Drugs for Pain and Sleep Problems

Understanding Pharmacology Essentials for Medication Safety

Nursing
41
Questions
0
True/False
36
Choices
5
Essay
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Questions

Q1
Free

Which is the best clinical definition of pain?

Multiple Choice
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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
Answer:
D) Whatever the patient says it is

Explanation:
Pain is a personal experience that includes physical and emotional components. What is painful for one person 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.
Q2
Free

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

Multiple Choice
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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 cant cure old age.
C) I dont mind taking pain drugs for my sprained ankle because I know it wont hurt this way forever.
D) I will take enough pain medication to make me comfortable without making me too sleepy.
Answer:
B) There is no reason for me to take drugs for pain; after all, you cant cure old age.

Explanation:
One cause of underreporting pain and undertreating it is that many patients and health care providers believe that pain is a normal part of aging. Pain may occur more frequently among older adults, but is never considered normal. Patients of any age with pain for any reason deserve to have their pain reduced to a manageable level.
Q3
Free

Which statement about pain is true?

Multiple Choice
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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.
Answer:
A) Each patient perceives a painful event differently.

Explanation:
How we feel and react to pain depends on our emotional makeup along with our previous experiences with pain. Issues like culture, age, gender, and our interactions with society also affect our responses to pain. As a result, no two people perceive pain in exactly the same way.
Q4

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?

Multiple Choice
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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.
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Q5

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?

Multiple Choice
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A) Localized
B) Referred
C) Radiating
D) Phantom
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Q6

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

Multiple Choice
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A) It ensures that pain assessment occurs on a regular basis for all patients.
B) It helps nurses understand that experiencing pain can change heart rate and respiratory rate.
C) It helps nurses to ensure that vital organ function is adequate before administering drugs to reduce pain.
D) It encourages nurses to assess two parameters during patient contact to improve time management.
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Q7

What is the best way for the nurse to determine a patients need for pain medication on the second day after an abdominal laparotomy?

Multiple Choice
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A) Check when the patient last received medication for pain.
B) Assess the patients facial expression and vital signs.
C) Consider the patients age and ethnicity.
D) Ask the patient to rate his or her pain.
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Q8

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

Multiple Choice
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A) Severe headache associated with a spinal tap
B) Insertion of a needle for intravenous (IV) therapy
C) Hip replacement surgery
D) Osteoarthritis
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Q9

How do morphine and other opioid pain medications relieve a patients pain?

Multiple Choice
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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.
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Q10

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

Multiple Choice
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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.
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Q11

The nurse is assigned to care for a patient with chronic low back pain. What adjustment in pain management does the nurse expect to make?

Multiple Choice
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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 patients pain.
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Q12

The nurse checks a patient for pain relief 1 hour after administering 15 mg of morphine intramuscularly. The patient is sleeping and has a respiratory rate of 10 breaths per minute. What is the nurses best first action?

Multiple Choice
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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 patients oxygen saturation and raise the head of the bed.
D) Document the finding as the only action.
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Q13

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

Multiple Choice
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A) Hold the dose and notify the prescriber.
B) Hold the dose and apply oxygen by mask or nasal cannula.
C) Check the patients oxygen saturation and ask about his or her pain level.
D) Call the Rapid Response Team and prepare to administer the prescribed opioid antagonist.
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Q14

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

Multiple Choice
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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 liters of fluid daily and increase fiber intake.
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Q15

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

Multiple Choice
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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 liters of fluids daily to reduce constipation.
D) Avoid drinks containing caffeine to prevent inactivating the drug.
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Q16

How do nonsteroidal anti-inflammatory drugs (NSAIDs) relieve a patients pain?

Multiple Choice
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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.
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Q17

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

Multiple Choice
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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?
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Q18

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

Multiple Choice
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A) aspirin (Bufferin)
B) ibuprofen (Advil)
C) naproxen (Aleve)
D) acetaminophen (Tylenol)
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Q19

A patient is taking acetaminophen (Tylenol). Which precaution is most important for the nurse to teach the patient?

