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Pharm Final Quiz 5 (Pain)

Total questions: 100

Worksheet time: 51mins

Name
Class
Date
1.

What are the four components of the neuroanatomy of pain?

a)

Transduction, Transmission, Perception, Modulation

b)

Sensation, Reaction, Perception, Modulation

c)

Transduction, Sensation, Reaction, Modulation

d)

Transmission, Sensation, Perception, Reaction

2.

Which of the following is NOT a type of pain listed in the study guide?

a)

Acute (visceral, somatic, referred)

b)

Chronic (spinal/non-spinal, neuropathic, phantom limb)

c)

Psychological pain

d)

Neither acute or chronic are listed

3.

Pain is the ____ vital sign!

a)

5th

b)

3rd

c)

10th

d)

2nd

4.

Opioids are used for which of the following?

a)

A) Post-op pain

b)

B) Chronic pain

c)

C) Both A and B

5.

When starting an opioid, the recommended approach is 'START LOW GO SLOW'.

a)

True

b)

False

6.

Which opioid is considered the standard and represents 1 unit in MMEs?

a)

Morphine

b)

Oxycodone

c)

Fentanyl

d)

Hydromorphone

7.

Hydromorphone is how many times stronger than morphine?

a)

4 times

b)

2 times

c)

8 times

d)

10 times

8.

Which medication is commonly used for chronic pain?

a)

Methadone

b)

Oxycodone IR

c)

Liquid morphine

d)

Hydrocodone+acetaminophen

9.

Which medication is used for post joint replacements?

a)

Oxycodone IR

b)

Methadone

c)

Tramadol

d)

Liquid morphine

10.

Which medication is used for Acute/Chronic/End of Life/Cancer Pain?

a)

Liquid morphine

b)

Methadone

c)

Oxycodone IR

d)

Tramadol

11.

Which of the following is a side effect/adverse event (SE/AE) of opioid use?

a)

Respiratory depression and/or arrest

b)

Hypertension

c)

Increased appetite

d)

Insomnia

12.

Fill in the blank: ________ is a side effect of opioid use that involves difficulty in urination and bowel movements.

a)

Urinary retention, constipation, bowel dysfunction

b)

Respiratory alkalosis, diarrhea, insomnia

c)

Hypertension, tachycardia, sweating

d)

Hyperglycemia, polyuria, weight gain

13.

Opioid use can cause cough suppression.

a)

True

b)

False

14.

Which of the following is NOT a side effect of opioid use?

a)

Cognitive dysfunction

b)

Dry mouth

c)

Elevated risk of fracture

d)

Increased blood pressure

15.

Which of the following is a sign of opioid toxicity?

a)

Miosis (pin point pupils)

b)

Mydriasis (dilated pupils)

c)

Tachycardia

d)

Hypertension

16.

Tolerance and physical dependence are possible with opioid use.

a)

True

b)

False

17.

Which of the following is a proactive measure to prevent OD/Death from opioids?

a)

Monitoring for respiratory depression

b)

Increasing opioid dose

c)

Ignoring side effects

d)

Reducing fluid intake

18.

Fill in the blank: ________ is an opioid used for chronic pain and is available in ER/IR formulations.

a)

Morphine

b)

Lidocaine

c)

Acetaminophen

d)

Aspirin

e)

Prednisone

19.

Which of the following is a risk associated with opioid use?

a)

A) Elevated risk of fracture

b)

B) Decreased risk of infection

c)

C) Improved cognitive function

d)

D) Increased sex hormones

20.

Opioid induced hyperalgesia is a condition where opioids increase sensitivity to pain.

a)

True

b)

False

21.

Fill in the blank: ________ are opioids used for chronic pain along with methadone and morphine.

a)

hydromorphone and tramadol

b)

acetaminophen and ibuprofen

c)

aspirin and naproxen

d)

lidocaine and bupivacaine

22.

What is the opioid antidote/reversal agent mentioned in the notes?

a)

Naloxone

b)

Sodium Bicarbonate

c)

Mucomyst

d)

Acetaminophen

e)

Straight Fent

23.

Naloxone is an opioid antagonist.

a)

True

b)

False

24.

Naloxone/Narcan is available by:

a)

Prescription only

b)

Over the counter only

c)

Prescription OR OTC

d)

Hospital use only

25.

List two signs/symptoms of opioid overdose (OD) as mentioned in the notes.

a)

Extreme respiratory depression, coma, analgesia

b)

Hypertension, tachycardia, fever

c)

Increased alertness, insomnia, euphoria

d)

Diarrhea, excessive sweating, muscle cramps

26.

