Pain Management: Easing Pain in Palliative Care Quiz Answers

Get All Weeks Pain Management: Easing Pain in Palliative Care Quiz Answers

In this course, you will be able to develop a systems view for assessing and managing pain in the palliative care setting. By the end of the course, you will be able to: 1) Describe the pain problem in the palliative care setting; 2) Assess a person’s pain, 3) Explain the benefits of integrative therapies and pharmacologic strategies to manage pain.

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Week 01: Pain Management: Easing Pain in Palliative Care Quiz Answers

Pain Assessment

Which of the following statements about pain assessment are true? Choose all that apply.

  • An elderly person with severe dementia cannot tell you he or she is having pain.
  • Pain and depression occur at the same time in about 1/3 of all patients.
  • When using a numeric rating scale from 0 to 10, 0 indicates no pain and 10 indicates the worst pain possible.
  • Patients often guard a body part or walk differently to protect against pain.
  • Changes in blood pressure and pulse are better indicators of the amount of pain a person has than what the person reports.

Which of the following statements are true about pain prevalence in the palliative care setting?

  • Chronic nonmalignant pain is easily managed with opioids.
  • Nearly 40% of cancer patients experience moderate to severe pain at some point during their illness.
  • Only 15% of elderly patients in long term care facilities experience pain.
  • Uncontrolled pain at the end of life is not a common symptom.

Unrelieved pain can result in . . .?

  • Depression
  • Disturbed Sleep
  • Slowed Rehabilitation
  • All of the above

Mary is a 75 year old woman who was diagnosed with colorectal cancer that has spread to her bones. She complains of achy, throbbing pain in her lower back and left hip. What kind of pain is she experiencing?

  • Somatic pain
  • Neuropathic pain
  • Visceral pain
  • Psychologic pain

Which of the following words may indicate visceral pain?

  • Achy and throbbing
  • Squeezing and cramping
  • Burning and tingling
  • Electrical jolts

____________, intensity , location, duration, aggravating/ allevating factors are five key components to a pain assessment.

Julio tells you he has burning, shooting pain radiating down his right leg. This type of pain is probably?

  • Psychologic pain
  • Visceral pain
  • Somatic pain
  • Neuropathic pain

Which of the following are common myths and misconceptions people may have about pain management and its treatment?

  • If used too early, pain medicine won’t work later.
  • Pain and suffering is inevitable. I just need to bear it.
  • I might die quicker if I take too much pain medication.
  • I don’t want to bother my healthcare provider with my complaints about pain.
  • All of the above

Which of the following is not an example of a physical examination finding for pain?

  • Inflammation
  • Opioid abuse
  • Absent bowel sounds
  • Swelling

June has persistent pain due to degenerative joint disease. This pain has lasted for a few years. Her pain would be labeled as . . .?

  • Acute pain
  • Subacute pain
  • Chronic nonmalignant pain
  • Chronic malignant pain

Which of the following is not a true statement about persons with substance abuse disorders and their pain experience?

  • Alcohol can affect how pain is expressed and can also make opioid therapy less safe.
  • The use of cannabis and recreational drugs can influence the pain management plan.
  • Smokers have a harder time stopping opioid therapy.
  • Substance use is common and should be checked for in all persons with pain.
  • Persons with a substance abuse history should never take opioids after surgery.

The process of nociception includes which of the following?

  • Transduction – as the pain stimuli is recognized, neurotransmitters that inhibit nociception are released in the spinal cord.
  • Perception – the cerebral cortex recognizes, defines, and perceives pain and responds.
  • Transmission – neurotransmitters that are released at the time of injury include prostaglandins, histamine, bradykinin, serotonin, and substance P which start an inflammatory response and pain.
  • Modulation – Neurons in the brainstem descend to the dorsal horn and release endorphins, serotonin and norepinephrine which promote the transmission of the pain impulse at the dorsal horn.

Uyen is a 78 year-old woman whose only medical problems are osteoarthritis and some memory loss. She received 5 mg of oxycodone 3 hours ago. As you enter her room, she lies quietly in bed, grimaces, and guards her hip as she turns in bed. Your assessment reveals the following information: alert and unsedated, BP = 120/80; HR = 80; R = 18. She rates her pain as 7 and describes it as achy, throbbing and unchanged in 3 hours.

Chose the number that best represents your assessment of Uyen’s pain to be marked on her record.

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Many barriers exist to the effective management of pain in clinical settings. Which of the following are common healthcare provider related barriers?

