Post 11 pain/ anesth

What patient teaching should the nurse do regarding the use of the PCA (patient controlled analgesia) pump?

A. Your family or other visitors may push the button for you if you are asleep.
B. You should not worry about any side effects as this medication is given intraveneously.
C. Push the administration button prior to any activity likely to cause pain, such as walking or coughing.
D. Call the nurse when you need medication. Only the nurse should push the button.



A 57 year old with severe pain from terminal cancer needs pain medicine. Which would be most appropriate?

A. Acetaminophen, sustained release morphine in regular doses and short acting oral morphine as needed for pain uncontrolled with above meds
B. Fentanyl patch, and an oral agonist-antagonist such as pentazocine (Talwin)
C. Meperidine (regular doses throughout day), acetaminophen or aspirin as needed
D. Tricyclic antidepressant and an anticonvulsant



Meperidine (DEMEROL) use is NOT recommended for pain when:

A. Long term use is required, due to buildup of neurotoxic metabolites.
B. The patient has gall bladder disease, due to spasm of the Sphincter of Oddi.
C. The patient has a history of drug abuse, since these patients are not thought to have "true" pain.
D. The pain is nociceptive in nature.



The American Pain Society published Practice Guidelines in 2002 for managing arthritis. For mild pain, the drug of choice is:


A. Acetaminophen
B. Aspirin
C. Celebrex
D. Ibuprofen



You are visiting a patient at home for therapy after orthopedic surgery. The patient is taking VICODAN but says even at the maximum prescribed dose, the pain is not bearable, and he refuses physical therapy. Your best action is to:


A. Instruct the patient to increase the dose of VICODAN.
B. Instruct the patient to take 2 tabs of TYLENOL in between each VICODAN
dose.
C. Contact the MD/NP about adding ibuprofen.
D. Delay therapy for a few weeks until the patient has time to
heal.



An adult patient with life threatening airway spasms from tetanus receives vecuronium (NORCURON) for several weeks. What drug(s) should the patient receive simultaneously?

A. Calcium
B. Diazepam (VALIUM)
C. Succinylcholine (ANECTINE)
D. Neostigmine (PROSTIGMIN) and atropine



Before sticking the large needle through the skin, the surgeon infiltrated the skin with lidocaine in order to:

A. Prevent reflex muscle spasm
B. Reduce pain
C. Decrease blood flow and thus risk of bleeding
D. Suppress autonomic nervous system reflexes



A patient with multiple sclerosis has muscle spasms which are making it difficult for her to work with her physical therapist. A drug which could be used to help this problem is:

A. Baclofen (LIORESOL)
B. Acetaminophen (TYLENOL)
C. Vecuronium (NORCURON)
D. All of the above



A common intravenous agent used in anesthesia for induction and/or maintenance is:

A. Vecuronium (NORCURON)
B. Lidocaine (XYLOCAINE)
C. Atropine
D. Propofol (DIPRIVAN)



A post-operative patient is taking 2 hydrocodone with acetaminophen tablets every 6 hours. How would you best measure efficacy of this medication?

A. Obtain labs to evaluate kidney function.
B. Ask the patient about pain level.
C. Get drug blood levels.
D. Check blood pressure and pulse.



A 3 year old had gastric surgery this morning and needs pain medicine. Which would be most appropriate?

A. Meperidine (DEMEROL) on a patient controlled analgesia (PCA)
pump
B. A fentanyl patch applied 12 hours after the end of surgery
C. Oral hydrocodone with acetaminophen (VICODAN) as needed
D. Small doses of intravenous morphine as needed



Cyclobenzaprine (FLEXERIL) is a muscle relaxant with significant anticholinergic properties. What would you predict for side effects?

A. Diarrhea, abdominal cramps
B. Hypertension, tachycardia
C. Bleeding disorders
D. Dizziness, dry mouth, blurred vision



The inhalation agent isoflurane (FURANE) works by:

A. Preventing the breakdown of acetylcholine at the neuromuscular
junction
B. Increasing action of the neuroinhibitory transmitter gamma-aminobutyric acid
(GABA)
C. Inhibiting reuptake of serotonin by pre-synaptic cells in the
brain
D. Depressing impulse transmission in the brain



A patient with cancer has been taking sustained release morphine around-the-clock for several months. What is the best measure of adverse reactions that you would anticipate at this time?

A. Check skin for rash
B. Check blood pressure
C. Check date of last BM
D. Check respiratory rate




Gabapentin (NEUROTIN) has been ordered for your diabetic patient because:

A. Anxiety is common in diabetics
B. Neuropathic pain is common in diabetics
C. It suppresses vagal stimulation during anesthetic induction
D. It helps maintain blood sugar during the stress of surgery



The anesthetist added bupivacaine to the morphine epidural infusion in order to:

A. Work synergistically with morphine to reduce pain
B. Maintain blood pressure
C. Decrease urinary retention
D. Improve muscle strength in the legs



A diabetic patient has severe neuropathic pain which has been unresponsive to opioids. What would be most appropriate to try next?

A. Acetaminophen
B. The non-steroidal anti-inflammatory naproxen (ALEVE)
C. Gabapentin (NEURONTIN)
D. Methadone


Thanks Lily Sok for all your input, we appreciate it!!!