How is Naloxone/Narcan administered?

a)

Intranasally (spray), IM, SQ, continuous IV drip

b)

Orally only

c)

Topically as a cream

d)

Sublingually only

27.

IM/SQ effects of Naloxone/Narcan begin within how many minutes?

a)

2-5 minutes

b)

10-15 minutes

c)

20-30 minutes

d)

30-60 minutes

28.

Tramadol/Ultram is:

a)

Weak agonist at mu receptors

b)

Strong agonist at mu receptors

c)

Antagonist at mu receptors

d)

No effect on mu receptors

29.

Naloxone/Narcan ONLY PARTIALLY blocks the effects of which drug?

a)

Tramadol

b)

Morphine

c)

Fentanyl

d)

Oxycodone

30.

Which of the following should NOT be used with MAOIs?

a)

A) Naloxone

b)

B) Tramadol

c)

C) Both A and B

d)

D) Neither A nor B

31.

Chemical mediators of inflammation are primarily stored in which cells?

a)

Mast cells

b)

Neutrophils

c)

Erythrocytes

d)

Platelets

32.

Name the chemical mediators of inflammation.

a)

Histamine, bradykinin, prostaglandins, leukotrienes

b)

Glucose, insulin, adrenaline, thyroxine

c)

Collagen, elastin, keratin, actin

d)

Hemoglobin, myoglobin, albumin, globulin

33.

What is the compensatory mechanism that attempts to restore homeostasis after injury?

a)

Inflammation

b)

Osmosis

c)

Photosynthesis

d)

Fermentation

34.

Which of the following is NOT a function of prostaglandins?

a)

Increase vasodilation

b)

Decrease capillary permeability

c)

Cause fever

d)

Sensation of pain

35.

NSAIDs are prostaglandin inhibitors.

a)

True

b)

False

36.

COX-1 enzyme protects the stomach lining, supports renal function, and regulates blood platelet aggregation.

a)

True

b)

False

37.

COX-2 triggers _______, pain, and fever, and supports renal function.

a)

inflammation

b)

digestion

c)

respiration

d)

metabolism

38.

Most commonly used NSAIDs are ______ COX inhibitors.

a)

non-selective

b)

selective

c)

irreversible

d)

partial

39.

Which of the following is NOT a common side effect of NSAIDs?

a)

GI upset

b)

GI dysfunction

c)

Excessive clotting

d)

Peripheral edema

40.

Aspirin is also known as _______.

a)

acetylsalicylic acid/ASA

b)

paracetamol

c)

ibuprofen

d)

naproxen

41.

Aspirin is a selective COX inhibitor.

a)

True

b)

False

42.

What is Reye's Syndrome associated with?

a)

Use of ASA in children with viral febrile illnesses

b)

Use of NSAIDs in adults

c)

Use of acetaminophen in children

d)

Use of antibiotics in viral infections

43.

What is a characteristic symptom of salicylism?

a)

Rash

b)

Tinnitus

c)

Fever

d)

Cough

44.

Fill in the blank: Severe symptoms of salicylism include angioedema, tachypnea, tachycardia, GI bleed (stool and emesis), and ________.

a)

hearing loss

b)

blurred vision

c)

muscle cramps

d)

rash

45.

Which of the following is a supportive treatment for acute ASA poisoning?

a)

IV sodium bicarbonate

b)

Oral antibiotics

c)

PO sodium bicarbonate

d)

SQ sodium bicarbonate

46.

Non-aspirin 1st Generation NSAIDs were developed as an alternative to decrease what?

a)

Analgesic effect

b)

Adverse effects

c)

Antipyretic effect

d)

COX inhibition

47.

All non-aspirin 1st Generation NSAIDs are anti-inflammatory agents with analgesic and antipyretic properties.

a)

True

b)

False

48.

Fill in the blank: The incidence of adverse effects (nausea/vomiting, gastric ulcers, bleeding) is ________ with non-aspirin 1st Generation NSAIDs compared to ASA.

a)

less

b)

more

c)

the same

d)

unaffected

49.

Indomethacin (Indocin) is approved for the treatment of ________ and gout.

a)

arthritis

b)

hypertension

c)

diabetes

d)

asthma

50.

Which NSAID can be given IV to preterm infants to promote closure of ductus arteriosus?

a)

Ibuprofen

b)

Indomethacin

c)

Naproxen

d)

Aspirin

51.

Which of the following is a powerful analgesic that is equivalent to morphine in analgesic effectiveness but has no opioid adverse effects?

a)

Ibuprofen

b)

Ketorolac

c)

Naproxen

d)

Diclofenac

52.

