1.
Mr. Wright is seen in the office for a follow-up of his coronary artery disease and diabetes mellitus. During the interview, which comments MOST SUGGEST psychological distress?
Correct Answer
B. “I’m so worried about my wife.”
Explanation
The comment "I'm so worried about my wife" suggests psychological distress because it indicates that Mr. Wright is experiencing significant concern or anxiety about his wife's well-being. The other comments may indicate physical pain, logistical concerns, or existential questioning, but they do not directly suggest psychological distress in the same way.
2.
Mrs. DeGilio is an 84-year-old woman with rheumatoid arthritis affecting her hands, feet, and knees. Today she notes increased swelling and pain in her knees. An important question in pain assessment is:
Correct Answer
B. How does it affect your life?
Explanation
This question focuses on the impact of pain on the individual's daily activities, functionality, and overall well-being. It provides insights into the extent to which pain interferes with daily tasks and quality of life. Understanding the functional implications of pain is crucial for comprehensive pain assessment and management, particularly in the context of chronic conditions like rheumatoid arthritis.
3.
Neuropathic pain is:
Correct Answer
B. A result of disordered nerve function
Explanation
Neuropathic pain is a result of disordered nerve function. Unlike other types of pain that result from tissue damage or inflammation, neuropathic pain occurs when there is damage or dysfunction to the nerve itself. This can be caused by various factors such as nerve compression, injury, or diseases like diabetes or multiple sclerosis. Neuropathic pain is often described as shooting, burning, or tingling sensations and is typically difficult to treat with traditional pain medications, such as anti-inflammatory agents or opioids.
4.
Mr. Martin has locally advanced transitional cell cancer of the bladder with chronic pelvic and abdominal pain. Which of the following is MOST IMPORTANT in determining the maximum dose of oral morphine during dose titration?
Correct Answer
A. Pain relief
Explanation
The most important factor in determining the maximum dose of oral morphine during dose titration is pain relief. The goal of titration is to find the dose that provides adequate pain relief without causing excessive side effects. Therefore, the priority is to ensure that the patient's pain is effectively managed, rather than focusing on other factors such as respiratory depression, regulatory limits, or the strength of the pill.
5.
Pharmacologic tolerance develops to all of the following side effects of opioid analgesics EXCEPT:
Correct Answer
B. Constipation
Explanation
Pharmacologic tolerance is the body's ability to adapt to the effects of a drug over time, resulting in a reduced response to the drug. In the case of opioid analgesics, tolerance can develop to various side effects. However, constipation is an exception to this. Opioids bind to receptors in the gastrointestinal tract, leading to decreased motility and increased water absorption, which causes constipation. Unlike other side effects such as sedation, respiratory depression, and nausea, the body does not develop tolerance to the constipating effects of opioids. Therefore, constipation remains a persistent side effect even with prolonged opioid use.
6.
All of the following are key elements of palliative care EXCEPT:
Correct Answer
C. Getting the patient to be DNR
Explanation
The correct answer is "getting the patient to be DNR." This is because a Do Not Resuscitate (DNR) order is a specific medical directive that pertains to a patient's wishes for resuscitation in the event of cardiac or respiratory arrest. While palliative care focuses on pain and symptom management, psychological and spiritual support, and coordination of care, it does not involve actively encouraging or promoting DNR orders. The decision to become DNR is a personal choice that should be made in consultation with the patient, their family, and the healthcare team.
7.
The single MOST IMPORTANT feature that defines opioid drug addiction (psychological dependence) is:
Correct Answer
D. Evidence of adverse life consequences from drug use
Explanation
The single most important feature that defines opioid drug addiction is evidence of adverse life consequences from drug use. This means that individuals who are addicted to opioids experience negative effects in various aspects of their lives as a result of their drug use. These consequences can include problems in relationships, work or school performance, financial difficulties, legal issues, and overall deterioration of physical and mental health. This feature distinguishes addiction from simple physical dependence or tolerance, as it highlights the significant impact that drug use has on a person's overall well-being.
8.
Every 12 hours, Mr. Kelly has been taking 60 mg of long-acting morphine. The best initial order for breakthrough short-acting morphine is:
Correct Answer
B. 15 mg q4
Explanation
The best initial order for breakthrough short-acting morphine is 15 mg q4. This is because it is a moderate dose that can provide effective pain relief without the risk of excessive sedation or respiratory depression. The frequency of every 4 hours ensures that Mr. Kelly has timely access to pain relief as needed.
9.
The single MOST IMPORTANT supplemental therapy to consider at the time of starting patients on opioids for pain is:
Correct Answer
B. Laxatives for constipation
Explanation
When starting patients on opioids for pain, constipation is a common side effect that can significantly impact the patient's quality of life. Opioids slow down bowel movements, leading to constipation. Therefore, the single most important supplemental therapy to consider is laxatives for constipation. Laxatives can help prevent or alleviate opioid-induced constipation, ensuring that patients can continue their pain management without the discomfort and complications associated with constipation. This is crucial for maintaining patient comfort and adherence to opioid therapy.
10.
You are attending a family meeting for a patient with moderately advanced Alzheimer’s type dementia in which you have been describing the nature and likely course of the disease. The patient is unable to participate. In concluding the meeting, it is MOST IMPORTANT to:
Correct Answer
A. Summarize the plan for care
Explanation
In concluding the meeting, it is most important to summarize the plan for care. This ensures that the family members understand the next steps and are aware of the care that will be provided to the patient with Alzheimer's type dementia. It helps in providing them with a clear understanding of the situation and what they can expect in terms of the patient's care and well-being. This information is crucial for the family to make informed decisions and actively participate in the patient's care.