Quiz 1-9 PDF

## WEEK 1 1. Australian health care settings require informed medical consent to be obtained for all blood products. Prior to the administration of all blood products including immunoglobulins, the risks and benefits must be explained to the patient or guardian so that they may make an informed dec...

## WEEK 1 1. Australian health care settings require informed medical consent to be obtained for all blood products. Prior to the administration of all blood products including immunoglobulins, the risks and benefits must be explained to the patient or guardian so that they may make an informed decision. Following this discussion, consent must be documented on the blood consent and prescription form and signed by both the doctor and the patient/guardian? - True - False 2. A patient is receiving a first-time blood transfusion of packed RBC. How long should the nurse stay and monitor the client to identify a transfusion reaction? - 60 minutes - **15 minutes** - 45 minutes - 30 minutes 3. A patient with O+ blood received A+ blood. The patient is at risk for. - Allergic transfusion reaction - **Haemolytic transfusion reaction** - Febrile transfusion reaction - None: O+ and A+ are compatible blood types 4. Positive patient identification should be carried out whenever possible. This means: - Stating the patient's full name and date of birth, and - getting them to agree - Only collecting blood for patients that are Rh D positive - **Asking the patient to state their full name and date of birth** - Being positive you have the right patient 5. What are the 5 pieces of information needed for patient identification and safe blood administration? - Address - Ward - **Allergy** - Age - Sex - First name - Hospital number - Surname - Date of birth 6. Where and how should the final check for a unit of blood for transfusion be done? - At the nurses station using the labelled blood bag, the pathology form stating blood bag details and the blood transfusion order - **At the patient's bedside, using their ID band, the labelled blood bag, the pathology form stating compatible blood bag details and the blood transfusion order** - It is not necessary since the unit of blood has been checked many times already - At the patient's bedside using the patient's ID, the labelled blood bag and the blood transfusion order 7. A patient is receiving 1 unit of packed red blood cells. The unit of blood will be completed at 1200. The patient is scheduled to have IV antibiotics at 1000. As the nurse you will: - Administer the IV antibiotic via secondary tubing into the blood transfusion y-tubing - Delay the antibiotic until the blood transfusion is done - **Administer the IV antibiotic as scheduled in a second IV access site** - Stop the blood transfusion and administer the IV antibiotic, and when the antibiotic is done resume the blood transfusion 8. Which of the answers below best indicates the compatible blood types that can be given to a person with a blood group B (rhesus negative)? - Blood type AB (rhesus negative), blood type B (rhesus negative), and blood type O (rhesus negative) - **Blood type B (rhesus negative) and blood type O (rhesus negative)** - Blood type B (rhesus negative) only - Blood type B (rhesus positive) and blood type O (rhesus positive) 9. What solution or solutions below are compatible with red blood cells? - No solutions are compatible with blood - **Normal Saline** - Any medications with normal saline - Dextrose Solutions 10. What would be a clinical indication for a transfusion to be prescribed and administered? - To increase the circulating blood volume - To increase the oxygen carrying capability of the blood - To decrease the risk of bleeding - **All of the above** 11. If the patient details on a pretransfusion blood sample are not identical to those on the request form, Blood Bank will allow the nurse to correct the details on the specimen tube so that the test/crossmatch can be done? - Yes, if it is urgent - Yes, if I go to Blood Bank immediately - Yes, if I take a new patient label to affix to the specimen - **No, a new accurately labelled specimen and request form will be required** 12. Once a prescribed unit of blood product has been obtained from the blood bank and is out of refrigeration, the transfusion should commence within what period of time before it starts to deteriorate? - 90 minutes - **30 minutes** - 1 hour - 4 hours 13. Which of the following are indicative signs and symptoms of circulatory overload? - Hypotension, oliguria, and urticaria - Hypothermia, hypotension, and bradycardia - **Dyspnoea, tachycardia, and