Chapter 52. Pain Management: Acute and Chronic Pain

____ 1. Which of the following statements is true about age and pain?

1. Use of drugs that depend heavily on the renal system for excretion may require dosage adjustments in very young children.

2. Among the NSAIDs, indomethacin is the preferred drug because of lower adverse effects profiles than other NSAIDs.

3. Older adults who have dementia probably do not experience much pain due to loss of pain receptors in the brain.

4. Acetaminophen is especially useful in both children and adults because it has no effect on platelets and has fewer adverse effects than NSAIDs.

____ 2. Pain assessment to determine adequacy of pain management is important for all patients. This assessment is done to:

1. Determine if the diagnosis of source of pain is correct

2. Determine if the current regimen is adequate or different combinations of drugs and non-drug therapy are required

3. Determine if the patient is willing and able to be an active participant in his or her pain management

4. All of the above

____ 3. Pathological similarities and differences between acute pain and chronic pain include:

1. Both have decreased levels of endorphins.

2. Chronic pain has a predominance of C-neuron stimulation.

3. Acute pain is most commonly associated with irritation of peripheral nerves.

4. Acute pain is diffuse and hard to localize.

____ 4. A treatment plan for management of chronic pain should include:

1. Negotiation with the patient to set personal goals for pain management

2. Discussion of ways to improve sleep and stress

3. An exercise program to improve function and fitness

4. All of the above

____ 5. Chronic pain is a complex problem. Some specific strategies to deal with it include:

1. Telling the patient to “let pain be your guide” to using treatment therapies

2. Prescribing pain medication on a “PRN” basis to keep down the amount used

3. Scheduling return visits on a regular basis rather than waiting for poor pain control to drive the need for an appointment

4. All of the above

____ 6. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence the:

1. Sensory aspects of pain

2. Discriminative aspects of pain

3. Motivational aspects of pain

4. Cognitive aspects of pain

____ 7. Patients need to be questioned about all pain sites because:

1. Patients tend to report the most severe or important in their perception.

2. Pain tolerance generally decreases with repeated exposure.

3. The reported pain site is usually the most important to treat.

4. Pain may be referred from a different site to the one reported.

____ 8. The chemicals that promote the spread of pain locally include:

1. Serotonin

2. Norepinephrine

3. Enkephalin

4. Neurokinin A

____ 9. Narcotics are exogenous opiates. They act by:

1. Inhibiting pain transmission in the spinal cord

2. Attaching to receptors in the afferent neuron to inhibit the release of substance P

3. Blocking neurotransmitters in the midbrain

4. Increasing beta-lipoprotein excretion from the pituitary gland

____ 10. Age is a factor in different responses to pain. Which of the following age-related statements about pain is NOT true?

1. Preterm and newborn infants do not yet have functional pain pathways.

2. Painful experiences and prolonged exposure to analgesic drugs during pregnancy may permanently alter neuronal organization in the child.

3. Increases in the pain threshold in older adults may be related to peripheral neuropathies and changes in skin thickness.

4. Decreases in pain tolerance are evident in older adults.