or viruses is always a part of inflammation.|
|c.||The same tissue responses occur regardless of the type of triggering event.|
|d.||The discomfort associated with inflammation can be reduced by over-the-counter drugs.|
ANS: CInflammation is a syndrome of normal tissue responses that always occur in the same way with any type of injury or invasion, regardless of the location on the body or what caused the response to start. DIF: Cognitive Level: Understanding REF: p. 83
- When is an inflammatory response a health problem rather than a helpful protection?
|a.||When a patient’s immune system is suppressed|
|b.||When infection accompanies inflammation|
|c.||When inflammation is prolonged|
|d.||When pain is experienced|
ANS: CInflammation starts tissue actions that cause visible and uncomfortable symptoms that are important in ridding the body of harmful organisms and helping repair damaged tissue. However, if the inflammatory response is prolonged or excessive, tissue damage may result. DIF: Cognitive Level: Understanding REF: p. 85
- A patient is prescribed an oral corticosteroid for a chronic inflammatory health problem. Which precaution is most important to teach?
|a.||“Never stop taking this drug without consulting your prescriber.”|
|b.||“Avoid crowds and people who are ill.”|
|c.||“Be sure to take this drug with food.”|
|d.||“Reduce your salt intake.”|
ANS: AAll of the choices are precautions that the nurse should teach the patient taking an oral corticosteroid for the long term. However, the most critical precaution is to not stop taking the drug because long-term corticosteroid use causes atrophy of the adrenal glands. With adrenal gland atrophy, the individual no longer makes his or her own normal levels of corticosteroids, which are essential for life. Long-term steroid use is never suddenly stopped. DIF: Cognitive Level: Applying or Higher REF: p. 88
- Why are corticosteroid drugs usually prescribed for a short period of time?
|a.||The inflammatory process cannot be controlled with less powerful drugs.|
|b.||Inhalation of corticosteroid drugs causes irreversible damage to the lungs.|
|c.||These drugs work less effectively when given over an extended period.|
|d.||Corticosteroids have many adverse effects and side effects.|
ANS: DWhen taken orally or parenterally, corticosteroids are usually given for a short period of time because they have many adverse effects and side effects. These drugs can be given over longer periods with the goal that the patient takes the lowest dose that will control inflammation, so that side effects and adverse effects can be minimized. DIF: Cognitive Level: Understanding REF: p. 86
- A patient who has been taking 30 mg of prednisone daily for the last 10 days reports crying more often and then suddenly getting angry at small issues. What is your best action?
|a.||Document the patient’s response as the only action.|
|b.||Hold the next dose and notify the prescriber immediately.|
|c.||Reassure the patient that this is an expected drug response.|
|d.||Suggest that the patient see a counselor or attend an anger management class.|
ANS: CPrednisone, a type of corticosteroid, increases a patient’s emotional responses (emotional lability). It is an uncomfortable but expected side effect that will stop after the drug has been discontinued. Usually, this side effect is not a reason to stop drug therapy and counseling or anger management will not stop the responses. It is helpful for the patient to know this and to be able to tell family members that they are not responsible for the changes in the patient’s emotional state. DIF: Cognitive Level: Applying or Higher REF: p. 87
- A patient who has been prescribed long-term low-dose prednisone to control inflammation reports concern about the changes in her appearance caused by the drug. What is your best response?
|a.||“This often happens when an individual takes this drug. You now have Cushing’s disease.”|
|b.||“When you stop taking this drug, the changes will disappear, but it may take a while.”|
|c.||“You can make use of different styles of clothes to minimize changes in appearance.”|
|d.||“Changes in your diet and an exercise program will eliminate these changes while you are on this drug.”|
ANS: BChanges in appearance are a side effect of corticosteroids. The patient develops a Cushingoid appearance. When a patient stops taking these drugs, the side effects and changes in body appearance disappear, but it may take a year or more for this to occur. DIF: Cognitive Level: Applying or Higher REF: p. 87
- A patient is prescribed topical hydrocortisone 0.1% for skin inflammation. What action is most important to teach the patient for applying this drug?
