pharm pain nclex style questions

1

The nurse finds it difficult to relieve a client's pain satisfactorily. Which measure should the nurse take NEXT when continuing efforts to promote comfort 1. increase the client's confidence in the nurse 2. enlist the help of the client's family 3. Allow the client additional time to work through his or her own responses to pain 4. Arrange to have the client share a room with a client who has little pain

b

The nurse is assessing a patient receiving dihydroergotamine for potential side effects. Which symptom, if found, would indicate a side effect of this drug? A. Nausea and vomiting B. Diarrhea C. Physical dependence D. Constipation

c

A nurse administers naloxone to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? A. Drowsiness B. Tics and tremors C. Increased pain D. Nausea and vomiting

b

A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect? A Immunostimulant B Antitussive C Expectorant D Decongestant

d

A patient takes oxycodone [OxyContin] 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? A. The patient should take an antacid with each dose. B. The patient should eat foods high in lactobacilli. C. The patient should take the medication on an empty stomach. D. The patient should increase fluid and fiber in the diet.

c

A patient with chronic pain was admitted to the hospital. The physician orders morphine PO 5 mg every 4 hours. The patient states that he usually takes his home morphine prescription 10 mg every 4 hours and has been for several months. This patient is at risk for which of the following? A. Physical dependence B. Abstinence syndrome C. Addiction D. Tolerance

a, b, c, e

Constipation is a side effect of opioid medications because of which of the following pathophysiologic reasons? (Select all that apply.) A. Decreasing propulsive intestinal contractions B. Increasing nonpropulsive contractions C. Increasing the tone of the anal sphincter D. Delaying gastric transit time E. Reducing fluid secretion into the intestinal lumen

c

The nurse is conducting a pain assessment for a patient with cancer. Which data will be the most helpful in assessing the patient's current level of pain? A. Vital signs and surgical history B. Pain pump attempt history C. Patient's description of pain D. Patient's nonverbal behavior

b

The healthcare provider orders celecoxib 200 mg PO every day for pain in the postoperative patient. The medication available is celecoxib 200 mg. How many capsules will the nurse administer? A. 0.5 B. 1 C. 2 D. 3

b

The healthcare provider orders celecoxib [Celebrex] 200 mg PO every day for pain in the postoperative patient. The nurse knows that this medication is which classification? A. Opioid analgesic B. Selective COX-2 inhibitor C. Propionic acid derivative D. Salicylate

a

A postoperative patient has an epidural infusion of morphine sulfate [Astramorph]. The patient's respiratory rate declines to 8 breaths per minute. Which medication would the nurse anticipate administering? A. Naloxone B. Meperedine C. Nalbuphine D. Prednisone

b, c, e

A patient with end-stage breast cancer is experiencing ineffective pain management. Which statement represents the most likely cause of this problem? (Select all that apply.) A. Most cancer pain is neuropathic and difficult to relieve. B. Many cancer patients are reluctant to take pain medication. C. Healthcare professionals often fear patient addiction to pain medication. D. Nociceptive pain does not respond well to traditional pain medications. E. The healthcare system often places a low priority on pain management.

b, c, d

An adult patient presents to the emergency department and is diagnosed with a severe migraine headache. Which class of medication would the nurse expect to be ordered for this patient? (Select all that apply.) A. Beta blocker B. Opioid analgesic C. Migraine-specific agent D. Antiemetic E. Aspirin-like agent

2

Ergotamine is prescribed for a client's migrane headaches. which is an expected outcome of the use of this drug? 1. prevention of the migrane 2. aborting the developing migrane 3. relief form the sleeplessness experienced in the past after a migrane 4. relief from the vision problems experienced in the past after a migrane

c

The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? A. "You will need to change this patch every day, regardless of your pain level." B. "This type of pain medication is not as likely to cause breathing problems." C. "With the first patch, it will take about 24 hours before you feel the full effects." D. "Use your heating pad for the back pain. It will also improve the patch's effectiveness."

b

The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? A. At least 30% of the U.S. population is prone to drug addiction and abuse. B. The development of opioid dependence is rare when opioids are used for acute pain. C. Morphine is a common drug of abuse in the general population. D. The use of PRN (as needed) dosing provides the most consistent pain relief without risk of addiction.

1

The nurse knows that the main reason that massage is used as a pain relieving therapy is because it: 1. blocks pain impulses from the spinal cord to the brain 2. clicks pain impulses from the brain to the spinal cord 3. stimulates the release of endorphins 4. distracts the clients focus on the source of the pain

1, 2, 4, 6

a client with lung cancer is being cared for at home. his pain is increasing in severity. the nurse recognizes that teaching has been effective when the family: (select all that apply) 1. gives the patient a long acting or sustained release oral pain medication regularly around the clock 2. uses an immediate release medication (oxycodone) for breakthrough pain 3. avoids long lasting opioids due to concern that he may become addicted 4. uses music for distraction as well as heat or cold in combination with the medications 5. substitutes aceteminophen to avoid tolerance to the medications 6. has the patient use a pain rating scale to measure the effectiveness at reaching his individual pain goal

3

a client with pancreatic cancer has been recieving morphine cia a subcutaneous pump for 2 weeks. the client is requiring an increased dose of the morphine to manage the pain. the nurse should document that the client is: 1. tolerating the medication well' 2. developing an addiction to morphine 3. developing a tolerance for the medication 4. experiencing physical dependance

1

a nurse is assessing a client with a bone cancer pain. which part of a thorough pain assessment is most significant for this client? 1. intensity 2. cause 3. aggravating factors 4. location