  • Patient’s fear of side effects
  • Lack of availability of pain medications in a pharmacy
  • Nurse concern about causing side effects when giving pain medications
  • Inadequate staff knowledge about pain assessment
  • Family caregiver concern about addiction

Ursula is a 78 year-old woman whose only medical problems are osteoarthritis and some memory loss. She received 5 mg of oxycodone 3 hours ago. As you enter her room, she smiles at you and continues talking and joking with her daughter. Your assessment reveals the following information: alert and unsedated, BP = 120/80; HR = 80; R = 18. She rates her pain as 7 and describes it as achy, throbbing and unchanged in the last 3 hours.

Choose the number that best represents your assessment of Ursula’s pain to be marked on her record.

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Week 02: Pain Management: Easing Pain in Palliative Care Quiz Answers

Non-Pharmacological Pain Treatment Assessment

Select the statement(s) about complementary and alternative therapies that is (are) true. Select all that apply.

  • Alternative therapies are used in place of conventional medical therapies.
  • Complementary and alternative medicine therapies that lack adequate evidence should be discouraged because they place patients at risk of adverse problems.
  • Alternative therapies are used together with conventional medical therapies.
  • Complementary therapies are used in place of conventional medical therapies.
  • Complementary therapies are used together with conventional medical therapies.
  • The terms complementary and alternative therapies mean the same thing.
  • Complementary and alternative medicine therapies may or may not have strong evidence to support their usage. The key is to find out what works for the patient.

Which of the following is not listed as an integrative health domain as defined by the National Center for Integrative Health?

  • Mind-Body medicine
  • Alternative medical systems
  • Manipulative and mind-body based.
  • Energy therapies
  • Holistic approaches

Which true statements apply to exercise therapy? Select all that apply.

  • Physical therapists help restore balance, coordination, flexibility and strength so that movement, blood and nerve flow are not compromised.
  • Walking has been shown to keep joints flexible and increase pain.
  • Range of motion exercises, both active and passive, should be practiced daily.
  • If there is pain associated with passive range of motion, that is understandable. It takes time to work through the pain.
  • Ultrasound therapy, usually used by physical therapists, uses high frequency sound waves to help muscle strains.

Which of the following statements about traditional body-based therapies are not true? Select all that apply.

  • Reflexology may reduce pain and anxiety, and promote sleep in the palliative care setting.
  • Heat therapy works best on damaged, superficial inflamed tissues.
  • Massage therapy is effective for patients with advanced cancer and is reimbursed by health insurance coverage 90% of the time.
  • Ice therapy is more likely than heat to make muscles feel better.

Which of the following are true statements that address safety issues when using complementary and alternative therapies? Select all that apply.

  • Acupuncture, if not done properly, can cause a collapsed lung, central nervous system injury, and/or infection.
  • Topical agents applied to an open wound are helpful in relieving nerve pain by causing numbness.
  • Standardization of the preparation of aromatherapies used is lacking.
  • Medical cannabis, while only legal in some states, has well documented parameters for prescribing, administration, and side effect profile.
  • Fentanyl patches may cause unintentional overdose if not administered properly.

Energy therapies include . . . Select all that apply.

  • Mindfulness
  • Therapeutic touch
  • Reiki
  • Qi Gong

For persons to be successful in using integrative therapies, they should be assessed for:

  • Support from family caregiver
  • Ability to pay for the therapy
  • Capacity to concentrate
  • All of the above
  • Willingness to try
  • Physical function and capability to participate

_____________ is one of the top 10 integrative health approaches used among US adults to improve function and reduce chronic pain. (Fill in the blank using one of the therapies below).

  • Yoga
  • Massage
  • Transcutaneous electrical nerve stimulation (TENS)
  • Acupressure

Which of the following is not an example of a mind-body therapies?

  • Reflexology
  • Music therapy
  • Distraction
  • Relaxation
  • Mindfulness

Which true statements apply to mind-body therapies?

  • Distraction puts pain in the background so that persons can focus instead on other activities they enjoy.
  • Relaxation therapy options include deep breathing, calming one muscle at a time, and picturing positive or peaceful places.
  • CBT can help a person change their thinking, including beliefs or attitudes they may or may not know they hold about pain.
  • Being mindful means paying close attention to what’s happening in the past, present, and future, including how pain has felt, feels now, and concerns for the future.

There are many reasons why people with serious, life-limiting illness and pain try complementary and alternative therapies, including:

  • Conventional therapy, like pain medicines, doesn’t seem to work anymore.
  • There are too many side effects with pain medications.
  • I feel more “in control” of my life.
  • Natural pain relief allows me to focus on my spiritual and emotional well-being.
  • All of the above

Some patients are not able to take pain treatments as prescribed because of financial difficulties or lack of insurance coverage. How might this barrier affect the person’s pain treatment?

