The ______ theory proposes tissue injury activates _________ and causes the release of chemical mediators.

Gate, Nociceptors

Opioids such as morphine activate the same receptors as ________ to reduce pain.

Endorphins

Nonsteroidal antiinflammatories drugs (NSAID's) control pain at the periphery level by blocking pain sensitizing chemicals and interfering with the product of _____________.

Prostaglandins

As a result of unrelieved pain, a client may develop glucose intolerance and _____________ respiratory rate, heart rate, blood pressure, and stress response.

increased

What is the level of stimulus needed to create a painful sensation?

A. Pain threshold

B. Pain tolerance

C. neuropathic pain

D. endorphins

E. Analgesics

F. Nociceptors

A. Pain threshold

What is a neurohormone that naturally suppress pain conduction?

A. Pain threshold

B. Pain tolerance

C. neuropathic pain

D. endorphins

E. Analgesics

F. Nociceptors

D. endorphins

What is pain due to disease or injure of the peripheral nervous system or central nervous system?

A. Pain threshold

B. Pain tolerance

C. neuropathic pain

D. endorphins

E. Analgesics

F. Nociceptors

C. Neuropathic Pain

What is the amount of pain a person can endure without interfering with normal functioning?

A. Pain threshold

B. Pain tolerance

C. neuropathic pain

D. endorphins

E. Analgesics

F. Nociceptors

B. Pain tolerance

Opioids act primarily on the _____________ and nonopioid analgesics act on the ____________________ at the pain receptor sites.

Central nervous system , Peripheral nervous system

In addition to suppressing pain, Opioids also suppress ___________ and ____________.

respiration and coughing

Opioids are contraindicated for use in clients with ____________ , ______________ , ____________ , and _____________ .

head injuries, respiratory depression, shock, hypotension

The client taking meperidine reports blurred vision. The nurse knows that this is a(n) _______________ and would report this to the _________________ .

side effect , health care provider

Pentazocine, an opioid agonist-antagonist, is classified as a schedule ____ drug.

IV

What type of pain originates from smooth muscle and organs?

A. Superficial pain

B. Vascular pain

C. Somatic pain

D. Visceral pain

D. Visceral pain

What type of pain originates in skeletal muscle, ligaments, and joints?

A. Superficial pain

B. Vascular pain

C. Somatic pain

D. Visceral pain

C. Somatic pain

What type of pain originates on the surface areas such as skin and mucous membranes?

A. Superficial pain

B. Vascular pain

C. Somatic pain

D. Visceral pain

A. Superficial pain

What kind of pain contributes to headaches or migraines?

A. Cancer pain

B. Vascular pain

C. Somatic pain

D. Visceral pain

B. Vascular pain

What type of pain occurs from pressure on nerves and organs?

A. Cancer pain

B. Vascular pain

C. Somatic pain

D. Visceral pain

A. Cancer Pain

Which drug effect is considered a major side effect of meperidine?

A. Decreased Blood pressure

B. Decreased pule rate

C. increased respiration

D. increased urine output

A. Decreased blood pressure

Which assessment finding is an indication of opioid overdose?

A. Dilated pupils

B. increased urinary output

C. pinpoint pupils

D. Diarrhea

C. Pinpoint pupils

Which nursing assessment would be least important when monitoring a client who is receiving hydromorphone?

A. Bowel sounds

B. Fluid intake

C. pain scale

D. vital signs

B. Fluid intake

Which information will the nurse include in a teaching plan for a client who is being discharged home after knee surgery with a prescription for an opioid? Select all that appy

A. Dietary restriction while taking hydrocordone

B. Instruction not to exceed recommended dosage

C. Instructions not to use alcohol or central nervous system depressants while taking hydrocodone

D. Instructions on how to prevent constipation

E. Side effect to report

B. Instruction not to exceed recommended dosage

C. Instructions not to use alcohol or central nervous system depressants while taking hydrocodone

D. Instructions on how to prevent constipation

E. Side effect to report

The client is brought to the emergency department with a reported overdose of morphine. Which drug will the nurse anticipate be prescribed?

A. Butorphanol

B. Naloxone

C. Flumazenil

D. Pentazocine

B. Naloxone

Mixed opioid agonist-antagonists were developed in hopes of decreasing which problem?

A. Chronic pain

B. opioid abuse

C. renal failure

D. respiratory depression

B. Opioid abuse

The client abruptly stopped taking an opioid after taking it for 8 weeks for a mild back injury sustained at work. Which time frame would the nurse anticipate withdrawal symptoms attributable to physical dependence to begin?