1

after administering meperidine hydrochloride, the nurse determines its effecctiveness as an analgesic was related to its ability to: 1. reduce the perception of pain 2. decrease the sensitivity of pain receptors 3. interfere with pain impulses traveling along sensory nerve fibers 4. block the conduction of pain impulses along the CNS

1

assessment of a client taking a nonsteroidal anti-inflammatory drug (NSAID) for pain management should include specific questions about which body system? 1. gastrointestinal 2. renal 3. pulmonary 4. cardiac

2

nursing responsibilities for the client with a patient controlled analgesia system include 1. reassuring the client that pain will be relieved 2. documenting the clients response to pain medication 3. instructing the client to continue pushing the button whenever pain occurs 4. titrating the clients pain medication until the client is free of pain

A

patient with chronic pain has a fentanyl patch applied to his right shoulder. The patient reports that his arm hurts and he requests a warm pack to apply to the area. Which statement by the nurse is correct? A. "Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release." B. "Your arm probably hurts because of the fentanyl patch." C. "I can remove your patch and reapply it after you are done with the warm pack." D "The fentanyl patch is heat resistant, so I will get you a warm pack."

2, 3

the nurse is assessing a client with chronic pain. what findings are expected for a client in chronic pain? select all that apply 1. facial grimacing 2. normal vital signs 3. physical inactivity 4. moaning 5. depression

2

the nurse teaches the client with chronic ccancer pain about optimal pain control. which reccomendation is most effective for pain control? 1. get used to some pain, and use a little less pain medication than needed to keep from getting addicted 2. take prescribed analgesics on an around the clock schedule to prevent recurrent pain 3. take analgesics only when pain returns 4. take enough analgesics around the clock so that you can sleep 12-16 hours per day to block the pain

2

when a nurse is assessing a client for pain, what finding is MOST significant? 1. the client protects a specific part of the body 2. the client tells the nurse about experiencing pain 3. the client has a change in vital signs 4. the client appears to be uncomfortable

2

The HCP prescribes morphine 2-4 mg push every 2 hours for PRN pain for a client who has postoperative pain following abdominal surgery. Prior to performing an abdominal dressing change with packing at 1000, the nursing assesses the client's pain as a 1 on a scale of 0=no pain to 10=worst pain. THe client is awake and oriented, and vital signs are WNL. The nurse reviews the pain medication record and sees that at 0700, the client reported a pain level of 8, when 4 mg of morphine was administered via IV. at 0900, the clients pain level was a 4, and 2 mg of IV morphine was administered. What should the nurse do? 1. perform the dressing change 2. administer morphine 2 mg IV before the dressing change 3. Administer morphine 4 mg IV after the dressing change 4. Call the HCP for a new medication prescription

b

The healthcare provider orders oxycodone oral suspension 10 mg PO every 4 hours PRN. The medication available is oxycodone 20 mg/mL. How many mL will the nurse administer? A. 0.25 mL B. 0.5 mL C. 1 mL D. 2 mL

b

The nurse is caring for a female patient receiving sumatriptan [Imitrex]. Which concept guides the nursing care of this patient? A. Coronary vasospasm is a common problem with this drug. B. Many patients experience symptoms of chest pressure or heavy arms. C. Sumatriptan increases the risk of nausea and vomiting with migraines. D. Sumatriptan is considered safe to use during pregnancy.

a, c, e

The nurse is caring for a patient who is being treated with opioids for cancer pain. The patient has become agitated and is reporting visual disturbances. The nurse suspects opioid-induced neurotoxicity. The nurse anticipates which management actions? (Select all that apply.) A. IV fluids B. Naloxone (Narcan) C. Decreasing the dose of the opioid D. Using NSAIDs instead of opioids E. Rotating different opioids

b

The nurse is planning care for a patient receiving morphine by means of a patient-controlled analgesia (PCA) pump. Which intervention may be required because of a potential adverse effect of this drug? A Administering a cough suppressant B Inserting a Foley catheter C Administering an antidiarrheal D Monitoring liver function tests

d

The nurse is preparing to give ergotamine. This agent is effective against headaches of which origin? A. Hypertension B. Hyperthyroidism C. Sinus pressure D. No identifiable cause

c

The nurse is reviewing the patient's current medication list and recognizes that which medication is considered a first-line drug for migraine prevention? A. Topiramate B. Metoclopramide C. Propranolol D. Ergotamine

a

The nurse is teaching a patient with a new prescription for ergotamine. Which statement is most appropriate to include in the teaching plan? A. "You should not use this drug more than 1 or 2 days per week." B. "You should rise slowly from a sitting to a standing position." C. "Be sure to include bananas and melons in your diet to increase potassium." D."You will need to return to the clinic for blood work monthly."

a

Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? A. Morphine B. Pentazocine C. Hydrocodone D. Nalmefene

b

Which condition should the nurse anticipate when the patient has received an intraspinal opioid medication to control cancer pain? A. Reduced risk of nausea, vomiting, and constipation B. Potential for delayed respiratory depression and catheter-related infections C. Less need for rescue medication to control breakthrough pain D. Greater risk of paresthesias and numbness in the lower extremities

c

Which of the following measurements would prompt the nurse to hold the sumatriptan dose and contact the provider? A. Resp rate 20 B. Heart rate 59 C. Blood pressure 190/100 D. SpO2 90%

a

Which side effect of morphine does not subside over time? A. Constipation B. Sedation C. Respiratory depression D. Nausea and vomiting

4

a client in a hospice program has increasing pain, The nurse and the client collaborate to schedule analgesics to provide: 1. doses of analgesic when pain is a 5 on a scale of 1-10 2. enough analgesic to keep the client semisomnolent 3. an analgesia free period so that the client can carry out daily hygienic activities 4. around the clock administration of analgesics for continuous pain relief