|a.||“Use a thick layer of drug just to the area that needs treatment.”|
|b.||“Apply a thin layer to the affected area and to the skin near the area.”|
|c.||“Apply a thick layer over and 1 inch around the affected area.”|
|d.||“Use as thin a layer as possible just to the area that needs treatment.”|
ANS: DTopical corticosteroids are absorbed through the skin and can have some systemic effects. Thus patients should use only the minimum amount needed to control the skin problem. Teach the patient to apply only a thin layer just to the areas of skin that need treatment. DIF: Cognitive Level: Applying or Higher REF: p. 89
- Which assessment is most important to perform when providing care to an older adult patient who has been prescribed a topical corticosteroid?
|b.||Intake and output|
|c.||Cognition or mental status|
|d.||Urinary tract infection|
ANS: ATopical corticosteroid use generally has no systemic effects. The skin exposed to the topical corticosteroid becomes thinner and more fragile, especially in an older adult. This area is at greater risk for injury and loss of integrity. DIF: Cognitive Level: Applying or Higher REF: p. 89
- A nursing home resident has been prescribed to take 20 mg of prednisolone immediately. The facility does not have prednisolone, only prednisone. What is your best action?
|a.||Substitute prednisone for prednisolone because they are both corticosteroids.|
|b.||Hold the dose until the pharmacy opens the next day.|
|c.||Notify the prescriber immediately of this situation.|
|d.||Administer the parenteral form of the drug.|
ANS: CAlthough prednisone and prednisolone are both corticosteroids, they are not the same strength and only the prescriber can change the drug or its dose. Because it was ordered to be administered as soon as possible, do not wait until the next day but notify the prescriber immediately. It is possible that, if the prednisolone is not available until tomorrow, the prescriber may change the drug, its dose, or its delivery route; however, these decisions must be made only by the prescriber. DIF: Cognitive Level: Applying or Higher REF: p. 88
- A patient is prescribed triamcinolone (Kenalog) ointment for an allergic skin rash. Which precaution is most important to teach this patient?
|a.||“Always wear gloves when applying this ointment.”|
|b.||“Do not use the ointment on an infected skin area.”|
|c.||“Keep the drug refrigerated between applications.”|
|d.||“Do not wash the ointment off until the area is healed.”|
ANS: BTopical corticosteroids lower immunity in the area where it is applied. This means that if there is a skin infection and topical corticosteroids are applied in that area, the infection can spread to surrounding areas more easily. For this reason, do not apply a topical corticosteroid if there is any question that the skin is infected instead of just being irritated or having a rash. DIF: Cognitive Level: Applying or Higher REF: p. 89
- A patient who usually takes 40 mg of prednisone daily for a chronic problem has been vomiting for 12 hours. What will you tell the patient about the drug therapy?
|a.||“Go to the prescriber’s office immediately for an injectable dose of the drug.”|
|b.||“If you stop vomiting by tomorrow, take two doses of the drug.”|
|c.||“Take no drugs until you stop vomiting for at least 24 hours.”|
|d.||“Take the drug even though you are vomiting.”|
ANS: AThe patient has been taking the drug for a long time, which means his or her adrenal glands have atrophied. Cortisone is essential for life. He or she must receive it daily or acute adrenal insufficiency can occur. DIF: Cognitive Level: Applying or Higher REF: p. 88
- For which health problem will you specifically monitor in the older patient prescribed to take a corticosteroid for the next month?
|a.||Sudden hair loss|
|c.||High blood glucose level|
|d.||Change in sleep patterns|
ANS: CCorticosteroids reduce the activity of insulin and promote high blood glucose levels. Older adults are more likely to have diabetes and corticosteroids make it more difficult to control. DIF: Cognitive Level: Applying or Higher REF: p. 89
- Which statement about corticosteroid use and pediatric patients is true?
|a.||Adrenal atrophy does not occur during long-term use because this organ is younger and healthier in children.|
|b.||Because these drugs slow cell division, they can interfere with normal growth and are not used in children.|
|c.||Children are at the same risk for every side effect of long-term corticosteroid use that adults experience.|
|d.||Drug doses are usually higher than for adults because children metabolize corticosteroids faster than adults.|
ANS: CCorticosteroids are prescribed for children who have severe or chronic inflammatory problems. Children are at risk for the same corticosteroid side effects as adults, including stomach ulcers. DIF: Cognitive Level: Understanding REF: p. 89
- Which statement made by the patient newly prescribed to take a nonsteroidal anti-inflammatory drug (NSAID) indicates that more teaching is needed?