Multiple Choice
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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.
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Q20

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

Multiple Choice
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A) Heart rate decreased from 80 to 72 beats per minute
B) Respiratory rate decreased from 20 to 16 breaths per minute
C) Weight increased from 128 to 137 pounds
D) Morning blood glucose increased from 86 to 94 mg/dL
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Q21

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?

Multiple Choice
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A) Fighting at school
B) Difficulty sleeping
C) Wetting the bed 3 to 4 nights per week
D) Crying more frequently for no apparent reason
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Q22

What is the most common sleep problem?

Multiple Choice
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A) Inappropriate sleeping
B) Sleep deprivation
C) Insomnia
D) Napping
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Q23

Which drug for insomnia can cause amnesia?

Multiple Choice
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A) amitriptyline (Elavil)
B) diphenhydramine (Benadryl)
C) temazepam (Restoril)
D) trazodone (Desyrel)
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Q24

A patient is prescribed a drug for insomnia. Which precaution is most important for the nurse to teach the patient?

Multiple Choice
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A) Avoid drinking fluids with caffeine before bedtime.
B) Rinse your mouth frequently with water or saline.
C) Avoid driving within 8 hours of taking this drug.
D) Do not take this drug for more than 1 week.
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Q25

A patient who has been taking flurazepam (Dalmane) for insomnia is now prescribed zolpidem (Ambien) instead. The patient asks the nurse why the prescription was changed. What is the nurses best response?

Multiple Choice
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A) Zolpidem (Ambien) is a first-line drug for the treatment of insomnia.
B) Flurazepam (Dalmane) is a benzodiazepine drug that can be habit-forming.
C) Zolpidem (Ambien) is also used to treat any anxiety or stress that may contribute to your insomnia.
D) Flurazepam (Dalmane) has both hypnotic and sedative effects that are less effective in the treatment of insomnia.
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Q26

A patient taking a drug for insomnia reports becoming sunburned even when only minimally exposed to the sun. What is the nurses best action?

Multiple Choice
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A) Ask the patient whether he or she usually burns when exposed to the sun.
B) Instruct the patient to stop the drug and notify the prescriber immediately.
C) Teach the patient to use sunscreen and wear protective clothing when outdoors.
D) Document the report as the only action and reassure the patient that this problem is temporary.
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Q27

A patient with insomnia also has liver disease. What precaution does the nurse include in this patients care plan?

Multiple Choice
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A) Monitor carefully for increased side effects and adverse effects.
B) Teach the patient that a higher dose is needed for effective action.
C) Check the patients electrolytes before administering the drug.
D) Assess the patients mental status every four hours.
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Q28

The nurse is preparing to teach a patient who has been prescribed zaleplon (Sonata) for insomnia. What does the nurse include in the teaching plan related to the action of this drug?

Multiple Choice
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A) This drug may take from 30 minutes to an hour to work.
B) Go to bed immediately after taking a dose of this drug.
C) Be sure to report any side effects to your prescriber.
D) There is a danger of becoming dependent on this drug.
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Q29

A patient is scheduled for a procedure to test mental function at 6 a.m. At 3 a.m. the patient requests something for sleep. What is the nurses best response?

Multiple Choice
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A) Ill call your prescriber and request an order for something to help you sleep.
B) Your prescriber has ordered temazepam (Restoril). I will give you a dose now.
C) Im sorry, but there is not enough time for sleep now before your procedure.
D) Im sorry, but you already received a dose of temazepam last evening at 9.
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Q30

Which statement about narcolepsy is true?

Multiple Choice
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A) Narcolepsy is an acute neurologic disorder.
B) With narcolepsy, the brain cannot regulate sleep-wake cycles.
C) The underlying problem in narcolepsy is increased oxygenation.
D) Sleep episodes with narcolepsy usually occur during the evening hours.
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Q31

How does oxybate (Xyrem) prevent or treat narcolepsy?

