Post11 Pain/Anesth

What patient teaching should the patient receive 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. Wear a Medi-Alert bracelet with an emergency phone number for pump instructions.

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

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. Contact the MD/NP about increasing the strength of the VICODAN.
B. Instruct the patient to take 2 tabs of TYLENOL in between each VICODAN dose.
C. Instruct the patient to increase the dose of VICODAN.
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

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

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

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

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

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

A post-operative patient is taking 2 hydrocodone with acetaminophen tablets every 6 hours. How would you best measure efficacy of this medication?
A. Ask the patient about pain level.
B. Get drug blood levels.
C. Check blood pressure and pulse.
D. Obtain labs to evaluate kidney function.