BAGUIO CENTRAL UNIVERSITY COLLEGE OF NURSING & SCHOOL OF MIDWIFERY PHARMACOLOGY CHOOSE THE BEST ANSWER nd SITUATION: #s 1-6:

Mahdz a 35-yr-old female w/ cancer is on her 2 cycle of chemotherapy. 1. Described as an unpleasant sensory & emotional experience caused by tissue damage a. Fear c. Anxiety b. Pain d. Stress 2. Mahdz had been having pains for almost a year now; you would expect her vital signs to? a. Elevate from baseline then reverse to normal as pain subsides b. Remain unchanged compared to baseline c. Become lower than her baseline vital signs when in pain d. Erratic, her BP would shoot up while her PR, RR & temp is either low of normal Mahdz complaints of severe pain, the initial action that the nurse should do is? a. Increase the dose of pain medication c. Call the nurse supervisor b. Refer to the physician d. Assess the patient Mahdz often complaint of pain even if pain meds are already given, the patient is suffering from a. Pain d. Malingering b. Acute mild pain e. Addiction to pain meds c. Chronic pain The nurse is quite irritated, stating that she has just administered her due analgesic 30 minutes ago, & that she is only over reacting. Which of the following patients right had been violated? a. Right to refuse medication administration c. Right to be relieved of symptoms b. Right to be informed of what she is being given d. Right to complain Mahdzs behavior aside from tissue destruction can be associated with? SATA a. Poor response to treatment d. Psychological factors b. Wanting to catch attention e. AOTA c. Depression Changes in patients vital sign when in pain is caused mainly by? a. Autonomic response to pain b. Hormonal response to pain

3.

4.

5.

6.

7.

c. d.

Emotional response to pain AOTA

8.

An adult patient in acute pain has elevated vital signs, which one would be a priority? a. BP: 150/90 d. Temp: 38C b. RR: 27 e. 02 saturation: 89% c. PR: 128 Pediatric patients who are unable to describe their pain are best assessed by? a. Observer scoring d. Visual analogue score b. LIkert scale e. Magil Pain questionnaire c. Verbal rating scale

9.

10. A patient complaint of recurrent severe facial pain secondary to trigeminal neuralgia, an alcohol was injected along the facial nerve to control the pain. This is an example of? a. Topical application c. Simple nerve block b. Plexus block d. Epidural infusion 11. A physical method of managing pain where a low voltage electrical current is passed to the affected muscle via electrodes connected to the skin along the area of pain? a. Physiotherapy c. Acupuncture b. TENS d. Ice application

A B D C
18. The safest analgesic? a. Aspirin b. Ibuprofen

HOT SPOTS From the illustration presented, answer the following: 12. Application of sunblocks with SPF 15 13. Site of action of narcotic drugs 14. Site of action of non narcotic analgesics 15. Site of action of nitrous oxide 16. Injection of 2% xylocaine around the wound prior to suturing 17. Site of action of ibuprofen

c. d.

Ice or warm compress Paracetamol

19. Correct statements regarding non-opioid analgesics include? SATA a. It is used for mild to moderate pain b. It should be used with caution among elderly, & those with gastric ulcers specifically the NSAIDs c. It use should only last for a week 20. Common problem associated with paracetamol is a. Reyes syndrome b. Gastric ulcer

d. e. f.

Used in all pain states Common unwanted SE is hepatotoxicity No problems with tolerance

c. d.