|a.||“I should avoid taking acetaminophen (Tylenol) any time I am also taking an over-the-counter NSAID.”|
|b.||“Because aspirin causes me to have asthma, I should never take another NSAID like ibuprofen (Advil).”|
|c.||“I should try to avoid taking any NSAID, even over-the-counter NSAIDs, for more than a few days or a week.”|
|d.||“Because Celebrex (celecoxib) has so few side effects, I don’t have to worry about how often I take it.”|
ANS: DBecause celecoxib mostly suppresses the COX-2 pathway, allowing the normal housekeeping functions of the COX-1 pathway to continue, it has fewer side effects than COX-1 NSAIDs. However, if a patient takes more than the prescribed dose, the side effects are the same as for the COX-1 NSAIDs. This drug does not affect platelet action and blood clotting. So, bruising and gum bleeding are not expected side effects. DIF: Cognitive Level: Applying or Higher REF: p. 91
- A patient is prescribed ibuprofen (Advil) 200 mg four times a day as needed for inflammation and pain related to arthritis. The patient is scheduled for oral surgery. What priority teaching is appropriate for this patient?
|a.||“The Advil will help relieve your pain after surgery.”|
|b.||“Report any bruising to your prescriber immediately.”|
|c.||“Ask about having the injectable form of this drug after surgery.”|
|d.||“Stop taking this drug at least 36 hours before your scheduled surgery.”|
ANS: DIbuprofen is a nonsteroidal anti-inflammatory drug (NSAID). These drugs reversibly inhibit the action of the COX enzyme. Reduced activity of COX-1 decreases platelet clumping and can reduce blood clotting for 1 to 2 days. Any patient taking a COX-1 NSAID is at increased risk for bleeding and should stop taking the drug 1 to 2 days before surgery. There is no injectable form of ibuprofen. DIF: Cognitive Level: Applying or Higher REF: p. 91
- A patient taking a nonsteroidal anti-inflammatory drug (NSAID) tells you that the drug causes an upset stomach. What is your best response?
|a.||“Always take this drug with food or with milk.”|
|b.||“Stop taking the drug and notify your prescriber.”|
|c.||“Try chewing the drug instead of swallowing it whole.”|
|d.||“Take the drug on an empty stomach to avoid vomiting.”|
ANS: AUpset stomach is a common side effect for NSAIDs. Most of the time, this side effect can be reduced or avoided by ensuring that the drug is taken on a full stomach, with food or with milk. DIF: Cognitive Level: Applying or Higher REF: p. 91
- For which drug should you ask a patient about an allergy to “sulfa” drugs before administering it?
ANS: CCelecoxib (Celebrex) is made from a chemical similar to the “sulfa drug” type of antibiotic. A patient who is allergic to sulfa drugs is likely to also be allergic to celecoxib. DIF: Cognitive Level: Applying or Higher REF: p. 91
- Which new symptom in a patient taking celecoxib (Celebrex) requires immediate medical attention?
ANS: CCelecoxib is a COX-2 inhibitor. Other drugs from this class have caused an increased incidence of strokes and heart attacks by promoting inappropriate blood clot formation in small blood vessels. Although the incidence of this problem is lower with celecoxib, any patient with new onset chest pain should be seen immediately. DIF: Cognitive Level: Applying or Higher REF: p. 92
- An older adult is prescribed naproxen (Naprosyn) 250 mg orally twice daily for management of arthritis pain. Which precaution is most important to teach the patient?