A. 6-12 hours

B. 24-48 hours

C. 48- 72 hours

D. 72- 96 hours

B. 24-48 hours

An 8 year old child is seen in the ER with a broken arm. Which intervention would the nurse do to be more successful in treating pain in an 8 year old child? Select all that apply

A. assume the child is hurt and administer pain drug

B. Discuss the child's typical responses with the caregiver

C. Utilize only non pharmacological pain control

D. Use a pain scale appropriate for children

E. Utilize developmentally appropriate communication technique

B. Discuss the child's typical responses with the caregiver

D. Use a pain scale appropriate for children

E. Utilize developmentally appropriate communication technique

A client will be discharged home with a prescription for an opioid with acetaminophen. Which drug, when taken with an opioid will the nurse question?

A. Ampicillin

B. Cholestyramine

C. Furosemide

D. Propranolol

B. Cholestyramine

Cholestyramine will decrease the effectiveness of acetaminophen. An alternative nonopioid would be an option

The nurse is concerned that a client is experiencing side effects of opioid agonist-antagonists. Which assessment would be priority for the nurse to monitor?

A. Constipation

B. Dysuria

C. Hypertension

D. Respiratory depression

D. Respiratory depression

A client 4-hours postoperative is requesting morphine for the third time for pain rated an 8 on the numeric pain scale. The vital signs include temperature 97.5 F, heart rate 88 beats/min, respiratory rate of 12 breaths per min, blood pressure 104/60, and oxygen saturation 98% on room air. Assuming that a dose of the drug is due, which action would be best for the nurse to take?

A. Administer the dose and contact the HCP about the respiratory rate

B. Administer the dose and contact HCP about inadequate pain control

C. Hold the dose and contact the HCP regarding the respiratory rate.

D. Hold the dose and contact the HCP about inadequate pain control

B. Administer the dose and contact HCP about inadequate pain control

The nurse would hold the dose is the respiratory rate is below 10 breaths per minute

The older adult client has a fentanyl patch 75 mcg for chronic pain. Which statement is correct regarding this drug for the older adult?

A. This patient should not have fentanyl patch for chronic pain

B. The dose may be too low

C. The dose may be too high for this patient

D. The dose is appropriate

C. The dose may be too high for this patient

A client was prescribed oral ketorolac for postoperative pain. Which time frame indicates the maximum length of time this drug can be taken?

A. 24 hours

B. 3 days

C. 5 days

D. 2 weeks

C. 5 days

Which drugs would be appropriate for pain management for a client who sustained multiple abrasions to both knees after falling off a bicycle? Select all that apply

A. Acetaminophen

B. Aspirin

C. Hydrocodone

D. Ibuprofen

E. Morphine

A. Acetaminophen

B. Aspirin

D. Ibuprofen

Which statement describes the pathophysiology of pain?

A. Chemical mediators sensitize the pain receptors

B. Nociceptive pain signals are transmitted through efferent fibers

C. Pain signals begin at the central nervous system and end at the periphery

D. Chemical mediators such as glucose and sodium are released upon tissue injury

A. Chemical mediators sensitize the pain receptors

Which medication is a non steroidal anti-inflammatory analgesic?

A. Diflunisal

B. Ketorolac

C. Celecoxib

D. Acetaminophen

A. Diflunisal

Which drug may cause tinnitus as a side effect?

A. Aspirin

B. Tramadol

C. Indomethacin

D. Acetaminophen

A. Aspirin

Aspirin is associated with tennitus and vertigo. Tramadol causes nausea, vomiting, constipation, dizziness, and headache. Indomethacin causes gastric distress. Overdose of acetaminophen causes hepatotoxicity.

pg 297

Which characteristic feature is indicative of cluster headaches?

A. pain is pulsatile

B. more common in women

C. headache preceded by an aura

D. pain is usually located around the eyes

D. Pain is usually located around the eyes

Which condition is a contraindication for the administration of opioid analgesic?

A. Gout

B. Diabetes

C. Skin Disease

D. Status Asthmaticus

D. Status asthmaticus

Respiratory insufficiency, renal or hepatic disorders, hypovolemia, urinary retention, sleep apnea, IOP, CNS or respiratory depression

Which food or dietary supplement would the nurse identify as potentially causing increased sedation with opioid therapy? select all that apply

A. Kava

B. Valerian

C. Bananas

D. Grapefruit

E. St. Johns Wort

A. Kava, B. Valerian, E. St. Johns Wort

A patient with migraine headaches who is on selective serotonin reuptake inhibitor therapy is prescribed sumatriptan. Which possible complication would the nurse anticipate in the patient?

A. Vasospasm

B. Hypertension

C. Serotonin Syndrome

D. Central Nervous system depression

C. Serotonin syndrome

Sumatriptan is contraindicated in patient receiving SSRI because of the risk for serotonin syndrome. 307-308

The nurse is teaching a student nurse about medication that are contraindicated when caring for patients with head injuries. Which medication identified by the student indicates an understanding of the teaching?