Headache Hepatotoxicity

21. Correct statement about the principles in pain management? a. Start with opioid analgesics to provide fast relief of pain b. Start with non opioid analgesics then opioid analgesics c. Avoid excessive administration of opioid analgesics since addiction is a concern d. Administer narcotic analgesics abruptly even reaching the ceiling dose mainly to control pain 22. The patients wife asked the RN on why the MD, with time, increases her husbands pain medication dosage. The RNs best response would be? a. It is to help your husband be relieved from intractable pain b. Ask the MD because he know what is best for your client c. Im not aware of that, Ill check on his chart d. The MD is trying to help your husband become immune to the side effects of the drug 23. The patients wife is concern on the possibility that her husband be addicted to the drug, the RNs best response would be? a. Yes, eventually your husband will be addicted to the drug, so be prepared about it b. Would you like to talk more about your concerns? c. Addiction is not our main concern for patients who are in pain, it is unavoidable but it is needed d. Why are you thinking about that? 24. Which of the following statements about narcotic analgesics is LEAST appropriate? a. The are reserved for severe intractable pain b. They often cause dependence c. They act on both peripheral & central nervous system d. Respiratory depression is a major disadvantage 25. Which of the following narcotic analgesics is a strong agonist? a. Propoxyphene b. Pentazocine

c. d.

Naltrexone Meperidine

26. Opioid analgesics works on different receptors, which of the following opioid analgesic works only on kappa receptors? a. Morphine c. Pentazocine b. Fentanyl d. Heroin

27. When giving opioid analgesics, the RN should always see to it that this drug is available in cases of overdose. SATA a. Narcan c. Epinephrine b. Naloxone d. AOTA 28. Pupillary dilation occurs when opioid analgesic would bind to which receptor? a. Mu c. Sigma b. Kappa d. Beta SITUATION: # 29-34: A patient with bone cancer has been given morphine sulfate to manage his pain. 29. Correct statements about morphine. SATA a. Binds to Kappa receptors only d. It can be used for post craniectomy patients b. It can be used to manage diarrhea e. It may lead to respiratory depression c. Has an antitussive effect f. It induces vomiting 30. Morphine may elevate the hormonal activity of which hormone? a. GnRH b. LSH

c. d.

Vasopressin FSH

31. The outgoing RN endorses the patient who is on morphine precautions, as the receiving RN, this means that prior to giving morphine, the patients _________________ should be assessed? a. BP, RR, pulse, temperature, 02 saturation c. Lung and abdominal status b. Level of consciousness, & vital signs d. BP, RR, pupillary reaction & level of consciousness 32. Which one of the following should be a priority for the nurse to monitor for patients who are given morphine? a. Patients level of consciousness d. Patients cardiac rate b. Patients blood pressure e. Patients deep tendon reflexes c. Patients respiratory pattern f. Patients hydration status 33. The RN heard the call bell coming from the patients room. She immediately rushed to the patient & assessed him. Which of the following findings would require the doctors attention? a. Pulse rate of 69 bpm, regular and weak d. Moaning in pain b. BP of 90/60 e. AOTA c. Labored breathing 34. The MD informs the RN that the patient is showing morphine overdose. The RN is aware that this condition can be reversed & prepares this medication? a. Codeine sulfate c. Naloxone b. Oxygen d. Epinephrine SITUATION: #35-40: Gloria 65-year-old female client suffers from breast cancer that metastasizes to the brain. She has been complaining of severe pain & was given by his MD morphine sulfate 10mg b.i.d. for almost 4 months now. 35. Gloria informs the nurse that she no longer feels pain relief with her usual 10 mg b.i.d. dose of the drug. She said that for her to fell free from pain she takes morphine 10mg now at 4 x in a day. The RN is aware that Gloria is now having: a. Addiction to the drug c. Habituation to the drug b. Tolerance to the drug d. Not following his doctors order 36. Gloria informs the nurse that she feels fine & that her body system functions normally if she uses morphine. The nurse is aware that Gloria is manifesting: a. Physiologic addiction to the drug c. Drug abuse b. Habituation to the drug d. Cumulative effect of the drug 37. Gloria tells the nurse that using morphine relieves her pain. The nurse is aware that this is the: a. Toxic effect of the drug c. Adverse effect of the drug b. Therapeutic effect of the drug d. Idiosyncratic reaction to the drug 38. The nurse assesses Gloria for signs of difficulty breathing & drowsiness. The nurse is checking for: a. Drug interaction c. Therapeutic effect of the drug b. Side effect of the drug d. Allergic effect to the drug