|a.||“Weigh yourself daily every morning, and if you gain more than 3 to 4 lb in a week, report it to your prescriber.”|
|b.||“Avoid taking blood pressure medicine at the same time as this drug because Naprosyn inactivates these drugs.”|
|c.||“Go to the emergency department for an injection of Naprosyn if you are vomiting and cannot keep the drug down.”|
|d.||“Drink a full glass of water every time you take a dose of Naprosyn.”|
ANS: ANaproxen and other NSAIDs cause salt and water retention that can lead to fluid overload and high blood pressure, increasing the risk for heart attack or heart failure. Teach older adult patients taking NSAIDs to check their weight daily and to report any weight gain of more than 3 to 4 lb to the prescriber. This amount of weight gain is associated with fluid retention rather than increased body fat. NSAIDs reduce the effectiveness of some blood pressure drugs because of the fluid retention, not because they inactivate the drug. DIF: Cognitive Level: Applying or Higher REF: p. 93
- A patient is prescribed 20 mg of ketorolac (Toradol) intramuscularly. How many milliliters should you draw up from a vial of ketorolac containing 30 mg/mL?
ANS: B1 is to 30 as X is to 20, so 1/30 = X/20; 20 1 = 20; 20/30 = 0.67 mL, rounded up to 0.7 mL. DIF: Cognitive Level: Applying or Higher REF: p. 90
- Why are aspirin and aspirin-containing drugs avoided for use in children?
|a.||Aspirin is associated with the development of Reye’s syndrome.|
|b.||Aspirin would drop a child’s body temperature below normal.|
|c.||Children are at higher risk for bleeding with aspirin use.|
|d.||A child’s liver is unable to metabolize aspirin.|
ANS: AWhen children have a viral infection and are given aspirin, Reye’s syndrome—a liver disease that can lead to coma, mental retardation, and death—may develop. DIF: Cognitive Level: Understanding REF: p. 93
- A patient has all of the following health problems and seasonal allergies. Which should you warn the patient can be made worse by over-the-counter antihistamines?
|d.||High blood pressure|
ANS: DWhen antihistamines bind to histamine receptors on blood vessels, they cause blood vessels to constrict. Blood vessel constriction raises blood pressure. When the patient already has high blood pressure, these drugs can make the problem worse. DIF: Cognitive Level: Applying or Higher REF: p. 95
- A 78-year-old man has been taking diphenhydramine (Benadryl) for seasonal allergies. Which new symptom should you report to the prescriber?
ANS: ADiphenhydramine is an antihistamine with anticholinergic actions that include dry mouth, drowsiness, and urinary retention. An enlarged prostate is common among older men and causes difficulty urinating. This problem can be made much worse when taking a drug that can cause urinary retention. DIF: Cognitive Level: Applying or Higher REF: p. 95
- A patient who has been taking montelukast (Singulair) for 3 months reports having urine the color of coffee. What is your best response?
|a.||“You need to increase your intake of water and decrease your intake of coffee.”|
|b.||“You need to stop taking this drug and notify your prescriber today.”|
|c.||“Don’t worry. All patients taking this drug have dark urine.”|
|d.||“Do not take this drug any more often than prescribed.”|
ANS: BMontelukast is a leukotriene inhibitor and can cause liver damage. Dark urine is one sign of liver damage. The patient needs to stop taking the drug and see his or her health care provider to determine whether liver damage is present. DIF: Cognitive Level: Applying or Higher REF: p. 96
- A patient with an inflammatory response is prescribed ranitidine (Zantac) 75 mg once a day. What is your best action?
|a.||Give the drug as ordered.|
|b.||Hold the drug and notify the prescriber.|
|c.||Teach the patient to take the drug first thing in the morning.|
|d.||Ask the patient if he or she is allergic to any drugs or other substances.|
ANS: BRanitidine (Zantac) is an H2 receptor blocker used to decrease production of stomach acids. The prescriber has confused this drug with cetirizine (Zyrtec), an H1 receptor blocker used to slow or stop tissue effects of inflammation. DIF: Cognitive Level: Applying or Higher REF: p. 94
- A patient who has been prescribed diphenhydramine (Benadryl) reports a dry mouth and feeling sleepy. What is your best action?
|a.||Document the finding and notify the prescriber.|
|b.||Remind the patient that naps provide needed rest.|
|c.||Suggest sucking on hard candy to relieve dry mouth.|
|d.||Reassure the patient that these are expected side effects.|
ANS: DDiphenhydramine is an H1 receptor blocker commonly used for inflammation triggered by allergic reactions such as hives, watery eyes, and runny nose. Side effects of these drugs include dry mouth and throat as well as drowsiness. Sometimes these drugs are prescribed as a sleep aid. DIF: Cognitive Level: Applying or Higher REF: p. 94
- Which precaution is important to teach a patient who takes antihistamines at home?