A. Ketorolac

B. Nalbuphie

C. Methylprednisolone

D. Acetaminophen

B. Nalbuphine

Narcotics depress respiration, resulting in carbon dioxide retention and increased ICP.

Which sign or symptom is indicative of salicylate toxicity? select all that apply

A. Vertigo

B. Anorexia

C. Nausea

D. Tinnitus

E. Diarrhea

F. Hyperventilation

Vertigo, tinnitus, Hyperventilation

Which medication would the nurse anticipate administering to a patient admitted for treatment of an opioid addiction?

A. Morphine

B. Naloxone

C. Methadone

D. Meperidine

C. Methadone

pg. 301

Which drug is an opioid agonist-antagonist? Select all that apply

A. Butorphanol

B. Fentanyl

C. Tapentadol

D. Nalbuphine

E. Buprenorphine

A. Butorphanol, D. Nalbuphine, E. Buprenorphine

Which lab level would the nurse monitor for in a patient who is receiving acetaminophen therapy? Select all that apply

A. uric acid level

B. Bilirubin

C. Creatinine

D. Alkaline phosphatase (ALP)

E. Alanine Aminotransferase (ALT)

B. Bilirubin, D. Alkaline phosphatase, E. Alanine aminotransferase

OD of Acetaminophen may cause liver damage, resulting in hepatotoxicity

Which medication class includes adjuvant analgesic medications? Select all

A. Corticosteroids

B. Anticonvulsants

C. Antidepressants

D. Antidysrhythmics

E. local anesthetics

All of them ABCDE

Adjuvant analgesic meds are those that are used to potentiate the action of opioid or nonopijoid analgesics.

Which adverse effect is associated with excessive doses of acetaminophen is likely to be found in a patient? Select all that apply

A. Nausea

B. Vomiting

C. Blurred vision

D. Hepatotoxicity

E. Hearing impairment

A. Nausea, B. Vomiting, D.. Hepatotoxicity

Life treating Hepatotoxicity, renal failure, hypokalemia, rhabdomyolysis, anemia, agranulocytosis, neutropenia, thrombocytopenia

Which phrase describes an adjuvant analgesic?

A. only used with opioid analgesics

B. Used when opioid analgesics are ineffective

C. Potentiates the action of an analgesic medication

D. Increases the likelihood of adverse reactions when used with analgesics

C. Potentiates the action of an analgesic medication

pg. 304

While admitting a patient for treatment of an acetaminophen overdose, the nurse would anticipate the administration of which medication to prevent toxicity?

A. Vitamin K

B. Naloxone

C. Acetylcysteine

D. Methylprednisolone

C. Acetylcysteine is the antidote for acetaminophen overdose.

Loading dose followed by doses every 4 hours for 17 more doses.

Vitamin K is antidote for Warfarin overdose and toxicity. Naloxone is used to reverse an opioid overdose or opioid induced respiratory depression. Methylprednisolone is a glucocorticoid that is used as an antiimflammatory.

Which narcotic is the drug of choice for pain relief during childbirth?

A. Meperidine

B. Hydromorphone

C. morphine sulfate

D. Oxycodone Hydrochloride

A. Meperidine

It does not diminish uterine contraction and causes less neonatal respiratory depression.

Which condition is a contraindication for the administration of acetaminophen?

A. Anemia

B. Asthma

C. joint pain

D. liver disease

D. liver disease

Acetaminophen is safe for anemia, asthma, and joint pain.

pg. 297

Which drug can be used as an adjunct to psychosocial treatments for alcoholism?

A. Meperidine

B. Tapentadol

C. Polyethylene glycol

D. Naltrexone hydrochloride

D. Naltrexone Hydrochloride

pg. 306

When teaching a patient about the administration of a fentanyl transdermal patch, which frequency would the nurse include for changing the patch?

A. When pain recurs

B. Every 24 hours

C. Every 72 hours

D. once a week

C. every 72 hours

pg. 301

Which medication would the nurse administer for severe postoperative pain?

A. Acetaminophen

B. Acetylsalicylic acid

C. Meperidine

D. Fentanyl

C. Meperidine 75 mg intramuscular

pg 300

Which condition would the nurse expect to see in a patient who ingested 14 grams of acetaminophen?

A. Renal failure

B. Kidney stones

C. Acute hepatotoxicity

D. Metabolic alkalosis

C. Acute hepatotoxicity

Pg 296

Which assessment is most important for the nurse to monitor in a patient receiving an opioid analgesic?

A. Heart rate

B. Mental status

C. Blood Pressure

D. Respiratory Rate

D. Respiratory rate

P 300

When developing a plan of care for a postoperative patient receiving morphine sulfate which patient problem would be the highest priority?