39. Glorias husband asks the nurse, Why not use aspirin instead of morphine? The nurses best response is? a. Although aspirin & morphine function to relieve pain, morphine is more potent b. Although aspirin & morphine function to relieve pain, morphine is more efficacious c. I dont know better ask your doctor d. Since you are rich, the doctor prescribe morphine which is a more expensive drug 40. The RN recognizes the possibility of morphine toxicity & prepares an antidote. The RN is aware that the principle involved here is drug antagonism & it occurs when drug A interferes with the action of drug B by competing with the same receptor site. This is simplified in which of the following equation? a. 1 + 1 = 2 c. 1 + 1 = 0 b. 1 + 1 = > 2 d. 0 + 1 = 2 41. Which of the following opioid has no medical use? a. Fentanyl b. Methadone

c. d.

Heroin Meperidine

42. Following the WHO protocol, for patients with moderate to severe pain, they may be given with which of the following drug? a. Ibuprofen + paracetamol c. Demerol b. Darvocet N d. Percocet 43. Which of the following NSAIDs is a fenamate? a. Piroxicam b. Salsalate

c. d.

Naproxen Meclofenamic acid

44. Prostaglandin that functions for platelet aggregation & vasoconstriction a. PGI2 c. b. PGE2 d. 45. Which of the following drugs inhibit the biosynthesis of prostaglandins? a. Acetic acids c. b. Fenamates d. 46. Which of the following prostaglandins causes vasoconstriction 1. PGI2 2. TXA2 3. PGE2 4. PGF2

PGF2 TXA2

Oxicams AOTA

a. b. c. d.

1,2,3 3,4 1,3 2,4

47. Which of the following prostaglandins (PG) is beneficial during labor? a. PGE c. b. PGI d.

PGF NOTA

48. NSAIDs produce anti inflammatory effect by which of the following statements? a. Reduction of PG synthesis by inhibiting lipooxygenase pathway b. Increase the production of free radicals & superoxide c. Potentiation of leukocyte chemotaxis d. Inhibition of the expression of the activity of adhesion molecules 49. Correct statements regarding NSAIDs except? a. Are only effective for mild to moderate pain b. Does not lead to euphoria

c. d.

It does not cause respiratory inhibition Are narcotics

50. Analgesia obtained from NSAIDs is caused by their ability to: a. Inhibit leukocyte chemotaxis b. Inhibit synthesis of PG in the brain

c. d.

Decreased PG generation AOTA

51. This enzymes protect the stomach by maintaining the mucosal lining & prevents bleeding a. Prostaglandins c. Cox 2 enzymes b. Lipooxygenases d. Cox 1 enzymes 52. Inhibition of this enzyme by COX inhibitors can lead to gastric ulcers & or stress & bleeding a. Prostaglandins c. Cox 2 enzymes b. Lipooxygenases d. Cox 1 enzymes 53. Inhibition of Cox 2 enzymes is beneficial. The statement is a. False

b.

True

54. Which of the following drugs strongly inhibit the Cyclooxygenase enzymes? a. Ibuprofen c. Ketoprofen b. Naproxen d. AOTA 55. Which of the following is an algeogesic substance a. PGI b. PGE2

c. d.

Histamine Bradykinin

56. Which of the following is an absolute contraindication in the use of Cox 1 inhibitors a. Ischemic heart disease c. Allergy to NSAID b. Severe liver disease d. Peptic ulcer disease 57. To prevent bleeding in patients taking aspirin for a prolonged period, this drug should be given. a. Vitamin A c. Antihistamine b. Naloxone d. Vitamin K 58. The initial manifestation of the possibility of having toxicity with aspirin is? a. Nasal polyp development c. Hepatic damage b. Rash & itching d. Tinnitus 59. Aspirin should not be given to children & some teens because of the possibility of which of the following? a. B,C,D are correct c. Development of mild hepatic dysfunction b. Development of chicken pox or flu d. Development of Reyes Syndrome 60. Which of the following is incorrect about salicylism a. It manifests with headache, dizziness, nausea, vomiting, tinnitus & hearing failure b. It leads to rapid breathing & acid base imbalance c. It can be managed with sodium bicarbonate d. It is cause by high dose of aspirin more than 5mcg/day 61. Correct statement about acetaminophen? a. Has analgesic & antipyretic property like aspirin b. It is safe but may cause liver damage in high doses

c. d.