distended neck veins** - Shivering, pyrexia, and thirst 14. If a blood unit has been out of refrigeration for longer than the accepted time limit, you should: - refrigerate for a minimum of 12 hours and then administer it - transfuse it as soon as possible and annotate the patient's notes with the time of administration - dispose of the contents in the sluice area, keeping the bag for record purposes - **return it to the blood bank and inform them of why you have done so** 15. Which components of blood can be transfused? - Whole blood - Platelets - Red blood cells - **All of the above** 16. What are the three mandatory unique patient identifiers that must be present on the request form before pretransfusion testing can take place? - Full name, date of birth, gender - **Full name, date of birth, unique medical record number** - Full name, unique medical record number, address - Full name, unique medical record number, previous transfusion history 17. If a transfusion reaction is suspected, you should: - leave the transfusion running and record a set of observations on the patient - disconnect and dispose of the blood bag immediately - **turn off the transfusion, inform medical staff immediately, and follow transfusion policy advice on dealing with acute transfusion reactions** - leave the transfusion running and contact the medical staff immediately 18. The registered nurse is caring for a patient with an ongoing transfusion of packed RBC's when suddenly the patient is having difficulty breathing, skin is flushed and having chills. Which action should the RN take first? - **Stop the transfusion** - Check the patient's temperature - Immediately remove the IV cannula - Administer oxygen 19. Red blood cells are vital for survival. Which statement below is NOT correct about red blood cells? - Red blood cells are suspended in the blood's plasma - Red blood cells help carry oxygen throughout the body with the help of the protein haemoglobin - Red blood cells help remove carbon dioxide from the body - **Extreme loss of red blood cells can lead to a suppressed immune system and clotting problems** 20. Blood compatability testing is essential to prevent transfusion of donor blood cells which may cause serious harm. What is the name of the blood test used to determine the patient's ABO and RhD type and to screen for antibodies? - group and hold - international normalised ratio - electrolytes and liver function - **full blood count** ## WEEK 3 1. Under what circumstances would the doctor consider prescribing antibiotics prior to catheterisation? - If the patient does not have a urinary tract infection - **If patient has an artificial heart valve** - If the patient has poor hygiene - If the patient has already had a catheter in situ for a week 2. After inserting the indwelling catheter, the nurse is inflating the balloon when the patient expresses discomfort. The nurse must: - Remove the catheter immediately - Complete balloon inflation as discomfort is expected - **Aspirate fluid from the balloon and advance the catheter further into bladder** - Pull back on the catheter slightly to determine tension 3. A patient with an indwelling catheter reports a need to urinate. Which of the following interventions should the nurse perform? - Tell the patient to increase mobility as this will assist drainage - Reassure the patient it's normal to feel the sensation and try to ignore it - **Check to see if the catheter is patent and draining** - Apply pressure over the bladder to determine if that increases the sensation 4. The postoperative medical orders include inserting an indwelling urinary catheter for a female patient. After positioning and prepping the patient, and washing hands, in what order should the nurse complete this procedure? Place in chronological order. - Using the non-dominate hand, separate and clean labia using one swipe per cotton ball - Remove and dispose of gloves - Apply sterile gloves - Inflate the catheter balloon - Pour cleansing solution over cotton balls - Using the sterile dominant hand, insert catheter 1-2 inches past where urine is noted in the urethra **Answer: 5, 3, 1, 6, 4, 2** 5. When performing a bladder scan, what setting should you select if your patient is a female who has had a hysterectomy? - both male and female - female - **male** - Neither 6. What is an urgent reason for catheterising a patient? - **Acute urinary retention** - Urinary tract infection - Urinary incontinence - High falls risk 7. Urine is produced by the kidneys and then transported to the urinary bladder via the: - **ureter** - urethra - renal vein - urinary meatus 8. A postoperative patient has not passed urine for 5 hours after return to the surgical unit. Initially the nurse should: - check the postoperative orders for catheterisation orders - **perform a bladder scan to detect volume in bladder** - ambulate the patient to the bathroom - call the doctor 9. To reduce the incidence of urinary tract infections in a catheterised patient, the nurse: - applies an antiseptic solution to the perineum daily - irrigates the catheter with an antiseptic solution - **performs perineal cleansing with mild soap and water twice a day and as needed** - applies an antibiotic ointment around the catheter at the urinary meatus at least twice a day 10. The most significant risk factor for developing a catheter associated UTI (CAUTI) is: - not drinking enough fluids - catheter tube that has kinked - **prolonged use of a urinary catheter** - drainage bag in contact with the floor 11. Normally the kidney's produce urine at a rate of approximately: - 20mls per hour or about 480mls per day - 200mls per hour or about 4800mls per day - 150mls per hour or about 3600 per day - **60mls per hour or about 1500ml per day** 12. Resistance is encountered during urinary catheterization of a male patient. What initial action will the nurse take: - Ask the patient to breathe quickly through the mouth - Apply more force to insert the catheter further - **Ask the patient to take slow, deep breaths** - Remove the catheter immediately 13. The nurse notes that urine does not flow after a female patient is catheterized. The nurse believes that the catheter has been placed into the vagina. Which action should the nurse take? - Insert the catheter a further 25 centimetres into the patient to verify it is in the vagina - Irrigate the catheter with saline - **Leave the catheter in place and insert another one** - Remove the catheter and reinsert it 14. An 82-year-old man requires an IDC insertion for retention post-operatively. He is alert and oriented but has difficulty seeing and hearing. His wife is at his bedside and answers most questions directed to the patient. To accomplish preoperative teaching with the patient, the nurse: - asks the patient's wife to wait in the hall in order to focus preoperative teaching with the patient himself - uses printed materials for instruction because the patient does not hear well - directs the teaching towards the wife because she is the obvious support and caregiver for the patient - **provides additional time for the patient to understand preoperative instructions and carry out procedures** 15. During assessment of a patient with a disorder of the urinary system, the nurse identifies a potentially nephrotoxic agent when the patient reports the use of: - prophylactic penicillin therapy for rheumatic heart disease - vitamin supplements - anticoagulants - **non-steroidal anti-inflammatories** 16. You're preparing for urinary catheterization of a patient with suspected pelvic fractures and you observe bleeding at the urethral meatus. What is your first priority? - Irrigate and clean the meatus before catheterisation - Test the discharge for occult blood before catheterization - **Delay catheterization and notify the doctor** - Heavily lubricate the catheter before insertion ## WEEK 5 1. A patient has a tracheostomy performed for high grade tumour of the larynx. After one week the tracheostomy is accidently dislodges and can't be reinserted. The patient is in respiratory distress. Endotracheal intubation be performed? - True - **False** 2. The first action the nurse should do if a patient with a tracheostomy tube is showing signs and symptoms of respiratory distress is to: - Call a Code Blue - Replace patient's entire tracheostomy tube with a new one - **Remove the inner cannula and assess secretions** - Suction the patient's tracheostomy tube. 3. A patient is recovering from a pneumothorax and has a chest tube present. Which of the following is an appropriate finding when assessing the chest tube drainage system? - Intermittent bubbling may be noted in the water seal chamber. - All of these options are appropriate finding - The chest tube is positioned at the patient's chest level to facilitate drainage. - 200 mls of drainage per hour is expected during recovery of a pneumothorax. 