|a.||Avoid drinking coffee and other beverages containing caffeine.|
|b.||Avoid drinking alcohol within 4 hours of taking the drug.|
|c.||Do not stop taking this drug suddenly.|
|d.||Avoid taking aspirin while on this drug.|
ANS: BMost antihistamines induce some degree of drowsiness or sleepiness. Alcohol potentiates this effect and the patient could fall or have another type of accident. DIF: Cognitive Level: Applying or Higher REF: p. 94
- A patient prescribed zileutin (Zyflo) has yellowing of the sclera. Which laboratory test result is most important to check?
|a.||Kidney function tests|
|b.||Complete blood count|
|c.||Liver function tests|
ANS: CZileutin is a leukotriene inhibitor with rare adverse effects that include liver impairment and allergic reactions. DIF: Cognitive Level: Applying or Higher REF: p. 96
- Which question is most important to ask a patient before giving the first dose of etaneracept (Enbrel)?
|a.||Do you have diabetes?|
|b.||Are you pregnant or breastfeeding?|
|c.||Do you have psoriasis or another skin disorder?|
|d.||Have you ever had tuberculosis or hepatitis B or C?|
ANS: DEtaneracept is a disease modifying antirheumatic drug (DMARD) that lowers immunity. If the patient has ever had certain viral diseases or tuberculosis, the disease can reappear in an active form when the immune response is suppressed. Previous infection with any of these diseases is a contraindication for this drug. DIF: Cognitive Level: Applying or Higher REF: p. 97 MULTIPLE RESPONSE BASIC CONCEPTS
- Which symptoms of inflammation are caused by leakage of blood plasma into the tissues at the site of injury or invasion? (select all that apply)
|a.||Increased production and migration of leukocytes|
|b.||Phagocytosis and fever|
|c.||Warmth and redness|
|d.||Swelling and pain|
ANS: C, DWith capillary leak, blood plasma leaks into the tissues causing swelling and pain. The swelling creates a cushion of fluid to prevent more tissue injury. Swelling alone can compress pain receptors (nociceptors) and result in pain perception. DIF: Cognitive Level: Remembering REF: p. 84
- Which factors determine the size and severity of the inflammatory response? (select all that apply)
|a.||Intensity of the injury|
|b.||Type of tissue injured|
|c.||Severity of the invasion|
|d.||Gender of the patient|
|e.||Extent of injury|
|f.||Duration of the invasion|
ANS: A, C, E, FThe inflammatory response is nonspecific. The same tissue responses occur with any type of invasion or injury. Size and severity of the inflammatory response depend on intensity, severity, duration, and extent of the injury or invasion. DIF: Cognitive Level: Remembering REF: p. 83
- Which main signs and symptoms should you teach a patient to recognize as inflammation? (select all that apply)
ANS: A, B, D, E, GThe five main signs and symptoms of inflammation are warmth, redness, swelling, pain, and loss of function. DIF: Cognitive Level: Understanding REF: p. 84 Chapter 07: Drugs for Pain ControlWorkman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition MULTIPLE CHOICE BASIC CONCEPTS
- What is another name for an opioid drug?
ANS: DOpioid analgesics, also called narcotics, are drugs that contain any ingredient derived from the poppy plant (or a similar synthetic chemical) that change an individual’s perception of pain and have the potential for psychologic or physical dependence. DIF: Cognitive Level: Remembering REF: p. 106
- How long must pain be present to be considered “chronic pain?”
ANS: CChronic pain is present daily for 6 months. It persists or increases with time, may not have an identifiable cause, and does not trigger the physiologic responses associated with acute pain. This means that an individual with chronic pain can have severe pain intensity without changes from the normal ranges for heart rate, breathing rate, or blood pressure. Chronic pain may hurt less on some days than others but is always present. DIF: Cognitive Level: Remembering REF: p. 104
- On a 0 to 10 pain rating scale, which of the following numbers reported by a patient represents the worst pain intensity?
