Week 8

Question 1

1. Pain is largely a subjective experience for the patient; however as health professionals we classify pain according to its time course or its origin. Define the following as they relate to pain;
   Acute Pain –

Answer 1

a state in which a person experiences the sensation of severe discomfort, sudden onset, generally sharp and may radiate, raised TPR BP, sweating, pallor, dilated pupils, increased muscle tension.

Question 2

1. Pain is largely a subjective experience for the patient; however as health professionals we classify pain according to its time course or its origin. Define the following as they relate to pain;
   Chronic Pain –

Answer 2

Is a persistent or recurring pain that continues for 3 months or more. It is a dull, aching, persistent or diffused pain. Person may be depressed, anxious, withdrawn, emotionless, and inactive.

Question 3

1. Pain is largely a subjective experience for the patient; however as health professionals we classify pain according to its time course or its origin. Define the following as they relate to pain;
   Nociceptive Pain –

Answer 3

Is a physiological pain that stems from stimulation of nociceptors due to injury or inflammation.

Question 4

1. Pain is largely a subjective experience for the patient; however as health professionals we classify pain according to its time course or its origin. Define the following as they relate to pain;
   Neuropathic Pain –

Answer 4

arises from a primary lesion, alteration or dysfunction in the PNS or CNS. It may be due to nerve compression.

Question 5

1. Pain is largely a subjective experience for the patient; however as health professionals we classify pain according to its time course or its origin. Define the following as they relate to pain;
   Psychogenic Pain –

Answer 5

Is psychological, psychiatric or psychosocial causes in its primary aetiology. Anxiety, fear and depression are known to cause severe pain.

Question 6

2. Opioid receptors are found in both the central and peripheral tissues. List three central effects and three peripheral effects of opioids
   Central Effects –

Answer 6

analgesia, suppression of the cough reflex, suppression of the respiratory centre, sedation and sleep, euphoria, dysphoria, miosis, nausea and vomiting, prolongation of labour, hypertension and brachycardia

Question 7

2. Opioid receptors are found in both the central and peripheral tissues. List three central effects and three peripheral effects of opioids
   Peripheral effects –

Answer 7

Gut – decreased motility, increased tone in smooth muscle, constipation. Spasms of sphincter muscles. Suppression of some spinal reflexes. Release of histimine.

Question 8

3. Describe the action taken following an opioid overdose including the use of opioid antagonists.

Answer 8

Opioid antagonists completely displace opioid analgesics from their receptor sites thus reversing their effects. Naloxone is a short acting antagonist and is used in overdose situations. A longer-acting variant is naltrexone. Naltrexone is primarily meant to treat opioid and alcohol dependence.

Question 9

4. Paracetamol is normal doses is considered to be a safer over the counter analgesic than aspirin. List the reasons why

Answer 9

• It is better tolerated than aspirin in patients in whom excessive gastric acid secretion or prolongation of bleeding time may be a concern.
• Adverse effects and allergenic reactions are rare
• Less drug-drug interactions due to negligible plasma protein binding
• It may be used in children and not associated with Reyes syndrome
• It is safe to use during pregnancy and lactation.

Question 10

Proper administration of an ordered narcotic:

a. Can lead to addiction
b. Should be done promptly to prevent increased pain and the need for larger doses
c. Would include holding the drug as long as possible until the person really needs it
d. Should rely on the person’s request for medication

Answer 10

b. Should be done promptly to prevent increased pain and the need for larger doses

Question 11

The nurse is caring for several clients who are receiving opioids for pain relief. Which client is at the highest risk of developing hypotension, respiratory depression, and mental confusion?

a. A 23 year old female, postoperative ruptured appendix
b. A 16 year old male, post-motorcycle injury with lacerations
c. A 54 year old female, post-myocardial infarction
d. An 86 year old male, postoperative femur fracture

Answer 11

d. An 86 year old male, postoperative femur fracture

Question 12

The client asks you if paracetamol will help his arthritis like ‘ my aspirin does’. You base your response on the knowledge that the pharmacotherapeutic actions of paracetamol are:

a. Analgesic and antipyretic
b. Analgesic and anti-inflammatory
c. Anti-inflammatory and antiplatelet
d. Antipyretic and anti-inflammatory

Answer 12

a. Analgesic and antipyretic

Question 13

Naloxone hydrochloride is classified as an:

a. Opioid analgesic
b. Opioid agonist
c. Opioid partial agonist
d. Opioid antagonist

Answer 13

d. Opioid antagonist

Question 14

The parenteral opioid analgesic that carries the greatest risk for respiratory depression with its use is:

a. Fentanyl citrate
b. Morphine sulfate
c. Hydromorphone
d. pethidine

Answer 14

c. Hydromorphone