4. The nurse should recognise that which of the following symptoms are an indication for oxygen therapy? - Anxiety; respiratory rate 32 breaths / minute - **Tachypnoea; SpO2 90%** - Acute myocardial infarction, SpO2 96% - Hypotension; urinary retention 5. A patient is about to have their chest tube removed according to the medical order. As the nurse assisting with the removal, which of the following actions will you perform? Select all that apply: - Place the patient in Semi-Fowler's position. - Gather supplies needed which will include a petroleum gauze dressing. - **Provide analgesia prior to removal as ordered by the doctor.** - Educate the patient how to take a deep breath out and inhale rapidly while the tube in being removed. - Place the patient in prone position after removal. - **Have the patient take a deep breath, exhale, and bear down during removal of the tube.** 6. A commonly recommended suction pressure setting for underwater seal drain [UWSD] is: - -10 cm H2O - -50 cm H2O - **-20 cm H2O** - -150 cm H2O 7. During hourly checks of a patient with a haemothorax, the RN is assessing the function of an UWSD. Which of the following findings should prompt the RN to notify the doctor to review? - Drainage system has been maintained below the patient's chest. - Tidalling in the tube in the water seal chamber during inhalation and exhalation. - Occlusive dressing in place over the chest tube insertion site - **Drainage amount of 140ml in the drainage collection chamber over past hour.** 8. To prevent excessive pressure on the tracheal capillaries which may lead to tissue hypoxia, the pressure in the tracheostomy tube cuff should be: - Monitored every 2-3 days - Less than 4 kPa (30 mm Hg or 35 cm H2O) - Sufficient to fill the pilot balloon until it is tense - **Less than 2.6 kPa (20 mm Hg or 25 cm H2O)** 9. What FiO2 percentage (percentage of oxygen) is delivered when the flow rate through a Hudson mask is 6L / min? - 25-30% - **30-40%** - >60% - 21-24% 10. A patient with pneumonia has been receiving continuous oxygen therapy for several days. Which of the following is an adverse effect associated with continuous oxygen therapy? - Dry, brittle hair - Copious respiratory secretions - Poor skin turgor - **Cracks in the oral mucosa** 11. A patient has a tracheostomy performed for prolonged mechanical ventilation. After one week the tracheostomy is accidently dislodges and can't be reinserted. The patient is in respiratory distress. Endotracheal intubation be performed? - **True** - False 12. The nurse managing a patient immediately after chest tube insertion should closely monitor for: - a decrease in urine output - mild pain at the insertion site - **tachypnoea, tachycardia, and decreased oxygen saturation** - a decrease in the need for supplemental oxygen 13. A pneumothorax occurs when extraneous ___ enters the pleural space. - blood - **air** - foreign particles - infection 14. You are reviewing the results of arterial blood gas for your patient with respiratory distress. You recognise that the normal value of PaO2 is: - 22-26 mEq/L - 7.35-7.45 - 35-45 mmHg - **80-100 mmHg** 15. The nurse is caring for a critically unwell patient with COPD who requires delivery of a precise concentration of oxygen. Which of the following is the correct oxygen delivery device? - **Venturi mask** - Nasal prongs - Oxygen face tent - Simple face mask 16. A potentially life-threatening condition in which air and pressure rapidly accumulate in the pleural space and, if not treated, can result in a mediastinal shift is called: - An open pneumothorax - An iatrogenic pneumothorax - **A tension pneumothorax** - A spontaneous pneumothorax 17. In a patient who has recently had a tracheostomy performed, all of the following equipment except which one should be at the bedside? - A tracheostomy reinsertion kit - A tracheostomy tube one size smaller - **A tracheostomy tube one size larger** - A tracheostomy tube the same size 18. Chest tube clamping is only recommended for: - Whenever a patient leaves the nursing unit and cannot be monitored - It is never beneficial to clamp a patient's chest tube - When ambulating a postoperative patient with a chest tube - **Changing the drainage container and this should be done quickly and then promptly unclamped** 19. When performing tracheostomy suctioning, what is the maximum period of time allowed? - **10 seconds** - 30 seconds - 5 seconds - 20 seconds 20. In addition to a respiratory assessment, nursing assessment of a patient with a chest tube should include: - changing the occlusive dressing Q 3 days and PRN - noting the colour, consistency, and amount of drainage - checking the drainage system for, air leaks, appropriate suction pressure (if ordered) and ‘bellows' expand to the indicator mark - assessing the insertion site/dressing outwardly following the tube all the way to