Holland/Adams/Brice, Core Concepts in Pharmacology 5th Edition Test Bank
Chapter 15

Question 1

Type: MCSA

The nurse is admitting a client to the floor with a diagnosis of migraine headache. The client relates she has had this type of headache for 12 years. On admission, the client states the headaches are coming more frequently, which has forced her to quit her job. What type of pain is this client experiencing?

1. Surgical pain
2. Chronic pain
3. Neuropathic pain
4. Acute pain

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 222

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-1 Relate the importance of pain assessment to effective pharmacotherapy.

Question 2

Type: MCMA

A client presents with chronic pain that has recently increased in severity. The nurse knows this type of pain can be increased with which occurrence? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Depression
2. Overuse of OTC pain relievers
3. Anxiety
4. Fatigue
5. New pain medication

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 222

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-1 Relate the importance of pain assessment to effective pharmacotherapy.

Question 3

Type: MCSA

The nurse is caring for two clients with the same diagnosis. One client complains of pain rated 6/10 and the other client complains of pain rated 1/10. How does the nurse explain why these two clients experience such differences in their pain rating?

1. The client’s reaction to pain is a subjective experience.
2. Both clients’ reaction to pain should be the same.
3. The client with the pain rated 1/10 does not want to complain.
4. One client has progressed further in the disease.

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 222

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-1 Relate the importance of pain assessment to effective pharmacotherapy.

Question 4

Type: MCSA

A client complains of pain that is a generalized dull, throbbing, or aching pain. What type of pain does the nurse document that this client is experiencing?

1. Visceral pain
2. Acute pain
3. Somatic pain
4. Neuropathic pain

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 223

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-2 Explain the neural mechanism for pain processing, including the involvement of spinal neurotransmitters.

Question 5

Type: MCMA

Which statements are true regarding pain medications? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Opioids act within the CNS.
2. NSAIDs act at the nociceptor level.
3. NSAIDs act within the CNS.
4. Opioids act at the nociceptor level.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Page Number: 224

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-2 Explain the neural mechanism for pain processing, including the involvement of spinal neurotransmitters.

Question 6

Type: MCMA

The nurse instructs a client on nonpharmacologic therapies for pain management. Which techniques should be included in this teaching? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Physical therapy
2. Heat or cold packs
3. Massage
4. Anti-inflammatory drugs
5. Opioid drugs

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 224

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-3 Describe the supportive roles of nonpharmacologic therapies and adjuvant analgesics in pain management.

Question 7

Type: MCSA

Which statements are true regarding opioid receptors? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Opioid blockers inhibit both the mu and kappa receptors.
2. Some opioids stimulate a particular receptor; others block a receptor.
3. Opioid blockers stimulate both the mu and kappa receptors.
4. Opioids interact with mu and kappa receptors.
5. Opioids interact with delta receptors.

Cognitive Level: Understanding

Client Need: Physiological Integrity

Page Number: 226

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-4 Compare and contrast the types of opioid receptors and their importance to pharmacotherapy.

Question 8

Type: MCSA

The client asks which type of medications will be given for severe pain. Which response by the nurse is most appropriate?

1. Acetaminophen (Tylenol)
2. Opioids
3. NSAIDs
4. Beta blockers

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 226

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-4 Compare and contrast the types of opioid receptors and their importance to pharmacotherapy.

Question 9

Type: MCSA

The nurse is caring for a client who has a morphine (Astramorph PF) patient-controlled analgesia (PCA). Which medication should the nurse ensure is readily available?

1. Meperidine (Demerol)
2. Naloxone (Narcan)
3. Butorphanol (Stadol)
4. Codeine

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Numbers: 227–228

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the role of opioids in the management of severe pain, and describe the treatment of acute opioid toxicity as well as the long-term treatment of opioid dependence.

Question 10

Type: MCSA

Which statement by the nurse is correct regarding treatment with methadone (Dolophine)?

1. Methadone (Dolophine) can only be safely administered for 1 month.
2. Methadone (Dolophine) is only administered when the client is tempted to use illegal drugs.
3. Methadone (Dolophine) can only be administered by IV.
4. Methadone (Dolophine) treatment continues for many months or years, until the patient decides to enter a total withdrawal treatment program.