Multiple Choice
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A) It increases sedation to ensure a good nights sleep.
B) It increases general central nervous system stimulation.
C) It antagonizes the sleep induction receptors of the brain.
D) It causes a paradoxical reaction resulting in hyperactivity.
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Q32

A patient is prescribed methylphenidate (Ritalin). The patient asks the nurse how this drug will help treat narcolepsy. What is the nurses best response?

Multiple Choice
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A) This drug reduces the input to your central nervous system sleep centers.
B) This drug sedates you so that you can get a good nights sleep and be less drowsy during the day.
C) This drug stimulates your brain to keep you awake and decrease daytime episodes of sudden sleep.
D) This drug continuously stimulates the brain stem areas ensuring that you breathe more deeply at night.
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Q33

A patient is taking modafinil (Provigil) for narcolepsy. Which precaution is most important for the nurse to teach the patient?

Multiple Choice
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A) Take this drug 1 hour before or 2 hours after a meal.
B) Report episodes of sleepwalking to your prescriber.
C) Check your pulse for rate and regularity twice daily.
D) Avoid eating grapefruit or drinking grapefruit juice.
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Q34

A drug for narcolepsy is prescribed for a 70-year-old nursing home patient. What adjustment in drug administration does the nurse expect to make for this patient?

Multiple Choice
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A) Ensuring that the drug is taken with a meal to prevent nausea.
B) Giving the drug earlier in the day to prevent nighttime incontinence.
C) Giving a lower-than-normal dose to avoid changes in thinking patterns.
D) Crushing the capsule and mixing it with gelatin to make swallowing easier.
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Q35

The nurse is preparing to teach a patient about oxybate (Xyrem) for the treatment of narcolepsy. Which precaution does the nurse stress?

Multiple Choice
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A) Avoid drinking alcohol while taking this drug.
B) Be sure to take this drug with food or milk.
C) Report constipation to your prescriber.
D) Use mints to prevent dry mouth.
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Q36

The nurse is teaching a young adult female about modafinil (Provigil) for narcolepsy. Which precaution does the nurse stress to the patient?

Multiple Choice
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A) Provigil increases your susceptibility to sexually transmitted infections.
B) Loss of inhibition while taking this drug can increase sexual behavior.
C) Provigil can be used during pregnancy but not while breastfeeding.
D) This drug reduces the effectiveness of birth control pills.
Answer:

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Q37

[Multiple Response] Which side effects are commonly associated with most nonsteroidal anti-inflammatory drugs (NSAIDs)? (Select all that apply.)
a. Bleeding
b. Constipation
c. Drowsiness
d. Dry mouth
e. Gastrointestinal ulcers
f. Hypertension g. Memory loss (temporary)

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Q38

[Multiple Response] Which symptoms are expected to be seen in a patient with insomnia? (Select all that apply.)
a. Difficulty falling asleep
b. Sleeping too much
c. Waking often during the night
d. Feeling unrested after sleep
e. Uncontrollable urge to sleep
f. Sleepwalking at least once per week g. Nightmares most of the night

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Q39

[Multiple Response] What are the major symptoms of narcolepsy? (Select all that apply.)
a. Amnesia for events occurring after narcolepsy
b. One-sided seizure activity
c. Cataplexy
d. Total paralysis at beginning or end of sleep
e. Incontinence of urine
f. Frequently waking up at night g. Colorful hallucinations h. Loss of involuntary muscle tone

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Q40

[Multiple Response] What are the major symptoms of narcolepsy? (Select all that apply.)
a. Amnesia for events occurring after narcolepsy
b. One-sided seizure activity
c. Cataplexy
d. Total paralysis at beginning or end of sleep
e. Incontinence of urine
f. Frequently waking up at night g. Colorful hallucinations h. Loss of involuntary muscle tone

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Q41

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

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