the drainage system, for loops, kinks, that the clamp is open - **All of the above** ## WEEK 7 1. A patient is 8 hours post-opt from an colostomy placement. Which finding requires immediate nursing action? - The stoma is swollen and large - The stoma is not draining any stool - **The stoma is pale** - The patient states the site is tender 2. You're providing diet teaching to a patient with an ileostomy. Which foods should the patient consume in very small amounts or completely avoid? - Avocado, bananas, rice - **Corn, popcorn, nut and seeds** - Orange juice, bread, and pasta - Vinegar, soft drinks, and cured meats 3. The stomal therapy nurse explains that the procedure that maintains the most normal functioning of the bowel is: - an ascending colostomy - an ileostomy - **a sigmoid colostomy** - a transverse colostomy 4. The nurse is teaching a patient to differentiate between hypoglycaemia and ketoacidosis. The patient demonstrates understanding by stating that a form of glucose should be taken if which symptoms develop? Select all that apply. - Shakiness - **Blurred vision** - **Palpitations** - Polyuria - Fruity breath odour - **Lightheadedness** 5. A 36-year-old male is newly diagnosed with Type 2 diabetes. Which of the following treatments do you expect the patient to be started on initially? - Regular subcutaneous insulin - Metformin orally BD - No intervention - monitor and repeat fasting glucose in 2 months - **Diet and exercise** 6. Mavis has Type 2 diabetes and increased her daily walking which resulted in a 10 kg weight loss over six months. What change has this probably caused? - An increase in her LDL (bad) cholesterol - An increase in her insulin resistance - An increase in her fasting blood glucose - **An increase in her insulin sensitivity** 7. A teenager with Type 1 diabetes is about to play a game of soccer with his school team. He checks his blood glucose (BGL) and finds it is 20.5 mmol/l for no apparent reason. A second check confirms a similar result. What should he do? - Nothing. The exercise should bring his BGL down to normal - Wait until his blood glucose is below 13 mmols before attempting to play. - Take his usual correction dose of insulin and go play - **Check for ketones. If negative, drink some water, take half of his usual correction dose of insulin and go play. If positive for ketones, drink plenty of water, take insulin, and do not play.** 8. You are caring for a patient with a stoma on the right side of the abdomen. This location indicates the stoma is most likely to be: - a descending colostomy - **an ileostomy** - a gastrostomy - a tracheostomy 9. Type 1 diabetics on initial diagnosis, typically have the following clinical characteristics: - Thin, older adult with glycosuria - **Thin, young with ketonuria** - Overweight, older adult with ketonuria - Overweight, young with no ketonuria 10. Describe, in order, how food travels from the stomach to the anus. It exits the stomach: - then to the jejunum - then to the descending colon - then to the transverse colon - then to the ileum - then to the sigmoid colon - then to the ascending colon - then to the caecum - then to the duodenum - then to the rectum **Answer: h, a, d, g, f, c, b, e, i** 11. True or False: A colostomy is a surgical opening created to bring the small intestine to the surface of the abdomen. - **True** - False 12. The nurse is assessing a stoma and recognises that it is prolapse if which of the following is evident? - **Protruding stoma with swollen appearance** - A sunken and hidden stoma - A dusky and bluish stoma - A narrow and flattened stoma 13. A patient with diabetes has a pre-breakfast blood glucose level of 2.8 mmols/L. The patient is sweaty, cold, and clammy. Which of the following nursing interventions is the MOST important initially? - Call the doctor - Give the patient 2 units of Actrapid insulin subcut - Recheck the blood glucose level - **Give the patient 150 mls of orange juice** 14. Which of the following symptoms do NOT present in hyperglycemia? - glycosuria - polyuria - extreme thirst - **blood sugar level <12 mmols** 15. What statement or statements are correct regarding diabetic ketoacidosis (DKA)? Choose all that apply - Expiratory wheeze is always present in DKA - **Ketones are present in the urine in DKA.** - Severe hypoglycemia is a classic sign in DKA. - DKA occurs mainly in Type 1 diabetics. 