Does not cause any GI upset Has anti inflammatory effect as aspirin

62. The following NSAIDs can be used for long term because they are better tolerated except? a. Ibuprofen d. Indomethacin b. Nimesulide e. Naproxen c. Ketoprofen 63. NSAIDS that inhibit the proliferation of T & B cell. a. Ibuprofen b. Nimesulide c. Ketoprofen

d. e.

Indomethacin Naproxen

64. NSAID with the strongest anti-inflammatory property with minimal SE a. Mefenamic acid c. b. Piroxicam d. 65. Which of the following NSAIDs selectively inhibits the Cox 2 enzymes? a. Ibuprofen d. b. Ketoprofen e. c. Indomethacin 66. Correct statements of the advantages of coxibs except? a. They are less likely to damage GI & to cause nausea b. Less likely to interfere with clotting

Diclofenac Celecoxib

Nimesulide Naproxen

c. d.

Useful for people who cant tolerate NSAIDs Appropriate for people with heart failure

67. It is used as an alternative to aspirin when the patient has peptic ulcer & there is no need for anti-inflammatory effect? a. Acetaminophen c. Celecoxib b. Indomethacin d. Paracetamol 68. Which group of NSAIDs can be used for chronic pain? a. Aspirin, paracetamol, ibuprofen b. Aspirin, piroxicam, ibuprofen 69. Defined as the absence or abolition of sensation. a. analgesia b. amnesia

c. d.

Diflunisal, paracetamol, ibuprofen Diflunisal, naproxen, piroxicam

c. d.

areflexia anesthesia

70. A form of anesthesia wherein an anesthetic gas is given to render patient able to undergo surgery a. intravenous c. dissociative b. local d. inhalational 71. Form of anesthesia wherein a patient seems to be awake ut is unconscious and does not feel any pain a. inhalational c. local b. intravenous d. dissociative 72. Form of anesthesia where an anesthetic is given to inhibit the generation & conduction of impulses from a specific area of the body a. inhalational c. general b. intravenous d. local 73. Bupivacaine, lidocaine, procaine, and tetracaine are what type of anesthetic agents? a. inhalational c. general b. intravenous d. local e. Adjuncts 74. Phase of anesthesia where in the drugs given begin to wear off hence another drug is given a. induction c. recovery b. maintenance d. premedication 75. The student nurse enters the operating room & sees the anesthesiologist giving thiopental intravenously. The nursing student is aware that they are already in which phase of anesthesia? a. Premedication c. maintenance b. induction d. recovery 76. At what stage of anesthesia is when the patient is conscious however with decrease pain perception? a. stage of excitement c. stage of surgical anesthesia b. stage of analgesia d. stage of medullary depression

77. Death may occur during this stage of anesthesia a. stage surgical anesthesia b. stagemedullary depression 78. Intravenous anesthetics include all of the following EXCEPT? a. Etomidate b. Nitrous oxide 79. All of the following are inhaled anesthetics EXCEPT: a. enflurane b. lidocaine c. sevoflurane

c. d.

stage analgesia stage excitement

c. d.