  • Patients may have to take a stepped approach to pain medications
  • Patients may have to use certain opioids over others
  • Patients may need to limit the amount of medication taken over a given time frame (e.g., only provided with 30 pills for a month)
  • Patients may have to use non-drug therapies only
  • All of the above

1. The sociocultural dimension of the pain experience involves a broad range of factors that influence a person’s pain description, experience, understanding, and response. Which of these are part of the sociocultural dimension?

  • Ethnicity
  • Marital status
  • Gender
  • Spirituality
  • Financial
  • All of the above

Which of the following integrative strategies have strong evidence for use in patients with chronic pain? Select all that apply.

  • Aromatherapy
  • Healing touch
  • Tai chi
  • Acupuncture

Which of the following statements are true about Capsaicin? Select all that apply.

  • Capsaicin cream may be recommended to treat shingles.
  • Capsaicin can only be prescribed by a provider; it is not available over the counter.
  • Zostrix is another name for Capsaicin.
  • Capsaicin cream side effects (like burning, stinging, or skin redness) are often unbearable for up to 50% of patients.
  • Capsaicin is a substance derived from chili peppers that can help to treat pain.

Week 03: Pain Management: Easing Pain in Palliative Care Quiz Answers

Medication Management Assessment

Naproxen (Aleve) helps with pain by

  • Reducing inflammation
  • Calming oversensitive nerves

What is the mechanism of action of Acetaminophen?

  • It works by calming overstimulated nerves in the nervous system that are causing pain sensations.
  • It works by interrupting the inflammatory pathway. With reduced inflammation, there will be reduced pain.
  • it remains unclear to this day.

How many milligrams of acetaminophen can a person safely take in a 24-hour period?

  • 2000 milligrams
  • 500 milligrams
  • 4000 milligrams
  • 1000 milligrams

A person you know has been taking 8 doses of a cold medication each day for the last 5 days. Each dose of this medicine has 650 mg acetaminophen in it. She is having chest wall pain from coughing wants to start taking “extra strength Tylenol” too. What is the best advice you can give?

  • “I think you are taking more Tylenol than is recommended, so maybe you should cut back on the on cold medication. If you are still hurting, something like ibuprofen might be effective and can be safely added when you’ve maxed out on acetaminophen”
  • “If you’re still having pain, I agree that more Tylenol is a good thing”
  • “Stay on the cold medication at your current doses and maybe try some ibuprofen”
  • “You are taking too much Tylenol already. I guess you will have to suffer in pain

In the last couple of years, healthcare providers have been encouraged to focus more on controlling pain well enough for patients to do typical daily tasks (like grocery shopping) rather than on the self-reported pain intensity score.

  • True
  • False

Week 04: Pain Management: Easing Pain in Palliative Care Quiz Answers

Opioid Safety and Addiction Assessment

Q1. Opioids ease pain in a completely different way than NSAIDs, or steroids.

  • False
  • True

Q2. A patient tells you that her pain is so bad that she is taking a dose of oral morphine every 30 minutes. What is your best response?

  • “That’s too often! Based on the concept of maximum blood concentration you should not take oral morphine more frequently than every 4 hours.”
  • “You should take it more frequently. Based on the concept of maximum blood concentration you can take oral morphine every 10-15 minutes.”
  • That’s too often! Based on the concept of maximum blood concentration you should not take oral morphine more frequently than every 1 hour.”
  • “That’s too often! Based on the concept of maximum blood concentration you should not take oral morphine more frequently than every 2 hours”

Q3. A patient is admitted to the hospital because his cancer pain is so severe that he needs IV opioids. How often can the nurse safely give him another dose?

  • Every 5 minutes.
  • Every 30 minutes.
  • Every 10-15 minutes.
  • Every 20 minutes.

Q4. A patient with newly diagnosed pancreatic cancer is complaining of 9/10 pain even though he is using NSAIDs (ibuprofen 600mg three times a day) and acetaminophen 650 mg (2 tablets) 6 times a day. Based on the WHO pain ladder, which opioid would you recommend right away?

  • Percocet (oxycodone + acetaminophen)
  • Tylenol # 3 (acetaminophen + codeine)
  • Morphine
  • Vicodin (hydrocodone + acetaminophen)

Q5. 30 mg of oral morphine is equal to how much IV morphine?

  • 30 mg IV morphine.
  • 100 mg IV morphine.
  • 0.1 mg IV morphine.
  • 10 mg IV morphine.