16. Traffic police pulled over a motorist who appeared to be drunk, but actually had low blood glucose. Impaired awareness of hypoglycaemia (IAH) was diagnosed. What does this refer to? - Gradual loss of hypoglycaemic symptoms due to repeated episodes of low blood glucose - Acquired brain injury caused by severe/prolonged hypoglycaemia - Lack of public knowledge regarding hypoglycaemia and proper treatment - Inappropriate treatment of hypoglycaemia with excessive carbohydrate 17. True or False? A temporary colostomy is performed on the client with colon cancer. The nurse is aware that the proximal end of a double barrel colostomy is the opening on the client's right side - **True** - False 18. Your patient has an ileostomy. What type of stool would you expect the stoma to be excreting? - Semi-solid stool - **Liquid stool** - Loose to partly formed stool - Similar to normal stool 19. The nurse is caring for a patient with a colostomy who explains that he makes small pin holes in the drainage bag to help expel gas. The nurse should teach him that this action: - won't affect the colostomy system - destroys the moisture barrier seal - is appropriate for relieving the gas in a colostomy system - **destroys the odour-proof seal** 20. The doctor orders a HbA1c blood test. This test reflects an average blood glucose over: - 1 year - 1 month - **3 months** - 3 weeks ## WEEK 9 1. The 2 cranial nerves responsible to coordinate a swallow reflex are the: - **vagus and glossopharyngeal nerves** - optic and oculomotor nerves - spinal accessory and hypoglossal nerves - abducens and facial nerves 2. In a non-pregnant adult, the empty bladder is palpable just above the symphysis pubis - True - **False** 3. Light palpation is a technique which: - the RN uses the flat surface of the fingers and palmar surface of the hands to depress 5 cm or greater in order to delineate abdominal organs an masses - the RN inserts the gloved, lubricated index finger into the rectum to assess for nodules, tenderness and occult blood. - the RN uses the dorsal surface of the hand to feel lightly over the abdominal surface in order to assess for heat, raised skin lesions or skin moisture - **the RN uses the flat surface of the fingers to depress approximately 2 cm in order to assess for masses, lumps or tenderness** 4. Nasogastric insertion requires the nurse to use an aseptic non-touch technique - True - **False** 5. What bed position do you place the client in when inserting a NG tube? - Semi-recumbant - **High-Fowler** - Prone - Trendelenburg 6. The best position for assessment of the abdomen is: - semi-Fowlers with arms supported in armchair position - Standing upright in a well lit room - **supine with head slightly raised and knees in bent position supported by pillows** - side lying / recovery position with upper leg supported on pillows 7. The correct sequence for assessment of the abdomen is: - inspection, auscultation, percussion, palpation - auscultation, inspection, percussion, palpation - palpation, auscultation, inspection, percussion - **inspection, palpation, percussion, auscultation** 8. If pH paper is not available tube placement can be confirmed by inserting air into the tube & auscultating stomach sounds? - True - **False** 9. When listening for vascular sounds such as the aorta, the RN listens with the ___ end of the stethoscope. **answer: bell** 10. The RN is undertaking a health history and recognises that the recommended maximum dose of paracetamol each day is: - 2000 grams - 5000 milligrams - 1000 milligrams - **4 grams** 11. When percussing the 4 quadrants of the abdomen, the most frequently heard sound is: - hyperresonance - **tympany** - resonance - Dullness 12. When auscultating the abdomen, the RN knows that bowel sounds (clicks and gurgles) are normally heard every: - 45-60 seconds - **5-30 seconds** - 90-120 seconds - 1-3 seconds 13. When should you stop advancing the nasogastric tube? Select all that apply - **When the measured distance is reached** - When the patient says they can feel the tube in their stomach - If the tube is seen in the oral cavity - **If the patient experiences respiratory distress or inability to speak** - **If there is significant resistance** - When the tube fills with gastric contents - If during insertion the patient's eyes are watering - If there is nasal haemorrhage 14. When low suction is applied to the Salem sump tube, the smaller lumen allows for an inflow of atmospheric air, which prevents what? - Active draining of gastric contents - The lungs from deflating - The tube position being displaced - **A vacuum if the gastric tube adheres to the wall of the stomach** 15. The length of tube insertion is measured from the patient's nares to the earlobe to the xiphisternum? - True - **False** 16. Bowel sounds are