Ketorolac should be limited to use for how many days?

a)

5 days

b)

10 days

c)

2 days

d)

14 days

53.

Ketorolac should be given with other NSAIDs.

a)

True

b)

False

54.

Which of the following is NOT an example of a traditional NSAID?

a)

Ibuprofen

b)

Naproxen

c)

Celecoxib

d)

Diclofenac

55.

2nd Generation NSAIDs treat pain and inflammation WITHOUT the adverse effects of blocking which enzyme?

a)

COX-1

b)

COX-2

c)

Both COX-1 and COX-2

d)

None of the above

56.

Selective COX-2 inhibitors suppress platelet aggregation.

a)

True

b)

False

57.

Which of the following drugs inhibits prostaglandins ONLY in the CNS and does NOT have GI adverse effects?

a)

Ibuprofen

b)

Acetaminophen

c)

Naproxen

d)

Meloxicam

58.

Acetaminophen reduces fever and pain in the CNS but has no ________ effect.

a)

anti-inflammatory

b)

sedative

c)

antiviral

d)

antibiotic

59.

What is the maximum adult daily dose of acetaminophen?

a)

4g

b)

2g

c)

6g

d)

8g

60.

What is the antidote to acetaminophen overdose?

a)

Naloxone

b)

Acetylcysteine

c)

Flumazenil

d)

Atropine

e)

Sodium Bicarbonate

61.

Acetylcysteine/Mucomyst is most effective if given shortly after ingestion of acetaminophen.

a)

True

b)

False

62.

Acetylcysteine/Mucomyst still provides protection if administered within how many hours of ingestion?

a)

24 hours

b)

12 hours

c)

36 hours

d)

48 hours

63.

Which of the following is NOT a step in the administration of acetylcysteine/Mucomyst?

a)

IV drip, approximately 2.5 L of solution continuously

b)

Stop the IV drip after 1 hour

c)

Scheduled liver labs

d)

Re-evaluate by watching lab values

64.

Local anesthetics are typically used for patients with what kind of history of allergic reactions?

a)

A low history of allergic reactions

b)

A high history of allergic reactions

c)

A long history of allergic reactions

d)

A severe history of allergic reactions

65.

Local anesthetics are metabolized by which enzymes?

a)

Hepatic enzymes

b)

Amylase enzymes

c)

Pepsin enzymes

d)

Lipase enzymes

66.

What do local anesthetics block in the axonal membrane?

a)

Potassium channels

b)

Calcium channels

c)

Sodium channels

d)

Chloride channels

67.

Blockage by local anesthetics starts in which type of neurons?

a)

Large myelinated neurons

b)

Small nonmyelinated neurons

c)

Motor neurons

d)

Sensory neurons only

68.

What should you do to protect a patient after administering a local anesthetic until the anesthetic wears off?

a)

Protect the patient from injury until the anesthetic wears off.

b)

Allow the patient to eat immediately after the procedure.

c)

Encourage the patient to engage in strenuous activity.

d)

Remove all monitoring equipment immediately after administration.

69.

For a lidocaine patch, how long should it be applied and removed?

a)

Apply for 6 hrs, remove for 6 hrs

b)

Apply for 12 hrs, remove for 12 hrs

c)

Apply for 24 hrs, remove for 24 hrs

d)

Apply for 8 hrs, remove for 8 hrs

70.

What should you do after applying a lidocaine patch?

a)

Wash hands after application.

b)

Expose the patch to direct sunlight.

c)

Apply heat over the patch area.

d)

Remove the patch after 5 minutes.

71.

Which of the following are injectable local anesthetics?

a)

Lidocaine, bupivacaine, ropivacaine

b)

Fentanyl, morphine, codeine

c)

Acetaminophen, ibuprofen, aspirin

d)

Epinephrine, norepinephrine, dopamine

72.

Who typically inserts an epidural for regional anesthesia?

a)

Nurse

b)

Anesthesiologist

c)

Surgeon

d)

Pharmacist

73.

Epidural administration typically contains which of the following?

a)

anesthetics

b)

opioids

c)

anesthetics AND opioids

d)

saline

74.

Which of the following is NOT a nursing intervention for epidural administration?

a)

Assess level of numbness

b)

Protect site and patient from injury

c)

Remove epidural catheter when ordered

d)

Administer oral antibiotics routinely

75.

You should monitor for respiratory depression if the epidural is placed too high.

a)

True

b)

False

76.

You should monitor for oversedation and respiratory depression if an opioid is used with an epidural.

a)

True

b)

False

77.