Q6. You need to account for incomplete cross tolerance when switching from IV to oral morphine.

  • False
  • True

Q7. You need to account for incomplete cross tolerance if switching from oral morphine to oral hydromorphone.

  • True
  • False

Q8. A patient develops kidney failure while taking morphine for cancer pain.

Please select all of the appropriate responses below.

  • “The breakdown products of morphine also provide pain relief. So why should this medication be stopped? The patient is still in pain!”
  • “Morphine is fine in patients with kidney failure. This patient does not need to change anything.”
  • “Morphine should not be used in patients with kidney failure. I recommend he switches to a safer alternative, like Dilaudid, fentanyl, or oxycodone.”
  • “I know that morphine should not be used in people with kidney failure, but it is the only thing available. I would rather monitor for side effects of morphine toxicity (i.e. muscle tremors [myoclonus]) than take patient off the medicine and he have a pain crisis.”

Q9. A friend of yours was diagnosed with pancreatic cancer several months ago. Since then, he has needed to take 5 doses of 15 mg oral morphine per day to keep the pain at less than 3 on a scale from 0 to 10. In the last few weeks, he tells you that he now uses up to 8 doses of 15 mg oral morphine per day so that the pain can still be less than 3 on a scale from 0 to 10. Trying to be funny, you ask him if “he’s becoming an addict?”. He replies, “well, I never thought of it that way. Now you have me worried. Do you think I am an addict?” True or false, your friend is an addict.

  • True
  • False

Q10. The safest opioids to use in patients with kidney failure include methadone, oxycodone, fentanyl, and ______________.

Week 05: Pain Management: Easing Pain in Palliative Care Quiz Answers

Easing Pain Assessment Answers

Q1. Mrs. Ana Garcia is a 34-year-old Latina woman with advanced cervical cancer. Ana was 16 years old and a junior in high school when she became sexually active with her boyfriend, Julio. Within 6 months she had become pregnant and dropped out of school. Marco was born the following year. Ana obtained her High School GED (General Education Development) and began to create a home and life for her boyfriend and son. She worked in food service, housekeeping, and other minimum wage jobs. In her early 20s, with the help of her family, Ana attended a Cosmetology Program and has worked as a hairdresser ever since.

Two years ago, Ana noticed heavier vaginal bleeding associated with a fullness and heaviness in the lower abdomen. An evaluation in the ED revealed a mass on her cervix, and she was referred to a cancer doctor. Her evaluation revealed a large cervical cancer. She began radiation treatment followed by chemotherapy. The treatment was difficult for Ana to tolerate. Even though it took some time, Ana rebounded and was able to go back to work. She was beginning to feel somewhat normal again.

One year later, Ana developed new low back pain over the course of three days. At that time, recurrent cancer was identified through radiologic imaging.

Would this pain be considered acute or chronic? Why?

1 point

  • Your answer cannot be more than 10000 characters.

Q2. Continuing with the same scenario provided in Question 1 –

Mrs. Ana Garcia is a 34-year-old Latina woman with advanced cervical cancer. Ana was 16 years old and a junior in high school when she became sexually active with her boyfriend, Julio. Within 6 months she had become pregnant and dropped out of school. Marco was born the following year. Ana obtained her High School GED (General Education Development) and began to create a home and life for her boyfriend and son. She worked in food service, housekeeping, and other minimum wage jobs. In her early 20s, with the help of her family, Ana attended a Cosmetology Program and has worked as a hairdresser ever since.

Two years ago, Ana noticed heavier vaginal bleeding associated with a fullness and heaviness in the lower abdomen. An evaluation in the ED revealed a mass on her cervix, and she was referred to a cancer doctor. Her evaluation revealed a large cervical cancer. She began radiation treatment followed by chemotherapy. The treatment was difficult for Ana to tolerate. Even though it took some time, Ana rebounded and was able to go back to work. She was beginning to feel somewhat normal again.

One year later, Ana developed new low back pain over the course of three days. At that time, recurrent cancer was identified through radiologic imaging.

Ana’s facial expression looks like she is hurting. Which of the following answers is most likely correct?

  • Ana’s pain is likely acute.
  • Ana is faking it.
  • Ana’s pain is likely chronic.
  • If Ana were in pain, she would be confused in addition to having a painful expression on her face.

Q3. What is the gold standard when assessing pain?

  • The FLACC Scale-Revised.
  • The patient self-report.
  • Surrogate report.
  • Pain is a personal experience, so there is no gold standard.