considered absent if all quadrants are auscultated and no sound is heard within how many minutes? - within 1 -2 minutes - **within 5 - 6 minutes** - within 3 - 4 minutes - within 2 - 3 minutes 17. To ease insertion, patients may be asked to swallow water through a straw unless this is contraindicated (ie: Nil by mouth)? - **True** - False 18. Coughing is normal during NGT insertion and should therefore not cause concern? - True - **False** 19. Blood or coffee ground vomit is known as haematemesis - **True** - False 20. Match the following abdominal structures to their associated abdominal regions: - Right lower quadrant: a lower pole of right kidney; caecum & appendix; right ovary / right spermatic cord; proximal ascending colon - Right upper quadrant: liver; duodenum; upper pole of right kidney; junction of ascending and transverse colon - Left lower quadrant: sigmoid colon; lower pole of right kidney; left ureter; left ovary / left spermatic cord - Left upper quadrant: spleen; stomach; upper pole of left kidney; junction of transverse and descending colon **Answer:** - RLQ = a - RUQ = b - LLQ = d - LUQ = c ## WEEK 11 1. Andrew is 25 years old and this is his first day following abdominal surgery. As you enter his room, he smiles at you and continues talking and joking with his visitor. Your assessment shows: BP 120/80; HR 80; Resps 18; Andrew reports pain score as "8" on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort). Based on this assessment, what pain score will you document on his Q-ADDS chart? - 4 - **8** - 2 - 6 2. The recommended route of administration of opioid analgesics for patients with brief, severe pain of sudden onset, such as trauma or postoperative pain is - intramuscular - **intravenous** - subcutaneous - Oral 3. Elderly patients cannot tolerate opioids for pain relief. - True - **False** 4. Benzodiazepines are not effective pain relievers unless the pain is due to muscle spasm. - True - **False** 5. An 85-year-old, male patient with a history of prostate cancer and metastasis to the lumbar spine, is receiving methadone (Dolophine), 10 mg, three times a day. The patient's spouse tells the pain management nurse that the patient exhibits a lack of motivation, loss of appetite, and an inability to get out of bed. The nurse initially focuses on: - mobility and exercise evaluation - psychological evaluation. - need for antidepressants. - **the patient's pain assessment.** 6. Analgesics for post-operative pain should initially be given - **around the clock on a fixed schedule** - only when the nurse determines that the patient has moderate or greater discomfort - only when the patient asks for the medication - only if non-pharmacological pain relief measures fail 7. Following abrupt discontinuation of an opioid, physical dependence is manifested by the following: - both a) and b) - The need for higher doses to achieve the same effect. - **sweating, yawning, diarrhea and agitation** - Impaired control over drug use, compulsive use, and craving 8. Patients may sleep in spite of severe pain - **True** - False 9. Which of the following analgesic medications is considered the drug of choice for the treatment of prolonged moderate to severe pain for cancer patients? - codeine - pethidine - tramadol - **morphine** 10. Patient's spiritual beliefs may lead them to think pain and suffering are necessary. - True - **False** 11. Respiratory depression rarely occurs in patients who have been receiving stable doses of opioids over a period of months. - **True** - False 12. Andrew is 25 years old and this is his first day following abdominal surgery. As you enter his room, he smiles at you and continues talking and joking with his visitor. Your assessment shows: BP 120/80; HR 80; Resps 18; Andrew reports pain score as "8" on a scale of 0 to 10 (0 = no pain/discomfort, 10 = worst pain/discomfort). Based on this assessment, what pain score will you document on his Q-ADDS chart? - 4 - **8** - 2 - 6 13. The pain management nurse notices a male patient grimacing as he moves from the bed to a chair. The patient tells the nurse that he is not experiencing any pain. The nurse's response is to: - obtaining an order for pain medication - confronting the patient's denial of pain. - **clarify the patient's report by reviewing the patient's nonverbal behaviour.** - supporting the patient's stoic behaviour. 14. Patients who can be distracted from pain usually do not have severe pain. - True - **False** 15. How likely is it that patients who develop pain already have an alcohol and/or drug abuse problem? - 5-15% - 75-100% - <1% - **