Which of the following is a muscle relaxant used as part of a multimodal pain regimen?

a)

baclofen/Lioresal

b)

gabapentin/Neurontin

c)

prednisone

d)

cyclosporine/Sandimmune

78.

Which drug is classified as an anticonvulsant that helps with neuropathic pain?

a)

pregabalin/Lyrica

b)

tizanidine/Zanaflex

c)

cyclobenzaprine/Flexeril

d)

tacrolimus/Prograf

79.

Fill in the blank: _______ is a muscle relaxant also known as Soma.

a)

carisoprodol

b)

diazepam

c)

acetaminophen

d)

ibuprofen

80.

Fill in the blank: _______ is a muscle relaxant also known as Flexeril.

a)

cyclobenzaprine

b)

diazepam

c)

acetaminophen

d)

ibuprofen

81.

Which of the following is used to prevent the body's response to antigens in organ/tissue transplant?

a)

Immunosuppressants

b)

Anticonvulsants

c)

Muscle relaxants

d)

Antibiotics

82.

Antibodies can completely destroy a transplant in days.

a)

True

b)

False

83.

Immunosuppressants are also used for severe cases of which autoimmune disorders?

a)

Rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis

b)

Asthma, allergic rhinitis, eczema

c)

Diabetes mellitus, hypertension, hyperlipidemia

d)

Osteoarthritis, gout, osteoporosis

84.

Which class of drugs is used PRIMARILY to prevent kidney/liver/heart transplant rejection?

a)

Calcineurin inhibitors

b)

Glucocorticoids

c)

Cytotoxic agents

d)

Anticonvulsants

85.

Fill in the blank: The drug of choice among calcineurin inhibitors is _______.

a)

cyclosporine/Sandimmune

b)

tacrolimus/Prograf

c)

sirolimus/Rapamune

d)

everolimus/Zortress

86.

Which statement is true about tacrolimus/Prograf when compared to cyclosporine/Sandimmune?

a)

It is less effective but less toxic

b)

It is more effective but also more toxic

c)

It is only used for pain management

d)

It is a muscle relaxant

87.

Grapefruit juice inhibits the metabolism of calcineurin inhibitors and leads to toxicity.

a)

True

b)

False

88.

Glucocorticoids are used to increase immune responses.

a)

True

b)

False

89.

Common glucocorticoid drugs have the suffix _____

a)

-one

b)

-pril

c)

-olol

d)

-sartan

90.

Which of the following is NOT a common glucocorticoid drug?

a)

A) Betamethasone

b)

B) Dexamethasone

c)

C) Amoxicillin

d)

D) Hydrocortisone

91.

Long term steroid use mimics ______, abrupt withdrawal mimics Addison’s disease.

a)

Cushings

b)

Graves

c)

Hashimoto's

d)

Myxedema

92.

Patients on steroids for less than 2 weeks do NOT need to ______ the drug.

a)

TAPER

b)

INCREASE

c)

STOP IMMEDIATELY

d)

DOUBLE

93.

Tapering of glucocorticoids should occur over ____ days.

a)

5-10

b)

1-2

c)

15-20

d)

30-40

94.

NEVER ABRUPTLY STOP ________!

a)

GLUCOCORTICOIDS

b)

NSAIDS

c)

OPIOIDS

d)

ANESTHETICS

95.

Cytotoxic agents suppress the immune system by killing ______ undergoing proliferation.

a)

T and B lymphocytes

b)

red blood cells

c)

platelets

d)

neurons

96.

Cytotoxic agents specifically target pathogens and dysfunctioning cells, and they do nothing to normal proliferating cells in the body.

a)

True

b)

False

97.

SATA: Select all of the adverse effects of cytotoxic agents.

a)

bone marrow suppression

b)

GI dysfunction

c)

alopecia

d)

oral sores

e)

destruction of T lymphocytes

98.

Which of the following are nursing interventions when caring for a patient with opioid abuse disorder?

a)

Advocate for pain control

b)

Consider pharmacological options and alternatives if tolerance to opioids is high

c)

Monitor for opioid withdrawal syndrome

d)

Refer to behavioral health services, including medication assisted treatment options

e)

All of the above

99.

 Buprenorphine, methadone, and naltrexone are all approved by the FDA as long-term medicinal options for treating opioid use disorder.

a)

True

b)

False

100.

SATA: What are some warning signs that a nurse you are working with might suffer from substance abuse disorder?

a)

Changes in job performance

b)

Extended absences from unit

c)

Isolation from colleagues

d)

Increased wasting/strange wasting behaviors

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