A. Acute pain related to tissue injury and inflammation

B. Risk for falls related to drowsiness and changes in mental status

C. Risk for impaired gas exchange related to respiratory depression

D. Risk for constipation related to decreased gastrointestinal motility

C. Risk for impaired gas exchange related to respiratory depression

ABC.'s. Airway Breathing Circulation. p. 300

A patient admitted to the hospital with a diagnosis pf pneumonia asks the nurse why am I receiving codeine? I am not in pain. Which effect of codeine would the nurse include in responding to the patient?

A. Antitussive

B. Expectorant

C. immunostimulant

D. immunosuppressant

A. Antitussive

pg. 301

Which trigger of migraine headaches would the nurse include when teaching a patient about the administration of sumatriptan for treatment of migraine headaches? Select all that apply

A. Red wine

B. Chocolate

C. Aspartame

D. Sleep deprivation

E. Monosodium Glutamate

All of them

When assessing a patient for adverse effects of morphine sulfate, which finding would the nurse expect?

A. Diarrhea

B. insomnia

C. Drowsiness

D. increased Bowel sounds

C. Drowsiness

Which statement describes the action of ibuprofen to relieve pain?

A. It blocks the action of phospholipase

B. It acts in the same way as endorphins

C. It reduces the production of leukotrienes

D. it block the action of cyclooxyrgenase

D. It blocks the action of cyclooxygenase

Corticosteroids block the action of phosphoipase

Opioid analgesics such as morphine and endorphins act on the same receptors

Cortisone acts by reducing the production of leukotrienes

Which assessment parameter is most important for the nurse to evaluate when determining safe dosing of morphine sulfate for the management of pain in a patient with a terminal cancer diagnosis?

A. Sedation level

B. Respiratory Rate

C. Input and output

D. Blood pressure

B. Respiratory rate

morphine may also increase level of sedation, cause urinary retention, and potentiate hypotension.

Which action would the nurse take to determine whether sumatriptan is having an adverse effect on a patient being treated for a migraine?

A. Assess vital signs

B. Ausculate Bowel sounds

C. Palpate peripheral pulses

D. Ausculate Breath sounds

A. Assess vital Signs

Side effects include hypotension or hypertension, bradycardia or tachycardia.

Which actions would the nurse take when a patient with a history of migraine headaches reports, "I'm seeing flashes of light, I have some blind spots, and my hands are tingling"?

A. Assess the patient's vital signs

B. Administer the patient's naratriptan

C. assess the patient's neurologic status

D. Notify the health care provider of patient's symptoms

B. Administer the patient's Naratriptan

Which question is a priority for the nurse to ask a patient diagnosed with migraine headaches who is prescribed sumatriptan?

A. Do you have a history of diabetes?

B. What other medications are you on?

C. Have you ever taken Sumatriptan?

D. Do you have a history of coronary artery disease?

D. Do you have a history of coronary artery disease

Sumatriptan works to decrease migraine pain by decreasing the arteries in the brain. Sumatriptan could cause the patient to experience a myocardial infarction by constricting the coronary arteries. P 307

Which action would be priority for the nurse to take when noting an elevated blood urea nitrogen and creatinine level in a patient receiving sumatriptan?

A. Assess the patient's breath sounds

B. Evaluate the patient's diet

C. Monitor the patient's intake and output

D. Stop the medication and notify the health care provider

D. Stop the medication and notify the health care provider

Life threatening adverse reaction to sumatriptan is renal failure..

Which discharge teaching would the nurse provide to a patient who is taking morphine for postoperative pain? select all that apply

A. increase rest periods

B. Take a stool softener

C. Decrease the medication dosage

D. Eat more animal protein and dairy

E. Increase fluid intake throughout the day

B. Take a stool softener

E. Increase fluid intake throughout the day

A patient receiving morphine has a respiratory rate of 7 breaths per min, and pupils are 1mm and unreactive. Which action would the nurse take?

A. call a code

B. Call anesthesia

C. Administer naloxone

D. Initiate rescue breathing

C. Administer naloxone

For which type of pain is a fentanyl transdermal patch best suited?

A. Pain after abdominal surgery

B. Acute treatment of a migraine headache

C. Lower back pain related to lumbar strain

D. Severe pai resulting fro cancer metastasis

D. Severe pain resulting from cancer metastasis

The nurse is teaching a student nurse about the benefits of the use of hydromorphone therapy over morphine sulfate. Which benefit identified by the student indicates teaching was effective? Select all that apply

A. Hydromorphone has no risk for respiratory depression

B. Hydromorphone has a faster onset of action compared with morphine

C. Hydromorphone has a greater hypnotic effect compared with morphine.

D. Hydromorphone has a shorter duration of action compared with morphine

E. The analgesic effect of hydromorphone is 6 times more potent than morphine

B. D. E.