ANS: DHow much pain the patient feels is called pain intensity. There are several ways to work with the patient to determine pain intensity. When a patient can speak and use a pain scale, the lower numbers indicate less pain, while the higher numbers indicate more pain. DIF: Cognitive Level: Remembering REF: p. 102
- What word describes pain that comes and goes?
ANS: BPain is divided into types on the basis of its cause, how long it lasts, and whether it is present continuously or comes and goes (intermittent). DIF: Cognitive Level: Remembering REF: p. 104
- 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.|
ANS: ACancer pain has many causes and is complex. This means that more than one pain strategy and often more than one type of drug for pain control are needed. The patient with cancer often receives traditional pain-control drugs but at much higher doses than those prescribed for other types of pain. DIF: Cognitive Level: Remembering REF: p. 104
- Which schedule of controlled substance has the lowest potential for addiction?
ANS: DIn the United States any drug that contains ingredients known to be addictive is classified by the federal government as a controlled substance and is regulated by the Federal Controlled Substances Act of 1970. This act classifies controlled substances into five schedules based on how likely they are to result in addiction. The drugs most likely to lead to addiction are in schedule I. Those with the least potential for addiction are in schedule V. DIF: Cognitive Level: Remembering REF: p. 105
- In which controlled substance class or schedule does heroin belong?
ANS: AHeroin has a very high likelihood of abuse and addiction. In addition, it has no accepted medical use in the United States. Therefore it meets the criteria for a controlled substance schedule I drug. DIF: Cognitive Level: Remembering REF: p. 105
- Which problem is a psychologic response to chronic opioid use?
ANS: BThe definition for addiction is the psychologic need or craving for the “high” feeling that results from using opioids when pain is not present. DIF: Cognitive Level: Remembering REF: p. 106
- What is the most common side effect of an opioid used for 5 days?
ANS: CThe most common side effect of opioids is constipation because these drugs slow intestinal movement. Most patients who are on opioids for 2 or more days experience constipation. Ask patients who are prescribed opioids about constipation on a daily basis. Be sure to administer any prescribed stool softeners or laxatives. DIF: Cognitive Level: Remembering REF: p. 108
- 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|
ANS: DPain is a personal experience that includes physical and emotional components. What is painful for one individual may not be painful to another. Because everyone experiences pain in a different way, the most useful clinical definition is that pain is whatever the patient says it is and exists whenever he or she says it does. DIF: Cognitive Level: Remembering REF: p. 101
- 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.|
ANS: AHow 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. DIF: Cognitive Level: Remembering REF: p. 103
- 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.|
ANS: CPain 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. DIF: Cognitive Level: Remembering REF: p. 102
- 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?
ANS: CRadiating pain may be felt all around and extending from the damaged area causing the pain. DIF: Cognitive Level: Remembering REF: p. 104
- 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.|
ANS: APain 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 health care workers 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. DIF: Cognitive Level: Remembering REF: p. 104
- 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|
ANS: DThe definition of chronic pain involves the length of time that pain is experienced and the progressive nature of the problem causing the pain. Osteoarthritis meets these criteria. A headache caused by fluid loss during a spinal tap is severe but has a duration of only 3 to 5 days. Hip replacement surgery, although resulting in postoperative pain, is time limited and often relieves chronic hip pain. IV needle insertion is considered painful by some patients, but is short procedural pain. DIF: Cognitive Level: Remembering REF: p. 104
- 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.|
ANS: BMorphine 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. DIF: Cognitive Level: Remembering REF: p. 107
- 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.|
ANS: CWhen 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. DIF: Cognitive Level: Remembering REF: p. 103
- 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|
|c.||Wetting the bed three to four nights per week|
|d.||Crying more frequently for no apparent reason|
ANS: AGabapentin is an anticonvulsant drug that can reduce certain types of pain. Children taking gabapentin often demonstrate an increase in aggressive behavior. DIF: Cognitive Level: Remembering REF: pp. 111-112
- Which term best describes what occurs when long-term opioid is suddenly stopped?
