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



Question 1. Xi, a fifty-four-year-old female, has a history of migraine that does not respond well to OTC migraine medication. She is asking to try Maxalt (rizatriptan) because it works well for her friend. Which of the following actions would you take for appropriate decision making?

Prescribe Maxalt, but to monitor the use, only give her four tablets with no refills.

Prescribe Maxalt and arrange to have her observed in the clinic or urgent care with the first dose.

Explain that rizatriptan is not used for postmenopausal migraines and recommend Fiorinal (aspirin and butalbital).

Prescribe sumatriptan (Imitrex) with the explanation that it is the most effective triptan.

Question 2. Chronic pain is a complex problem. Some specific strategies to deal with it include ________.

telling the patient to “let pain be your guide” to using treatment therapies

prescribing pain medication on a pro re nata (PRN) basis to keep down the amount used

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

All the given options

Question 3. Phil is starting treatment with febuxostat (Uloric). Education of patients starting febuxostat includes which one of the following instructions?

Gout may worsen with therapy.

Febuxostat may cause severe diarrhea.

The patients should consume a high-calcium diet.

The patients will need frequent CBC monitoring.

Question 4. The Pain Management Contract is most appropriate for:

Patients with a history of chemical dependency or possible inappropriate use of pain medications

All patients with chronic pain who will require long-term use of opiates

Patients who have a complex drug regimen

Patients who see multiple providers for pain control

Question 5. Patients whose total dose of prednisone exceed 1 gram will most likely need a second prescription for _________.

metformin, a biguanide to prevent diabetes

omeprazole, a proton pump inhibitor to prevent peptic ulcer disease

naproxen, an NSAID to treat joint pain

furosemide, a diuretic to treat fluid retention

Question 6. Sallie has been taking 10 mg of prednisone per day for the past six months. She should be assessed for ________.


iron deficiency anemia


renal dysfunction

Question 7. All NSAIDs have an FDA black box warning regarding __________.

potential for causing life-threatening GI bleeds

increased risk of developing systemic arthritis with prolonged use

risk of life-threatening rashes, including Stevens-Johnson

potential for transient changes in serum glucose

Question 8. Which of the following statements is true about age and pain?

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

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

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

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

Question 9. Kirk sprained his ankle and is asking for pain medication for his mild-to-moderate pain. The appropriate first-line medication would be __________.

ibuprofen (Advil)

acetaminophen with hydrocodone (Vicodin)

oxycodone (OxyContin)

oral morphine (Roxanol)

Question 10. Patients who are on or who will be starting chronic corticosteroid therapy need monitoring of __________.

serum glucose

stool culture

folate levels

vitamin B12

Question 11. Jamie has fractured his ankle and has received a prescription for acetaminophen and hydrocodone (Vicodin). Education when prescribing Vicodin includes which one of the following instructions?

It is OK to double the dose of Vicodin if the pain is severe.

Vicodin is not habit forming.

He should not take any other acetaminophen-containing medications.

Vicodin may cause diarrhea; therefore, he should increase his fluid intake.

Question 12. Patients prescribed aspirin therapy require education regarding the signs of aspirin toxicity. An early sign of aspirin toxicity is _____.

black, tarry stools




Question 13. Henry is eighty-two years old and takes two aspirin every morning to treat the arthritis pain in his back. He states that the aspirin helps him to “get going” each day. Lately, he has had some heartburn from the aspirin. After ruling out an acute GI bleed, what would be an appropriate course of treatment for Henry?

Add an H2 blocker such as ranitidine to his therapy.

Discontinue the aspirin and switch him to Vicodin for the pain.

Decrease the aspirin dose to one tablet daily.

Have Henry take an antacid fifteen minutes before taking the aspirin each day.

Question 14. Patients with RA who are on chronic low-dose prednisone will need co-treatment with which medications to prevent further adverse effects?

A bisphosphonate

Calcium supplementation

Vitamin D

All of the above

Question 15. One of the main drug classes used to treat acute pain is NSAIDs. They are used due to which of the following reasons?

They have less risk for liver damage than acetaminophen.

Inflammation is a common cause of acute pain.

They have minimal GI irritation.

Regulation of blood flow to the kidney is not affected by these drugs.

Question 16. Chemical dependency assessment is integral to the initial assessment of chronic pain. Which of the following raises a “red flag” about potential chemical dependency?

Use of more than one drug to treat the pain

Multiple times when prescriptions are lost with requests to refill

Preferences for treatments that include alternative medicines

Presence of a family member who has abused drugs

Question 17. Jayla is a nine-year-old who has been diagnosed with migraines for almost two years. She is missing up to a week of school each month. Her headache diary confirms she averages four or five migraines per month. Which of the following would be appropriate?

Prescribe amitriptyline (Elavil) daily, start at a low dose and increase the dose slowly every two weeks until effective in eliminating migraines.

Encourage her mother to give her Excedrin Migraine (aspirin, acetaminophen, and caffeine) at the first sign of a headache to abort the headache.

Prescribe propranolol (Inderal) to be taken daily for at least three months.

Explain that it is rare for a nine-year-old to get migraines and that she needs an MRI to rule out a brain tumor.

Question 18. Narcotics are exogenous opiates. They act by ______.

inhibiting pain transmission in the spinal cord

attaching to receptors in the afferent neuron to inhibit the release of substance P

blocking neurotransmitters in the midbrain

increasing beta-lipoprotein excretion from the pituitary

Question 19. Pathological similarities and differences between acute pain and chronic pain include which of the following options?

Both have decreased levels of endorphins.

Chronic pain has a predominance of C-neuron stimulation.

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

Acute pain is diffuse and hard to localize.

Question 20. Different areas of the brain are involved in specific aspects of pain. The reticular and limbic systems in the brain influence ______.

the sensory aspects of pain

the discriminative aspects of pain

the motivational aspects of pain

the cognitive aspects of pain

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