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 230

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the role of opioids in the management of severe pain, and describe the treatment of acute opioid toxicity as well as the long-term treatment of opioid dependence.

Question 11

Type: MCSA

The nurse is caring for a client who has been diagnosed with migraine headaches that occur every 2–3 days and placed on preventive therapy with the beta blocker propranolol (Inderal). Which data indicates the medication is effective?

1. The client has supplemented propranolol with sumatriptan (Imitrex) four times this week.
2. The apical pulse is 78 beats per minute for this client.
3. The client had only one headache in the past week.
4. The client has developed orthostatic hypotension.

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Page Number: 237

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 15-7 Discuss the pharmacotherapeutic approaches to preventing and aborting migraines.

Question 12

Type: MCSA

A client has taken OTC acetaminophen (Tylenol) and ibuprofen (Motrin) for migraine headaches without relief. Which class of medication would the nurse anticipate being ordered?

1. Triptans
2. Calcium channel blockers
3. Beta-adrenergic blockers
4. Tricyclic antidepressants

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 236

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 15-7 Discuss the pharmacotherapeutic approaches to preventing and aborting migraines.

Question 13

Type: MCSA

The client is prescribed propranolol (Inderal) for migraine headache prophylaxis. The nurse prepares discharge instructions based on the fact that propranolol (Inderal) belongs to which class of medication?

1. Beta blocker
2. Calcium channel blocker
3. Ergot alkaloid
4. Triptan

Cognitive Level: Remembering

Client Need: Physiological Integrity

Page Number: 236

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-7 Discuss the pharmacotherapeutic approaches to preventing and aborting migraines.

Question 14

Type: MCSA

The client reports severe headaches that are preceded by flashing lights and strange smells. How would the nurse appropriately document this phenomenon?

1. An aura of a migraine
2. A tension headache
3. An adverse reaction to acetaminophen (Tylenol)
4. Combining food with NSAIDs

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 235

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-7 Discuss the pharmacotherapeutic approaches to preventing and aborting migraines.

Question 15

Type: MCMA

A client is being discharged with a prescription for oxycodone HCl (OxyContin). Which discharge instructions are appropriate? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. Increase the dose of oxycodone if the pain returns
2. Maintain adequate fluid intake
3. Withhold the medication if respirations are fewer than 12 breaths per minute
4. Use OTC sleep-inducing antihistamines when needed
5. Use OTC medications for constipation, if needed

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 231

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the role of opioids in the management of severe pain, and describe the treatment of acute opioid toxicity as well as the long-term treatment of opioid dependence.

Question 16

Type: MCSA

The client has been prescribed Percocet for pain. What should the nurse advise this client to avoid?

1. Green, leafy vegetables
2. Increased fluids
3. Vitamin supplements
4. Acetaminophen (Tylenol)

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 228

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the role of the opioids in the management of severe pain, and describe the treatment of acute opioid toxicity as well as the long-term treatment of opioid dependence.

Question 17

Type: MCSA

The client with a headache rates the pain at a 3 on a 1–10 scale. Which medication would the nurse administer?

1. Sumatriptan (Imitrex), subcutaneous
2. Dihydroergotamine (D.H.E. 45) intranasally
3. Butorphanol (Stadol) IM
4. Ibuprofen (Motrin) PO

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 233

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-6 Identify representative drugs used in the management of less severe pain and explain their mechanisms of drug action, primary actions, and important adverse effects.

Question 18

Type: MCSA

The nurse is providing care for a client who is taking acetaminophen (Tylenol). What should the nurse pay particular attention to during the assessment?

1. Respiratory rate
2. Pulse rate
3. Blood pressure
4. Severe upper or lower abdominal pain

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 231

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-6 Identify representative drugs used in the management of less severe pain and explain their mechanisms of drug action, primary actions, and important adverse effects.

Question 19

Type: MCSA

The nurse is caring for a client who is 24 hours postoperative cholecystectomy. The client has a meperidine (Demerol) PCA pump. Which symptom should be reported to the physician immediately?

1. Constipation
2. Respiratory rate of 18 breaths per minute
3. Urine output of 15 mL per hour
4. Blood pressure of 130/80 mmHg

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 231

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the role of opioids in the management of severe pain, and describe the treatment of acute opioid toxicity as well as the long-term treatment of opioid dependence.