ANS: CWithdrawal is the occurrence of autonomic nervous system symptoms when long-term opioid therapy is stopped suddenly after physical dependence is present. Symptoms include nausea, vomiting, abdominal cramping, sweating, delirium, and seizures. DIF: Cognitive Level: Remembering REF: p. 108 ADVANCED CONCEPTS
- 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.”|
ANS: BOne 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. DIF: Cognitive Level: Applying or Higher REF: p. 104
- 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.|
ANS: DPain experience and pain tolerance are very personal. True assessment of a patient’s discomfort cannot be determined by and should not be based on the patient’s behaviors or changes in vital signs. Nor can it be based on how recently the patient received a drug for pain. The only way to know is to ask the patient to rate the pain. DIF: Cognitive Level: Applying or Higher REF: p. 103
- 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.”|
ANS: CThe fear of addiction to opioids is one cause of poorly treated pain. Remind the patient that addiction will not occur if the drugs are taken to relieve pain. Pain after surgery is acute and temporary pain. The use of opioid drugs, when used for relief of acute pain, even in high doses, rarely results in addiction. DIF: Cognitive Level: Applying or Higher REF: p. 106
- 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.|
ANS: BAdaptation to the presence of chronic pain is physiologic, not psychologic. Thus the usual alterations in physiologic parameters when acute pain is present do not accompany chronic pain. DIF: Cognitive Level: Applying (Application) or Higher REF: p. 104
- 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.|
ANS: AMany patients experience some degree of respiratory depression with opioid analgesics. If the patient can be aroused with minimally intrusive techniques and the respiratory rate increases spontaneously, no further intervention is required. DIF: Cognitive Level: Applying or Higher REF: pp. 108-109
- 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.|
ANS: CMany 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/min, but some patients may have a usual rate of only 10 breaths/min. Although this is not a customary response and you should document it in the patient care notes, check other indicators of breathing adequacy before notifying the prescriber. DIF: Cognitive Level: Applying or Higher REF: p. 109
- 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.”|
ANS: DThis 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. DIF: Cognitive Level: Applying or Higher REF: p. 109
- 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.”|
ANS: AIn addition to the usual side effects and adverse effect of opioids, an older adult is at risk for low vision. The pupil of the older adult does not dilate fully and less light enters the eye, reducing vision. When the older patient takes an opioid drug, the pupil is even smaller than usual, reducing vision even more. This problem increases the older patient’s risk for tripping over objects and falling. DIF: Cognitive Level: Applying or Higher REF: p. 110
- 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?”|
ANS: BCelecoxib is similar to the class of antibiotics known as “sulfa drugs.” An allergic reaction to celecoxib is more likely if the patient is also allergic to sulfa drugs. DIF: Cognitive Level: Applying or Higher REF: p. 111
- A patient taking warfarin (Coumadin) has mild to moderate pain after exercising. Which over-the-counter pain reliever should you recommend?
ANS: DOnly acetaminophen does not interfere with blood clotting. The other drugs do interfere with blood clotting, and so does warfarin. Taking warfarin with any other drug that interferes with blood clotting places the patient at extreme risk for excessive bleeding and brain hemorrhage. DIF: Cognitive Level: Applying or Higher REF: p. 111
- 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.”|
ANS: AAcetaminophen 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. DIF: Cognitive Level: Applying or Higher REF: p. 111
- 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.|
ANS: CNortriptyline is an antidepressant. These drugs can make heat failure worse and can cause urinary retention. Fluid retention with weight gain is a symptom of worsening heart failure. A weight gain of 9 lb in a week is significant and an indicator of rapidly worsening heart failure. DIF: Cognitive Level: Applying or Higher REF: p. 111
- 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?