Ketamine Thiopental

d. e.

nitrous oxide AOTA

80. Prototype inhalational anesthetic used for comparison of newly developed inhalational anesthetics a. enflurane c. sevoflurane b. halothane d. nitrous oxide 81. All of the following are true statements about nitrous oxide EXCEPT? a. It is colorless, odorless, and does not burn c. It is also known as laughing gas b. It is an intravenous anesthetic d. It is a weak anesthetic but powerful analgesic 82. All of the following statements about halothane are correct EXCEPT? a. Letters C,D,& E are correct b. Letters C,D, & E are incorrect c. It reduces hepatic and renal blood flow d. It lowers blood pressure e. It may cause hepatic hepatitis & arrhythmias 83. This anesthetic agent causes or may trigger malignant hyperthermia a. nitrous oxide c. b. halothane d. 84. The anesthetic of choice for children a. nitrous oxide b. halothane 85. Which anesthetic is the safest? a. nitrous oxide b. halothane 86. All of the following are correct statements about isoflurane EXCEPT? a. Cause rapid recovery c. b. Causes good muscle contraction d. 87. Inhalational anesthetic that is indicated for seizure prone patients? a. Halothane b. Enflurane

sevoflurane methoxyflurane

c. d.

sevoflurane methoxyflurane

c. d.

sevoflurane methoxyflurane

Makes the cardiac output stable Does not increase intracranial pressure

c. d.

Isoflurane Sevoflurane

88. Which among the following statements about nitrous oxide is INCORRECT? a. Does not cause muscle relaxation c. It is usually given with other anesthetics b. Causes complete anesthesia d. Commonly known as the laughing gas 89. It is the most potent inhalational anesthetic. a. sevoflurane b. methoxyflurane

c. d.

halothane nitrous oxide

90. Which of the following intravenous barbiturates may cause skin necrosis? a. Thiamylal c. Etomidate b. Thiopental d. Methohexital 91. Which of the following drugs cause dissociative anesthesia? a. thiopental b. ketamine 92. Which of the following does not belong to the group? a. Amnesia b. Sedation

c. d.

etomidate propofol

c. d.

Analgesia Muscle relaxation

93. Which benzodiazepine drug used in sedation also possesses an anticonvulsant effect? a. lorazepam c. midazolam b. diazepam d. ketamine 94. The following are correct statements about benzodiazepines EXCEPT? a. Letters C,D, & E are correct b. Letters C,D, & E are incorrect c. Used primarily in the treatment of anxiety disorders d. Excellent in producing amnestic& sedative responses e. Commonly used drugs for anesthesia include: diazepam, lorazepam&midazolam 95. The following are correct statements about local anesthetics EXCEPT? a. Letters C,D, & E are correct b. Letters C,D, & E are incorrect c. They are mostly vasodilators hence necessitate the addition of epinephrine d. Local anesthetics comes in 2 groups the ester linked and amide link groups e. They produce conduction blockade of nerve impulses by preventing increase in permeability of nerve membranes 96. All of the following are ester link anesthetics EXCEPT? a. Tetracaine b. Bupivacaine

c. d.

cocaine procaine

97. This anesthetic has been used to induce euphoria, reduce hunger, and increase work tolerance a. procaine c. Tetracaine b. cocaine d. Bupivacaine 98. Which among the following groups of drugs is not used in anesthesia? a. Anticholinergics d. b. Muscle relaxants e. c. Inhaled anesthetics

AOTA NOTA

99. This drug group makes the patient feel relax and rested but not necessarily asleep a. hypnotic c. sedative hypnotic b. sedative d. hypnagogic 100. Which of the following barbiturates is given during labor? a. long acting b. amobarbital

c. d.

pentobarbital secobarbital

101. A benzodiazepine used for insomnia and treatment of preoperative anxiety a. lorazepam c. temazepam b. midazolam d. flurazepam 102. At what stage of sleep is most restful associated with decrease in BP, RR and basal metabolic rate? a. stage IV c. stage II b. stage III d. stage I

103. The stage of sleep characterized by transition between wakefulness and sleep. a. stage I c. stage III b. stage II d. stage IV 104. A short acting benzodiazepine that us used in induction of anesthesia and causes amnesia a. midazolam c. estazolam b. triazolam d. temazepam 105. Which of the following side effects of benzodiazepine must be reported? a. abuse b. drowsiness c. hangover d. sedation