Q4. Continuing from the previous scenario provided for Questions 1-3 –

It has been six months since Ana started a new chemotherapy regimen for her recurrent cancer. Ana has been seen in the outpatient palliative care clinic for help with ongoing pain and symptom management. During her visit, she rates her pain a 6 out of 10 on a 0-10 pain intensity scale. It has been slowly getting worse in the last 6 months. She tells you that the pain is in her lower back but can travel down her legs if she is sitting in certain positions. It’s described as dull, achy and constant. The pain that goes down her legs is sharp and shooting.

Ana’s pain is now best described as:

  • Acute
  • Subacute
  • Chronic Malignant Pain
  • Chronic Non-Malignant Pain

Q5. Continuing with the previously provided scenario –

It has been six months since Ana started a new chemotherapy regimen for her recurrent cancer. Ana has been seen in the outpatient palliative care clinic for help with ongoing pain and symptom management. During her visit, she rates her pain a 6 out of 10 on a 0-10 pain intensity scale. It has been slowly getting worse in the last 6 months. She tells you that the pain is in her lower back but can travel down her legs if she is sitting in certain positions. It’s described as dull, achy and constant. The pain that goes down her legs is sharp and shooting.

Ana is experiencing both somatic nociceptive and neuropathic pain?

  • True
  • False

Q6. Research has shown that women have lower pain thresholds and less tolerance to pain stimuli than men.

  • True
  • False

Q7. Acupuncture therapy works by stimulating various anatomical points in the body through the use of sterile needles.

  • True
  • False

Q8. Knowing that most medical providers recommend less than 3000 mg of acetaminophen per day, how many tablets of Percocet (5 mg oxycodone/325 mg acetaminophen) can the patient safely take before you would consider changing to a different pain medicine?

  • 9 tablets
  • 12 tablets.
  • 15 tablets.
  • 10 tablets.

Q9. You think Ana would also benefit from taking anti-inflammatory medications. She has kidney failure so you feel like NSAIDs are a bad option. What is the one other type of anti-inflammatory medication reviewed that may be a better option?

  • Comment Answers Below

Q10. Continuing on with the provided scenario –

A few weeks later, Ana comes back to the outpatient palliative care clinic with her husband, Marco. She says that her pain has continued to get worse and she now rates it an 8 out of 10. She is using 10 tablets of Percocet each day but pain scores have not improved. Marco is concerned that Ana is taking too much medication and he is worried about addiction.

Which of the following are patient and family caregiver barriers to good pain management?

  • Worry about addiction.
  • Concern about side effects.
  • Pain treatments have not worked.
  • Admitting pain is a sign of weakness.
  • I might die if I take too much pain medication.
  • All of the above.

Q11. What is the best first step in the safe management of this patient?

  • Stop the Percocet, she is getting too much acetaminophen.
  • Encourage Ana to take more Percocet…her pain is still rated severe.
  • Advise Ana that there is “nothing we can do” and that she will just have to suffer.

Q12. Continuing on with the provided scenario –

Out of concern for acetaminophen toxicity, you tell Ana to stop taking Percocet. In its place, you recommend liquid morphine 10 mg orally every 4 hours scheduled and every 2 hours as needed for breakthrough pain. One week later, she calls you to let you know that her pain is much better controlled; she is taking 10 doses of morphine (100 mg oral morphine) per day.

Unfortunately, Ana gets a GI virus two weeks later. Her nausea and vomiting are so bad that she cannot keep any medicines down. She is in quite a bit of pain when you see her in clinic. As a result, you feel she should be admitted to the hospital for IV pain medicine. Based on the amount she was taking at home (100 mg oral morphine per day), how much IV morphine do you think the medical provider should schedule?

  • 300 mg IV morphine.
  • 33.3 mg IV morphine.
  • 333.3 mg IV morphine.
  • 3.33 mg IV morphine.

Q13. Continuing on with the provided scenario –

One week later, with both scheduled and as needed doses of IV morphine, Ana’s pain has stabilized and is rated 3/10. She has been able to eat and take medicines for the past two days and now feels ready to take oral pain medicines.

In the last 24 hours, Ana has received a total of 60 mg IV morphine to manage her pain. Now that she can eat, what dose of oral morphine should she be on?

  • 180 mg oral morphine.
  • 18 mg oral morphine.
  • 1800 mg oral morphine.
  • 60 mg oral morphine.

Q14. ________________ is poorly controlled pain that makes patients act in ways that look like addiction.

  • Physical Dependence
  • Addiction
  • Pseudo-addiction
  • Tolerance

Q15. What other non-drug therapies have strong evidence to relieve Ana’s pain?

  • Radiation therapy
  • Massage
  • Music Therapy
  • Exercise
Conclusion:

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