ANS: BDependence is described as physical changes in autonomic nervous system function that can occur when opioids are used long term and are not needed for pain control. DIF: Cognitive Level: Understanding REF: p. 108
- 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.”|
ANS: CAn issue that can occur with longer-term opioid use is drug tolerance. Tolerance is the adjustment of the body to long-term opioid use that increases the rate of drug elimination and reduces the main effect (pain relief) and side effects of the drug. It occurs with anyone who is taking opioids for a long period of time. More drug is needed to achieve the same degree of pain relief. DIF: Cognitive Level: Applying or Higher REF: p. 106
- 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.|
ANS: CWhen giving the first dose of an opioid to a patient who has never taken an opioid (is opioid naïve), check the patient’s respiratory rate and oxygen saturation. Opioids can cause some degree of respiratory depression. After giving the drug, be sure to monitor the patient’s respiratory rate and oxygen saturation for indications of respiratory depression. This is especially important when the patient is receiving an opioid for the first time or when the drug dosage has been increased. DIF: Cognitive Level: Applying or Higher REF: p. 108
- 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.”|
ANS: DMS Contin is an extended release tablet so crushing or dissolving it can cause a drug overdose from releasing too much drug at a time. The best action is to contact the prescriber with the information about the patient’s difficulty swallowing because a different form or morphine or a different drug may be needed to control the pain. Teach patients and their families to take an extended release (ER) form of an oral opioid drug by swallowing the capsule or tablet whole because chewing it or opening the capsule allows too much of the drug to be absorbed all at once and an overdose can occur. DIF: Cognitive Level: Applying or Higher REF: p. 109
- 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.|
ANS: AOpioids may be prescribed to women during pregnancy. These drugs do cross the placenta and enter the fetus. The fetus can become addicted to opioids and go through withdrawal after birth. Opioids also cross into breast milk. DIF: Cognitive Level: Applying or Higher REF: p. 110
- 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|
ANS: BOpioids, especially meperidine (Demerol), can make the chest muscles of older adults tighter, which makes breathing and coughing more difficult. Thus the risk for pneumonia and hypoxia is greater for them. Check the respiratory rate and depth as well as the oxygen saturation at least every 2 hours. In addition, meperidine causes the buildup of a toxic metabolite in older adults that can result in seizures. Avoid the use of meperidine in older adults. DIF: Cognitive Level: Applying or Higher REF: p. 110
- 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.|
ANS: BWhen the patient is receiving an opioid for the first time or when the drug dosage has been increased, if the respiratory rate is 8 or less and the patient is sleeping, try to wake him or her. First call the patient’s name. If there is no response, gently shake his or her arm or leg. Shake more firmly if needed. If the patient does not respond to these actions, use a slightly stronger trigger (without using enough force to cause harm) such as squeezing the trapezius muscle (located at the angle of the shoulder and neck muscle) or applying pressure to the nail bed. DIF: Cognitive Level: Applying or Higher REF: p. 109
- 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.|
ANS: DIf the patient cannot be aroused, immediately call for help. If the patient’s oxygen saturation is below 95% or is five percentage points lower than his or her normal saturation, arouse the patient and check the saturation when fully awake. If the saturation does not improve when fully awake, apply supplemental oxygen and notify the charge nurse or prescriber. DIF: Cognitive Level: Applying or Higher REF: p. 109 MULTIPLE RESPONSE BASIC CONCEPTS
- Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs)? (select all that apply.)
|g.||Memory loss (temporary)|
ANS: A, E, FNSAIDs disrupt platelet action and reduce clotting, which increases the risk for bleeding in response to minor trauma. NSAIDs also reduce the thick, gel-like coating of the stomach, allowing normal stomach acids to irritate the stomach lining and form ulcers. Finally, NSAIDs cause the kidneys to retain more sodium and water. These enter the bloodstream and raise blood pressure. DIF: Cognitive Level: Remembering REF: p. 111 COMPLETION ADVANCED CONCEPTS
- 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?
ANS:2.2 1 kg = 2.2 lb. The child’s weight in kilogram is 64/2.2 or 29.09 kg (round down to 29).29 ´ 75 mcg = 2175 mcg or 2.175 mL round up to 2.2 mL. DIF: Cognitive Level: Applying or Higher REF: p. 107
- 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?
ANS:0.4 1 kg = 2.2 lb. The infant’s weight in kilogram is 11/2.2 or 5 kg.5kg ´ 8 mg = 40 mg.The drug concentration is 80 mg/0.8 mL or 10 mg/0.1 mL.40 mg/10 = 4. 4 ´ 0.1 mL = 0.4 mL. DIF: Cognitive Level: Applying or Higher REF: p. 107