Question 20

Type: MCSA

The nurse is caring for a client receiving morphine sulfate 2–4 mg IV every 4 hours as needed for pain. The client’s family calls the nurses’ station to request pain medication for the client. When the nurse arrives in the room, the client is lying in the bed. The nurse obtains the following vital signs: BP 120/80, P 80, and R 8. What is the nurse’s first action?

1. Call the physician after giving the pain medication
2. Call the physician
3. Find out when the client had the last dose of medication
4. Withhold the medication

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 231

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-5 Explain the role of opioids in the management of severe pain, and describe the treatment of acute opioid toxicity as well as the long-term treatment of opioid dependence.

Question 21

Type: MCSA

The nurse is providing discharge teaching to a client who is to take aspirin 325 mg per day. What statement by the client indicates an understanding of the teaching?

1. “Now that I take an aspirin a day, my gastric ulcer will heal.”
2. “I will check with my physician before taking any OTC medications.”
3. “Now that I take aspirin, I can no longer take my acetaminophen (Tylenol).”
4. “I can still take my ibuprofen every day, as I did before taking the aspirin.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 232

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 15-6 Identify representative drugs used in the management of less severe pain and explain their mechanism of drug action, primary actions, and important adverse effects.

Question 22

Type: MCSA

The nurse is performing the AM assessment on a client who is postoperative cholecystectomy. The client states he needs his pain medication. The client has meperidine (Demerol) 50 mg IM ordered for pain. What must the nurse assess before administering a narcotic?

1. A full set of vital signs including temperature, blood pressure, heart rate, and respirations
2. The last time the client had a bowel movement
3. The quality, intensity, location, and duration of pain
4. How long the pain has been going on

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 222

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-1 Relate the importance of pain assessment to effective pharmacotherapy.

Question 23

Type: MCSA

What should be included in the discharge instructions for a client diagnosed with cancer who is taking hydrocodone with acetaminophen (Vicodin) prn?

1. Use Tylenol for any pain unrelieved by the Vicodin.
2. Notify the physician if the medication relieves the pain.
3. Increase the intake of fluids and fiber in the diet to prevent constipation.
4. Take the medication only when the pain is greater than an 8 on a scale of 1–10.

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 231

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-5 Explain the role of opioids in the management of severe pain, and describe the treatment of acute opioid toxicity as well as the long term treatment of opioid dependence.

Question 24

Type: MCSA

What is the mechanism of action of sumatriptan (Imitrex) and other triptans?

1. They cause vasoconstriction of cranial arteries.
2. They block prostaglandin synthesis.
3. They block COX-2.
4. They affect mu receptors.

Cognitive Level: Understanding

Client Need: Physiological Integrity

Page Number: 237

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 15-7 Discuss the pharmacotherapeutic approaches to preventing and aborting migraines.

Question 25

Type: MCSA

A client who was admitted with gastrointestinal bleeding secondary to aspirin use therapy is being discharged. The client asks why acetaminophen (Tylenol) doesn’t work as well as the aspirin the client had been taking. What would be the nurse’s best response?

1. “You should take double the prescribed dose of Tylenol.”
2. “Tylenol does not reduce inflammation.”
3. “Tylenol is only appropriate for severe pain.”
4. “Tylenol and aspirin are the same drug.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 234

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-6 Identify representative drugs used in the management of less severe pain and explain their mechanisms of drug action, primary actions, and important adverse effects.

Question 26

Type: MCSA

A client asks the nurse why the prescriber discussed using imagery and relaxation therapy after they had prescribed a pain medication. Which response by the nurse explains why the prescriber discussed this with the client? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected.

1. “These techniques can help improve your mood and reduce anxiety.”

2. “I think we may need to ask the prescriber for understanding.”

3. “Only the pain medicine will help with the pain.”

4. “I think the prescriber should have discussed ways to reduce the stress in your life.”

Cognitive Level: Applying

Client Need: Physiological Integrity

Page Number: 224

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 15-3 Describe the supportive roles of nonpharmacologic therapies and adjuvant analgesics in pain management.